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This study aimed to investigate the safety and effectiveness of adjustable GV for the surgical treatment of iNPH after a 3-year follow-up.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>Adult patients treated with ventriculoperitoneal shunt (VPS) using programmable GVs were retrospectively evaluated. Neurological outcome was assessed according to the iNPH Grading Scale (INPHGS). Postoperative early and late complications, pre- and post-implantation pressure settings, and type and number of post-implantation pressure adjustments were recorded at each follow-up.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>A total of 76 patients were evaluated, with a median postoperative follow-up of 36 (24\u201342) months. The mean preoperative and postoperative iNPHGS scores were 4.2\u2009\u00b1\u20091.6 and 3.5\u2009\u00b1\u20091.5, respectively, demonstrating a significant overall clinical improvement after VPS surgery (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). Overall, 7 (9.2%) patients required surgical intervention due to late complications. No cases of valve dysfunction were reported. During follow-up, 54 (71.1%) patients underwent valve setting adjustments, with a median number of post-implantation valve setting modifications of 1. No significant associations were found between postoperative outcomes and preoperative characteristics including age and initial opening pressure parameters.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p>Adjustable GVs are a safe and effective alternative to traditional fixed differential pressure valves for the surgical treatment of iNPH. After a 3-year follow-up, the overall postoperative complication rate was acceptable, with a significantly lower rate of valve dysfunction compared to previous literature findings.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1007\/s00701-025-06563-y","type":"journal-article","created":{"date-parts":[[2025,5,24]],"date-time":"2025-05-24T06:37:08Z","timestamp":1748068628000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Programmable gravitational valves in idiopathic normal pressure hydrocephalus: long-term outcomes after a 3-year follow-up"],"prefix":"10.1007","volume":"167","author":[{"given":"Stefano","family":"Colonna","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-1944-5992","authenticated-orcid":false,"given":"Carla","family":"Paracampo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elena","family":"Garro","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Enrico","family":"Lo Bue","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alberto","family":"Morello","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alessandro","family":"Pesaresi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luca","family":"Ceroni","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Salvatore","family":"Petrone","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Diego","family":"Garbossa","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fabio","family":"Cofano","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alessandro","family":"Fiumefreddo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,5,24]]},"reference":[{"issue":"4","key":"6563_CR1","doi-asserted-by":"publisher","first-page":"1252","DOI":"10.3171\/2017.11.JNS172212","volume":"130","author":"N Agarwal","year":"2019","unstructured":"Agarwal N, Kashkoush A, McDowell MM, Lariviere WR, Ismail N, Friedlander RM (2019) Comparative durability and costs analysis of ventricular shunts. 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