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At present, symptoms can be alleviated only by cerebrospinal fluid (CSF) shunt surgery. Yet, various complications after shunting may occur, occasionally requiring repeated shunt revisions. In this retrospective, population-based study, our objective was to compare revision rates and causes for revision surgeries between adjustable shunt valve and fixed-pressure valves in iNPH patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Altogether 1220 patients were evaluated for possible iNPH at Kuopio University Hospital between 1991 and 2023. Probable iNPH was diagnosed in 809 patients who received their first ventriculoperitoneal shunt (VPS). Of the patient cohort, 566 were shunted using an adjustable valve (2008\u20132023) and 243 received a fixed pressure valve (1991\u20132012). Hospital records and nationwide registries were used to construct a timeline for each patient from the shunt insertion and until death (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009430) or the end of 2023.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Overall revision rate was lower in iNPH patients receiving an adjustable valve (14% vs. 30%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u2009.001, 95% CI 0.27\u20140.56). The incidence of multiple revisions was also lower in the adjustable valve group (27% vs. 32%\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.002, 95% CI 0.21\u20140.71). The most common cause for revision was peritoneal catheter malposition in the adjustable valve group (44%) and shunt underdrainage in the fixed-pressure valve group (25%).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Adjustable shunt valves have decreased the need for shunt revision surgeries due to under- and overdrainage.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00701-026-06786-7","type":"journal-article","created":{"date-parts":[[2026,2,3]],"date-time":"2026-02-03T18:15:55Z","timestamp":1770142555000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Reduced risk of shunt revision with adjustable valves: a population-based cohort study over three decades"],"prefix":"10.1007","volume":"168","author":[{"given":"Siiri","family":"Oksa","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roosa","family":"Kasurinen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anssi","family":"Lipponen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ville","family":"Leinonen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antti J.","family":"Luikku","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,2,3]]},"reference":[{"issue":"5","key":"6786_CR1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0217705","volume":"14","author":"J Andersson","year":"2019","unstructured":"Andersson J, Rosell M, Kockum K, Lilja-Lund O, S\u00f6derstr\u00f6m L, Laurell K (2019) Prevalence of idiopathic normal pressure hydrocephalus: a prospective, population-based study. 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The study was approved by the Research Ethical Committee of the Kuopio University Hospital.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval"}},{"value":"All data until 2008 has been collected retrospectively and since then prospectively. All patients since 2008 have provided their informed written consent. Finnish legislation and the Finnish National Supervisory Authority for Welfare and Health have approved the use of existing patient data for retrospective research purposes in cases where informed consent was unavailable. All procedures being performed were part of routine care. The patient data used in this study is anonymized and individual patients cannot be identified.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to participate"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interest"}}],"article-number":"29"}}