{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T22:58:36Z","timestamp":1781218716940,"version":"3.54.1"},"reference-count":16,"publisher":"Georg Thieme Verlag KG","issue":"04","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Neurol Surg A Cent Eur Neurosurg"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Although setting a low initial opening pressure in a programmable valve with a gravitational unit seems to be the gold standard treatment for idiopathic normal pressure hydrocephalus (iNPH) patients, there are no studies in the literature describing the optimal initial low-pressure setting. Here, we sought to describe the optimal initial opening pressure setting for iNPH in terms of both efficacy and safety.<\/jats:p>\n                  <jats:p>Patients with probable iNPH underwent shunt surgery with a programmable valve with a gravitational unit, using either an opening pressure of 3 or 6.5\u2009cmH2O, and were prospectively followed for 1 year. Clinical improvement and complications were recorded.<\/jats:p>\n                  <jats:p>Nineteen patients with an opening pressure of 3\u2009cmH2O and 37 patients with an opening pressure of 6.5\u2009cmH2O were analyzed. There was no significant difference between the groups. A significant improvement in the iNPH Japanese scale score was observed 1 year following shunt placement in both the 3.0\u2009cmH2O (p\u2009=\u20090.001) and 6.5\u2009cmH2O groups (p\u2009&lt;\u20090.001), but there was no statistical difference between groups (p\u2009=\u20090.708). Two patients (10.5%) had subdural effusions that required surgery in the 3\u2009cmH2O group and none in the 6.5\u2009cmH2O group (p\u2009=\u20090.043).<\/jats:p>\n                  <jats:p>Patients with iNPH treated with a programmable valve with an initial opening pressure of 6.5\u2009cmH2O showed the same clinical improvement as those treated with an initial opening pressure of 3\u2009cmH2O but with fewer overdrainage complications.<\/jats:p>","DOI":"10.1055\/a-2793-8905","type":"journal-article","created":{"date-parts":[[2026,1,23]],"date-time":"2026-01-23T00:19:46Z","timestamp":1769127586000},"page":"268-272","source":"Crossref","is-referenced-by-count":0,"title":["Optimizing Initial Shunt Pressure in Idiopathic Normal Pressure Hydrocephalus"],"prefix":"10.1055","volume":"87","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1408-0684","authenticated-orcid":false,"given":"Rodolfo Casimiro","family":"Reis","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Hospital do Servidor P\u00fablico Estadual de S\u00e3o Paulo, S\u00e3o Paulo, Brazil"},{"name":"HCor, S\u00e3o Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miguel Bertelli","family":"Ramos","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Hospital do Servidor P\u00fablico Estadual de S\u00e3o Paulo, S\u00e3o Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Igor Napole\u00e3o Paiva","family":"Ara\u00fajo","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Hospital do Servidor P\u00fablico Estadual de S\u00e3o Paulo, S\u00e3o Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jo\u00e3o Carlos Teixeira Leal","family":"Filho","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Hospital do Servidor P\u00fablico Estadual de S\u00e3o Paulo, S\u00e3o Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victor da Maia Silva","family":"Cachapuz","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Hospital do Servidor P\u00fablico Estadual de S\u00e3o Paulo, S\u00e3o Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fernando Campos Gomes","family":"Pinto","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Hospital das Cl\u00ednicas, University of S\u00e3o Paulo, S\u00e3o Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jos\u00e9 Marcus","family":"Rotta","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Hospital do Servidor P\u00fablico Estadual de S\u00e3o Paulo, S\u00e3o Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2026,6,11]]},"reference":[{"issue":"04","key":"ref1","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1016\/0022-510X(65)90016-X","article-title":"The special clinical problem of symptomatic hydrocephalus with normal cerebrospinal fluid pressure. Observations on cerebrospinal fluid hydrodynamics","volume":"2","author":"S Hakim","year":"1965","journal-title":"J Neurol Sci"},{"issue":"05","key":"ref2","doi-asserted-by":"crossref","first-page":"447","DOI":"10.3949\/ccjm.73.5.447","article-title":"When do common symptoms indicate normal pressure hydrocephalus?","volume":"73","author":"R Factora","year":"2006","journal-title":"Cleve Clin J Med"},{"key":"ref3","doi-asserted-by":"crossref","first-page":"670","DOI":"10.1227\/01.neu.0000316271.90090.b9","article-title":"Diagnosis, treatment, and analysis of long-term outcomes in idiopathic normal-pressure hydrocephalus","volume":"62","author":"M J McGirt","year":"2008","journal-title":"Neurosurgery"},{"key":"ref4","doi-asserted-by":"crossref","first-page":"63","DOI":"10.2176\/nmc.st.2020-0292","article-title":"Guidelines for management of idiopathic normal pressure hydrocephalus (third edition): endorsed by the Japanese Society of normal pressure hydrocephalus","volume":"61","author":"M Nakajima","year":"2021","journal-title":"Neurol Med Chir (Tokyo)"},{"key":"ref5","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1016\/j.jns.2016.01.028","article-title":"CSF tap test - obsolete or appropriate test for predicting shunt responsiveness? 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