{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T04:38:50Z","timestamp":1792730330944,"version":"4.5.0"},"reference-count":30,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JNS"],"published-print":{"date-parts":[[2011,5]]},"abstract":"\nObject<\/jats:title>\nPatients with idiopathic normal pressure hydrocephalus (iNPH) often present with impaired gait and cognition together with ventricular enlargement and normal intracranial pressure. Many have vascular risk factors as well as periventricular and deep white matter changes on MR imaging. Abnormal CSF dynamics, that is, high resistance to outflow or improvement after CSF drainage, indicate good effects of shunt surgery.<\/jats:p>\nThe authors examined whether the worst-case iNPH patients with extensive vascular white matter disease and normal CSF dynamics would benefit from shunt surgery. These patients also fulfilled the criteria for Binswanger disease. Therefore, a randomized controlled double-blind study was performed.<\/jats:p><\/jats:sec>\n\nMethods<\/jats:title>\nFourteen consecutive patients fulfilling the above criteria were randomized to receive either open or closed shunts. At 3 months after surgery, the patients with initially ligated shunts had their shunts opened. Clinical evaluation consisting of 7 quantitative psychometric and 6 continuous gait tests was performed preoperatively and 3 and 6 months after surgery.<\/jats:p><\/jats:sec>\n\nResults<\/jats:title>\nPatients randomized to receive open shunts had improved motor (30% increase) and psychometric (23% increase) scores 3 months after shunt placement. There were no significant changes between the 3- and 6-month follow-up in these same patients. Conversely, those with initially ligated shunts were unchanged during the first 3-month period, although they improved in both motor (28%) and cognitive (18%) functions following removal of the ligature.<\/jats:p><\/jats:sec>\n\nConclusions<\/jats:title>\nPatients with enlarged ventricles, hydrocephalic symptoms, and extensive vascular white matter changes benefit from shunt surgery.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2010.11.jns10967","type":"journal-article","created":{"date-parts":[[2011,1,14]],"date-time":"2011-01-14T16:14:07Z","timestamp":1295021647000},"page":"1432-1438","source":"Crossref","is-referenced-by-count":76,"title":["Shunt surgery in patients with hydrocephalus and white matter changes"],"prefix":"10.3171","volume":"114","author":[{"given":"Magnus","family":"Tisell","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mats","family":"Tullberg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Per","family":"Hellstr\u00f6m","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mikael","family":"Edsbagge","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mats","family":"H\u00f6gfeldt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carsten","family":"Wikkels\u00f6","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-jns10967","series-title":"Acta Pathol Jpn","first-page":"97","article-title":"Normal pressure hydrocephalus. 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model","volume":"105","author":"Czosnyka","year":"1990"},{"key":"b10-jns10967","series-title":"J Neurol Neurosurg Psychiatry","first-page":"549","article-title":"Testing of cerebrospinal compensatory reserve in shunted and non-shunted patients: a guide to interpretation based on an observational study","volume":"60","author":"Czosnyka","year":"1996"},{"key":"b11-jns10967","series-title":"Neurosurgery","first-page":"80","article-title":"Diagnostic intracranial pressure monitoring and surgical management in idiopathic normal pressure hydrocephalus: a 6-year review of 214 patients","volume":"66","author":"Eide","year":"2010"},{"key":"b12-jns10967","series-title":"Med Biol Eng Comput","first-page":"644","article-title":"Infusion technique can be used to distinguish between dysfunction of a hydrocephalus shunt system and a progressive dementia","volume":"42","author":"Eklund","year":"2004"},{"key":"b13-jns10967","series-title":"Med Biol Eng Comput","first-page":"719","article-title":"Assessment of cerebrospinal fluid outflow resistance","volume":"45","author":"Eklund","year":"2007"},{"issue":"3","key":"b14-jns10967","series-title":"Cochrane Database Syst Rev","first-page":"CD003157","article-title":"Shunting for normal pressure hydrocephalus (NPH)","author":"Esmonde","year":"2002"},{"key":"b15-jns10967","series-title":"Neurosurgery","first-page":"1166","article-title":"Idiopathic normal pressure hydrocephalus: a systematic review of diagnosis and outcome","volume":"49","author":"Hebb","year":"2001"},{"key":"b16-jns10967","series-title":"Neurosurgery","first-page":"527","article-title":"Neuropsychological effects of shunt treatment in idiopathic normal pressure hydrocephalus","volume":"63","author":"Hellstr\u00f6m","year":"2008"},{"key":"b17-jns10967","series-title":"J Neurol Neurosurg Psychiatry","first-page":"721","article-title":"Comparison between the lumbar infusion and CSF tap tests to predict outcome after shunt surgery in suspected normal pressure hydrocephalus","volume":"73","author":"Kahlon","year":"2002"},{"key":"b18-jns10967","series-title":"Neurosurgery","first-page":"292","article-title":"Cerebrospinal fluid shunting in idiopathic normal-pressure hydrocephalus of the elderly: effect of periventricular and deep white matter lesions","volume":"39","author":"Krauss","year":"1996"},{"key":"b19-jns10967","series-title":"Neurosurgery","first-page":"491","article-title":"White matter lesions in patients with idiopathic normal pressure hydrocephalus and in an age-matched control group: a comparative study","volume":"40","author":"Krauss","year":"1997"},{"key":"b20-jns10967","series-title":"Acta Neurol Scand","first-page":"38","article-title":"An adjustable CSF shunt: advices for clinical use","volume":"108","author":"Lundkvist","year":"2003"},{"key":"b21-jns10967","series-title":"Arch Neurol","first-page":"783","article-title":"The predictive value of cerebrospinal fluid dynamic tests in patients with th idiopathic adult hydrocephalus syndrome","volume":"52","author":"Malm","year":"1995"},{"key":"b22-jns10967","series-title":"Neurology","first-page":"576","article-title":"Three-year survival and functional outcome of patients with idiopathic adult hydrocephalus syndrome","volume":"55","author":"Malm","year":"2000"},{"key":"b23-jns10967","series-title":"Acta Neurochir Suppl (Wien)","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1007\/3-211-32318-X_48","article-title":"Guidelines for management of idiopathic normal pressure hydrocephalus: progress to date","volume":"95","author":"Marmarou","year":"2005"},{"key":"b24-jns10967","series-title":"Neurobiol Aging","first-page":"707","article-title":"Normal pressure hydrocephalus triggers intrathecal production of TNF-alpha","volume":"24","author":"Tarkowski","year":"2003"},{"key":"b25-jns10967","series-title":"Br J Neurosurg","first-page":"214","article-title":"Long-term outcome in 109 adult patients operated on for hydrocephalus","volume":"20","author":"Tisell","year":"2006"},{"key":"b26-jns10967","series-title":"Acta Neurol Scand","first-page":"417","article-title":"White matter changes in normal pressure hydrocephalus and Binswanger disease: specificity, predictive value and correlations to axonal degeneration and demyelination","volume":"105","author":"Tullberg","year":"2002"},{"key":"b27-jns10967","series-title":"AJNR Am J Neuroradiol","first-page":"1665","article-title":"Normal pressure hydrocephalus: vascular white matter changes on MR images must not exclude patients from shunt surgery","volume":"22","author":"Tullberg","year":"2001"},{"key":"b28-jns10967","series-title":"J Neurol","first-page":"5","article-title":"Diagnosis and management of normal-pressure hydrocephalus","volume":"247","author":"Vanneste","year":"2000"},{"key":"b29-jns10967","series-title":"Stroke","first-page":"1318","article-title":"A new rating scale for age-related white matter changes applicable to MRI and CT","volume":"32","author":"Wahlund","year":"2001"},{"key":"b30-jns10967","series-title":"J Neurol Neurosurg Psychiatry","first-page":"64","article-title":"The clinical effect of lumbar puncture in normal pressure hydrocephalus","volume":"45","author":"Wikkels\u00f8","year":"1982"}],"container-title":["Journal of 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article"],"short-title":[],"issued":{"date-parts":[[2011,5]]},"references-count":30,"journal-issue":{"issue":"5"},"URL":"https:\/\/doi.org\/10.3171\/2010.11.jns10967","relation":{},"ISSN":["0022-3085","1933-0693"],"issn-type":[{"value":"0022-3085","type":"print"},{"value":"1933-0693","type":"electronic"}],"subject":[],"published":{"date-parts":[[2011,5]]}}}