{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,17]],"date-time":"2026-02-17T02:46:50Z","timestamp":1771296410935,"version":"3.50.1"},"reference-count":24,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JNS"],"published-print":{"date-parts":[[2016,7]]},"abstract":"<jats:sec><jats:title>OBJECTIVE<\/jats:title><jats:p>The study aim was to assess the influence of presurgical clinical symptom severity and disease duration on outcomes of shunt surgery in patients with idiopathic normal-pressure hydrocephalus (iNPH). The authors also evaluated the cerebrospinal fluid tap test as a predictor of improvements following shunt surgery.<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS<\/jats:title><jats:p>Eighty-three patients (45 men and 38 women, mean age 76.4 years) underwent lumboperitoneal shunt surgery, and outcomes were evaluated until 12 months following surgery. Risks for poor quality of life (Score 3 or 4 on the modified Rankin Scale [mRS]) and severe gait disturbance were evaluated at 3 and 12 months following shunt surgery, and the tap test was also conducted. Age-adjusted and multivariate relative risks were calculated using Cox proportional-hazards regression.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>Of 83 patients with iNPH, 45 (54%) improved by 1 point on the mRS and 6 patients (7%) improved by \u2265 2 points at 3 months following surgery. At 12 months after surgery, 39 patients (47%) improved by 1 point on the mRS and 13 patients (16%) improved by \u2265 2 points. On the gait domain of the iNPH grading scale (iNPHGS), 36 patients (43%) improved by 1 point and 13 patients (16%) improved by \u2265 2 points at 3 months following surgery. Additionally, 32 patients (38%) improved by 1 point and 14 patients (17%) by \u2265 2 points at 12 months following surgery. In contrast, 3 patients (4%) and 2 patients (2%) had worse symptoms according to the mRS or the gait domain of the iNPHGS, respectively, at 3 months following surgery, and 5 patients (6%) and 3 patients (4%) had worse mRS scores and gait domain scores, respectively, at 12 months after surgery. Patients with severe preoperative mRS scores had a 4.7 times higher multivariate relative risk (RR) for severe mRS scores at 12 months following surgery. Moreover, patients with severe gait disturbance prior to shunt surgery had a 46.5 times greater multivariate RR for severe gait disturbance at the 12-month follow-up. Patients without improved gait following the tap test had multivariate RRs for unimproved gait disturbance of 7.54 and 11.2 at 3 and 12 months following surgery, respectively. Disease duration from onset to shunt surgery was not significantly associated with postoperative symptom severity or unimproved symptoms.<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS<\/jats:title><jats:p>Patients with iNPH should receive treatment before their symptoms become severe in order to achieve an improved quality of life. However, the progression of symptoms varies between patients so specific timeframes are not meaningful. The authors also found that tap test scores accurately predicted shunt efficacy. Therefore, indications for shunt surgery should be carefully assessed in each patient with iNPH, considering the relative risks and benefits for that person, including healthy life expectancy.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2016.5.jns16377","type":"journal-article","created":{"date-parts":[[2016,7,15]],"date-time":"2016-07-15T15:29:42Z","timestamp":1468596582000},"page":"2002-2009","source":"Crossref","is-referenced-by-count":28,"title":["Disability risk or unimproved symptoms following shunt surgery in patients with idiopathic normal-pressure hydrocephalus: post hoc analysis of SINPHONI-2"],"prefix":"10.3171","volume":"126","author":[{"given":"Shigeki","family":"Yamada","sequence":"first","affiliation":[{"name":"Normal Pressure Hydrocephalus Center, Department of Neurosurgery and Stroke Center, Rakuwakai Otowa Hospital, Kyoto;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Teruo","family":"Kimura","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Dohtoh Neurosurgical Hospital, Hokkaido;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Naoto","family":"Jingami","sequence":"additional","affiliation":[{"name":"Department of Neurology, Kyoto University Graduate School of Medicine, Kyoto;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masamichi","family":"Atsuchi","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Atuchi Neurosurgical Hospital, Kagoshima;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Osamu","family":"Hirai","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Shinko Hospital, Kobe;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takahiko","family":"Tokuda","sequence":"additional","affiliation":[{"name":"Department of Molecular Pathobiology of Brain Diseases (Neurology), Kyoto Prefectural University of Medicine, Kyoto;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masakazu","family":"Miyajima","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Juntendo University Graduate School of Medicine, Tokyo;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hiroaki","family":"Kazui","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Osaka University Graduate School of Medicine, Osaka; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Etsuro","family":"Mori","sequence":"additional","affiliation":[{"name":"Department of Behavioral Neurology and Cognitive Neuroscience, Tohoku University Graduate School of Medicine, Miyagi, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masatsune","family":"Ishikawa","sequence":"additional","affiliation":[{"name":"Normal Pressure Hydrocephalus Center, Department of Neurosurgery and Stroke Center, Rakuwakai Otowa Hospital, Kyoto;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"_","family":"_","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"key":"b1-jns16377","series-title":"J Neurol Neurosurg Psychiatry","doi-asserted-by":"publisher","first-page":"806","DOI":"10.1136\/jnnp-2013-306117","article-title":"Natural course of idiopathic normal pressure hydrocephalus","volume":"85","author":"Andr\u00e9n K,","year":"2014","unstructured":"Andr\u00e9n K, Wikkels\u00f8 C, Tisell M, Hellstr\u00f6m P: Natural course of idiopathic normal pressure hydrocephalus. J Neurol Neurosurg Psychiatry 85:806\u2013810, 201410.1136\/jnnp-2013-30611724292998"},{"key":"b2-jns16377","series-title":"Neurology","doi-asserted-by":"publisher","first-page":"2063","DOI":"10.1212\/WNL.0000000000002193","article-title":"Practice guideline: Idiopathicnormal pressure hydrocephalus: Response to shunting and predictors of response: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology","volume":"85","author":"Halperin JJ,","year":"2015","unstructured":"Halperin JJ, Kurlan R, Schwalb JM, Cusimano MD, Gronseth G, Gloss D: Practice guideline: Idiopathicnormal pressure hydrocephalus: Response to shunting and predictors of response: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology. Neurology 85:2063\u20132071, 201510.1212\/WNL.000000000000219326644048"},{"key":"b3-jns16377","series-title":"Ann Neurol","doi-asserted-by":"publisher","first-page":"535","DOI":"10.1002\/ana.22015","article-title":"Lack of shunt response in suspected idiopathic normal pressure hydrocephalus with Alzheimer disease pathology","volume":"68","author":"Hamilton R,","year":"2010","unstructured":"Hamilton R, Patel S, Lee EB, Jackson EM, Lopinto J, Arnold SE, : Lack of shunt response in suspected idiopathic normal pressure hydrocephalus with Alzheimer disease pathology. Ann Neurol 68:535\u2013540, 201010.1002\/ana.2201520687117"},{"key":"b4-jns16377","series-title":"Cerebrospinal Fluid Res","doi-asserted-by":"publisher","first-page":"18","DOI":"10.1186\/1743-8454-7-18","article-title":"Diagnosis of idiopathic normal pressure hydrocephalus is supported by MRI-based scheme: a prospective cohort study","volume":"7","author":"Hashimoto M,","year":"2010","unstructured":"Hashimoto M, Ishikawa M, Mori E, Kuwana N: Diagnosis of idiopathic normal pressure hydrocephalus is supported by MRI-based scheme: a prospective cohort study. Cerebrospinal Fluid Res 7:18, 20102104051910.1186\/1743-8454-7-18"},{"key":"b5-jns16377","series-title":"Fluids Barriers CNS","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/2045-8118-9-1","article-title":"The value of the cerebrospinal fluid tap test for predicting shunt effectiveness in idiopathic normal pressure hydrocephalus","volume":"9","author":"Ishikawa M,","year":"2012","unstructured":"Ishikawa M, Hashimoto M, Mori E, Kuwana N, Kazui H: The value of the cerebrospinal fluid tap test for predicting shunt effectiveness in idiopathic normal pressure hydrocephalus. Fluids Barriers CNS 9:1, 20122223983210.1186\/2045-8118-9-1"},{"key":"b6-jns16377","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"124","DOI":"10.1227\/01.NEU.0000249208.04344.A3","article-title":"Is aqueductal stroke volume, measured with cine phase-contrast magnetic resonance imaging scans useful in predicting outcome of shunt surgery in suspected normal pressure hydrocephalus?","volume":"60","author":"Kahlon B,","year":"2007","unstructured":"Kahlon B, Annertz M, St\u00e5hlberg F, Rehncrona S: Is aqueductal stroke volume, measured with cine phase-contrast magnetic resonance imaging scans useful in predicting outcome of shunt surgery in suspected normal pressure hydrocephalus?. Neurosurgery 60:124\u2013130, 200710.1227\/01.NEU.0000249208.04344.A317228260"},{"key":"b7-jns16377","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"327","DOI":"10.1227\/01.NEU.0000249273.41569.6E","article-title":"Long-term outcome in patients with suspected normal pressure hydrocephalus","volume":"60","author":"Kahlon B,","year":"2007","unstructured":"Kahlon B, Sjunnesson J, Rehncrona S: Long-term outcome in patients with suspected normal pressure hydrocephalus. Neurosurgery 60:327\u2013332, 20071729018310.1227\/01.NEU.0000249273.41569.6E"},{"key":"b8-jns16377","series-title":"Lancet Neurol","doi-asserted-by":"publisher","first-page":"585","DOI":"10.1016\/S1474-4422(15)00046-0","article-title":"Lumboperitoneal shunt surgery for idiopathic normal pressure hydrocephalus (SINPHONI-2): an open-label randomised trial","volume":"14","author":"Kazui H,","year":"2015","unstructured":"Kazui H, Miyajima M, Mori E, Ishikawa M: Lumboperitoneal shunt surgery for idiopathic normal pressure hydrocephalus (SINPHONI-2): an open-label randomised trial. Lancet Neurol 14:585\u2013594, 201510.1016\/S1474-4422(15)00046-025934242"},{"key":"b9-jns16377","series-title":"Acta Neurol Scand","doi-asserted-by":"publisher","first-page":"145","DOI":"10.1111\/j.1600-0404.2012.01676.x","article-title":"One-year outcome in the European multicentre study on iNPH","volume":"126","author":"Klinge P,","year":"2012","unstructured":"Klinge P, Hellstr\u00f6m P, Tans J, Wikkels\u00f8 C: One-year outcome in the European multicentre study on iNPH. Acta Neurol Scand 126:145\u2013153, 20122257142810.1111\/j.1600-0404.2012.01676.x"},{"issue":"3 Suppl","key":"b10-jns16377","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"S40","DOI":"10.1227\/01.NEU.0000168187.01077.2F","article-title":"Outcome of shunting in idiopathic normal-pressure hydrocephalus and the value of outcome assessment in shunted patients.","volume":"57","author":"Klinge P,","year":"2005","unstructured":"Klinge P, Marmarou A, Bergsneider M, Relkin N, Black PM: Outcome of shunting in idiopathic normal-pressure hydrocephalus and the value of outcome assessment in shunted patients.. Neurosurgery 57:3 SupplS40\u2013S52, ii\u2013v, 20051616042810.1227\/01.NEU.0000168187.01077.2F"},{"key":"b11-jns16377","series-title":"J Neurosurg","article-title":"Idiopathic normal pressure hydrocephalus: diagnostic and predictive value of clinical testing, lumbar drainage, and CSF dynamics.","author":"Mahr CV,","unstructured":"Mahr CV, Dengl M, Nestler U, Reiss-Zimmermann M, Eichner G, Preu\u00df M, : Idiopathic normal pressure hydrocephalus: diagnostic and predictive value of clinical testing, lumbar drainage, and CSF dynamics.. J Neurosurg [epub ahead of print January 29, 2016. DOI: 10.3171\/20158.JNS151112]26824377"},{"key":"b12-jns16377","series-title":"CNS","first-page":"22","article-title":"Influence of comorbidities in idiopathic normal pressure hydrocephalus\u2014research and clinical care. A report of the ISHCSF task force on comorbidities in INPH Fluids Barriers","volume":"10","author":"Malm J,","year":"2013","unstructured":"Malm J, Graff-Radford NR, Ishikawa M, Kristensen B, Leinonen V, Mori E, : Influence of comorbidities in idiopathic normal pressure hydrocephalus\u2014research and clinical care. A report of the ISHCSF task force on comorbidities in INPH Fluids Barriers. CNS 10:22, 2013"},{"key":"b13-jns16377","series-title":"Arch Neurol","doi-asserted-by":"publisher","first-page":"783","DOI":"10.1001\/archneur.1995.00540320059013","article-title":"The predictive value of cerebrospinal fluid dynamic tests in patients with the idiopathic adult hydrocephalus syndrome","volume":"52","author":"Malm J,","year":"1995","unstructured":"Malm J, Kristensen B, Karlsson T, Fagerlund M, Elfverson J, Ekstedt J: The predictive value of cerebrospinal fluid dynamic tests in patients with the idiopathic adult hydrocephalus syndrome. Arch Neurol 52:783\u2013789, 1995763963010.1001\/archneur.1995.00540320059013"},{"key":"b14-jns16377","series-title":"Eur Neurol","doi-asserted-by":"publisher","first-page":"59","DOI":"10.1159\/000075345","article-title":"Predictors of outcome in patients with normal-pressure hydrocephalus","volume":"51","author":"Meier U,","year":"2004","unstructured":"Meier U, K\u00f6nig A, Miethke C: Predictors of outcome in patients with normal-pressure hydrocephalus. Eur Neurol 51:59\u201367, 20041466087910.1159\/000075345"},{"key":"b15-jns16377","series-title":"J Neurosurg","article-title":"One-year outcome in patients with idiopathic normal-pressure hydrocephalus: comparison of lumboperitoneal shunt to ventriculoperitoneal shunt.","author":"Miyajima M,","unstructured":"Miyajima M, Kazui H, Mori E, Ishikawa M: One-year outcome in patients with idiopathic normal-pressure hydrocephalus: comparison of lumboperitoneal shunt to ventriculoperitoneal shunt.. J Neurosurg [epub ahead of print February 12, 2016. DOI: 10.3171\/201510.JNS151894]26871203"},{"key":"b16-jns16377","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"382","DOI":"10.3171\/2015.2.JNS142318","article-title":"Concurrent Alzheimer's pathology in patients with clinical normal pressure hydrocephalus: correlation of high-volume lumbar puncture results, cortical brain biopsies, and outcomes","volume":"124","author":"Pomeraniec IJ,","year":"2016","unstructured":"Pomeraniec IJ, Bond AE, Lopes MB, Jane JA Sr: Concurrent Alzheimer's pathology in patients with clinical normal pressure hydrocephalus: correlation of high-volume lumbar puncture results, cortical brain biopsies, and outcomes. J Neurosurg 124:382\u2013388, 201610.3171\/2015.2.JNS14231826339853"},{"key":"b17-jns16377","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"1257","DOI":"10.3171\/2014.7.JNS14283","article-title":"A randomized controlled dual-center trial on shunt complications in idiopathic normal-pressure hydrocephalus treated with gradually reduced or \u201cfixed\u201d pressure valve settings","volume":"121","author":"S\u00e6hle T,","year":"2014","unstructured":"S\u00e6hle T, Farahmand D, Eide PK, Tisell M, Wikkels\u00f6 C: A randomized controlled dual-center trial on shunt complications in idiopathic normal-pressure hydrocephalus treated with gradually reduced or \u201cfixed\u201d pressure valve settings. J Neurosurg 121:1257\u20131263, 201410.3171\/2014.7.JNS14283"},{"key":"b18-jns16377","series-title":"Acta Neurol Scand","doi-asserted-by":"publisher","first-page":"311","DOI":"10.1111\/j.1600-0404.1994.tb02640.x","article-title":"Idiopathic normal pressure hydrocephalus: the CSF tap-test may predict the clinical response to shunting","volume":"89","author":"Sand T,","year":"1994","unstructured":"Sand T, Bovim G, Grimse R, Myhr G, Helde G, Cappelen J: Idiopathic normal pressure hydrocephalus: the CSF tap-test may predict the clinical response to shunting. Acta Neurol Scand 89:311\u2013316, 1994808542710.1111\/j.1600-0404.1994.tb02640.x"},{"key":"b19-jns16377","series-title":"Acta Neurochir (Wien)","doi-asserted-by":"publisher","first-page":"515","DOI":"10.1007\/s00701-002-0936-3","article-title":"Five-year outcome of normal pressure hydrocephalus with or without a shunt: predictive value of the clinical signs, neuropsychological evaluation and infusion test","volume":"144","author":"Savolainen S,","year":"2002","unstructured":"Savolainen S, Hurskainen H, Palj\u00e4rvi L, Alafuzoff I, Vapalahti M: Five-year outcome of normal pressure hydrocephalus with or without a shunt: predictive value of the clinical signs, neuropsychological evaluation and infusion test. Acta Neurochir (Wien) 144:515\u2013523, 20021211148410.1007\/s00701-002-0936-3"},{"key":"b20-jns16377","series-title":"Acta Neurochir (Wien)","doi-asserted-by":"publisher","first-page":"1977","DOI":"10.1007\/s00701-013-1835-5","article-title":"Systematic review of the outcome of shunt surgery in idiopathic normal-pressure hydrocephalus","volume":"155","author":"Toma AK,","year":"2013","unstructured":"Toma AK, Papadopoulos MC, Stapleton S, Kitchen ND, Watkins LD: Systematic review of the outcome of shunt surgery in idiopathic normal-pressure hydrocephalus. Acta Neurochir (Wien) 155:1977\u20131980, 201310.1007\/s00701-013-1835-5"},{"key":"b21-jns16377","series-title":"Dan Med J","first-page":"A4911","article-title":"Treatment and clinical outcome in patients with idiopathic normal pressure hydrocephalus\u2014a systematic review","volume":"61","author":"Torsnes L,","year":"2014","unstructured":"Torsnes L, Bl\u00e5fjelldal V, Poulsen FR: Treatment and clinical outcome in patients with idiopathic normal pressure hydrocephalus\u2014a systematic review. Dan Med J 61:A4911, 201425283616"},{"key":"b22-jns16377","series-title":"AJNR Am J Neuroradiol","doi-asserted-by":"publisher","first-page":"2311","DOI":"10.3174\/ajnr.A4046","article-title":"Preoperative prognostic value of MRI findings in 108 patients with idiopathic normal pressure hydrocephalus","volume":"35","author":"Virhammar J,","year":"2014","unstructured":"Virhammar J, Laurell K, Cesarini KG, Larsson EM: Preoperative prognostic value of MRI findings in 108 patients with idiopathic normal pressure hydrocephalus. AJNR Am J Neuroradiol 35:2311\u20132318, 201410.3174\/ajnr.A404625012669"},{"key":"b23-jns16377","series-title":"J Neurol Neurosurg Psychiatry","doi-asserted-by":"publisher","first-page":"562","DOI":"10.1136\/jnnp-2012-303314","article-title":"The European iNPH Multicentre Study on the predictive values of resistance to CSF outflow and the CSF tap test in patients with idiopathic normal pressure hydrocephalus","volume":"84","author":"Wikkels\u00f8 C,","year":"2013","unstructured":"Wikkels\u00f8 C, Hellstr\u00f6m P, Klinge PM, Tans JT: The European iNPH Multicentre Study on the predictive values of resistance to CSF outflow and the CSF tap test in patients with idiopathic normal pressure hydrocephalus. J Neurol Neurosurg Psychiatry 84:562\u2013568, 20132325096310.1136\/jnnp-2012-303314"},{"key":"b24-jns16377","series-title":"Acta Neurol Scand","article-title":"Disease duration: the key to accurate CSF tap test in iNPH.","author":"Yamada S,","year":"2016","unstructured":"Yamada S, Ishikawa M, Miyajima M, Atsuchi M, Kimura T, Kazui H, : Disease duration: the key to accurate CSF tap test in iNPH.. Acta Neurol Scand [epub ahead of print]201626923727"}],"container-title":["Journal of Neurosurgery"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/126\/6\/article-p2002.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/126\/6\/article-p2002.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/126\/6\/article-p2002.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,3,23]],"date-time":"2025-03-23T03:08:50Z","timestamp":1742699330000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/126\/6\/article-p2002.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2016,7]]},"references-count":24,"journal-issue":{"issue":"6"},"URL":"https:\/\/doi.org\/10.3171\/2016.5.jns16377","relation":{},"ISSN":["0022-3085","1933-0693"],"issn-type":[{"value":"0022-3085","type":"print"},{"value":"1933-0693","type":"electronic"}],"subject":[],"published":{"date-parts":[[2016,7]]}}}