{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T12:21:03Z","timestamp":1789474863750,"version":"build-2803163510"},"reference-count":33,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2018,10]]},"abstract":"<jats:sec><jats:title>OBJECTIVE<\/jats:title><jats:p>Changes in the pressure gradient between intraocular and intracranial compartments at the lamina cribrosa level are a possible explanation of normal tension glaucoma (NTG). Shunt-treated normal pressure hydrocephalus (NPH) is a model for testing whether the increase (time from disease onset to CSF shunt placement, i.e., \u201cprotection period\u201d) and decrease (time from shunt placement to observation, i.e., \u201cexposure period\u201d) in intracranial pressure (ICP) are glaucoma protective or risk factors, respectively. The authors estimated the prevalence of NTG in patients with shunt-treated NPH and calculated the extent of optic nerve exposure to changes in the trans\u2013lamina cribrosa gradient.<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS<\/jats:title><jats:p>Data obtained in patients with NPH who had undergone ventriculoperitoneal (VP) shunt placement were analyzed. Patients with more than 6 months\u2019 follow-up, no pathologies associated with ICP changes or CSF dynamics disturbances, and no surgical or valve-related complications were scheduled for ophthalmic evaluation.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>Nine of 22 patients had NTG, which is about a 40-fold increase in rate compared with the rate in the general elderly population without hydrocephalus (p &lt; 0.001). The median protection period was 12.0 months in patients with NTG and 18.0 months in those without NTG (p = 0.033). The median ICP decrease multiplied by duration of exposure in months was 76.0 mm Hg \u00d7 months in the NTG group and 24.1 mm Hg \u00d7 months in the no-NTG group (p = 0.048). The patients\u2019 median adjusted age (adjusted for \u201cprotection\u201d and \u201cexposure\u201d times) was 85.1 years in the NTG group and 78.8 years in the no-NTG group (p = 0.001).<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS<\/jats:title><jats:p>A crucial risk factor for development of NTG in patients with shunt-treated NPH is the duration of optic nerve exposure to the lowering of ICP. Patients with NPH who are candidates for CSF shunting should be informed of the risk of incurring glaucoma. Longitudinal studies could provide estimates of tolerated times for a given ICP decrease.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2017.5.jns163062","type":"journal-article","created":{"date-parts":[[2017,11,17]],"date-time":"2017-11-17T14:59:16Z","timestamp":1510930756000},"page":"1078-1084","source":"Crossref","is-referenced-by-count":33,"title":["Glaucoma in patients with shunt-treated normal pressure hydrocephalus"],"prefix":"10.3171","volume":"129","author":[{"given":"Pasquale","family":"Gallina","sequence":"first","affiliation":[{"name":"Department of Surgery and Translational Medicine, Neurosurgery Unit, Tuscany School of Neurosurgery, University of Florence;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alfonso","family":"Savastano","sequence":"additional","affiliation":[{"name":"Department of Surgery and Translational Medicine, Ophthalmic Unit, University of Florence;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eleonora","family":"Becattini","sequence":"additional","affiliation":[{"name":"Department of Surgery and Translational Medicine, Neurosurgery Unit, Tuscany School of Neurosurgery, University of Florence;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simone","family":"Orlandini","sequence":"additional","affiliation":[{"name":"Department of Surgery and Translational Medicine, Neurosurgery Unit, Tuscany School of Neurosurgery, University of Florence;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Scollato","sequence":"additional","affiliation":[{"name":"Neurosurgery Unit, University Hospital \u201cOspedali Riuniti\u201d of Trieste, Cattinara;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stanislao","family":"Rizzo","sequence":"additional","affiliation":[{"name":"Department of Surgery and Translational Medicine, Ophthalmic Unit, University of Florence;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giulia","family":"Carreras","sequence":"additional","affiliation":[{"name":"Occupational & Environmental Epidemiology Section, Cancer Prevention and Research Institute (ISPO), Florence; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicola","family":"Di Lorenzo","sequence":"additional","affiliation":[{"name":"Department of Surgery and Translational Medicine, Neurosurgery Unit, Tuscany School of Neurosurgery, University of Florence;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Berardino","family":"Porfirio","sequence":"additional","affiliation":[{"name":"Department of Clinical and Experimental Biomedical Sciences \u201cMario Serio,\u201d University of Florence, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1","series-title":"N Engl J Med","doi-asserted-by":"publisher","first-page":"117","DOI":"10.1056\/NEJM196507152730301","article-title":"Symptomatic occult hydrocephalus with \u201cnormal\u201d cerebrospinal-fluid pressure. 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