{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T12:04:51Z","timestamp":1791893091131,"version":"4.3.4"},"reference-count":62,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[1998,3]]},"abstract":"<jats:p content-type=\"fine-print\"><jats:italic>Object.<\/jats:italic> The goal of this prospective study was to compare outcome after placement of a low- or medium-pressure shunt in patients with normal-pressure hydrocephalus (NPH).<\/jats:p><jats:p content-type=\"fine-print\"><jats:italic>Methods.<\/jats:italic> Ninety-six patients with NPH were randomized to receive a low-pressure ventriculoperitoneal shunt (LPV; 40 \u00b1 10 mm H<jats:sub>2<\/jats:sub>O) or medium high\u2014pressure ventriculoperitoneal shunt (MPV; 100 \u00b1 10 mm H<jats:sub>2<\/jats:sub>O). The patients' gait disturbance and dementia were quantified by applying an NPH scale, and their level of disability was evaluated by using the modified Rankin scale (mRS). Patients were examined prior to and 1, 3, 6, 9, and 12 months after surgery. Primary outcome measures were determined by differences between preoperative and last NPH scale scores and mRS grades. The LPV and MPV shunt groups were compared by calculating both the differences between mean improvements and the proportions of patients showing improvement.<\/jats:p><jats:p content-type=\"fine-print\">Intention-to-treat analysis of mRS grades yielded a mean improvement of 1.27 \u00b1 1.41 for patients with LPV shunts and 0.68 \u00b1 1.58 for patients with MPV shunts (p = 0.06). Improvement was found in 74% of patients with LPV shunts and in 53% of patients with MPV shunts (p = 0.06) and a marked-to-excellent improvement in 45% of patients with LPV shunts and 28% of patients with MPV shunts (p = 0.12). All outcome measures indicated trends in favor of the LPV shunt group, with only the dementia scale reaching significance. After exclusion of serious events and deaths unrelated to NPH, efficacy analysis showed the advantage of LPV shunts to be diminished. Reduction in ventricular size was also significantly greater for patients in the LPV shunt group (p = 0.009). Subdural effusions occurred in 71% of patients with an LPV shunt and in 34% with an MPV shunt; however, their influence on patient outcome was limited.<\/jats:p><jats:p content-type=\"fine-print\"><jats:italic>Conclusions.<\/jats:italic> Outcome was better for patients who had an LPV shunt than for those with an MPV shunt, although most differences were not statistically significant. The authors advise that patients with NPH be treated with an LPV shunt.<\/jats:p>","DOI":"10.3171\/jns.1998.88.3.0490","type":"journal-article","created":{"date-parts":[[2009,6,16]],"date-time":"2009-06-16T02:25:11Z","timestamp":1245119111000},"page":"490-495","source":"Crossref","is-referenced-by-count":172,"title":["Dutch Normal-Pressure Hydrocephalus Study: randomized comparison of low- and medium-pressure shunts"],"prefix":"10.3171","volume":"88","author":[{"given":"Agnita J. W.","family":"Boon","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph T. J.","family":"Tans","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ernst J.","family":"Delwel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saskia M.","family":"Egeler-Peerdeman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick W.","family":"Hanlo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hans A. L.","family":"Wurzer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cees J. J.","family":"Avezaat","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dirk A.","family":"de Jong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rob H. J. M.","family":"Gooskens","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jo","family":"Hermans","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"ref391","doi-asserted-by":"crossref","first-page":"336","DOI":"10.1136\/jnnp.40.4.336","article-title":"Idiopathic normal pressure hydrocephalus\u2014a report of 73 patients.","volume":"40","author":"Greenberg","year":"1977","journal-title":"J Neurol Neurosurg Psychiatry"},{"key":"ref481","doi-asserted-by":"crossref","first-page":"484","DOI":"10.1227\/00006123-198410000-00002","article-title":"Treatment of normal pressure hydrocephalus with low versus medium pressure cerebrospinal fluid shunts.","volume":"15","author":"McQuarrie","year":"1984","journal-title":"Neurosurgery"},{"key":"ref131","doi-asserted-by":"crossref","first-page":"534","DOI":"10.1212\/WNL.20.6.534","article-title":"A simple constant-infusion manometric test for measurement of CSF absorption. 1. 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The need for model for testing valves under physiological conditions.","volume":"1","author":"Trost","year":"1991","journal-title":"Eur J Pediatr Surg"},{"key":"ref71","doi-asserted-by":"crossref","first-page":"1601","DOI":"10.1212\/WNL.39.12.1601","article-title":"Variables predicting surgical outcome in symptomatic hydrocephalus in the elderly.","volume":"39","author":"Graff-Radford","year":"1989","journal-title":"Neurology"},{"key":"ref441","doi-asserted-by":"crossref","first-page":"534","DOI":"10.1212\/WNL.20.6.534","article-title":"A simple constant-infusion manometric test for measurement of CSF absorption. 1. 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Results of shunting in 62 patients.","volume":"52","author":"Black","year":"1980","journal-title":"J Neurosurg"},{"key":"ref411","first-page":"143","article-title":"A biomechanical model of hydrocephalus and its relationship to treatment","volume-title":"Hydrocephalus.","author":"Hakim","year":"1984"},{"key":"ref531","doi-asserted-by":"crossref","first-page":"213","DOI":"10.3171\/jns.1987.66.2.0213","article-title":"A new approach in the treatment of hydrocephalus.","volume":"66","author":"Sainte-Rose","year":"1987","journal-title":"J Neurosurg"},{"key":"ref321","doi-asserted-by":"crossref","first-page":"655","DOI":"10.1227\/00006123-199004000-00015","article-title":"Communicating hydrocephalus in adults: prediction of outcome after ventricular shunting procedures.","volume":"26","author":"Benzel","year":"1990","journal-title":"Neurosurgery"},{"key":"ref421","doi-asserted-by":"crossref","first-page":"961","DOI":"10.1136\/jnnp.41.11.961","article-title":"Adult idiopathic communicating hydrocephalus with and without shunting.","volume":"41","author":"Hughes","year":"1978","journal-title":"J Neurol Neurosurg Psychiatry"},{"key":"ref61","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/BF01401149","article-title":"Conductance to outflow of CSF in normal pressure hydrocephalus.","volume":"71","author":"B\u00f8rgesen","year":"1984","journal-title":"Acta Neurochir"},{"key":"ref241","first-page":"15","article-title":"Normal pressure hydrocephalus: twelve years experience.","volume":"29","author":"Spanu","year":"1986","journal-title":"Neurochirurgia"},{"key":"ref151","doi-asserted-by":"crossref","first-page":"475","DOI":"10.1111\/j.1600-0404.1991.tb04998.x","article-title":"Clinical parameters in 74 consecutive patients shunt operated for normal pressure hydrocephalus.","volume":"84","author":"Larsson","year":"1991","journal-title":"Acta Neurol Scand"},{"key":"ref311","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1056\/NEJM196507152730301","article-title":"Symptomatic occult hydrocephalus with \u201cnormal\u201d cerebrospinal fluid pressure. 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Pathogenesis and Treatment.","author":"Tokoro","year":"1991"},{"key":"ref121","first-page":"89","article-title":"Hydroc\u00e9phalie \u00e0 pression normale. Etude pr\u00e9- et postop\u00e9ratoire de 56 cas.","volume":"27","author":"Janny","year":"1981","journal-title":"Neurochirurgie"},{"key":"ref191","doi-asserted-by":"crossref","first-page":"643","DOI":"10.1227\/00006123-199410000-00010","article-title":"Low-pressure hydrocephalic state and viscoelastic alterations in the brain.","volume":"35","author":"Pang","year":"1994","journal-title":"Neurosurgery"},{"key":"ref371","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/BF01401149","article-title":"Conductance to outflow of CSF in normal pressure hydrocephalus.","volume":"71","author":"B\u00f8rgesen","year":"1984","journal-title":"Acta Neurochir"},{"key":"ref101","first-page":"143","article-title":"A biomechanical model of hydrocephalus and its relationship to treatment","volume-title":"Hydrocephalus.","author":"Hakim","year":"1984"},{"key":"ref01","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1056\/NEJM196507152730301","article-title":"Symptomatic occult hydrocephalus with \u201cnormal\u201d cerebrospinal fluid pressure. A treatable syndrome.","volume":"273","author":"Adams","year":"1965","journal-title":"N Engl J Med"},{"key":"ref81","doi-asserted-by":"crossref","first-page":"336","DOI":"10.1136\/jnnp.40.4.336","article-title":"Idiopathic normal pressure hydrocephalus\u2014a report of 73 patients.","volume":"40","author":"Greenberg","year":"1977","journal-title":"J Neurol Neurosurg Psychiatry"},{"key":"ref511","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1212\/WNL.35.3.307","article-title":"Surgical treatment of idiopathic hydrocephalus in elderly patients.","volume":"35","author":"Petersen","year":"1985","journal-title":"Neurology"},{"key":"ref361","doi-asserted-by":"crossref","first-page":"687","DOI":"10.3171\/jns.1997.87.5.0687","article-title":"Dutch Normal-Pressure Hydrocephalus Study: prediction of outcome after shunting by resistance to outflow of cerebrospinal fluid.","volume":"87","author":"Boon","year":"1997","journal-title":"J Neurosurg"},{"key":"ref551","first-page":"15","article-title":"Normal pressure hydrocephalus: twelve years experience.","volume":"29","author":"Spanu","year":"1986","journal-title":"Neurochirurgia"},{"key":"ref221","doi-asserted-by":"crossref","first-page":"213","DOI":"10.3171\/jns.1987.66.2.0213","article-title":"A new approach in the treatment of hydrocephalus.","volume":"66","author":"Sainte-Rose","year":"1987","journal-title":"J Neurosurg"},{"key":"ref161","doi-asserted-by":"crossref","first-page":"478","DOI":"10.1212\/WNL.28.5.478","article-title":"Communicating hydrocephalus in adults. Diagnostic tests and results of treatment with medium pressure shunts.","volume":"28","author":"Magnaes","year":"1978","journal-title":"Neurology"},{"key":"ref291","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1212\/WNL.42.1.54","article-title":"Shunting normal pressure hydrocephalus: do the benefits outweigh the risks? A multicenter study and literature review.","volume":"42","author":"Vanneste","year":"1992","journal-title":"Neurology"},{"key":"ref281","first-page":"271","article-title":"Results and complications in 55 shunted patients with normal pressure hydrocephalus.","volume":"3","author":"Udvarhelyi","year":"1975","journal-title":"Surg Neurol"},{"key":"ref251","first-page":"611","article-title":"The implications of shunt surgery in the intracranial hydrodynamics of normal pressure hydrocephalus (NPH)","volume-title":"Hydrocephalus. 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