{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,1]],"date-time":"2025-11-01T05:30:46Z","timestamp":1761975046116},"reference-count":121,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JNS"],"published-print":{"date-parts":[[2006,12]]},"abstract":"<jats:sec>\n<jats:title>Object<\/jats:title>\n<jats:p>The average 65-year-old patient with moderate dementia can look forward to only 1.4 quality-adjusted life years (QALYs), that is, longevity times quality of life. Some of these patients suffer from normal-pressure hydrocephalus (NPH) and respond dramatically to shunt insertion. Currently, however, NPH cannot be diagnosed with certainty. The authors constructed a Markov decision analysis model to predict the outcome in patients with NPH treated with and without shunts.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>Transition probabilities and health utilities were obtained from a review of the literature. A sensitivity analysis and Monte Carlo simulation were applied to test outcomes over a wide range of parameters. Using shunt response and complication rates from the literature, the average patient receiving a shunt would gain an additional 1.7 QALYs as a result of automatic shunt insertion. Even if 50% of patients receiving a shunt have complications, the shunt response rate would need to be less than 5% for empirical shunt insertion to do more harm than good. Authors of most studies have reported far better statistics.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>In summary, many more patients with suspected NPH should be considered for shunt insertion.<\/jats:p><\/jats:sec>","DOI":"10.3171\/jns.2006.105.6.815","type":"journal-article","created":{"date-parts":[[2008,1,24]],"date-time":"2008-01-24T12:41:37Z","timestamp":1201178497000},"page":"815-822","source":"Crossref","is-referenced-by-count":43,"title":["Shunts in normal-pressure hydrocephalus: do we place too many or too few?"],"prefix":"10.3171","volume":"105","author":[{"given":"Sherman C.","family":"Stein","sequence":"first","affiliation":[{"name":"Departments of Neurosurgery and Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark G.","family":"Burnett","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Seema S.","family":"Sonnad","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"key":"b1-1050815","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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