CSF Shunting for Patients with Idiopathic Normal-Pressure Hydrocephalus: Is There Really a Benefit?

Surgical cerebrospinal fluid (CSF) shunting is reported to reverse normal-pressure hydrocephalus (NPH), but studies have shown variability in observed clinical effectiveness, durability of benefit, and surgical risks as well as concern for placebo effect. In this multicenter study, 99 patients whose gait velocity improved after temporary CSF drainage (either by lumbar puncture with collection of 40–50 mL or by external lumbar drainage of 300 mL of CSF) were randomized to shunt placement with either an open valve setting that allowed shunting or a placebo valve setting that prevented it.