Efficiency of endoscopic third ventriculostomy for normal pressure hydrocephalus management

Abstract

Abstract Background Idiopathic normal pressure hydrocephalus (iNPH) is characterized by gait impairment, cognitive dysfunction, and urinary symptoms. Ventriculoperitoneal shunting (VPS) remains the standard treatment, while endoscopic third ventriculostomy (ETV) has been proposed as a potential alternative. Results This retrospective cohort included patients with iNPH who underwent ETV or VPS between 2021 and 2025. Eligible patients presented with ≥ 2 features of the iNPH triad, symptom duration < 12 months, supportive MRI findings, and a positive CSF tap test. Pre- and postoperative assessments included Mini-Mental State Examination (MMSE), Timed Up and Go (TUG), and urinary continence. Outcomes and complications were compared at 12-month follow-up. Twenty-seven patients were included (ETV n = 9, VPS n = 18; mean age 67.7 ± 6.0 years). Both groups showed significant postoperative improvement in MMSE (26.3 ± 2.2 to 28.9 ± 1.2) and TUG (17.9 ± 4.2 to 13.1 ± 3.4; P < 0.001), with urinary improvement in 88.9%. No significant differences were observed between groups. All complications (14.8%) occurred in the VPS group; none were recorded after ETV. Conclusion ETV and VPS provided comparable short-term clinical outcomes. Although ETV showed fewer complications, these findings were not statistically significant and should be interpreted cautiously. Larger prospective studies are required to further define optimal patient selection.