What is the treatment for NPH?
In an effort to move the CSF out of the brain, a shunt system is implanted. This specially designed system allows small amounts of CSF to drain from the brain and be carried through a small tube to the abdomen where it is then reabsorbed by the body. This fluid is constantly being replaced naturally with fresh CSF made by the brain. The shunt is implanted and remains in place long-term.
Is surgery required to place the shunt?
Yes. A surgical procedure is necessary to implant the shunt.
Has this type of surgery ever been done before?
Shunt surgery initially began in the mid-1950s to treat infants with hydrocephalus, a condition sometimes called “water on the brain.” Following the early development of the hydrocephalus shunt, the procedure was expanded and used to treat adults with normal pressure hydrocephalus. Many advances have been made since the original shunts were introduced. The most significant improvement is the adjustable shunt valve, which can be controlled with a magnet after surgery to change the valve pressure setting, if and when necessary. This avoids the need for a revision surgery.
How is this surgery done for NPH?
It is done in the same manner as the surgical procedure that is done on infants. A small incision is usually made behind one ear and a bit of bone is removed from the skull in order to access the fluid cavity of the brain.
There are three basic components to the shunt. A small flexible tube, about the size of a coffee stirrer, is inserted into the fluid cavity of the brain where the CSF is produced. This tube is connected to a valve-like device that is implanted just under the skin. A second tube is connected to the valve and is tunneled under the skin to the abdominal area. The CSF will then drain into the abdominal cavity or belly
The patient will be asleep, under general anesthesia while the procedure is being done. Most patients can go home after a short stay in the hospital.
What happens after the procedure is completed?
All patients will need to be evaluated at regular follow-up visits. Generally, there will be one visit a week or two after surgery with other follow-up visits every three months thereafter. During these visits, one or more medical professionals will evaluate the patient's physical and mental condition. Additionally, blood and urine testing may be done during these visits.
Are there any risks associated with the surgical procedure?
The risks are to the same as those associated with any shunt placement surgery and general anesthesia. Some of the risks include bleeding, infection, shunt malfunction, headache, or sensitivity to the shunt material. Please note this is not a complete list of all potential side effects. The treating physician will have a detailed discussion with the patient and family prior to surgery. At this time, patients and family members are encouraged to ask questions to gain a better understanding of all of the risks and potential benefits involved.
