Eligibility

Ages Eligible for Study

40 years and up

Genders Eligible for Study

Both

Keywords

Normal Pressure Hydrocephalus

Sponsors

Other

University of California, Los Angeles

Other

NIH/National Insitute of Neurological Disorders & Stroke

Inclusion Criteria

- Findings of gait/balance disturbance must be present, plus at least one other area of
impairment in cognition, urinary symptoms or both

- Minimum duration of symptoms of at least three months, progression over time, and no
other neurological, psychiatric or general medical conditions that are sufficient to
explain the presenting symptoms

- MRI or CT performed after onset of symptoms must show evidence of ventricular
enlargement (Evan's index > 0.3) not entirely attributable to cerebral atrophy or
congenital enlargement

- Criteria for shunt placement: we place greatest emphasis on the results of the
temporary CSF drainage trial. Patients who experience a temporary improvement in
neurological function (gait, bladder control, and/or cognition) are offered a shunt
operation. For patients in whom the CSF drainage results were equivocal, then other
factors such as elevated baseline ICP and/or high Rout will also be considered for a
shunt under these circumstances

Exclusion Criteria

- Age < 40

- Fixed musculoskeletal deformities that will exclude gait improvement

- Advanced dementia

- Inability to obtain an MRI study

- General medical conditions in which operative risks are excessive

- Patients taking Warfarin (Coumadin) will be excluded

Detailed Description

The main purpose of this study is to compare two types of treatment of hydrocephalus: placement of a ventriculoperitoneal (VP) shunt versus an endoscopic third ventriculostomy (ETV). A second goal of this study will be to understand how the two different types of procedures, VP shunt versus ETV, affect brain blood flow and pressures. Understanding these changes is important because the investigators hope is to someday be able to predict who will better respond to one procedure or another.