Brain Shunt surgery show promise in treatment of iNPH patients

Luciano et al., 2025 (N Engl J Med): A randomized, double-blind, placebo-controlled trial of shunt surgery was conducted among 99 participants having idiopathic normal pressure hydrocephalus (iNPH). It was observed that shunt surgery increases the gait velocity and was found unchanged in the placebo. A significant difference favoring shunt surgery was seen for the Tinetti but not the Montreal cognitive assessment or overactive bladder questionnaire. Adverse events were mixed, with more falls in placebo. The placebo-controlled effectiveness in idiopathic normal pressure hydrocephalus iNPH shunting (PENS) trial provides evidence that shunt surgery is effective for improving gait velocity at 3 months in patients with iNPH selected for shunt surgery. The study supports the potential benefits of evaluating patients who have symptoms, neurological findings, and brain imaging consistent with iNPH and treating with shunt surgery when indicated. Further evaluation of effectiveness and safety beyond 3 months is needed.