Beneficial Effect of Siphoning in Treatment of Adult Hydrocephalus

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Abstract
ADULT hydrocephalus differs from that of childhood in that the former is usually not associated with persistently elevated intracranial pressure (ICP). A diagnosis of hydrocephalus in children is seldom questioned because the findings of ventriculomegaly in association with elevated ICP are pathognomonic. Conversely, ventriculomegaly in adults can be confounded by degenerative changes of the brain parenchyma. In many patients with adult hydrocephalus—particularly so-called normal pressure hydrocephalus—the diagnosis is considered "confirmed" only if improvement occurs after a cerebrospinal fluid (CSF) shunting procedure. This is partly because of a lack of definitive clinical or neuroimaging criteria to predict which patients with presumed normal pressure hydrocephalus will respond to a shunt.1 A risk of this treatment-dependent diagnostic approach is that patients who do not improve after shunting may be labeled as "nonresponders" and, therefore, considered to be misdiagnosed.