Guidelines for management of idiopathic normal pressure hydrocephalus: progress to date.

The aim of this project was to develop evidenced based guidelines for the diagnosis and management of idiopathic normal pressure hydrocephalus (iNPH). An advisory panel consisting of the authors assisted by international experts met on several occasions and formulated preliminary guidelines for iNPH managemen. The authors developed evidentiary tables based on available literature from 1966 to the present. Additional meetings to refine the evidentiary tables and incorporate expert opinion when necessary resulted in the development the iNPH guidelines. Evidence based guidelines identifying the value of clinical examination, brain imaging, Tap Test, CSF drainage, ICP monitoring and Surgical Management in diagnosing and treating the iNPH patient were developed. These are the first international evidence based guidelines focused on iNPH. Class I data were scant and guidelines relied mostly on class II and III evidence. It became clear that more prospective randomized studies are needed to resolve some of the controversial issues such as iNPH classification and sensitivity of diagnostic tests for identifying shunt responsive iNPH.