What is the definitive treatment for normal pressure hydrocephalus?

• A. Lumbar puncture
• B. Ventriculoperitoneal shunt
• C. Endoscopic third ventriculostomy
• D. Serial lumbar punctures

Answer: (B)

Definitive treatment for normal pressure hydrocephalus is surgically diverting CSF with a ventriculoperitoneal shunt. In NPH, ventricles enlarge because CSF absorption at the arachnoid granulations is impaired, leading to the classic gait disturbance, cognitive slowing, and urinary symptoms. Placing a shunt creates a continuous pathway for CSF to move from the ventricles to the peritoneal cavity, reducing ventricular size and often improving driving symptoms over the long term. This addresses the underlying problem of ongoing CSF accumulation.

Lumbar puncture or serial lumbar punctures can temporarily relieve symptoms by removing CSF and are sometimes used as a predictive tap test, but they do not provide lasting drainage. Endoscopic third ventriculostomy bypasses an obstructed pathway and creates a new route for CSF flow, which is not as effective in the typically communicating hydrocephalus of NPH, making it a less reliable definitive therapy.