Managing normal pressure hydrocephalus in the developing countries; personalizing the treatment

The current recommended treatment for NPH is insertion of a programmable shunt. In developing countries however, this might sometimes not be feasible due to cost and logistical reasons. Patients in rural areas are required to travel hundreds of miles for frequent follow-up visits for reprogramming, rendering the treatment protocol troublesome and sometimes even not possible. Our approach was to treat these patients with standard gravitational shunts (MIETKE GAV) instead of programmable shunts and assess the outcome. 43 cases were treated by the authors from the period of 2018 to 2023. Only patients classified as probable NPH according to the INPH guidelines criteria were included. We used fixed pressure non-programmable gravitational shunts for all patients. Improvement was assessed using the Krauss method and only patients with 50% improvement or more were considered improved. There were 33 males and 10 females with a mean age was 74 years. Initially only 30 (69.7%) improved however, after a second surgery for 7 of the remaining 13 patients, the final number of improved patients were 35 (81.3%). Median follow up was 23 months. The use of fixed pressure gravitational shunts such as the GAV shunt, is a good second option for treating NPH patients in developing countries and rural communities. This approach provides a cheap, reliable, and practical solution for NPH patients living in rural areas, without the need for frequent follow-up visits. Although long-term follow-up is still needed, the success rate so far is satisfactory.