Supplementary table 6: Review’s table showing type of study and level of evidence provided by the included published articles.

Author / Year / Number of patients / Mean age / Study group / Type of study / Level of evidence / Comments
Greenberg et [27]. / 1977 / 73 / 69 / retrospective / case series / 4 / early surgical series
Laws et al [38]. / 1977 / 19 / 66 / retrospective / case series / 4 / early surgical series
Black et al [12]. / 1980 / 62 / 68 / retrospective / case series / 4 / early surgical series
Borgesen et al [14,15]. / 1982 / 31 / 65 / prospective / case series / 4 / early infusion study
Vassilouthis et al [68]. / 1984 / 16 / Not specified / retrospective / case series / 4 / early surgical series
Black et al [13]. / 1985 / 36 / 73 / retrospective / case series / 4 / early surgical series
Peterson et al [52]. / 1985 / 45 / 68 / retrospective / case series / 4 / early surgical series
Thomsen et al [64]. / 1986 / 19 / 60 / retrospective / case series / 4 / compared pre and post shunt cognitive function
Haan et al [28]. / 1988 / 17 / 71 / prospective / case series / 4 / value of lumbar drainage as a predictive test
Spanu et al [62]. / 1989 / 36 / not specified / retrospective / case series / 4 / early surgical series
Benzel et al [11]. / 1990 / 37 / 65 / retrospective / case series / 4 / advised using high opening pressure valves
Larsson et al [37]. / 1991 / 26 / 66 / prospective / case series / 4 / Study of clinical parameters of INPH and SNPH
Vanneste et al [67]. / 1992 / 127 / 73 / retrospective / case series / 4 / concluded that NPH is rare over diagnosed condition
Raftopulos et al [57,58]. / 1994 / 23 / 70 / prospective / case series / 4 / recommend the use of quantitative ICP-Mo as shunt response predictor
Malm et al [39]. / 1995 / 34 / 71 / prospective / case series / 4 / a study of shunts / valves function
Tedeschi et al [63]. / 1995 / 18 / 63 / prospective / case series / 4 / PET study of cerebral glucose metabolism
Weiner et al [69]. / 1995 / 36 / 70 / retrospective / case series / 4 / Compared flow regulated and differential pressure valves in NPH.
Krauss et al [35]. / 1996 / 41 / 70 / prospective / case series / 4 / Patients with extensive deep white matter changes can still benefit from shunt if properly selected.
Caruso et al [17]. / 1997 / 18 / 65 / retrospective / case series / 4 / factors that had a significant
influence on outcome were a short clinical history and a clinical onset without dementia
Krauss et al [36]. / 1997 / 37 / 71 / prospective / case series / 4 / aqueductal flow void study
Pisani et al [54]. / 1998 / 35 / 68 / retrospective / case series / 4 / used continuous lumbar subarachnoid CSF pressure monitoring
Bech et al [7,8,10]. / 1999 / 27 / 64 / prospective / case series / 4 / cerebral and leptomeningeal biopsy study
Malm et al [40]. / 2000 / 42 / 70 / prospective / case series / 4 / Outcome at three years.
Mori et al [50]. / 2001 / 120 / 67 / retrospective / case series / 4 / long term more than 3 years: 73% improvement
Klinge et al [33]. / 2002 / 53 / 67 / prospective / case series / 4 / investigated impact of cerebrovascular risk factors in iNPH
Savolainen et al [60]. / 2002 / 25 / 67 / prospective / cohort / 4 / long term outcome study (prognostic test acted as a additional confounder in the cohort)
Mataro et al [42]. / 2003 / 15 / 73 / prospective / case series / 4 / study cerebral blood flow (CBF) changes after surgery
McGirt et al [43]. / 2004 / 132 / 74 / retrospective / case series / 4 / A study of long term outcome in INPH
Poca et al [55]. / 2004 / 43 / 71 / prospective / case series / 4 / Concluded that the use of strict diagnostic and treatment protocols can improve the results of surgery.
Tisell et al [65]. / 2004 / 19 / 69 / prospective / case series / 4 / Biomarkers study
Aygok et al [6]. / 2005 / 50 / 66 / Not specified / case series / 4 / three years outcome study
Bech Azedine et al [9]. / 2005 / 17 / 66 / prospective / case series / 4 / study of lumbar infusion test (LIT),
Delwel et al [19]. / 2005 / 66 / 70 / prospective / case series / 4 / infusion test did not predict shunt response
Eide et al [24]. / 2005 / 19 / 68 / prospective / case series / 4 / Mean CSFP wave amplitude was a better predictor of outcome than Rout
Marmarou et al [41]. / 2005 / 84 / 75 / prospective / case series / 4 / prospective surgical series of INPH patients validating role of ELD
Meier et al [44,45]. / 2005 / 60 / 66 / prospective / case series / 4 / prospective study of INPH patients shunted using Dual switch Miethke valve
Eide et al [20]. / 2006 / 22 / 75 / prospective / case series / 4 / study of ICP pulse amplitude
Eide et al [21]. / 2006 / 39 / 71 / retrospective / case series / 4 / ICP wave amplitudes can be used to predict shunt response
Kiefer et al [31]. / 2006 / 64 / not specified / prospective / case series / 4 / outcome prediction study
Meier et al [49]. / 2006 / 18 / 65 / prospective / case series / 4 / adding antigravity unit is to adjustable valves is beneficial
Meier et al [48]. / 2006 / 30 / 68 / prospective / case series / 4 / First clinical experience with the proGAV valve.
Meier et al [47]. / 2006 / 63 / 68 / prospective / case series / 4 / prospective study with three years outcome assessment
Meier et al [46]. / 2006 / 123 / 67 / prospective / controlled trial / 4 / Prospective randomized study that showed lower valve opening pressure is associated with better outcome.
Spagnoli et al [61]. / 2006 / 66 / 73 / prospective / case series / 4 / studied impact of cerebrovascular disease, recommended shunt insertion
Agren-Wilson et al [1]. / 2007 / 55 / 72 / retrospective / case series / 4 / Biomarkers study
Al zain et al [3,4]. / 2007 / 39 / 68 / prospective / case series / 4 / MRI flow studies
Goodwin et al [26]. / 2007 / 15 / 78 / retrospective / case series / 4 / Elderly patients on long-term warfarin anticoagulation can be safely evaluated
and treated for NPH
Murakami et al [51]. / 2007 / 24 / 78 / retrospective / case series / 4 / Measurement of rCBF by 3D-SSP SPECT may predict response to shunt operations.
Pfisterer et al [53]. / 2007 / 47 / 76 / prospective / cohort / 4 / used continuous intraventricular pressure
Akiguchi et al [2]. / 2008 / 19 / 76 / retrospective / case series / 4 / INPH often appears as a shunt-responsive type of parkinsonism and reversible white matter lesions among the geriatric population.
Brean et al [16]. / 2008 / 18 / 73 / prospective / cohort / 4 / data favour determination of CSFP pulsatility rather than Rout for prediction of shunt response
Hellstrom et al [29]. / 2008 / 47 / 73 / prospective / case series / 4 / Study of neuropsychological effect of shunt. Patients with complications were excluded from the analysis.
Hertel et al [30]. / 2008 / 70 / 71 / retrospective / case series / 4 / series of Miethke Dual Switch Valve
Klinge et al [34]. / 2008 / 65 / 67 / retrospective / case series / 4 / A retrospective analysis of PET-CBF studies
Pujari et al [56]. / 2008 / 55 / 72 / retrospective / case series / 4 / 7 years outcome after shunt insertion
Tullberg et al [66]. / 2008 / 18 / 68 / retrospective / case series / 4 / Biomarkers study
Woodworth et al [70]. / 2009 / 51 / 73 / retrospective / case series / 4 / no correlation between Pcsf waves and shunt response
Chang et al [18]. / 2009 / 162 / 74 / prospective / case series / 4 / Prospective study of cerebral blood flow and cerebrovascular reactivity, Postoperative CBF and CVR increased significantly in responders.
Razay et al [59]. / 2009 / 18 / 76 / prospective / cohort / 4 / Cohort study:failed to carry out a sufficiently long follow-up of patients
Anile et al [5]. / 2010 / 96 / 68 / retrospective / case series / 4 / Comparison between CSF-outflow resistance (R-out) and intracranial elastance (IE).
Eide et al [22]. / 2010 / 45 / 72 / prospective / case series / 4 / shunt response can be anticipated in 9/10 patients with elevated overnight ICP pulse amplitude
Eide et al [25]. / 2010 / 31 / 71 / prospective / case series / 4 / a study of monitoring cerebral metabolism with microdialysis and ICP readings, and relate to the clinical responses to extended lumbar drainage and shunt surgery.
Eide et al [23]. / 2010 / 130 / 68 / retrospective / case series / 4 / ICP pulsatility can predict 9/10 of responders.
Kiefer et al [32]. / 2010 / 75 / 68 / prospective / case series / 4 / outcome prediction study

Supplementary table 7: review’s table showing type of shunt and valve used in the included published articles as well as the percentage of improved patients at different time points postoperatively.( VP = ventriculoperitoneal, VA = ventriculoatrial, Vpleural = ventriculopleural, DVP = differential pressure valve, FRV = flow regulating valve, AGD = antigravity or antisiphone device, + = with or without).

Author / Date / Number of patients / Type of shunt / Type of valve / Outcome assessment method / Percentage of patients with good 3 months’ outcome / Percentage of patients with good 1 year’s outcome / Percentage of patients with good 3 years’ outcome
Greenberg et [27]. / 1977 / 73 / VP&VA / DPV / Functional grading / 45 / 37
Laws et al [38]. / 1977 / 19 / VP,VA &Vpleural / DPV / Clinical / 74
Black et al [12]. / 1980 / 62 / VP&VA / DPV / Stein – Langfitt scale / 47
Borgesen et al[14,15]. / 1982 / 31 / not specified / DPV / Clinical indices / 54 / 42
Vassilouthis et al[68]. / 1984 / 16 / VP / DPV / Black grading scale / 100
Black et al [13]. / 1985 / 36 / VP&VA / DPV / Clinical indices / 64
Peterson et al[52]. / 1985 / 45 / VP&VA / DPV / Functional grading / 75 / 42
Thomsen et al [64]. / 1986 / 19 / VA / DPV / Functional grading / 72
Haan et al [28]. / 1988 / 17 / VP / DPV / Clinical indices / 54
Spanu et al [62]. / 1989 / 36 / VP&VA / DPV / Clinical / 76
Benzel et al[11]. / 1990 / 37 / VP&Vpleural / DPV / Black grading scale / 78
Larsson et al [37]. / 1991 / 26 / VP / DPV / Clinical indices / 77
Vanneste et al [67]. / 1992 / 127 / VP&VA / DPV / Clinical ordinal scales / 31
Raftopulos et al [57,58]. / 1994 / 23 / VA / DPV / Black grading scale / 90 / 96 / 91
Malm et al [39]. / 1995 / 34 / VP / adjustable +FRV / Clinical indices / 73
Tedeschi et al[63]. / 1995 / 18 / VP / not specified / Clinical indices / 33
Weiner et al[69]. / 1995 / 36 / VP / DPV +FRV / Clinical / 86
Krauss et al [35]. / 1996 / 41 / VP&VA / mixed / Clinical indices / 90
Caruso et al[17]. / 1997 / 18 / VP / not specified / Clinical indices / 67
Krauss et al[36]. / 1997 / 37 / VP&VA / mixed / Clinical indices / 89
Pisani et al[54]. / 1998 / 35 / Stein – Langfitt scale / 60
Bech et al [7,8,10]. / 1999 / 27 / VP / not specified / Clinical ordinal scale / 33
Malm et al [40]. / 2000 / 42 / not specified / not specified / Clinical indices / 74 / 28
Mori et al [50]. / 2001 / 120 / VP&LP / mixed + AGD / Japanese NPH grading scale / 80 / 73
Klinge et al [33]. / 2002 / 53 / VP / mixed / Stein – Langfitt scale / 51
Savolainen et al[60]. / 2002 / 25 / not specified / not specified / Clinical indices / 76 / 72 / 47
Mataro et al [42]. / 2003 / 15 / VP / mixed / Japanese NPH grading scale / 93
McGirt et al [43]. / 2005 / 132 / VP&VA&LP / mixed / Clinical indices / 33 / 75
Poca et al[55]. / 2004 / 43 / VP / DPV + AGD / NPH scale / 86
Tisell et al [65]. / 2004 / 19 / VP / DPV / Clinical indices / 86
Aygok et al [6]. / 2005 / 50 / not specified / mixed / Clinical indices / 91 / 80
Bech Azedine et al[9]. / 2005 / 17 / VP / FRV / Clinical ordinal scale / 76
Delwel et al[19]. / 2005 / 66 / VP / DPV / Clinical indices / 59
Eide et al[24]. / 2005 / 19 / VP / adjustable / NPH grading scale (ordinal) / 74
Marmarou et al [41]. / 2005 / 84 / VP&VA / mixed / Clinical indices / 91
Meier et al [44,45]. / 2005 / 60 / VP / DPV + AGD / Kiefer score and black scale / 83
Eide et al[20]. / 2006 / 22 / VP / adjustable / NPH grading scale (ordinal) / 91
Eide et al [21]. / 2006 / 39 / VP / adjustable / NPH grading scale (ordinal) / 69
Kiefer et al [31]. / 2006 / 64 / VP / mixed + AGD / Kiefer score / 66
Meier et al [49]. / 2006 / 18 / VP / adjustable + AGD / Kiefer score / 72
Meier et al [48]. / 2006 / 30 / VP / adjustable + AGD / Kiefer score and black scale / 89
Meier et al [47]. / 2006 / 63 / VP / DPV + AGD / Kiefer score and black scale / 80 / 67
Meier et al [46]. / 2006 / 123 / VP / DPV + AGD / Kiefer score and black scale / 88
Spagnoli et al [61]. / 2006 / 66 / VP / DPV / Clinical ordinal and modified Rankin scales / 89 / 60
Agren-Wilson et al [1]. / 2007 / 55 / VP / not specified / Clinical indices / 65
Al zain et al [3,4]. / 2007 / 39 / VP / mixed + AGD / Kiefer score and black scale / 89
Goodwin et al[26]. / 2007 / 15 / VP / adjustable + AGD / Clinical indices / 87
Murakami et al [51]. / 2007 / 24 / LP / adjustable / Mori grading scale / 58
Pfisterer et al [53]. / 2007 / 47 / VA / adjustable / Clinical / 96
Akiguchi et al [2]. / 2008 / 19 / VP / not specified / Japanese NPH grading scale / 89
Brean et al [16]. / 2008 / 18 / VP / adjustable / NPH grading scale (ordinal) / 89
Hellstrom et al [29]. / 2008 / 47 / VP / mixed + AGD / Clinical indices / 79
Hertel et al [30]. / 2008 / 70 / VP / DPV + AGD / Black scale / 91
Klinge et al[34]. / 2008 / 65 / VP / mixed / Stein – Langfitt scale / 55
Pujari et al [56]. / 2008 / 55 / VP / mixed / Clinical indices / 87 / 95 / 85
Tullberg et al[66]. / 2008 / 18 / VP / mixed / Clinical indices / 72
Woodworth et al [70]. / 2008 / 51 / VP&VA / mixed + AGD / Clinical indices / 69
Chang et al [18]. / 2009 / 162 / VP&LP / adjustable / Japanese NPH grading scale / 90
Razay et al [59]. / 2009 / 18 / VP / adjustable / CIBIC-plus / 85
Anile et al [5]. / 2010 / 96 / VP / mixed / Stein – Langfitt scale / 88
Eide et al[22]. / 2010 / 45 / VP / adjustable / NPH grading scale (ordinal) / 78
Eide et al [25]. / 2010 / 31 / VP / adjustable + AGD / NPH grading scale (ordinal) / 77
Eide et al [23]. / 2010 / 130 / VP / adjustable + AGD / NPH grading scale (ordinal) / 79
Kiefer et al [32]. / 2010 / 75 / VP / adjustable + AGD / Kiefer score / 72

Supplementary table 8: Review’s table of mortalities and morbidities reported in included published papers presented as percentages (SDH= subdural haemorrhage or effusion. CVA: cerebrovascular accident. ICH: intracerebral haemorrhage)

Author / Publication date / Number of patients / Mortality or severe deficit / Revision / SDH / CVA or ICH / Infection / seizure
Greenberg et al [27]. / 1977 / 73 / 7 / 13 / 3 / 6 / 1
Black et al [12]. / 1980 / 62 / 8 / 11 / 11 / 0 / 0 / 6
Borgesen et al [14,15]. / 1982 / 31 / 13
Black et al [13]. / 1985 / 36 / 6 / 28 / 3 / 8
Peterson et al [52]. / 1985 / 45 / 2 / 20 / 16 / 4 / 6
Haan et al [28]. / 1988 / 17 / 11 / 35 / 18
Spanu et al [62]. / 1989 / 36 / 6 / 11 / 8 / 3 / 6
Benzel et al [11]. / 1990 / 37 / 1 / 11 / 14 / 6 / 5
Vanneste et al [67]. / 1992 / 127 / 6
Raftopulos et al [57]. / 1994 / 23 / 0 / 22 / 47
Weiner et al [69]. / 1995 / 36 / 0 / 48 / 7 / 3
Krauss et al [35]. / 1996 / 41 / 0 / 10 / 9
Caruso et al [17]. / 1997 / 18 / 11
Malm et al [40]. / 2000 / 42 / 2 / 10 / 7 / 10
McGirt et al [43]. / 2004 / 132 / 1 / 33 / 2 / 7
Poca et al [55]. / 2004 / 43 / 0 / 10
Tisell et al [65]. / 2004 / 19 / 10.5
Aygok et al [6]. / 2005 / 50 / 0 / 6
Delwel et al [19]. / 2005 / 66 / 17 / 9
Eide et al [24]. / 2005 / 19 / 0 / 5
Marmarou et al [41]. / 2005 / 84 / 0 / 3
Meier et al [44,45]. / 2005 / 60 / 1.7 / 5 / 3 / 5
Eide et al [20]. / 2006 / 22 / 5 / 5 / 5 / 5
Eide et al [22]. / 2006 / 39 / 0 / 3 / 3 / 5
Meier et al [9]. / 2006 / 18 / 0 / 0 / 0 / 0 / 0
Meier et al [48]. / 2006 / 30 / 0 / 3
Meier et al [46]. / 2006 / 123 / 1 / 11 / 6 / 2
Spagnoli et al [61]. / 2006 / 66 / 0 / 9 / 9 / 1.5 / 3
Agren-Wilson et al [1]. / 2007 / 55 / 7
Goodwin et al [26]. / 2007 / 15 / 0 / 7
Pfisterer et al [53]. / 2007 / 47 / 5 / 4 / 2
Akiguchi et al [2]. / 2008 / 19 / 0 / 5
Brean et al [16]. / 2008 / 18 / 5 / 5 / 5
Hertel et al [30]. / 2008 / 70 / 0 / 11 / 4.5 / 3
Pujari et al [56]. / 2008 / 55 / 53 / 10
Woodworth et al [70]. / 2008 / 51 / 0 / 32 / 6 / 10
Anile et al [5]. / 2010 / 96 / 0 / 5 / 1
Eide et al [21]. / 2010 / 45 / 0 / 7 / 7 / 2
Eide et al [25]. / 2010 / 31 / 0 / 3 / 3 / 10
Eide et al [23]. / 2010 / 130 / 0.7 / 8 / 5

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