REVIEW  IDIOPATHIC NORMAL PRESSURE HYDROCEPHALUS REVISITED: THE ROLE OF INTERDISCIPLINARITY Open access

Journal of Neurosurgical Sciences 2025 February;69(1):64-78

DOI: 10.23736/S0390-5616.25.06411-2

Copyright © 2025 THE AUTHORS

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lingua: Inglese

Instrumental assessment of INPH: structural and functional neuroimaging

Chifumi ISEKI ¹ ✉, Kazunari ISHII ², Nicolò G. POZZI ³, Massimiliano TODISCO ⁴, Claudio PACCHETTI ⁵

¹ Department of Behavioral Neurology and Cognitive Neuroscience, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan; ² Department of Radiology, Kindai University Faculty of Medicine, Osakasayama, Osaka, Japan; ³ Department of Neurology, University Hospital and Julius-Maximilians-Universität Würzburg, Würzburg, Germany; ⁴ Translational Neurophysiology Research Unit, IRCCS Mondino Foundation, Pavia, Italy; ⁵ Parkinson’s Disease and Movement Disorders Unit, IRCCS Mondino Foundation, Pavia, Italy

INTRODUCTION: For the accurate diagnosis of idiopathic normal pressure hydrocephalus (iNPH) an accurate neuroimaging is essential. Disproportionately enlarged subarachnoid-space hydrocephalus (DESH) is a key neuroradiological feature and novel imaging techniques, including voxel-based morphometry and AI-assisted analyses are emerging as powerful tools to investigate iNPH pathophysiology. Converging evidence also suggests a role for dopaminergic dysfunction in iNPH. Molecular imaging of the dopamine transporter (DaT) enables the investigation of dopaminergic function and holds potential for advancing differential diagnosis and guiding treatment decisions in iNPH.
EVIDENCE ACQUISITION: A comprehensive literature search was conducted using MeSH key words. Studies assessing the role of structural and functional neuroimaging in iNPH. The evidence was summarized, and key results were provided.
EVIDENCE SYNTHESIS: DESH is crucial for accurate diagnosis and treatment planning. Advanced structural and functional imaging techniques are expanding our understanding of iNPH pathophysiology. Only few functional imaging studies have directly examined the dopaminergic dysfunction in iNPH and severe methodological limitations exist in both clinical classification and imaging processing. Nonetheless, evidence supports the presence of dopaminergic dysfunction in iNPH, which may be linked to specific clinical symptoms, aid in differential diagnosis, and be reversed with shunt surgery treatment.
CONCLUSIONS: This review covers the structural and functional imaging data in iNPH, providing a comprehensive outlook of the current knowledge, highlighting the limitations and possible future perspectives.

KEY WORDS: Functional neuroimaging; Neuroimaging; Magnetic resonance imaging