The "Clinical Map" of Idiopathic Normal Pressure Hydrocephalus (iNPH) Management in South Korea: A Nationwide Multicenter Survey of Practice Patterns and a Comparison with International Guidelines.
Abstract
Objective
Following the recent Class I evidence establishing the efficacy of cerebrospinal fluid shunting for idiopathic normal pressure hydrocephalus (iNPH), standardizing clinical protocols has become a global necessity. This study aimed to delineate the current "Clinical Map" of Korea, identifying its alignment with updated global guidelines and highlighting unique socio-economic barriers through a nationwide multicenter survey.
Methods
A structured nationwide survey was conducted among 88 board-certified neurosurgeons. The survey evaluated diagnostic criteria, standardized tap test protocols, surgical nuances, and healthcare policy satisfaction. Practice patterns were descriptively compared with recommendations from international guidelines.
Results
Of 100 invited board-certified neurosurgeons, 88 responded (response rate, 88%). Near-universal adoption of programmable valve systems (99%) and DESH-based imaging criteria (93%) was observed. Among the 84 respondents who performed the tap test, 77% employed a large-volume protocol (30-50 mL), with objective gait metrics-the 10-meter walk test (80%) and Timed Up and Go test (27%)-serving as primary outcome tools. VP shunting remained the first-line modality (76%), though LP shunting has gained substantial preference (23%), paralleling trends in Japan. Regarding reimbursement, 61%, 58%, and 51% of respondents considered shunt surgery fees, outpatient valve pressure adjustment, and the diagnostic tap test, respectively, to be inadequately compensated relative to clinical effort.
Conclusions
In Korea, contemporary iNPH practices were widely adopted among neurosurgeons affiliated with hydrocephalus-related subspecialty societies, although practice variation and perceived reimbursement inadequacies were identified. These findings support the development of Korean national iNPH guidelines and reform of the National Health Insurance reimbursement system to reflect the diagnostic and follow-up demands of hydrocephalus care.