[Expert consensus for the diagnosis and treatment of idiopathic normal pressure hydrocephalus (2026 edition)].

内容摘要

Idiopathic normal pressure hydrocephalus (iNPH) is a common and treatable syndrome related to cerebrospinal fluid circulation disorders in the elderly, with clinical problems including missed diagnosis, misdiagnosis and significant variations in therapeutic efficacy. Therefore, multidisciplinary experts in the Chinese Association for Geriatric Health Care's Hydrocephalus Specialty Branch, the Chinese Medical Association's Neurosurgery Branch, the Chinese Neurosurgery Critical Care Management Collaborative Group, and the Beijing Medical Association's Neurosurgery Branch were organized to formulate the Expert consensus for the diagnosis and treatment of idiopathic normal pressure hydrocephalus (2026 edition). Based on the Chinese expert consensus on the diagnosis and treatment of idiopathic normal pressure hydrocephalu (2016 edition), this consensus systematically reviews relevant literature from January 2016 to June 2025. Combining the findings of comprehensive qualitative analysis and clinical practice, it develops clinical practice recommendations covering epidemiology, pathophysiological mechanisms, diagnosis, assessment, treatment and follow-up. This consensus clarifies the core clinical features, characteristic imaging features, and key auxiliary diagnostic indicators. Comprehensive diagnosis of iNPH requires integration with the results of the cerebrospinal fluid tap test, and differential diagnosis should be made from various neurodegenerative diseases and secondary hydrocephalus. The cerebrospinal fluid tap test is recommended as the core preoperative evaluation tool, with standardized multi-dimensional assessment methods for cognition, urinary function and gaitto match the test. Surgical shunting is confirmed as the current effective treatment, with detailed recommendations on the selection of surgical approaches, shunt system selection and the management of comorbidities, 39 recommendations were finally established. This consensus provides a standardized reference for the clinical diagnosis, assessment and treatment of iNPH. It also highlights future research directions, including early diagnostic biomarkers, minimally invasive surgical techniques and intelligent shunt systems. 特发性正常压力脑积水（iNPH）是老年人群中常见、可干预的脑脊液循环障碍相关综合征之一，临床诊治中存在漏诊、误诊及治疗效果差异大等问题。基于此，中国老年保健协会脑积水专病分会、中华医学会神经外科学分会、中国神经外科重症管理协作组以及北京医学会神经外科学分会组织多学科专家制订《特发性正常压力脑积水诊治专家共识（2026版）》。该共识在《中国特发性正常压力脑积水诊治专家共识（2016）》基础上，系统检索2016年1月至2025年6月相关文献，结合定性综合分析结果及临床实践，从流行病学、病理生理机制、诊断、评估、治疗及随访等方面制订临床实践建议，明确iNPH的核心临床特征、特征性影像学表现，以及辅助诊断关键指标，同时需结合脑脊液释放试验结果综合诊断，并与多种神经退行性疾病、继发性脑积水等鉴别；推荐脑脊液释放试验为术前核心评估手段，同时规范与之相关的认知、排尿、步态等多维度评估方法；外科分流手术为目前有效治疗方式，在手术方式选择、分流系统选择、合并症处理方面提供了详尽的建议，最终形成39条推荐意见。该共识为iNPH的临床规范化诊断、评估及治疗提供了标准化参考，同时指出疾病早期诊断标志物、微创手术技术、智能分流系统等方面为未来研究方向。.