Preoperative differentiation between responders and non-responders to ventriculoperitoneal (VP) shunting in the treatment of normal pressure hydrocephalus (NPH) remains a significant challenge. Identifying biomarkers in presurgical assessment represents a promising approach to reducing the need for invasive cerebrospinal fluid CSF testing. In this prospective observational study, thirty adult patients were classified into Group A (responders to VP shunting) and Group B (non-responders) based on their responsiveness to invasive CSF testing. The overall clinical condition and Idiopathic NPH (iNPH) scale were assessed at baseline. Additionally, biomarker levels were compared between the two groups. Elevated levels of Neurofilament Light Chain (NfL) and Neurofilament Heavy Chain (NfH) in CSF and a reduced level of beta-amyloid Aβ42 were observed. No significant differences in biomarker levels were found between groups. Individual biomarkers demonstrated only poor predictive value (AUC = 0.37-0.53). Clinical factors were stronger predictors (AUC = 0.642-0.669), with no improvement when combined with all examined biomarkers (AUC = 0.428-0.431). No single biomarker reliably predicted confirmed postoperative shunt responsiveness among patients who underwent VP shunt placement and demonstrated clinical improvement. Clinical factors were stronger predictors, suggesting that patient history and clinical assessment (e.g., the iNPH scale) provide more reliable diagnostic information. Notably, combining biomarkers with clinical factors did not improve predictive accuracy.

Department of Anaesthesiology and Intensive Care Medicine Charles University Faculty of Medicine in Hradec Kralove Hradec Kralove Czech Republic

Department of Anaesthesiology and Intensive Care Medicine University Hospital Hradec Kralove Hradec Kralove Czech Republic

Department of Clinical Biochemistry University Hospital Hradec Kralove Hradec Kralove Czech Republic

Department of Neurosurgery Charles University Faculty of Medicine in Hradec Kralove Hradec Kralove Czech Republic

Department of Neurosurgery University Hospital Hradec Kralove Hradec Kralove Czech Republic

Institute of Medical Biochemistry and Laboratory Diagnostics 1st Faculty of Medicine Charles University and General University Hospital Prague Prague Czech Republic

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