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Results The median postoperative ventricular volume decrease was 25 mL (P less then .001). The proportional decrease in ventricular volume was greater than that in the Evans index (P less then .001). The postoperative decrease in ventricular volume was associated with a postoperative increase in the idiopathic normal pressure hydrocephalus scale score (P = .004). Shunt responders (75%) demonstrated a greater ventricular volume decrease than nonresponders (P = .002). Conclusions Clinical improvement after shunt surgery in idiopathic normal