Purpose Elderly patients with iNPH (idiopathic normal pressure hydrocephalus) might be potentially high-risk surgical patients. Our purpose was to investigate the outcome of serial removal of cerebrospinal fluid (CSF) in the patients with iNPH who refused to have the ventriculoperitoneal or lumboperitoneal shunt surgery or had contraindications to them. Patients and methods There were 42 patients, with a median age of 78 years. Recurrent CSF removal was performed when the patients had deteriorated gait which was defined as >10% pre-removal change on the average of two walking trials during timed up and go (TUG). All the patients underwent mini-mental status examination (MMSE), frontal assessment battery (FAB), Stroop test, Tinetti Performance Oriented Mobility Assessment (POMA), TUG and nine-hole peg test (NHPT) with the dominant hand, before and after CSF removal. Results Thirty-five patients had two CSF removal procedures with a mean interim period of 7.4 months ranging from 1.5 to 35 months. Thirteen patients had three CSF removal procedures. The mean TUG scores were decreased after the first, second and third procedures (p
