A randomized trial investigated the efficacy of a ventriculoperitoneal (VP) shunt in patients with idiopathic normotensive hydrocephalus (NPH). NPH is a condition characterized by enlargement of the brain's ventricles at normal intracranial pressure, leading to symptoms such as gait disturbances, dementia, and urinary incontinence. In the study, patients were randomly assigned to either shunt placement or conservative treatment without surgery. The results showed that patients treated with a shunt had a significant improvement in symptoms compared to the control group. The improvement was manifested mainly in the area of walking and cognitive functions. The study confirmed that the correct selection of patients is crucial for the success of the treatment. The use of programmable valves enables individual pressure adjustment and reduces the risk of complications. Overall, the randomized trial supports the use of a shunt as an effective treatment for selected patients with idiopathic NPH.