This chapter presents the key steps which serve as a guide to achieving a favorable outcome in idiopathic normal pressure hydrocephalus (iNPH) patients: proper selection criteria for diagnosis of iNPH, deficiencies in identifying the degree of clinical impairment and therefore clinical improvement; standardized management protocols related to outcome; impact of complications after surgery, and impact of comorbidities. Great efforts have been made to improve diagnosis and management of NPH and achieve better selection of patients with idiopathic NPH and NPH of known cause. Standardized protocols in the areas of shunt management, clinical outcome grading, time to follow-up after surgery, and clinical judgment are now under development which will enable comparability and reproducibility. The commonly used outcome scales for iNPH, the modified Rankin Scale (mRS) and Barthel ADL Index (BI). Comorbidity is a major confounder in outcome assessment in the iNPH patient population.