Ventriculoperitoneal Versus Lumboperitoneal Shunts in Idiopathis Normal Pressure Hydrocephalus: A Systematic Review and Meta-Analysis

Introduction: Ventriculoperitoneal (VP) shunting is currently the gold standard for the treatment of idiopathic normal pressure hydrocephalus (iNPH). However, existing literature supports the use of lumboperitoneal shunting (LP) as an alternative to VP shunting. There is an unmet need for evidence comparing outcomes between VP and LP shunts for the treatment of iNPH. This study aimed to summarize the literature and compare the use of VP and LP shunts for the treatment of iNPH, evaluating differences in clinical outcomes and complications.

Methods: A systematic review of the literature was performed to identify studies on iNPH with the treatment of either a VP or LP shunt. Clinical outcomes of interest included Idiopathic Normal Pressure Hydrocephalus Grading Scale (iNPHGS), modified Rankin Scale (mRS), total complications, hematomas, and revisions.

Results: A total of 81 studies, including 4332 patients, were identified. Of these, 3477 patients (80.3%) underwent VP shunt, and 855 patients (19.7%) underwent LP shunt. Both techniques demonstrated overall clinical improvement at the last follow-up, but the intergroup difference did not reach statistical significance (p=0.66). VP and LP shunts yielded similar rates of total complications (17.35% vs. 23.48%, p = 0.26); however, the VP group was more likely to develop a postoperative hematoma (5.08% vs. 2.21%, p = 0.02). In addition, revision rates were significantly lower in patients who underwent VP shunting (7.61%) compared to their counterparts who underwent LP shunting (14.14%; p = 0.02).

Conclusion : In a comprehensive synthesis of the literature, the use of VP shunt in iNPH was found to offer comparable clinical outcomes to the LP shunt in terms of clinical improvement and overall complication rate. Although LP shunts embody a viable alternative to VP shunts for the treatment of iNPH, surgical decision-making should take into account the potential increased risk for revisions associated with LP shunts.