Efficacy and Complications of Lumboperitoneal Shunt for Idiopathic Normal Pressure Hydrocephalus in Elderly Patients: A Systematic-review and Meta-analysis
Artur Menegaz de Almeida1, Gabriel Marinheiro dos Santos Bezerra2, Carlos Alberto Campello Jorge1, Ítalo Andrade3, Lucca Lopes4, Victória Morbach Siebel5, Allan Polverini6
1Federal University of Mato Grosso, 2Federal University of Ceará, 3Santo Agostinho Faculty, 4Sciences Medical School of Santos, 5Feevale University, 6Hospital de Amor de Barretos - Fundação Pio XII
Objective:

We sought to perform a Systematic Review and Meta-analysis to assess the functional outcomes of Lumboperitoneal shunt (LPS) in patients ≥ 60 years of age with Idiopathic Normal Pressure Hydrocephalus (iNPH).


Background:

INPH, the most common form of hydrocephalus in adults, is a syndrome that can potentially be reversed by cerebrospinal fluid shunt. It is marked by a set of complex symptoms, with unexplained symmetric gait disturbance being the primary symptom. LPS is one of the recommended shunt types for iNPH. However, the benefits of LPS are conflicting in the literature.

Design/Methods:

MEDLINE, Embase, and Cochrane were searched for RCTs and prospective studies that directly compared patients before and after LPS surgery. Studies were analyzed based on the following endpoints: Mini-Mental State Exam (MMSE), Evan’s Index, subdural hematoma events, infection, and shunt malfunction. Data was examined using the Mantel-Haenszel method and 95% confidence intervals (CIs). Heterogeneity was assessed using I² statistics. The Baujat plot was used to estimate the individual heterogeneity of each included study.


Results:
Seven studies and 809 patients were included. Evan’s Index was significantly better in the post-shunt group (MD 0.0272; 95% CI 0.0012–0.0533; p=0.04; I² =75%). MMSE (MD -0.5656; 95% CI -1.3166–0.1854; p=0.1; I² = 0%), subdural hematoma events (Proportion 0.05; 95% CI 0.03–0.07; p=0.39; I² = 1%), shunt infection (Proportion 0.01; 95% CI 0.00–0.03; p=0.41; I² =0%), and shunt malfunction (Proportion 0.03; 95% CI 0.02–0.05; p=0.85; I² =0%) endpoints did not show any statistically significant difference between groups.
Conclusions:

This meta-analysis suggests that LPS may be an efficient intervention for iNPH in patients ≥ 60 years old, given the decrease in the Evan Index, a scale that measures the degree of ventricular distention. 


10.1212/WNL.0000000000204404