Outcome of Programmable Lumboperitoneal Shunt in the Surgical Management of Idiopathic Normal Pressure Hydrocephalus

Background: Normal pressure hydrocephalus (NPH) is a complex neurological disorder characterized by enlarged ventricles in the brain. While the ventriculoperitoneal shunt is the preferred procedure, lumbar-peritoneal shunts also serve as an alternative. Lumbo-peritoneal shunts are an alternative for diverting cerebrospinal fluid without intracranial surgery. Objectives: To assess the efficacy of programmable LP shunts in managing idiopathic normal-pressure hydrocephalus (iNPH), focusing on postoperative outcomes and complications. Methods: This is a multicenter cohort study, including retrospective and prospective data. It involves 20 iNPH hospitalized patients from January 1st, 2019, to January 1st, 2022. The patients underwent programmable lumboperitoneal shunt surgery and had a six-month follow-up period. Patients with confirmed diagnosis of iNPH were included in this study. Other possible causes of symptoms were ruled out, and there were no reasons why the LP shunt should not be placed. Results: This cohort study involved 20 iNPH patients treated with programmable LP shunts; 19 patients (95%) experienced gait improvement, 16(80%) showed improvement in urinary symptoms, and 16 patients (80%) showed improvement in dementia. The most common post-operative complications included over-shunting (15%), subdural hygroma, CSF collection, and infection (10%). Most patients presented between 2–4 months. When evaluating predictors of operative time, the regression analysis revealed no significant factor that could predict operative time accurately. Conclusions: Lumbar-peritoneal shunts showed significant effectiveness rates with a moderate complication rate. It is minimally invasive without life-threatening complications and can be recommended for iNPH treatment.