Lumboperitoneal shunt placement under local anesthesia: a technical note from an experience with more than 200 cases

The purpose of this technical note was to report that lumboperitoneal shunt (LPS) placement under local anesthesia can be a promising alternative for treating idiopathic normal pressure hydrocephalus (iNPH), particularly in elderly patients who might be reluctant to undergo surgery under general anesthesia. The authors present their experience with 202 cases of LPS placement performed for iNPH under local anesthesia between March 2022 and September 2024. The median operative time was 35 minutes, and the median operating room time was 71 minutes. Procedure-related complications were observed in 6 cases (3.0%), with no major complications specifically associated with local anesthesia. No cases required interruption of surgery due to pain, anxiety, or lack of patient cooperation, indicating that the procedure was well tolerated. This experience suggests that LPS placement under local anesthesia can be a safe and efficient option, even in patients with mild cognitive impairment, providing a viable alternative for those at higher risk of complications from general anesthesia. The authors believe that this technique offers a valuable addition to the surgical options for iNPH, and further study could help standardize this approach for wider clinical use.