Minimizing complications in lumboperitoneal shunt for normal pressure hydrocephalus: Technical note and case series

Background: Normal pressure hydrocephalus (NPH) is a complex syndrome that requires diversion of cerebrospinal fluid in an absorbing compartment. Nowadays, lumboperitoneal shunt is widely validated as treatment option. We present a novel surgical technique to minimize post-surgical complications. Methods: All patients treated for a NPH between 2019 and 2024 at our department were analyzed. Pre- and postoperative clinical and surgical data were assessed. A novel technique with curvilinear lumbar skin incision and tight valve fixing to the lumbar muscular fascia was described. Results: One hundred and eight patients were analyzed with a mean age of 76.5 years. Among these, nine patients had overdrainage symptoms that improved with valve pressure opening adjustment while in five patients, a computed tomography scan showed subdural hematoma of which one underwent surgical evacuation. No surgical complications occurred involving proximal catheter failure or valve malfunction. No infections or wound healing problem were reported. All patients presented neurological improvement. Conclusion: To our experience, our technique with curvilinear incision and valve fixing seems safe, effective, and could lower post surgical complications.