Efficacy of lumboperitoneal shunting in patients with normal pressure hydrocephalus

Abstract

ABSTRACTis one of the common effective treatment modalities used in the surgical management of communicating hydrocephalus, pseudotumor cerebri, CSF fistula and normal pressure hydrocephalus (NPH)(13).Its relative ease to perform and shorter surgery time, lack of risk for intracranial complications, including intracerebral hemorrhages, seizures or shunt dysfunction, lower risk of shunt infections and lethal complications all make LPS a favorable surgical treatment modality as compared to VPS surgery. Ventricular catheter placement may be challenging in patients with small ventricles, even though the current use of navigation has provided convenience in placing a shunt catheter and higher success rates. Therefore, its simplicity █ INTRODuCTION N ormal pressure hydrocephalus (NPH) is a syndrome first defined in 1965 by Hakim and Adams. This syndrome is a significant neurological condition that occurs predominantly in elderly people and its clinical presentation consists of a triad of major symptoms, including gait disturbance, dementia and urinary incontinence (12).Surgical treatment of NPH typically includes the diversion of cerebro-spinal fluid (CSF) into the peritoneum, pleura or atrium. While ventriculoperitoneal shunt (VPS) surgery has historically been widely performed, today, minimally invasive surgical procedures such as lumboperitoneal shunt (LPS) have become the surgical treatment of choice (2). The LPS surgery RESulTS:At the 3 rd month after LP shunt surgery, headache was resolved in almost all patients. At the end of first year, while statistically significant improvements were noted in the Modified Rankin Scale Scores and Mini-Mental State Examination Scores, gait disturbance, urinary incontinence and cognitive functions were improved by 86%, 72% and 65% of the patients, respectively. CONCluSION: LP shunt surgery is associated with a lower rate of complication in comparison to ventriculoperitoneal shunt surgery and is an effective procedure in the treatment of NPH.

Outcomes and complications of different surgical treatments for idiopathic normal pressure hydrocephalus: a systematic review and meta-analysis

“…24,26,29,43 Comparable results were reported for patients treated with VA 44,51 and LP shunts. 2,37,38 We found that cognitive function improved in more than 50% of patients who underwent shunting, with nonsignificant differences regarding the types of shunt used.…”

Lumboperitoneal Shunt Preference in Treatment of Patients with Normal Pressure Hydrocephalus

“…LPS surgery is an effective surgical technique. It can be used as an alternative to the VPS procedure in the treatment of NPH patients (33).…”

Parkinsonism and cerebrospinal fluid disorders

“…Even though the response rate varies among different studies depending on definition of improvement, treatment modalities, and follow-up duration [19,[50][51][52], previous reviews reported improvement in 71-83% of NPH patients [53,54]. In particular, gait disturbance is the most responsive sign of the NPH triad [55,56], and gait improvement following a CSF tap test or ELD is an important outcome predictor [54]. However, not all gait parameters respond to CSF diversion procedures and some NPH patients do not improve at all [57,58].…”