Efficacy And Safety Of Ventriculoperitoneal Shunt And Lumboperitoneal Shunt For Normal Pressure Hydrocephalus:A Systematic Review And Meta-analysis

Objective:The pathogenesis of normal pressure hydrocephalus,especially idiopathic normal pressure hydrocephalus,is unknown,but such patients are very common.Different CSF diversion procedures(ventriculoperitoneal and lumboperitoneal shunting)have been utilized for the treatment of normal pressure hydrocephalus.The purpose of this study was to perform a systematic review and meta-analysis to assess overall rates of favorable outcomes and adverse events for each of these treatments.Methods:Multiple databases(PubMed,Ovid Cochrane Central Register of Controlled Trials,Ovid Cochrane Database of Systematic Reviews,Medline,Ovid EMBASE,Web of Science,Scopus,CNKI,VIP and other databases)were searched for studies involving patients with normal pressure hydrocephalus.Outcomes included the proportion of patients who showed improvement in clinical symptoms(gait,cognition,and bladder function),relevant scale scores(MMSE,mRS,TUG)or imagings(CT or MRI).Adverse events considered in the analysis included postoperative hemorrhagic complications,mechanical failure(obstruction,disconnection,fracture,migration of the distal end),functional failure(underdrained or overdrained)and infection.The two researchers independently screened the obtained literature,extracted the required data,and used Review Manager 5.3 software for meta-analysis of the obtained data.Results:A total of 8 studies,encompassing 1680 patients of which 834 received VPS and 846 received LPS,were identified.Most of patients experienced improvement after shunting,without significant differences between the two different techniques utilized(OR=1.13,95%CI=0.71-1.80,P=0.61).The incidence of infection after ventriculoperitoneal shunt was higher than lumboperitoneal shunt(OR=2.76,95%CI=1.31-5.82,P=0.008).Other postoperative adverse events,including postoperative hemorrhagic complications(OR=1.16,95%CI=0.69-1.96,P=0.57),postoperative shunt related mechanical failure(OR=0.95,95%CI=0.57-1.59,P=0.85)and shunt related functional failure(OR=0.39,95%CI=0.09-1.66,P=0.20),without significant differences existed between the two groups.Conclusion:Outcomes did not differ significantly among different CSF diversion techniques,and overall improvement in most patients.Except that the incidence of postoperative intracranial infection was slightly higher in the ventriculoperitoneal shunt group,no difference was found among other complications.