Complications of Lumboperitoneal Shunts for Normal Pressure Hydrocephalus

For the past half century, the mainstay of cerebrospinal fluid shunting for normal pressure hydrocephalus (NPH) has been ventriculoperitoneal shunt surgery. Lumboperitoneal (LP) shunt has been used occasionally and seemed to be associated with higher failure rates compared to ventriculoperitoneal shunts. There is no uniformity in the reporting of complication and surgical revision rates. Goals of this study were to understand better the complications and the causes of surgical revisions post-LP shunt insertion in NPH patients. Nine patients with NPH undergoing lumboperitoneal shunt surgery for the first time by the senior author at an academy tertiary-care institution were retrospectively reviewed. Presence of complications and surgical revisions were the two main outcome variables. Logistic regression analysis was used first to assess if there was a correlation between preoperative patient characteristics and complications and second to evaluate if there was any association between postsurgical complications and surgical revision. Primary shunts were inserted into nine patients and 44% required revision surgery. Median time to surgical revision was nine (two to 16) months. Multivariate logistic analysis showed no statistical significant association between preoperative patient characteristics and postoperative complications as well as no relationship between preoperative characteristics or complications and surgical revisions. While minimizing risks of intracranial complications, high rates of postoperative complications as well as the frequent need for multiple shunt revisions are significant disadvantages for lumboperitoneal shunt in NPH. Our Japanese colleagues ascribe lower complication rates to an overall lower BMI. Prospective studies with stronger statistical power are needed to clarify this question. Categories: Neurology, Neurosurgery