The Lumboperitoneal Shunt Study: A Systematic Review and Single-Arm Meta-Analysis of 2696 Patients

BACKGROUND AND OBJECTIVES: Lumboperitoneal shunt (LPS) is often regarded as a secondary treatment option for various forms of hydrocephalus. While some studies have compared its results to conventional treatments, there needs to be more comprehensive evidence systematically evaluating its isolated outcomes. METHODS: The authors systematically searched the Embase, PubMed, and Web of Science databases to identify articles of patients submitted to LPS. Random effects with single-proportion statistics were used to pool the outcomes. Subanalyses for normal pressure hydrocephalus, communicating hydrocephalus, and idiopathic intracranial hypertension were applied. RESULTS: A total of 49 of 3091 retrieved studies involving 2696 patients submitted to LPS were included in the analysis. Normal pressure hydrocephalus (631), communicating hydrocephalus (693), and idiopathic intracranial hypertension (275) accounted for 1599 cases. The risk of requiring shunt revision was 25% (95% CI: 18%-32%, I 2 = 93%). For communicating hydrocephalus, idiopathic intracranial hypertension, and normal pressure hydrocephalus, the pooled revision rate was 21%, 46%, and 10%, respectively. Notably, headaches were reported in 91 patients, with minimal overall risk, but considerable heterogeneity (I 2 = 63%). Overdrainage was observed in 119 patients, also showing high heterogeneity (I 2 = 75%) but minimal risk. Similarly, tonsillar herniations were observed in 19 patients with minimal risk and significant heterogeneity (I 2 = 50%). Infections affected 68 patients at a 1% risk (95% CI: 1%-2%, I 2 = 25%). Three patients died from shunt-related complications (0.1%). The main reasons for shunt revisions were obstruction (30% [95% CI: 16%-42%; I 2 = 93%]) and shunt migration, slippage, or fracture (20% [95% CI: 13%-28%; I 2 = 65%]). CONCLUSION: LPS displays safety across multiple studies, demonstrating acceptable revision and complication rates when compared with ventriculoperitoneal shunts. However, substantial heterogeneity limits the strength of conclusions. There is a compelling argument for Western countries to actively advocate for the integration of LPS into their neurosurgical practices. Further clinical trials are necessary to optimize the management of hydrocephalus.