Systematic review of the outcome of shunt surgery in idiopathic normal-pressure hydrocephalus

Abstract

When patients are properly selected, shunt insertion is a safe and effective management of idiopathic normal-pressure hydrocephalus with a prolonged positive outcome.

A randomized controlled dual-center trial on shunt complications in idiopathic normal-pressure hydrocephalus treated with gradually reduced or “fixed” pressure valve settings

“…26 After shunt surgery in iNPH patients, improvement rates between 61% and 90% have been reported, 6,[11][12][13][14]16,18,23 with recent studies revealing a rate above 80%. 13,24 The complication rates are high, up to 50%, 3,8,22 although a rate of 20% is evident in recent studies. 8,26 The major complications are mechanical obstruction, infection, and subdural hematoma (SDH); the frequency of SDH is between 2% and 16%.…”

Complications of Lumboperitoneal Shunts for Idiopathic Intracranial Hypertension

“…Progress in preventing short and long-term shunt complications requiring surgical revision has been slow over the last several decades [2]. Furthermore, the literature lacks uniformity in the reporting of complication and surgical revision rates after LP shunting [2,[12][13][14][15]. This variation may be explained by the different size of previous cohorts' studies as well as the tendency to underreport poor outcomes [1,12,[16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34].…”

“…On the other hand, LP shunt has been associated with higher failure rates compared to ventriculoperitoneal shunts [1][2][8][9][10][11][12][13]. However, there is no uniformity in the reporting of complication and surgical revision rates [2,[12][13][14][15]. Differences in the size of previous cohorts' studies as well as the tendency to under-report poor outcomes may explain this regrettable situation [1,12,[16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34].…”

“…LP shunt and optic nerve fenestration (ONF), being palliative treatments, should only be offered when the first two have failed or in an emergency situation. On the other hand, LP shunt has been associated with higher failure rates compared to ventriculoperitoneal shunts [1][2][8][9][10][11][12][13]. However, there is no uniformity in the reporting of complication and surgical revision rates [2,[12][13][14][15].…”

Complications of Lumboperitoneal Shunts for Normal Pressure Hydrocephalus

“…Nevertheless, the LP shunt has been associated with higher failure rates compared to ventriculoperitoneal shunts [3][4][7][8][9][10][11][12][13]. However, the literature is characterized by lack of uniformity in reporting complication and surgical revision rates after LP shunting [4,[13][14][15]. Difference in the size of previous cohort studies as well as the tendency to under-report poor outcomes may at least in part explain this finding [3,[16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32].…”