Efficacy and safety of idiopathic normal pressure hydrocephalus shunting: a systematic review and meta-analysis.

OBJECTIVE

Shunting is commonly used in patients with idiopathic normal pressure hydrocephalus (iNPH). However, evidence comparing the relative effectiveness and safety of different iNPH shunting methods is lacking. Therefore, this systematic review investigated the efficacy and safety of different iNPH shunts.

METHODS

The PubMed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), and Web of Science databases were systematically searched for articles comparing iNPH shunting from inception to July 29th, 2023 to identify randomized controlled trails or cohort studies comparing iNPH shunting with placebo or other treatment. Evidence was summarized using fixed and randomized effects frequentist meta-analysis when the I2 was <50% and >50%, respectively. Subgroup analysis based on different study designs and surgical procedures was conducted to explore sources of heterogeneity. The sensitivity analyses were conducted by systematically excluding each study to determine the potential effect of individual studies on overall risk.

RESULTS

Eleven studies including 1417 participants were initially identified. All included randomized controlled trials had a high risk of bias, while cohort studies had a low risk of bias. Ventriculoperitoneal (VP) shunting was effective at decreasing the times of 10m walks (MD=-2.52, 95% CI: -4.78 to -0.26, I2=0), while lumboperitoneal (LP) shunting was effective at improving cognitive level (MD=1.29, 95% CI: 1.09 to 1.49, I2=0), 10 m walks (MD=-32.20, 95% CI: -48.07 to -16.33), and bladder control (MD=-0.25, 95% CI: -0.35 to -0.15, I2=76). Regarding adverse events, the VP and LP groups showed no differences in subdural hematoma, intracranial infection, intracranial hemorrhage, tube-related complications, or seizures. Compared with VP shunting, ventriculoatrial shunting was associated with a higher risk of subdural hematoma.

CONCLUSION

VP and LP are the best medical treatments for patients with iNPH.