First Clinical Evaluation of a Modular Lumboperitoneal Shunt System With a Gravitational Unit for Communicating Hydrocephalus: A Retrospective Case Series.

BACKGROUND AND

OBJECTIVES

In Europe and North America, communicating hydrocephalus (HC) is commonly treated with ventriculoperitoneal shunts, whereas lumboperitoneal shunts (LPS) are preferred in Japan and other Asian countries. However, no LPS valve with an integrated gravitational unit had been available until recently, leaving overdrainage as a persistent complication. The objective of this study was to report initial clinical experiences with a novel modular LPS valve system that incorporates a gravitational unit and to assess its safety, feasibility, and early clinical outcomes across various HC etiologies.

METHODS

We conducted a retrospective analysis of 39 consecutive patients who underwent LPS implantation between March 2023 and March 2025. Patient characteristics, complications, and early outcomes were assessed, with particular focus on overdrainage and response to valve adjustments.

RESULTS

The median age was 64.5 [54-72] years. Indications included posthemorrhagic hydrocephalus (41.7%), idiopathic normal pressure HC (37.5%), idiopathic intracranial hypertension (8.3%), cerebrospinal fluid fistula (12.8%), and meningeosis (7.7%). LPS was also implemented as salvage therapy in 5 cases with complex cranial wound disorders. In 15.4% of cases, complications requiring surgery occurred, primarily due to peritoneal catheter dislocation. Clinical overdrainage was observed in 20.5% of patients and resolved after noninvasive, outpatient valve adjustment. No overdrainage requiring surgery was observed. With a median follow-up of 15 [12.0-55.0] weeks, improvements in gait were reported in 100% of idiopathic normal pressure HC cases presented on follow-up. Of idiopathic intracranial hypertension patients with a median follow-up of 89 [88.0-90.0] weeks, 67% reported better visual function.

CONCLUSION

This is the first study to report on an LPS valve system with an integrated gravitational unit. Our findings suggest it is a feasible, potentially effective treatment option across multiple forms of communicating HC. This system may redefine overdrainage management standards in LPS for select populations. Further prospective studies are warranted to validate these results.