Effectiveness and Safety of Ventriculoperitoneal Shunt Versus Lumboperitoneal Shunt for Idiopathic Intracranial Hypertension: A Systematic Review and Comparative Meta-Analysis

• Published in: World neurosurgery 2024-05, Vol.185, p.359-369.e2
• Main Authors: Andreão, Filipi Fim, Ferreira, Marcio Yuri, Oliveira, Leonardo de Barros, Sousa, Marcelo Porto, Palavani, Lucca B., Rairan, Luis García, Tinti, Isadora Santo Urbano, Júnyor, Flavio de Souza, Batista, Sávio, Bertani, Raphael, Amarillo, Diego Gomez, Daccach, Fernando Hakim
• Format: Article
• Language: English
• Subjects: Cerebrospinal Fluid Shunts - methods; Humans; Idiopathic intracranial hypertension; Lumboperitoneal shunts; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Pseudotumor Cerebri - complications; Pseudotumor Cerebri - surgery; Treatment Outcome; Ventriculoperitoneal Shunt - methods; Ventriculoperitoneal shunts
• ISSN: 1878-8750; 1878-8769; 1878-8769
• DOI: 10.1016/j.wneu.2024.02.095

Idiopathic Intracranial Hypertension (IIH) is a condition characterized by elevated intracranial pressure. Although several mechanisms have been proposed as underlying causes of IIH, no identifiable causative factor has been determined for this condition. Initial treatments focus on weight or CSF reduction, but severe cases may require surgery. This study compares outcomes in IIH patients treated with lumboperitoneal shunts (LPSs) versus ventriculoperitoneal shunts (VPSs). This systematic-review and meta-analysis follows Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines and includes studies about VPS and LPS patients, reporting one of the outcomes of interest. We conducted searches on PubMed, Embase, Web of Science, and Cochrane Library. Our analysis involved twelve studies, comprising 5990 patients. The estimated odds ratio (OR) for visual improvement was 0.97 (95% CI 0.26–3.62; I2 = 0%) and for headache improvement was 0.40 (95% CI 0.20–0.81; I2 = 0%), favoring LPS over VPS. Shunt revision analysis revealed an OR of 1.53 (95% CI 0.97–2.41; I2 = 77%). The shunt complications showed an OR of 0.91 (95% CI 0.68–1.22; I2 = 0%). The sub-analyses for shunt failure uncovered an OR of 1.41 (95% CI 0.92–2.18; I2 = 25%) and for shunt infection events an OR of 0.94 (95% CI 0.50–1.75; I2 = 0%). The interventions showed general equivalence in complications, shunt failure, and other outcomes, but LPS seems to hold an advantage in improving headaches. Substantial heterogeneity highlights the need for more conclusive evidence, emphasizing the crucial role for further studies. The findings underscore the importance of considering a tailored decision between VPS and LPS for the management of IIH patients.