Affiliation:
1. Department of Neurosurgery, Hualien Tzu Chi Hospital Buddhist Tzu Chi Medical Foundation Hualien Taiwan
2. Department of Chest Medicine, Hualien Tzu Chi Hospital Buddhist Tzu Chi Medical Foundation Hualien Taiwan
3. Department of Medical Research, Hualien Tzu Chi Hospital Buddhist Tzu Chi Medical Foundation Hualien Taiwan
4. School of Medicine Tzu Chi University Hualien Taiwan
Abstract
AbstractIntroductionThe current standard surgical treatment for cerebrospinal fluid diversion is a ventriculoperitoneal shunt (VPS) implantation. Lumboperitoneal shunts (LPS) are an alternative treatment for communicating hydrocephalus. Prior studies comparing these two included a limited number of participants.MethodsWe performed a meta‐analysis determined the treatment failure, complications and effectiveness of lumboperitoneal shunt for communicating hydrocephalus. We reviewed studies with clinical and imaging diagnoses of communicating hydrocephalus, all causes and subtypes of communicating hydrocephalus, and studies that analyzed the primary and secondary outcomes listed below. We included randomized controlled trials (RCTs), non‐RCTs and retrospective studies. We performed the meta‐analysis in R, using a random‐effects model and reporting 95% confidence intervals.ResultsData from 25 studies, including 3654 patients, were analyzed. The total complication rates were 12.98% (188/1448) for lumboperitoneal shunt and 23.80% (398/1672) for ventriculoperitoneal shunt. The odds ratio for lumboperitoneal shunt versus ventriculoperitoneal shunt complication rates was 0.29 (95% CI 0.19 to 0.45, p < 0.0001), and the I2 was 72%. The shunt obstruction/malfunction rate was 3.99% (48/1204) for lumboperitoneal shunt and 8.31% (115/1384) for ventriculoperitoneal shunt (Odds ratio 0.54, 95% CI 0.37 to 0.79, p = 0.002, I2 = 0%). Based on the Modified Rankin Scale score, there were no differences in effectiveness between lumboperitoneal shunt and ventriculoperitoneal shunt. Nevertheless, lumboperitoneal shunt improved radiological outcomes.ConclusionsThis analysis demonstrated that lumboperitoneal shunt is a safe and equally effective choice for treating communicating hydrocephalus. More studies are needed to confirm the safety of lumboperitoneal shunt.
Subject
Pharmacology (medical),Physiology (medical),Psychiatry and Mental health,Pharmacology