Neurosurg Rev. 2026 Jun 15;49(1):447. doi: 10.1007/s10143-026-04359-x.
ABSTRACT
The optimal shunt strategy for adult posthemorrhagic hydrocephalus (PHH) remains uncertain. Although ventriculoperitoneal shunting (VPS) is widely used, it is associated with notable complications related to ventricular catheterization. Lumboperitoneal shunting (LPS) offers a less invasive alternative by avoiding ventricular access. This study aimed to systematically review and meta-analyze the complication profiles of LPS and VPS in adult PHH. PubMed, Embase, and Web of Science databases were systematically searched for original studies that reported postoperative complications in adults with PHH treated with LPS or VPS. Primary outcome was shunt-related complications; secondary outcomes included shunt-failure, obstruction, infection, and shunt complication in severe stage PHH. Two authors independently performed data extraction and quality assessment using the Joanna Briggs Institute Critical Appraisal Checklist. Pooled proportions were estimated using single-arm random-effects meta-analyses with restricted maximum likelihood and Freeman-Tukey double arcsine transformation, with back-transformation applied for reporting. The study protocol was registered in PROSPERO (CRD420251143570). Of 3,183 records screened, 10 studies comprising 1,410 patients met inclusion criteria. Overall evidence quality ranged from moderate to high. The pooled shunt complication proportion was 0.37 (95% CI, 0.30-0.45) for LPS and 0.24 (95% CI, 0.13-0.37) for VPS, with substantial heterogeneity observed among VPS cohorts (LPS: I2= 30.77%; VPS: I2 = 88.09%). No significant differences were observed between the two groups for shunt failure, obstruction, infection, or shunt complication in severe stage PHH (P = 0.33, 0.56, 0.31 and 0.78, respectively). Subgroup analysis and meta-regression revealed an inverse association between age and shunt-related complications in LPS cohorts. Overall, LPS showed complication-related outcomes comparable to VPS in adult PHH; however, because the evidence is mostly based on observational and indirect comparisons, these findings should be interpreted with caution. Further comparative studies are required to more definitively evaluate the relative effectiveness and safety of LPS and VPS.
PMID:42295512 | DOI:10.1007/s10143-026-04359-x