Lumboperitoneal and Ventriculoperitoneal Shunting for Leptomeningeal Disease-Associated Hydrocephalus: A Systematic Review and Meta-Analysis of Postoperative Outcomes and Comparative Effectiveness Publisher



B Hajikarimloo BARDIA ; I Mohammadzadeh IBRAHIM ; Sm Tos Salem M ; A Mortezaei ALI ; A Bahri AMIRMOHAMMAD ; R Tavanaei ROOZBEH ; M Akhlaghpasand MOHAMMADHOSEIN ; F Ghorbanpouryami FATEMEH ; A Ebrahimi AZIN ; D Najari DORSA
Source: Neurological Sciences Published:2025

Abstract

Background: Oncological leptomeningeal disease (LMD)-associated hydrocephalus can lead to elevated intracranial pressure and a progressive decline in neurological performance. Due to the unclear role of ventriculoperitoneal shunt (VPS) and lumboperitoneal shunt (LPS) techniques and the optimal procedure, we conducted a meta-analysis to evaluate and compare the clinical outcomes and safety profiles of VPS and LPS in individuals with LMD-associated hydrocephalus. Methods: A comprehensive search was conducted on March 23, 2025. Seventeen studies with 802 patients involving 732 VPS and 79 LPS patients were included. Results: The meta-anlaysis revealed a pooled symptom relief rate of 83% (95% CI: 73–92%)., with no significant difference between LPS (88% [95% CI: 70–100%] and VPS [95% CI: 73–92%] (P = 0.88; OR = 1.22, P = 0.78). The pooled shunt revision was 7% (95% CI: 4–12%) without any significant difference between LPS and VPS (P = 0.85). The 3-, 6-, and 12-month overall survival (OS) rates were 66%, 38%, and 20%, respectively, without any significant difference between groups (P = 0.83, 0.15, and 0.33, respectively). Overall complication rate was 15% (95% CI: 10-20%) without any significant difference between subgroups (LPS: 19% vs. VPS: 14%, P = 0.60). The meta-analysis revealed a pooled shunt infection rate of 3% (95% CI: 2-5%) and shunt failure rate of 6% (95% CI: 3-10%) without significant difference between subgroups. Conclusion: LPS and VPS provide promising and comparable clinical outcomes and safety profiles in managing LMD-associated hydrocephalus patients. The selection of the shunting approach should be performed individually, considering patient preferences, prognosis, and intervention risks. © 2025 Elsevier B.V., All rights reserved.