Different Therapeutic Approach to Idiopathic Normal Pressure Hydrocephalus: Lumboperitoneal Shunts Versus Ventriculoperitoneal Shunts

Objective: Idiopathic normal pressure hydrocehalus (iNPH) or Adam-Hakims syndrome is an uncommon but important cause of dementia, gait disturbance and bladder incontinence. Our aim was to compare the efficacy and complication rates of ventriculoperitoneal and lumboperitoneal shunts in the treatment of iNPH. Method: This is a retrospective study conducted in 25 patients who were treated with either ventriculoperitoneal or lumboperitoneal shunts for iNPH between 2003 and 2012. Age, gender, clinical presentation, methods of treatment, and complication rates were recorded. Results: Two of the twelve patients in lumboperitoneal shunt (LPS) group were revised; 1 distal catheter infection was replaced by a ventriculoperitoneal shunt (VPS). In addition, there was one revision for wound detachment (due to scratching by the patient). In VPS group (13 patients), one of the patients was complicated with subdural haemorrhage 3 months after the operation and extraction of shunt was carried out immediately. Moreover one dysfunctioning VPS was revised with a LPS after 3 years. Conclusion: Our results indicate that when the patients are properly selected for shunt insertion, both LPSs and VPSs, are effective in controlling all the clinical manifestations of iNPH with positive results.