Clinical Outcomes of Lumboperitoneal Shunt Surgery for Normal Pressure Hydrocephalus : A 5-Year Single-Center Retrospective Study of Patients with at Least 1 Year of Follow-Up.

Objective: Lumboperitoneal shunt (LPS) surgery is a widely used treatment for normal pressure hydrocephalus, especially in East Asia. Although LPS surgery has been widely studied internationally, large-scale data from the Republic of Korea are limited. This study aimed to evaluate clinical outcomes and complications of LPS surgery in NPH patients, with particular focus on anesthesia type and valve pressure management strategies.

Methods: A retrospective review was conducted of 244 patients with normal pressure hydrocephalus who underwent LPS surgery between February 2020 and February 2025. Valve pressures were initially set at the highest level and gradually adjusted downward based on clinical response. Functional outcomes-including the modified Rankin Scale (mRS), Timed Up and Go (TUG), 10-meter gait test, and Mini-Mental State Examination (MMSE)-were assessed at 1 year and followed for up to 4 years. Complications were categorized by type and whether surgical intervention was required.

Results: Among 244 patients, 119 completed at least 1 year of follow-up. At 1 year, 53.8% of patients showed mRS improvement, and 66.4% demonstrated gait improvements (TUG and 10-meter walk). Stable or improved function was observed in 93.3% of patients. MMSE scores did not show significant change. The overall complication rate was 16.8%, with 11.1% requiring surgical revision, primarily for chronic subdural hematoma and catheter-related issues. No surgery-related mortality occurred, but three patients (1.2%) died from falls despite improved gait, underscoring the need for fall prevention. The adoption of an initial high-pressure setting reduced overdrainage-related complications, contributing to a decreased annual revision rate of 5.6%.

Conclusion: A retrospective study showed that LPS surgery with local anesthesia is effective for NPH patients, demonstrating favorable functional outcomes and acceptable complications. Using higher initial valve pressures significantly decreased the need for revision surgeries and complications related to overdrainage.