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Background <p>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.</p> Methods <p>A comprehensive search was conducted on March 23, 2025. Seventeen studies with 802 patients involving 732 VPS and 79 LPS patients were included.</p> Results <p>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%] (<i>P</i> = 0.88; OR = 1.22, <i>P</i> = 0.78). The pooled shunt revision was 7% (95% CI: 4–12%) without any significant difference between LPS and VPS (<i>P</i> = 0.85). The 3-, 6-, and 12-month overall survival (OS) rates were 66%, 38%, and 20%, respectively, without any significant difference between groups (<i>P</i> = 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%, <i>P</i> = 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.</p> Conclusion <p>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.</p>

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Lumboperitoneal and ventriculoperitoneal shunting for leptomeningeal disease-associated hydrocephalus: a systematic review and meta-analysis of postoperative outcomes and comparative effectiveness

  • 期刊论文

  • 发表日期：

    2025年6月24日

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  • Bardia Hajikarimloo,
  • Ibrahim Mohammadzadeh,
  • Salem M. Tos,
  • Ali Mortezaei,
  • Amirmohammad Bahri,
  • Roozbeh Tavanaei,
  • Mohammadhosein Akhlaghpasand,
  • Fatemeh Ghorbanpouryami,
  • Azin Ebrahimi,
  • Dorsa Najari,
  • Ehsan Bahrami Hezaveh,
  • Mohammad Amin Habibi

摘要

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.