Neurosurgery 99:3–18, 2026
Scope Systematic review + single-arm random-effects meta-analysis of 49 studies including 2696 patients who underwent lumboperitoneal shunt (LPS) placement.
Search/eligibility Databases: PubMed, Embase, Web of Science (through Sept 2023); included observational studies reporting LPS complications; excluded case reports (≤4 patients), non-English, overlapping cohorts, prior non-LPS shunts; study was not prospectively registered.
Main etiologies Largest indication groups were communicating hydrocephalus (693), normal pressure hydrocephalus (631), and idiopathic intracranial hypertension (275) (1599 combined).
Revision risk Overall pooled risk of requiring shunt revision: 25% (95% CI 18%–32%; I²=93%) at median mean follow-up 19.2 months; by etiology: CH 21%, IIH 46%, NPH 10%.
Complication risks Infection: 1% (95% CI 1%–2%; I²=25%); shunt-related mortality: 0.1% (3 deaths).
Overdrainage/tonsillar herniation Overdrainage occurred in 119 patients with high heterogeneity (I²=75%); tonsillar herniation in 19 patients with significant heterogeneity (I²=50%), both reported as minimal pooled risk.
Revision causes Most common reasons for revision were obstruction (30%) and migration/slippage/fracture (20%).
Overall conclusion LPS shows acceptable revision and complication rates and appears comparable to ventriculoperitoneal shunts (VPS), but substantial heterogeneity limits confidence; supports broader integration of LPS in Western practice and calls for randomized trials.
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