Clinical response after cerebrospinal fluid shunting in complex versus pure idiopathic normal pressure hydrocephalus: A systematic review and meta-analysis.
Clin Neurol NeurosurgJun 25, 2026 (epub)
Caio Arruda Maciel, Kauã Gabriel Oliveira da Silva, Vinícius Galbim de Paula et al.
✦ AI-curated · Sources linked
In 30 seconds
This systematic review and meta-analysis examined shunt outcomes in patients with pure idiopathic normal pressure hydrocephalus (iNPH) versus complex iNPH, which often coexists with other neurodegenerative diseases. The analysis included 19 studies and found that global shunt response was lower in complex iNPH (odds ratio 0.31, 95% CI 0.09-1.10), though not statistically significant.
Key findings
- Global shunt response was lower in complex iNPH (OR 0.31, 95% CI 0.09-1.10).
- Urinary improvement did not significantly differ between pure and complex iNPH (OR 0.85, 95% CI 0.58-1.25).
- Cognition showed a directionally positive estimate in complex iNPH, while gait results were heterogeneous.
- Exploratory analysis suggested a phenotype-by-time interaction for incontinence, but findings were based on sparse data.
Why it matters
Understanding the differential outcomes of shunt surgery in pure versus complex iNPH is crucial for clinicians. It informs patient counseling and management strategies, particularly in cases with overlapping neurodegenerative conditions.