Combining Unilateral Biportal Endoscopic Surgery with Lumboperitoneal Shunt Surgery for Patients with Coexisting Normal-Pressure Hydrocephalus and Lumbar Spinal Stenosis: A Technical Note.

ABSTRACT

BACKGROUND: Normal-pressure hydrocephalus (NPH) is a condition characterized by an abnormal cerebrospinal fluid homeostasis in the brain, resulting in cognitive decline, gait disturbances, and urinary incontinence. Globally, the frequency of NPH becomes has become a major clinical concern with an increase in the elderly population. A lumboperitoneal (LP) shunt surgery is one therapeutic intervention, which diverts cerebrospinal fluid from the brain to the peritoneal cavity to mitigate NPH symptoms. However, LP shunt surgery can be precluded by lumbar spine degeneration. METHODS: In the cases of comorbidity involving NPH and lumbar spine degeneration, the combination of unilateral biportal endoscopic surgery, which is a minimally invasive spinal procedure, and LP shunt surgery is a new alternative. Both spinal degeneration and NPH are concurrently addressed in this approach. RESULTS: A 70-year-old patient with NPH and severe lumbar stenosis successfully underwent the aforementioned combined surgery, with remarkable improvement in symptoms. CONCLUSIONS: While the result is promising, the efficacy of this method warrants validation by conducting larger studies. Nonetheless, combining unilateral biportal endoscopic and LP shunt surgeries could redefine treatment for elderly patients with NPH and spinal stenosis.