# Comparative Outcomes and Efficacy of Programmable Versus Nonprogrammable Ventriculoperitoneal Shunts in the Management of Normal Pressure Hydrocephalus: A Retrospective Study

## TL;DR

This study compares programmable and nonprogrammable shunts for normal pressure hydrocephalus and finds similar symptom improvements but shorter hospital stays with nonprogrammable shunts.

## Contribution

The study provides new comparative data on clinical outcomes of programmable versus nonprogrammable shunts in normal pressure hydrocephalus management in a resource-limited setting.

## Key findings

- No significant difference in symptom improvement between programmable and nonprogrammable shunts.
- Nonprogrammable shunts were associated with significantly shorter hospital stays.
- Complication rates were higher in programmable shunts but not statistically significant.

## Abstract

Normal pressure hydrocephalus (NPH) is a neurological disorder in older adults, characterized by gait disturbance, urinary incontinence, and cognitive impairment, along with ventriculomegaly and normal intracranial pressure. The management of NPH often involves ventriculoperitoneal shunting (VPS), which can be programmable (P‐VPS) or nonprogrammable (NP‐VPS). While P‐VPS offers the advantage of adjustable pressure settings, its impact on clinical outcomes and complications remains debated, particularly in resource‐limited settings like Jordan.

A retrospective review was conducted of 38 adult patients diagnosed with idiopathic NPH who underwent VPS placement between 2018 and 2024. Patients were classified into two groups: P‐VPS and NP‐VPS. Clinical outcomes, including symptom improvement, complication rates, hospital stay duration, and shunt revisions, were analyzed. Statistical comparisons were made using SPSS, with p values < 0.05 considered significant.

The study found no significant differences between the two groups in symptom improvement. However, the NP‐VPS group had a significantly shorter hospital stay (5.7 ± 3.2 days vs. 14.1 ± 11.9 days, p = 0.007). Complication rates, including infection and shunt revision, were higher in the P‐VPS group (20.0% vs. 7.7% for infection; 32.0% vs. 15.4% for revision), though differences were not statistically significant.

Both P‐VPS and NP‐VPS resulted in similar symptom improvements, with NP‐VPS showing a trend toward shorter hospital stays and comparable complication rates. Further multicenter studies with larger sample sizes are needed to validate these findings and refine management strategies for NPH.