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Cerebrospinal fluid (CSF) diversion is the gold standard treatment. Despite ventriculo-peritoneal shunt (VPS) is more commonly used, lumbo-peritoneal shunt (LPS) offers a minimally invasive alternative, raising questions about their relative efficacy and safety. A systematic review was conducted on multiple databases with a two-step selection process in order to exclude studies with insufficient data, irrelevance, and lacking of comparative analysis between the two procedures. From the included studies we comparatively analyzed preoperative clinical-radiological characteristics, surgical details and clinical-radiological outcome. We included 6 studies matching out inclusion criteria. Both VPS and LPS improved functional and cognitive performance. VPS provided faster symptoms relief, but has been related with higher risks of infection, whereas LPS showed a safer profile but required more frequent revisions due to mechanical issues. VPS and LPS are both effective treatments for iNPH. The choice of intervention should be tailored on the individual patient risk profiles, resource availability, and surgical expertise. Future research should focus on standardizing assessment scores, solve controversies, and evaluate long-term outcomes.<\/jats:p>","DOI":"10.1007\/s10143-025-03582-2","type":"journal-article","created":{"date-parts":[[2025,5,20]],"date-time":"2025-05-20T08:36:09Z","timestamp":1747730169000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Advancing treatment strategies for idiopathic normal pressure hydrocephalus: a systematic review on studies comparing ventricular and lumbo-peritoneal shunts"],"prefix":"10.1007","volume":"48","author":[{"given":"Matteo","family":"Palermo","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gianluca","family":"Trevisi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Signorelli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Doglietto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessio","family":"Albanese","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandro","family":"Olivi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carmelo Lucio","family":"Sturiale","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,5,20]]},"reference":[{"key":"3582_CR1","doi-asserted-by":"publisher","first-page":"542","DOI":"10.1111\/ene.13543","volume":"25","author":"G Allali","year":"2018","unstructured":"Allali G, Laidet M, Armand S, Assal F (2018) Brain comorbidities in normal pressure hydrocephalus. 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