In a multi-center, randomized trial, the SINPHONI-2 investigators evaluated lumboperitoneal shunts for the treatment of idiopathic NPH, in contrast to the more common practice of using ventriculoperitoneal shunts. Patients (N=93, 60-85 years) with idiopathic NPH from 20 neurological centers in Japan were randomly assigned to either immediate lumboperitoneal shunting with daily physical exercises for 12 months or daily physical exercises without shunting for 3 months followed by lumboperitoneal shunting with daily exercises for 12 months. The primary endpoint was an improvement in the modified Rankin Scale (mRS) by at least 1 point at 3 months after randomization. Thirty-two of 49 patients (65%) in the immediate group vs 2 of 44 (5%) in the postponed group, had ≥1 point improvement at 3 months (p<0.0001). At 12 months, the number of improved patients was comparable between groups (67% in immediate group, 58% in postponed group). There was no statistically significant difference in adverse events between groups at 3 months. These findings suggest that lumboperitoneal shunts for idiopathic NPH are effective and safe. Further studies to compare lumboperitoneal and ventriculoperitoneal shunts for NPH are still needed.