Lumbar peritoneal shunt

Neurosurgery Unit, NSCB Medical College, Jabalpur, Madhya Pradesh, India.
Neurology India (Impact Factor: 1.23). 03/2010; 58(2):179-84. DOI: 10.4103/0028-3886.63778
Source: PubMed


A lumbar peritoneal (LP) shunt is a technique of cerebrospinal fluid (CSF) diversion from the lumbar thecal sac to the peritoneal cavity. It is indicated under a large number of conditions such as communicating hydrocephalus, idiopathic intracranial hypertension, normal pressure hydrocephalus, spinal and cranial CSF leaks, pseudomeningoceles, slit ventricle syndrome, growing skull fractures which are difficult to treat by conventional methods (when dural defect extends deep in the cranial base or across venous sinuses and in recurrent cases after conventional surgery), raised intracranial pressure following chronic meningitis, persistent bulging of craniotomy site after operations for intracranial tumors or head trauma, syringomyelia and failed endoscopic third ventriculostomy with a patent stoma. In spite of the large number of indications of this shunt and being reasonably good, safe, and effective, very few reports about the LP shunt exist in the literature. This procedure did not get its due importance due to some initial negative reports. This review article is based on search on Google and PubMed. This article is aimed to review indications, complications, results, and comparison of the LP shunt with the commonly practiced ventriculoperitoneal (VP) shunt. Shunt blocks, infections, CSF leaks, overdrainage and acquired Chiari malformation (ACM) are some of the complications of the LP shunt. Early diagnosis of overdrainage complications and ACM as well as timely appropriate treatment especially by programmable shunts could decrease morbidity. Majority of recent reports suggest that a LP shunt is a better alternative to the VP shunt in communicating hydrocephalus. It has an advantage over the VP shunt of being completely extracranial and can be used under conditions other than hydrocephalus when the ventricles are normal sized or chinked. More publications are required to establish its usefulness in the treatment of wide variety of indications.

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    • "There are large variety of indications beside hydrocephalus reasoned intracranial pressure increase for shunt procedures as ventriculoperitoneal shunt(VP) or lumbar peritoneal(LP) shunt [9] . One of the indications is CSF leakadge due to recurrent intracranial operations for pituitary macroadenomas as in our patient. "
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    ABSTRACT: Lumbar peritoneal shunt is a technique of cerebrospinal fluid diversion from the lumbar thecal sac to the peritoneal cavity. By diverting, a second compartment of the body; abdomen starts to accompany the case as a new problem source. 32 years old woman who had been considered to be primary infertile for fifteen years applied to our infertility clinic. She had a transsphenoidal surgery due to macroadenoma of pituitary gland fourteen years ago. By trans-vaginal ultrasonography we revealed 4 antral follicles and diffuse ascites in pouch of douglas due to the shunt. There were spicular projections fom uterus and bowel serosa to inner abdominal wall, that we thought about severe intraabdominal adhesions. Controlled ovarian hyperstimulation was started with 300 IU menotropin on third day of the cycle. We yielded 4 oocyte. One grade-1 embryo transferred at day two. After two weeks hCG positivity was determined. At 39th week 3 900 g female baby was born vaginaly with 1st minute apgar score as 9 and 5th minute apgar score as 10.
    Preview · Article · Sep 2012
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    • "A cycle of 1 to 3 lumbar punctures should always be performed in patients who remain symptomatic after ETV, before ETV is assumed to have failed and an extra cranial cerebrospinal fluid shunt is implanted. Patients with temporary defect in CSF hydrodynamics would show clinical improvement after lumbar puncture while those with permanent defect in CSF absorption or permeation will need some form of shunt.[99100] "
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