LUMBOPERITONEAL SHUNT - CLINICAL-APPLICATIONS, COMPLICATIONS, AND COMPARISON WITH VENTRICULOPERITONEAL SHUNT

Lumboperitoneal (LP) shunting has the advantage of completely extracranial surgical management, minimizing intracranial complications. An LP shunt has been intentionally adopted for patients who require cerebrospinal fluid diversion. A retrospective study was designed to examine the indications for and complications associated with LP shunts in 207 patients (including 28 pediatric patients) treated during the past 11 years. Follow-up averaging 5.1 years revealed no deaths related directly to LP shunt placement. Twenty-nine patients (14%) underwent revision of the shunt because of obstruction. Shunt-related infections were observed in only 2 patients (1%). Radicular pain occurred in 10 patients (5%), 2 of whom required shunt replacement. Postoperative occurrence of dyspnea and disturbance of consciousness necessitated conversion to a ventriculoperitoneal (VP) shunt in 2 patients (1%), who subsequently were noted to have Chiari malformations. In 4 patients (2%), an acute subdural hematoma developed after mild head trauma. Symptomatic chronic subdural hematomas were observed in 2 patients (1%). One patient had a mild myelopathy that rapidly resolved after shunt replacement. The comparison to 120 patients treated with a VP shunt during the identical period (an average follow-up of 5.2 years) suggests the following conclusions. After subarachnoid hemorrhage caused by a ruptured aneurysm, hydrocephalus is usually of the communicating type and is an indication for an LP shunt. The incidence of infection and malfunction with an LP shunt is significantly lower than that with a VP shunt. An LP shunt is also indicated for pediatric patients, although a relatively higher incidence of malfunction is noted compared to adults. In the light of their simplicity, extracranial management, and fewer complications, it is suggested that LP shunts be more widely used by neurosurgeons.