Abstract
Diversion of lumbar cerebrospinal fluid (CSF) into the peritoneal space was attempted as early as 1898 by Ferguson (1898), who removed the arch of the fifth lumbar vertebra, pulled the cauda equine aside, and drilled a hole through the body of the vertebra. He passed a loop of silver wire bent inferiorly in the thecal sac, toward the peritoneum to act as a conduit for CSF flow. Three such cases did poorly. Subsequently in 1905, Nichol drew the free edge of the omentum into a defect in the spinal dura (Nicholl 1905). At around the same time, Cushing anastamosed the spinal subarachnoid space with the peritoneal or retroperitoneal spaces through a combined laminectomy and laparotomy using a silver cannula (Cushing 1905). Of 12 such patients, he experienced three deaths. Heile experimented with several different anastomotic techniques, including intestinal serosa, silk strands, saphenous vein, a rubber catheter, and a direct anastomosis of the kidney pelvis following nephrectomy (Heile 1914). All these early attempts at CSF diversion, although heroic, were associated with very high mortality and disastrous complications. Indeed Cushing wrote, “among the first of my patients – as will probably have been true of most young men entering this particular field – were infants with what is known as essential hydrocephalus, for which a greater number of treatments have as yet been advocated than successes recorded – if indeed there are any clear-cut successes at all recorded.”
References
Aoki N (1990) Lumboperitoneal shunt: clinical applications, complications, and comparison with ventriculoperitoneal shunt. Neurosurgery 26:998–1003; discussion 1003–1004
Banta JT, Farris BK (2000) Pseudotumor cerebri and optic nerve sheath decompression. Ophthalmology 107:1907–1912
Bloch O, McDermott MW (2012) Lumboperitoneal shunts for the treatment of normal pressure hydrocephalus. J Clin Neurosci 19(8):1107–1111
Chumas PD, Kulkarni AV, Drake JM, Hoffman HJ, Humphreys RP, Rutka JT (1993a) Lumboperitoneal shunting: a retrospective study in the pediatric population. Neurosurgery 32(3):376–383
Chumas PD, Armstrong DC, Drake JM (1993b) Tonsillar herniation: the rule rather than the exception after lumboperitoneal shunting in pediatric population. J Neurosurg 78:568–573
Cushing H (1905) The special field of neurological surgery. Cleveland Med J 4:1–25
Deen HG, Pettit PD, Sevin BU, Wharen RE, Reimer R (2003) Lumbar peritoneal shunting with video-laparoscopic assistance: a useful technique for the management of refractory postoperative lumbar CSF leaks. Surg Neurol 59:473–477; discussion 477–478
Drake JM, Sainte-Rose C (1995a) CSF shunt components. In: The shunt book. Blackwell Science, Cambridge, pp 104–105
Drake JM, Sainte-Rose C (1995b) Shunt complications. In: The shunt book. Blackwell Science, Cambridge, p 152
Duthel R, Nuti C, Motuo-Fotso MJ, Beauchesne P, Brunon J (1996) Complications of lumboperitoneal shunts: a retrospective study of a series of 195 patients (214 procedures). Neurochirurgie 42:83–89; discussion 89–90
Ferguson AH (1898) Intraperitoneal diversion of the cerebrospinal fluid in cases of hydrocephalus. N Y Med 67:902
Heile B (1914) Zur chirugischen behandlung des hydrocephalusinternus durch ableitting der cerebrospinal flusskeit nach der bauchhole und nach der pleurakuppe. Arch F Klin Chir 105:501–516
Jackson IJ (1951) A review of the surgical treatment of internal hydrocephalus. J Pediatr 38(2):251–258
Jackson IJ, Snodgrass SR (1955) Peritoneal shunts in the treatment of hydrocephalus and increased intracranial pressure; a 4-year survey of 62 patients. J Neurosurg 12:216–222
James HE, Tibbs PA (1981) Diverse clinical applications of percutaneous lumboperitoneal shunts. Neurosurgery 8(1):39–42
Jea A, Al-Otibi M, Rutka JT, Drake JM, Dirks PB, Kulkarni AV, Taylor MD, Humphreys RP (2007) The history of neurosurgery at the Hospital for Sick Children in Toronto. Neurosurgery 61(3):612–624; discussion 624–625
Johnston I, Besser M, Morgan MK (1988) Cerebrospinal fluid diversion in the treatment of benign intracranial hypertension. J Neurosurg 69(2):195–202
Kanai M, Kawano K, Uehara S (1999) Upward migration of the LP shunt catheter into the cranial base. Osaka City Med J 45:123–127
Kestle J, Drake J, Milner R, Sainte-Rose C, Cinalli G, Boop F, Piatt J, Haines S, Schiff S, Cochrane D, Steinbok P, MacNeil N (2000) Long-term follow-up data from the Shunt Design Trial. Pediatr Neurosurg 33(5):230–236
Kulkarni AV, Chumas PD, Drake JM, Armstrong DC (1999) The reliability of the “absent cistern sign” in assessing LP shunt function. Can J Neurol Sci 26:40–43
Matson DD (1949) A new operation for the treatment of communicating hydrocephalus. J Neurosurg 6:238–247
Miyajima M, Kazui H, Mori E, Ishikawa M, on behalf of the SINPHONI-2 Investigators (2016) One-year outcome in patients with idiopathic normal-pressure hydrocephalus: comparison of lumboperitoneal shunt to ventriculoperitoneal shunt. J Neurosurg 12:1–10
Nadkarni TD, Rekate HL, Wallace D (2008) Concurrent use of a lumboperitoneal shunt with programmable valve and ventricular access device in the treatment of pseudotumor cerebri: review of 40 cases. J Neurosurg Pediatr 2:19–24
Nicholl JH (1905) Case of hydrocephalus in which peritoneo-meningeal drainage has been carried out. Glasgow Med J 63:187–191
Payner TD, Prenger E, Berger TS, Crone KR (1994) Acquired Chiari malformations: incidence, diagnosis and management. Neurosurgery 34:429–434
Rekate HL, Wallace D (2003) Lumboperitoneal shunts in children. Pediatr Neurosurg 38:41–46
Riffaud L, Moughty C, Henaux PL, Haegelen C, Morandi X (2008) Acquired Chiari I malformation and syringomyelia after valveless lumboperitoneal shunt in infancy. Pediatr Neurosurg 44:229–233
Sainte-Rose C, Hoffman HJ, Hirsh JF (1989) Shunt failure. In: Marlin AE (ed) Concepts in paediatric neurosurgery, vol 9. Karger, Basel, pp 7–20
Sood S, Barrett RJ, Powell T, Ham SD (2005) The role of lumbar shunts in the management of slit ventricles: does the slit-ventricle syndrome exist? J Neurosurg Pediatr 103:119–123
Spetzler RF, Wilson CB, Grollmus JM (1975) Percutaneous lumboperitoneal shunt. Technical note. J Neurosurg 43(6):770–773
Spitze A, Lam P, Al-Zubidi N, Yalamanchili S, Lee AG (2014) Controversies: optic nerve sheath fenestration versus shunt placement for the treatment of idiopathic intracranial hypertension. Indian J Ophthalmol 62:1015–1021
Wall M (2008) Idiopathic intracranial hypertension (pseudotumor cerebri). Curr Neurol Neurosci Rep 8:87–93
Wang VY, Barbaro NM, Lawton MT, Pitts L, Kunwar S, Parsa AT et al (2007) Complications of lumboperitoneal shunts. Neurosurgery 60:1045–1048; discussion
Yadav YR (2005) Cranio-cerebral erosion (growing skull fracture): management by lumber-peritoneal shunt: case report. Clin Pract Rev 6:224–229
Yadav YR, Pande S, Raina VK, Singh M (2004) Lumboperitoneal shunts: review of 409 cases. Neurol India 52:188–190
Yoshida S, Masunaga S, Hayase M, Oda Y (2000) Migration of the shunt tube after lumboperitoneal shunt-two case reports. Neurol Med Chir (Tokyo) 40:594–596
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Section Editor information
Rights and permissions
Copyright information
© 2017 Springer International Publishing AG
About this entry
Cite this entry
Mukherjee, S., Chumas, P.D. (2017). In-Depth View: How to Perform a Lumboperitoneal CSF Shunt. In: Di Rocco, C., Pang, D., Rutka, J. (eds) Textbook of Pediatric Neurosurgery. Springer, Cham. https://doi.org/10.1007/978-3-319-31512-6_29-1
Download citation
DOI: https://doi.org/10.1007/978-3-319-31512-6_29-1
Received:
Accepted:
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-31512-6
Online ISBN: 978-3-319-31512-6
eBook Packages: Springer Reference Biomedicine and Life SciencesReference Module Biomedical and Life Sciences