Lumboperitoneal Shunt

A lumboperitoneal (LP) shunt refers to a device that surgically placed to drain the excess cerebrospinal fluid (CSF) from the lumbar thecal sac into the peritoneal cavity ¹. The shunt procedure helps to bypass or redirect bodily fluids from one point in the body to another. A lumboperitoneal shunt may be helpful for the patient with CSF leakage, hydrocephalus, or idiopathic intracranial hypertension. The disruption of normal CSF flow can result in the buildup of fluid inside the cranial cavity and creates harmful pressure on the brain’s tissues. Untreated hydrocephalus may lead to damage to the brain and raise complications like gait difficulty, dementia, loss of bladder control, etc.

This procedure connects a tube from the CSF fluid space in the lumbar spine to the abdomen. The tube may comprise a one-way valve that helps to drain excess CSF. Unlike the ventriculoperitoneal shunt, neurosurgeons place LP shunts in between two lumbar vertebrae and puncture the lumbar subarachnoid space or cerebrospinal fluid sack. Then the tube runs under the skin to the peritoneal cavity and drains away from the normal bodily fluid drainage system. That’s how this shunt help to restore the normal flow of CSF ².

Usually, a lumboperitoneal shunt comprises three parts: a ventricular catheter, a valve, and a peritoneal catheter. The valve connects the ventricular catheter with the peritoneal catheter which placed in the peritoneal cavity. This device may arise some complications during and after placement. These include catheter misplacement, shunt infection, valve obstruction, catheter dislodgement, over drainage, intracranial bleeding, and possible revision surgery or removal surgery. These shunts require more revision operations and become less durable than VP shunts.

Who is an ideal candidate for Lumboperitoneal Shunt?

Peoples can develop hydrocephalus of any age and require a shunt for recovery. Lumboperitoneal shunt can replace VP shunt on several occasions. Research shows that about 33,000 people perform shunts every year in the USA ³. The National Institute for Neurological Disorders and Stroke (NINDS) found out almost 2 of every 1,000 babies develop hydrocephalus by born ⁴.

The reasons for excess fluid buildup include excess CSF production, poor CSF absorption, and disruption of the normal flow of CSF. Neurosurgeons use various clinical tests to diagnose hydrocephalus. These include ultrasound imaging techniques, MRI scans, and CT scans ². These clinical tests help surgeons to view and detect any abnormalities inside of the cranial cavity and brain tissues.

How do Neurosurgeons perform Lumboperitoneal Shunt?

Lumboperitoneal shunt (VP) procedure requires a professional medical team led by an expert neurosurgeon, an anesthesiologist, a vascular surgeon, an anesthesiologist, and nurses to perform successfully. Surgeons require about 1 hour to perform this shunt operation in the operating room. The basic steps include ¹:

• Anesthesiologists will administer general anesthesia to the patient before surgery to fall asleep, and nurses will prepare the incision site by shaving the incision area.
• Neurosurgeons will make an incision near the base of the spine to guide the catheter, and the catheter will insert into the subarachnoid space of the lower spine.
• This catheter runs through the chest and abdomen and allows excess fluid to drain into the peritoneal cavity.
• Finally, surgeons will close the incisions with stitches or staples.

After the operation, the patient closely observed for 24 hours. A typical stay of 2 to 7 days requires in the hospital, depending on their clinical progress. Post-surgical complications can have dire consequences for the patient with shunt operation ⁵. The nurse needs to monitor the patient continuously for any signs of these complications during his stay in the hospital. If any complications arise, they need to act immediately.

References

1. Yang, T. H., Chang, C. S., Sung, W. W. & Liu, J. T. Lumboperitoneal shunt: A new modified surgical technique and a comparison of the complications with ventriculoperitoneal shunt in a single center. Med. 55, (2019).
2. Wang, V. Y. et al. Complications of lumboperitoneal shunts. Neurosurgery 60, 1045–1048 (2007).
3. Er, U., Akyol, Ç. & Bavbek, M. Delayed intracerebellar hemorrhage secondary to lumboperitoneal shunt insertion. Asian J. Neurosurg. 11, 447 (2016).
4. Aoki, N. Lumboperitoneal shunt: Clinical applications, complications, and comparison with ventriculoperitoneal shunt. Neurosurgery 26, 998–1004 (1990).
5. Yadav, Y. R., Parihar, V. & Sinha, M. Lumbar peritoneal shunt. Neurol. India 58, 179–184 (2010).