Lumboperitoneal shunts for the treatment of post-traumatic hydrocephalus

Objective: To assess the effectiveness and safety of lumboperitoneal shunt for treatment of post-traumatic hydrocephalus(PTH).Methods: A retrospective analysis of medical records of patients with lumboperitoneal shunts admitted in Shanghai Tenth People's Hospital from January 2014 to March 2017 was done.Experience with lumboperitoneal shunt placement for PTH was reviewed.The diagnosis of PTH was based on ventricular enlargement with the Evans' index(EI>0.3) before shunt implantation.Patients were evaluated for improvements in Glasgow Coma Scale(GCS), Glasgow Outcome Scale(GOS), and EI after shunt placement.Results: Totally, the study included 34 PTH patients with the average age of 49.32 years(range: 9–67 years).The average follow-up period was(3.9±3.5) months.Before lumboperitoneal shunt, the GOS score was(4±1), the GCS score was(8.53±3.38), and the EI score was(0.40±0.08).After shunt implantation, the GOS score was(3±1), the GCS score was(10.29±3.15), and the EI score was(0.34±0.13), respectively(P<0.05).Before lumboperitoneal shunt, 24(70.58%) patients had a GOS score of 4(vegetative state), and 10(29.42%) patients had a GOS score of 3(severe disabled).After lumboperitoneal shunt, 18(52.94%) patients had improvement in GOS(11 patients improve from GOS 4 to GOS 3, 5 patients from GOS 3 to GOS 2 and 2 patients from GOS 3 to GOS 1), 22(64.71%) patients achieved improvement in their GCS(14 patients GCS improvements ≥2 and 8 patients GCS improvement=1), 21(61.76%) patients had EI improvement(18 patients with EI<0.3).There was no complication in this study.Conclusion: Lumboperitoneal shunt placement is safe and effective for PTH, and serious complications are not observed.

Lumboperitoneal Shunt for Syringomyelia

A simple method of treatment for syringomyelia was investigated in this study. Fourteen patients with syringomyelia were treated by percutaneous lumboperitoneal (LP) shunt. After the surgical shunt, obvious shrinkage of the syrinx was observed in nine patients, no change of the syrinx in two patients, and noticeable postoperative expansion of the syrinx in three patients. The results suggest that cerebrospinal fluid (CSF) moves under intraspinal pressure into the spinal cord, contributing to the formation and maintenance of the syrinx in most of our patients, and that LP shunting can effectively shrink of the syrinx.

Should a VP or LP Shunt be Used for the Treatment of Pseudotumorcerebri in Adults?

Introduction: Pseudotumorcerebri(PTC) is a condition characterized by false brain tumor symptoms, caused by high intracranial pressure (ICP). Treatment options include medication, weight loss, surgery, and shunting. Shunting, either ventriculoperitoneal (VP) or lumboperitoneal (LP), emerged as the preferred method of treatment, but there is an ongoing debate as to which technique should be prioritized. The aim of this study is to gather additional evidence to determine the optimal type of shunt for treating PTC. Materials and Methods: Ninety patients with PTC were studied at Damascus University between 2016 and 2021. The study monitored symptoms before and after treatment, with improvement related to the technique used (VP or LP shunts). Of all patients, 83 were women and 7 were men. In addition, complications were analyzed. Results: Both shunts showed similar postoperative rates of symptom improvement, but VP shunts were utilized more frequently overall in this study. Patients who received LP shunt surgery had a higher rate of postoperative complications compared to those who received VP shunt surgery, but the chi-squared analysis did not provide sufficient evidence to confirm a significant relationship between the type of surgery and the occurrence of postoperative complications. Conclusion: Despite ongoing controversy about the optimal treatment for benign intracranial hypertension (BTC), most authors approved the trend of using VP (ventriculoperitoneal) shunts, given a lower rate of complications. However, there is no statistically significant difference between outcomes of VP and LP (lumboperitoneal) shunting techniques, according to our research.

Minimally-invasive treatment of communicating hydrocephalus using a percutaneous lumboperitoneal shunt

Objective:To investigate the clinical value of a minimally-invasive treatment of communicating hydrocephalus using a percutaneous lumboperitoneal (LP) shunt.Method:The clinical and long-term follow-up data of 256 patients suffering from communicating hydrocephalus and undergoing percutaneous LP shunt during 1998 to 2008 were retrospectively analyzed.Results:After the follow-up,which lasted 6 months to 10 years,219 cases of communicating hydrocephalus recovered well (ventricular size returned to normal and symptoms completely disappeared),25 cases were brought under control (ventricle size reduced by 50% and symptoms partially abated),and 12 cases showed no obvious changes.Fifteen obese subjects needed modifications of the shunt due to the obstruction of the abdominal end following wrapping,and one subject underwent extubation as the subject was unable to tolerate stimulation of the cauda equina.The effectiveness of shunting was 91.40% and the probability of shunt-tube obstruction,which occurs predominantly in the abdominal end,was only 5.85%,far lower than that of ventriculoperitoneal (VP) shunt.Three subjects had a history of infection following VP shunting.Conclusion:LP shunting is minimally invasive and effective in treating communicating hydrocephalus,with fewer complications.