20 Lumboperitoneal Shunt



10.1055/b-0040-176509

20 Lumboperitoneal Shunt

Ryan F. Amidon, Christ Ordookhanian, and Paul E. Kaloostian

20.1 Symptoms and Signs




  • Gait disturbance



  • Difficulty maintaining balance and walking



  • Mild dementia



  • Impaired bladder control



  • Headache



  • Fatigue



  • Nausea



  • Irritability



  • Confusion



  • Large head size



  • Seizures



  • Impaired vision



  • Abnormal sleeping behavior



  • Memory loss



20.2 Surgical Pathology




  • Cranial benign/malignant trauma



  • Cranial benign/malignant infection



  • Cranial benign/malignant tumor



  • Cranial benign/malignant surgical complication



20.3 Diagnostic Modalities




  • Patient history



  • Physical examination



  • Neurological examination



  • CT of brain (detect enlarged ventricles)



  • MRI of brain (detect enlarged ventricles)



  • Ultrasound of brain



  • Cerebrospinal fluid (CSF) testing (predict shunt responsiveness, determine shunt pressure)




    • Lumbar or spinal tap



    • External lumbar drainage



    • Measure CSF outflow resistance



20.4 Differential Diagnosis




  • Communicating hydrocephalus: CSF can still flow between ventricles, but gets blocked after exiting




    • Resulting from subarachnoid hemorrhage, head trauma, infection, tumor, or surgical complication



    • Normal pressure hydrocephalus (NPH)



    • Pseudotumor cerebri (idiopathic intracranial hypertension)



  • Noncommunicating hydrocephalus (obstructive hydrocephalus): CSF flow blocked along passage(s) connecting ventricles



  • Congenital hydrocephalus vs. acquired hydrocephalus



  • Hydrocephalus ex-vacuo: Occurs when stroke, degenerative diseases, or head trauma damages brain (brain tissue shrinkage may occur)



20.5 Treatment Options



20.5.1 Surgery if Deemed Suitable Candidate




  • Determine overall prognosis and Karnofsky performance score



  • If poor surgical candidate with poor life expectancy, medical management recommended



  • Endoscopic third ventriculostomy (neuroendoscope visualizes ventricular surface and a hole is created in floor of third ventricle, allowing CSF to bypass obstruction and flow toward sites of resorption)



  • Shunting (relieving fluid buildup responsible for hydrocephalus)




    • Types:




      • Ventriculoperitoneal (VP): Ventricular inflow, peritoneal cavity (abdomen) outflow



      • Lumboperitoneal (LP): Lumbar spine inflow, peritoneal cavity (abdomen) outflow



      • Ventriculopleural (VPL): Ventricular inflow, pleural cavity (lung) outflow



      • Ventriculoatrial (VA): Ventricular inflow, right atrium of heart outflow



    • Components:




      • Inflow/proximal catheter (drains CSF from ventricles or subarachnoid space)



      • Valve mechanism (regulates differential pressure or controls flow through shunt tubing, connected to proximal catheter)



      • Outflow/distal catheter (directs CSF from valve to abdominal or peritoneal cavity, heart, or other drainage site)

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19 Ventriculoperitoneal Shunt 21 Ventriculopleural Shunt 22 Ventriculoatrial Shunt 6 Spinal Radiosurgery 11 Hemicraniectomy (Unilateral, Bilateral, Bifrontal versus Frontotemporal) 15 Subdural Grid Placement

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May 15, 2020 | Posted by in NEUROSURGERY | Comments Off on 20 Lumboperitoneal Shunt

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