Lumboperitoneal Shunts in Children

Rekate, Harold L.; Wallace, Donna

doi:10.1159/000067562

Cited by 75 publications

(43 citation statements)

References 25 publications

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“…For most such cases, we advocate the use of LP shunts, which can drain both pathways. 15,34 In this case, however, the decision was complicated by the presence of the Chiari malformation Type II and NVH. We elected to explore the previous surgical site.…”

Section: Illustrative Cases 1 Andmentioning

confidence: 87%

“…Strategies that are effective in the management of this difficult condition involve increasing the resistance of the valves in moderately affected patients while requiring shunt systems that access the CSAS through LP shunts or through shunts that access the cisterna magna. 15,16,20,28,32,34 Based on these experiences and observations of a referral practice for patients with severe problems related to shunt management, we have analyzed a group of enigmatic hydrocephalic conditions that may be explained with reference to changes in the volume of the CSAS.…”

mentioning

confidence: 99%

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The importance of the cortical subarachnoid space in understanding hydrocephalus

Rekate

Nadkarni

Wallace

2008

PED

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Object In this paper the authors define the role of the cortical subarachnoid space (CSAS) in poorly understood forms of hydrocephalus to cerebrospinal fluid (CSF) dynamics to improve understanding of the importance of the CSAS and its role in selecting patients for endoscopic third ventriculostomy (ETV). The secondary purpose of this work was to define testable hypotheses to explain enigmatic disorders of CSF dynamics and to suggest how these concepts could be tested. Methods The magnitude of the contribution of the CSAS is explored using the solid geometry of concentric spheres. With this starting point, clinical conditions in which CSF dynamics are not easily understood are explored regarding the potential role of the CSAS. Overall, problems of CSF dynamics are easily understood. Insights may be gained when the results of a pathological process or its treatment vary from what has been expected. Results Acute changes in ventricular volume at the time that hydrocephalus develops, the failure of shunts, and the changes in ventricular volume with shunt repair may occur very rapidly. Changes in the volume of water in the brain, especially in the brain substance itself, are unlikely to occur at this rapid rate and may be interpreted as a simple redistribution of the CSF between the ventricle and CSAS with no initial change in the actual volume of brain parenchyma. Problems such as pseudotumor cerebri, shunt failure with nonresponsive ventricles, and negative-pressure hydrocephalus can be explained by assessing the ability of ventricular CSF to flow to the CSAS and the ability of this fluid to exit this compartment. Ventricular enlargement at the time of shunt failure implies a failure of flow between the ventricles and CSAS, implying that all patients who show this phenomenon are potential candidates for ETV. Conclusions The important role of the CSAS in the pathophysiology of various forms of hydrocephalus has been largely ignored. Attention to the dynamics of the CSF in this compartment will improve understanding of enigmatic conditions of hydrocephalus and improve selection criteria for treatment paradigms such as ETV. These concepts lead to clearly defined problems that may be solved by the creation of a central database to address these issues.

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Section: Illustrative Cases 1 Andmentioning

confidence: 87%

mentioning

confidence: 99%

The importance of the cortical subarachnoid space in understanding hydrocephalus

Rekate

Nadkarni

Wallace

2008

PED

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“…One of the major advantages of LPS surgery over VPS is that it lacks the risk of intracranial complications such intracerebral hemorrhages, seizures or shunt malpositioning, and this advantage is one of the main factors that make it the preferred surgical treatment at an increasing rate (1, 19,20). VPS surgery has been reported to be associated with an obstruction risk of 58% and the rate of epilepsy associated with cortical damage due to ventricular catheter insertion has been found to be considerable and to range from 9.4% to 24% (7,21).…”

Section: █ Discussionmentioning

confidence: 99%

“…While ventriculoperitoneal shunt (VPS) surgery has historically been widely performed, today, minimally invasive surgical procedures such as lumboperitoneal shunt (LPS) have become the surgical treatment of choice (2). The LPS surgery may be the motive to prefer LPS surgery in patients with small ventricles (1,4,19,20,22). LPS systems are constituted of 3 main components: a lumbar catheter, a valve, and a peritoneal catheter (18).…”

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confidence: 99%

Efficacy of lumboperitoneal shunting in patients with normal pressure hydrocephalus

Bayar

Tekiner²,

Çelik³

et al. 2016

Turkish Neurosurgery

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ABSTRACTis one of the common effective treatment modalities used in the surgical management of communicating hydrocephalus, pseudotumor cerebri, CSF fistula and normal pressure hydrocephalus (NPH)(13).Its relative ease to perform and shorter surgery time, lack of risk for intracranial complications, including intracerebral hemorrhages, seizures or shunt dysfunction, lower risk of shunt infections and lethal complications all make LPS a favorable surgical treatment modality as compared to VPS surgery. Ventricular catheter placement may be challenging in patients with small ventricles, even though the current use of navigation has provided convenience in placing a shunt catheter and higher success rates. Therefore, its simplicity █ INTRODuCTION N ormal pressure hydrocephalus (NPH) is a syndrome first defined in 1965 by Hakim and Adams. This syndrome is a significant neurological condition that occurs predominantly in elderly people and its clinical presentation consists of a triad of major symptoms, including gait disturbance, dementia and urinary incontinence (12).Surgical treatment of NPH typically includes the diversion of cerebro-spinal fluid (CSF) into the peritoneum, pleura or atrium. While ventriculoperitoneal shunt (VPS) surgery has historically been widely performed, today, minimally invasive surgical procedures such as lumboperitoneal shunt (LPS) have become the surgical treatment of choice (2). The LPS surgery RESulTS:At the 3 rd month after LP shunt surgery, headache was resolved in almost all patients. At the end of first year, while statistically significant improvements were noted in the Modified Rankin Scale Scores and Mini-Mental State Examination Scores, gait disturbance, urinary incontinence and cognitive functions were improved by 86%, 72% and 65% of the patients, respectively. CONCluSION: LP shunt surgery is associated with a lower rate of complication in comparison to ventriculoperitoneal shunt surgery and is an effective procedure in the treatment of NPH.

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“…Management is aimed at controlling symptoms of increased intracranial pressure (ICP) and prevention of visual failure due to papilledema. Various surgical procedures like lumbar peritoneal (LP) shunt, (11)(12)(13)(14)16,22,25) optic nerve sheath fenestration (OPSF), (5,8,10,14,21,24,26) ventriculoperitoneal (VP) shunt (28,29) and venous stenting (4,5) have been described. Incidence of CSF diversion is increasing in IIH in USA (9).…”

Section: Introductionmentioning

confidence: 99%

Lumbar peritoneal shunt in idiopathic intra cranial hypertension

Yadav

Parihar²,

Agarwal³

et al. 2011

Turkish Neurosurgery

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AIm: Treatment options for idiopathic intracranial hypertension (IIH) are lumbar peritoneal shunt (LP), optic nerve fenestration, ventriculoperitoneal shunt and venous stenting. We report our experience of 24 cases of LP shunt. mAterIAl and methOds: All the patients had preoperative fundus examination, cerebrospinal fluid pressure estimation and examination, visual field charting, CT scan and MR venography. Postoperative fundus examination and visual field charting was done in all cases. Follow up ranged from 18 to 137 months. results: Preoperative papilledema, headache, decreased vision, optic atrophy and diplopia were seen in 24, 24, 19, 10 and 11 patients respectively. Shunt failure, CSF leak and temporary over drainage complications in the form of headache were seen in 2, 1 and 15 cases respectively. Vision improved in 10 out of 18 patients. Only one patient, out of 9 who had only perception of light and optic atrophy preoperatively, had improved vision while all patients with vision of finger counting or better without optic atrophy improved after shunt.COnClusIOn: LP shunt is safe and effective in IIH. Results in terms of improvement in vision were better in good pre operatively vision group. yÖntem ve GereÇ: Tüm hastalara ameliyat öncesinde göz dibi muayenesi, görme alanı, beyin omurilik sıvısı basıncının ölçümü ve analizi, bilgisayarlı tomografi ve manyetik rezonans görüntüleme venografisi yapılmıştır. Ameliyat sonrası tüm hastalara gözdibi muayenesi ve görme alanı değerlendirmesi yapıldı. Hastalar 18-137 ay arasında izlendi.BulGulAr: Ameliyat öncesi dönemde papilödemi, başağrısı, görmede azalma, optik atrofi ve çift görme 24,24,19,10,11 hastada sırası ile görülmüştür. Onsekiz hastadan 10'unda görme düzelmiş. Optik atrofisi olmayan 9 hastada görme daha iyi hale gelmiş, optik atrofisi olan bir hastada ise preoperatif dönemde olan ışık algılaması daha iyi hale gelmiş. sOnuÇ: İntrakraniyal basınç artışında lumboperitoneal şant güvenli ve etkili bir yöntemdir. Ameliyat öncesi dönemde görmesi iyi olan hastaların görmesindeki düzelme daha belirgin olmaktadır.

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Lumboperitoneal Shunts in Children

Cited by 75 publications

References 25 publications

The importance of the cortical subarachnoid space in understanding hydrocephalus

The importance of the cortical subarachnoid space in understanding hydrocephalus

Efficacy of lumboperitoneal shunting in patients with normal pressure hydrocephalus

Lumbar peritoneal shunt in idiopathic intra cranial hypertension

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