Analysis of the operative complications associated with the lumboperitoneal shunt for the 119 cases of adult communicating hydrocephalus

Abstract

A retrospective study was designed to examine the operative complications associated with the lumboperitoneal shunt (L-P shunt) for 119 cases of adult communicationg hydrocephalus during the past 19 years. The shunt system was a 3-piece type (lumbar catheter, double chamber flushing device and peritoneal catheter connected by 2 stainless connectors) made from Silastic rubber. CSF flow was controlled by a pressure sensitive- slit valve in the tip of the lumbar catheter. Initial success ratio of the L-P shunt was only 53% (63 cases). Another 56 cases (47%) had a total of 104 shunt-related complications, and needed 82 shunt revisions. The causes of the complications and mulfunctions were: 33 shunt infections in 21 cases, 10 mechanical problems, such as catheter rupture or migration in 8 cases, 26 problems at the tip of the spinal catheter in 26 cases, 17 problems at the tip of the peritoneal catheter in 15 cases, 4 obstructions due to debris in the shunt system, 2 abortions of the shunt operation due to difficulty of lumbar catheter placement in 2 cases, 2 acute epidural hematomas in 2 cases, 2 severe pneumoencephalopathies in 2 cases, and unknown causes in 8 cases. Shunt infections were the main causes of the problems that occurred in the early postoperative phase (within 2 weeks). On the other hand, lumbar catheter problems were the main caused in problems occurring in the late postoperative phase (later than 2 months). Shunt infection should be avoided by taking adequate pre- and intraoperative precautions. Catheter disruptions and migrations were unique in this shunt system. These complications should be avoided by careful fixation and connection of the 1 or 2-piece shunt system. During the operation, great care must be paid in order that the catheter does not injure the neural tissue and is not placed in the subdural space but in the subarachnoid space properly. Intraoperative shuntgrams may be useful for the proper placement of the lumbar catheter. However, the obstruction of the lumbar catheter due to late onset inflammation remained unsolved. This study advised us that lumboperitoneal shunt operations should be performed with full comprehension of the unique complications they entail.