Abstract
Background: Lumboperitoneal (LP) shunts were the mainstay of cerebrospinal fluid diversion therapy for idiopathic intracranial hypertension (IIH). The traditionally cited advantage of LP shunts over ventriculoperitoneal (VP) shunts is the ease of insertion in IIH. This needs to be placed at the level of L3/4 to be below the level of the spinal cord. The objective of this study was to analyse the position of LP shunts inserted without portable fluoroscopy guidance. Methods: A retrospective analysis of radiology was performed for patients who underwent lumboperitoneal shunts between 2006 and 2016 at the National Hospital for Neurology and Neurosurgery. Patients who had insertion of a LP shunt without fluoroscopy guidance were selected. Patients without post-procedural imaging were excluded. A retrospective analysis of the clinical notes was also performed. Results: Between 2006 and 2016, 163 lumboperitoneal shunts were inserted in 105 patients. A total of 56 cases were excluded due to lack of post-procedural imaging; therefore, 107 post-procedural x-rays were reviewed. In 17 (15.8%) cases the proximal end of the LP shunt was placed at L1/L2 level or above. Conclusions: Insertion of LP shunts without portable fluoroscopy guidance gives a 15.8% risk of incorrect positioning of the proximal end of the catheter. We suggest that x-ray is recommended to avoid incorrect level placement. Further investigation could be carried out with a control group with fluoroscopy against patients without.
Highlights
Historically, lumboperitoneal (LP) shunts were the mainstay of cerebrospinal fluid (CSF) diversion therapy for idiopathic intracranial hypertension (IIH)
The traditionally cited advantage of LP shunts over ventriculoperitoneal (VP) shunts is the ease of insertion in IIH patients who usually have small and sometimes difficult to catheterise ventricles[1,2,3,4]
Studies have shown that IIH patients who underwent LP shunting had improvement in both visual acuity and visual fields with patients reporting an improvement in headache symptoms post LP shunting[6,9]
Summary
Lumboperitoneal (LP) shunts were the mainstay of cerebrospinal fluid (CSF) diversion therapy for idiopathic intracranial hypertension (IIH). Studies have shown that IIH patients who underwent LP shunting had improvement in both visual acuity and visual fields with patients reporting an improvement in headache symptoms post LP shunting[6,9]. In these previous studies, and in many others, the most common complication was shunt obstruction, with up to 65% of cases requiring revision in one study[9]. The traditionally cited advantage of LP shunts over ventriculoperitoneal (VP) shunts is the ease of insertion in IIH This needs to be placed at the level of L3/4 to be below the level of the spinal cord. Further investigation could be carried out with a control group with fluoroscopy against patients without
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