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Published on: October 14, 2022
Lumboperitoneal shunts in children
Harold L Rekate1, Donna Wallace
1Division of Pediatric Neurosurgery, Barrow Neurological Institute, 2910 N Third Avenue, Phoenix, AZ 85013, USA. Harold.rekate@bnaneuro.net
Insights
Lumboperitoneal (LP) shunts effectively treated cerebrospinal fluid absorption abnormalities in children. This study found LP shunts safe for specific pediatric neurosurgical indications, with no hindbrain herniation complications.
Area of Science:
- Pediatric Neurosurgery
- Neurology
- Biomedical Engineering
Background:
- Abnormalities in cerebrospinal fluid (CSF) absorption can lead to serious neurological conditions in children.
- Lumboperitoneal (LP) shunts are a potential treatment option for managing CSF absorption issues.
- Careful patient selection is crucial for optimizing outcomes and minimizing risks associated with shunting procedures.
Purpose of the Study:
- To evaluate the safety and efficacy of lumboperitoneal (LP) shunts in pediatric patients.
- To assess the outcomes in children with specific cerebrospinal fluid absorption abnormalities.
- To determine the risk of hindbrain herniation following LP shunt placement in this cohort.
Main Methods:
- Retrospective analysis of 25 pediatric patients (mean age 9.6 years) who underwent LP shunting over 10 years.
- Review of magnetic resonance imaging (MRI) studies, treatment indications, and pre- and postoperative symptoms.
- Focus on specific conditions including postoperative pseudomeningocele, pseudotumor cerebri, and slit ventricle syndrome.
Main Results:
- Complete resolution of preoperative symptoms was observed in all 25 patients post-LP shunt placement.
- No patient experienced symptomatic or radiographic evidence of hindbrain herniation.
- Twenty-one of the 25 shunts utilized integrated valve mechanisms.
Conclusions:
- Lumboperitoneal (LP) shunts are a safe and effective treatment for carefully selected pediatric patients with specific CSF absorption disorders.
- The risk of hindbrain herniation is not excessive when LP shunts are used for appropriate indications.
- LP shunting offers a viable therapeutic option for complex pediatric neurosurgical cases involving CSF dynamics.
Objective:
To determine the safety and efficacy of lumboperitoneal (LP) shunts in carefully selected children with abnormalities of the absorption of cerebrospinal fluid.
Methods:
Magnetic resonance imaging studies, indications for treatment and pre- and postoperative symptoms of 25 patients (mean age 9.6 years) who had undergone LP shunting in the past 10 years in a single pediatric neurosurgical practice were analyzed retrospectively.
Results:
Indications for treatment included postoperative pseudomeningocele, pseudotumor cerebri and a severe form of slit ventricle syndrome. Preoperative symptoms resolved completely in all 25 patients as a result of the shunt, and no patient developed symptomatic or radiographic hindbrain herniation. Twenty-one shunts incorporated valve mechanisms.
Conclusion:
LP shunts may be used for specific indications without excessive risk of hindbrain herniation.