LUMBOPERITONEAL SHUNTS FOR IDIOPATHIC INTRACRANIAL HYPERTENSION

WHAT IS A LUMBOPERITONEAL SHUNT?

Gloved hands hold the Strata NSC LP valve

Shunts typically consist of two catheters and a valve that redirect excess cerebrospinal fluid (CSF) produced by the body to another part of the body. A lumboperitoneal shunt moves fluid from the spinal space in the lower back (lumbar subarachnoid space) to the abdominal area (peritoneum) where it is absorbed by the body.

The Medtronic Strata™ NSC LP valve can be used to surgically treat idiopathic intracranial hypertension and communicating hydrocephalus. With the Strata NSC LP valve, the drainage rate of the valve can be changed non surgically after it is implanted to address changing patient needs.

BENEFITS AND RISKS

A shunt redirects cerebrospinal fluid from the nervous system to another area of the body. It is designed to:

 

  • Regulate the amount, flow direction, and pressure of cerebrospinal fluid
  • Allow for adjustment of shunt drainage rate as needed

 

Unlike most surgical procedures, in which the risks are highest during the operation itself, most of the common problems associated with lumboperitoneal shunting may occur at a later time. The most common complications are obstruction, infection, and overdrainage.

OBSTRUCTION

Obstruction of a shunt may occur in any of the parts of the shunt system due to plugging by blood clots, bacterial colonisation, or other biological debris at some point along the shunt’s course. Another cause is disconnection of the components. If you feel your symptoms returning, your shunt may be obstructed. If this occurs, it’s important to call your doctor and get to the hospital for observation and treatment immediately. Removal and replacement of the shunt may be required.

INFECTION

Infection is a risk with any surgical operation, especially when a foreign body like a shunt is implanted. If left untreated, infection can cause the wound to open up or cause systemic infection with chills and high fever.

If you develop an infection, the shunt may need to be removed and replaced. Symptoms of infection may include unusual redness or swelling of the wounds along the length of the shunt path.

OVERDRAINAGE

Overdrainage is generally caused when too much CSF is drained out of the ventricles too quickly. If you notice your symptoms returning — headache, nausea, vomiting, drowsiness, and changes in vision (particularly double vision) — overdrainage may be the problem. The problem may be that there is too much CSF being siphoned off too quickly and your valve needs readjusting to a pressure level that better suits you.

IS A LUMBOPERITONEAL SHUNT THE APPROPRIATE TREATMENT FOR YOU?

There are several tests that can help to decide whether you are a candidate for a shunt. These same studies can also help evaluate the shunt in case of malfunction or infection.

BRAIN IMAGING

You may have one of the following methods of brain imaging done:

  • Magnetic resonance imaging (MRI) is a non-invasive diagnostic tool that uses radio signals and a magnet to form computer images of the brain, ventricles, and spine.
  • Computerised (axial) tomography (CAT or CT) scans are special x-ray techniques, which outline the ventricles and other structures of the brain in cross section.

Your doctor will decide which type of brain imaging will work best in your situation.

LUMBAR PUNCTURE OR SPINAL TAP

The lumbar puncture or spinal tap is an invasive diagnostic test that allows CSF to be removed for examination and the pressure of CSF within the spinal column to be measured.