Lumboperitoneal shunt for pseudotumor cerebri had been favored by many investigators for CSF diversion for decades; however, it has been associated with various side effects. Because of the small ventricular size adequate positioning of a ventricular catheter is challenging.

Complications following lumboperitoneal (LP) shunting have been reported in 18% to 85% of cases. The need for multiple revision surgeries, development of iatrogenic Chiari malformation, and frequent wound complications have prompted many to abandon this procedure altogether for the treatment of idiopathic benign intracranial hypertension (pseudotumor cerebri), in favor of ventriculoperitoneal (VP) shunting 1).

A 31 year old woman was diagnosed with pseudotumour cerebri following development of headaches, loss of vision, and papilledema, in association with a cerebrospinal fluid (CSF) opening pressure of 36 cm H2O. Cranial imaging showed an attenuated ventricular system and no other abnormality. In particular, the posterior fossa was satisfactory in appearance. She was treated with lumboperitoneal shunt insertion, with resolution of her symptoms.

Twelve months later, the patient reported a 6 month history of left hemisensory loss, left arm weakness, and unsteadiness. Neurological examination revealed wasting and reduced power of the intrinsic muscles of the left hand, and left-sided hyperaesthesia to pin-prick. Magnetic resonance (MR) imaging showed the development of cerebellar tonsillar descent and syringomyelia through- out the cervico-thoracic spinal cord. The patient underwent insertion of a low pressure ventriculoperitoneal shunt and removal of the lumboperitoneal shunt, with subsequent symptomatic improvement. There was, however, no resolution of the syrinx on follow up MR imaging.

Menger RP, Connor DE Jr, Thakur JD, Sonig A, Smith E, Guthikonda B, Nanda A. A comparison of lumboperitoneal and ventriculoperitoneal shunting for idiopathic intracranial hypertension: an analysis of economic impact and complications using the Nationwide Inpatient Sample. Neurosurg Focus. 2014 Nov;37(5):E4. doi: 10.3171/2014.8.FOCUS14436. PubMed PMID: 25363432.
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