[Simplfied technique of lumbar subarachnoid-peritoneal shunt (author's transl)]. 1977

N Kuwana, and T Kuwabara, and F Nakajima, and H Hosoda, and K Yamaguchi

The authors have developed a simplified technique of lumbar subarachnoid peritoneal shunt in which the spinal tube is easily introduced through a puncture needle without doing a laminectomy. Seventeen cases of communicating hydrocephalus of various orgin have been treated by this procedure. In this paper, we reported our shunting system and the technique of precedures, and discussed the clinical results and some advantages of this method. The spinal tube is a custom made Silastic tube with small side holes 2 mm apart from each other at slanting tip located within the first 1.0 cm of the end. French No. 5 tube is available for older children and for adults, and French No. 3.6 tube for infants. Total length of the tube measures 30 cm with 4 black markers at 5 cm intervals from the tip for assisting in positioning. The puncture needle is a modified Touhey needle. Two needles different in size are prepared according to the size of the tube. Outer diameter of these needles is 2.1 mn & 1.8 mn. Our operative procedures are divided into following three steps. 1) Puncture of the lumbar subarachnoid space and insertion of the spinal tube through the needle. 2) Introduction and placement of the peritoneal tube into some point of the peritoneal cavity. Concerning to this point, we have the three candidates, namely into the Douglas pouch, the suprahepatic space, and the bursa omental cavity. 3) Connection of the spinal tube and the peritoneal catheter end. We used a kind of flushing device only in some exceptional cases, and recently, we feel that it is not so necessary for this shunting. We have employed this technique in a total of 17 cases. Eleven cases of them are adults and the other 6 cases are children less than 2 years of age. Postoperative follow up period varied from 13 months to 1 month, and all the cases except two had good result, suggesting the shunt system is working well with no evidence of complications such as low pressure syndrome or radicular irritation. Some troubles occurred in two children. One was a disconnection between the spinal and the peritoneal tube, and the other was an obstruction at the peritoneal tube end. The authors believe that our L-P shunt has several advantages as listed below, 1)Procedure is very simple, in other words, there is no need of laminectomy. 2) The entire system is short. 3) No need to pass the catheter into the brain tissue. 4) Obstruction of the spinal catheter end is very unusual. 5) Alteration of communicating hydrocepalus into non communicating one by secondary obstruction of aqueduct of Sylvius is less likely with this shunting system. 6) Siphon effect might be minimal, if present. 7) As compared to V-A shunt, severe complication like septicemia will not occur in the L-P shunt. With this simple method and good material, we hope that this L-P shunt is employed more widely for the patients with communicating hydrocephalus.

UI MeSH Term Description Entries
D007223 Infant A child between 1 and 23 months of age. Infants
D008161 Lumbosacral Region Region of the back including the LUMBAR VERTEBRAE, SACRUM, and nearby structures. Lumbar Region,Lumbar Regions,Lumbosacral Regions,Region, Lumbar,Region, Lumbosacral,Regions, Lumbar,Regions, Lumbosacral
D008297 Male Males
D010529 Peritoneal Cavity The space enclosed by the peritoneum. It is divided into two portions, the greater sac and the lesser sac or omental bursa, which lies behind the STOMACH. The two sacs are connected by the foramen of Winslow, or epiploic foramen. Greater Sac,Lesser Sac,Omental Bursa,Bursa, Omental,Cavity, Peritoneal,Sac, Greater,Sac, Lesser
D002557 Cerebrospinal Fluid Shunts Tubes inserted to create communication between a cerebral ventricle and the internal jugular vein. Their emplacement permits draining of cerebrospinal fluid for relief of hydrocephalus or other condition leading to fluid accumulation in the ventricles. Cerebrospinal Fluid Shunt,Shunt, Cerebrospinal Fluid,Shunts, Cerebrospinal Fluid
D002675 Child, Preschool A child between the ages of 2 and 5. Children, Preschool,Preschool Child,Preschool Children
D005260 Female Females
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D006849 Hydrocephalus Excessive accumulation of cerebrospinal fluid within the cranium which may be associated with dilation of cerebral ventricles, INTRACRANIAL HYPERTENSION; HEADACHE; lethargy; URINARY INCONTINENCE; and ATAXIA. Communicating Hydrocephalus,Congenital Hydrocephalus,Obstructive Hydrocephalus,Post-Traumatic Hydrocephalus,Aqueductal Stenosis,Cerebral Ventriculomegaly,Fetal Cerebral Ventriculomegaly,Hydrocephalus Ex-Vacuo,Hydrocephaly,Aqueductal Stenoses,Cerebral Ventriculomegalies,Cerebral Ventriculomegalies, Fetal,Cerebral Ventriculomegaly, Fetal,Fetal Cerebral Ventriculomegalies,Hydrocephalus Ex Vacuo,Hydrocephalus Ex-Vacuos,Hydrocephalus, Communicating,Hydrocephalus, Congenital,Hydrocephalus, Obstructive,Hydrocephalus, Post-Traumatic,Post Traumatic Hydrocephalus,Stenoses, Aqueductal,Stenosis, Aqueductal,Ventriculomegalies, Cerebral,Ventriculomegalies, Fetal Cerebral,Ventriculomegaly, Cerebral,Ventriculomegaly, Fetal Cerebral
D013346 Subarachnoid Space The space between the arachnoid membrane and PIA MATER, filled with CEREBROSPINAL FLUID. It contains large blood vessels that supply the BRAIN and SPINAL CORD. Space, Subarachnoid,Spaces, Subarachnoid,Subarachnoid Spaces

Related Publications

N Kuwana, and T Kuwabara, and F Nakajima, and H Hosoda, and K Yamaguchi
January 1981, Neuro-Chirurgie,
N Kuwana, and T Kuwabara, and F Nakajima, and H Hosoda, and K Yamaguchi
September 1974, No shinkei geka. Neurological surgery,
N Kuwana, and T Kuwabara, and F Nakajima, and H Hosoda, and K Yamaguchi
January 2010, Neurology India,
N Kuwana, and T Kuwabara, and F Nakajima, and H Hosoda, and K Yamaguchi
September 1979, La Radiologia medica,
N Kuwana, and T Kuwabara, and F Nakajima, and H Hosoda, and K Yamaguchi
December 1977, Archivos de farmacologia y toxicologia,
N Kuwana, and T Kuwabara, and F Nakajima, and H Hosoda, and K Yamaguchi
January 1979, Gastroenterologie clinique et biologique,
N Kuwana, and T Kuwabara, and F Nakajima, and H Hosoda, and K Yamaguchi
July 1980, No shinkei geka. Neurological surgery,
N Kuwana, and T Kuwabara, and F Nakajima, and H Hosoda, and K Yamaguchi
January 1982, Neuro-Chirurgie,
N Kuwana, and T Kuwabara, and F Nakajima, and H Hosoda, and K Yamaguchi
July 1977, [Zasshi] [Journal]. Nihon Kyobu Geka Gakkai,
N Kuwana, and T Kuwabara, and F Nakajima, and H Hosoda, and K Yamaguchi
March 1977, Nihon Jibiinkoka Gakkai kaiho,
Copied contents to your clipboard!