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Lumbar Catheter Misplacement into the Spinal Subdural Epiarachnoid Space Causing Lumboperitoneal Shunt Malfunction: Report of Two Cases

Lumboperitoneal (LP) shunting is a standard treatment for idiopathic normal pressure hydrocephalus (iNPH), with equivalent efficacy to ventriculoperitoneal (VP) shunting, and it is associated with a favorable outcome in approximately 75% of patients with iNPH. Despite the advantages, LP shunting can...

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Autores principales: IZUTSU, Nobuyuki, HOSOMI, Koichi, KAWAMOTO, Saki, KHOO, Hui Ming, YANAGISAWA, Takufumi, TANI, Naoki, OSHINO, Satoru, SAITOH, Youichi, KISHIMA, Haruhiko
Formato: Online Artículo Texto
Lenguaje:English
Publicado: The Japan Neurosurgical Society 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8769383/
https://www.ncbi.nlm.nih.gov/pubmed/35079461
http://dx.doi.org/10.2176/nmccrj.cr.2020-0203
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author IZUTSU, Nobuyuki
HOSOMI, Koichi
KAWAMOTO, Saki
KHOO, Hui Ming
YANAGISAWA, Takufumi
TANI, Naoki
OSHINO, Satoru
SAITOH, Youichi
KISHIMA, Haruhiko
author_facet IZUTSU, Nobuyuki
HOSOMI, Koichi
KAWAMOTO, Saki
KHOO, Hui Ming
YANAGISAWA, Takufumi
TANI, Naoki
OSHINO, Satoru
SAITOH, Youichi
KISHIMA, Haruhiko
author_sort IZUTSU, Nobuyuki
collection PubMed
description Lumboperitoneal (LP) shunting is a standard treatment for idiopathic normal pressure hydrocephalus (iNPH), with equivalent efficacy to ventriculoperitoneal (VP) shunting, and it is associated with a favorable outcome in approximately 75% of patients with iNPH. Despite the advantages, LP shunting can result in problems associated with the lumbar catheter, the obstruction of which has not been well described. This report presents two cases of LP shunt malfunction caused by lumbar catheter misplacement into the spinal subdural epiarachnoid space (SSES), and by subsequent obstruction. A 67-year-old man and a 69-year-old woman with iNPH underwent LP shunt placement without intraoperative fluoroscopy. Shortly after the surgery, they experienced a temporary improvement of their symptoms which was, however, followed by recurrence within a few months. This was suggestive of shunt malfunction. Although shunt pumping tests were normal, shuntography and subsequent computed tomography (CT) revealed lumbar catheter misplacement into the SSES. Shunt revisions, in which only the lumbar catheters were exchanged, were performed with intraoperative fluoroscopy and shuntography. Their symptoms have improved again following the revisions. In the present cases, lumbar catheter misplacement into the SSES caused LP shunt malfunction, and shuntography and CT were useful to detect the abnormality. Moreover, unrecognized lumbar catheter misplacement into the SSES might potentially have occurred in some patients considered as “non-responders” to LP shunting; hence, shuntography may be useful in those patients.
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spelling pubmed-87693832022-01-24 Lumbar Catheter Misplacement into the Spinal Subdural Epiarachnoid Space Causing Lumboperitoneal Shunt Malfunction: Report of Two Cases IZUTSU, Nobuyuki HOSOMI, Koichi KAWAMOTO, Saki KHOO, Hui Ming YANAGISAWA, Takufumi TANI, Naoki OSHINO, Satoru SAITOH, Youichi KISHIMA, Haruhiko NMC Case Rep J Case Report Lumboperitoneal (LP) shunting is a standard treatment for idiopathic normal pressure hydrocephalus (iNPH), with equivalent efficacy to ventriculoperitoneal (VP) shunting, and it is associated with a favorable outcome in approximately 75% of patients with iNPH. Despite the advantages, LP shunting can result in problems associated with the lumbar catheter, the obstruction of which has not been well described. This report presents two cases of LP shunt malfunction caused by lumbar catheter misplacement into the spinal subdural epiarachnoid space (SSES), and by subsequent obstruction. A 67-year-old man and a 69-year-old woman with iNPH underwent LP shunt placement without intraoperative fluoroscopy. Shortly after the surgery, they experienced a temporary improvement of their symptoms which was, however, followed by recurrence within a few months. This was suggestive of shunt malfunction. Although shunt pumping tests were normal, shuntography and subsequent computed tomography (CT) revealed lumbar catheter misplacement into the SSES. Shunt revisions, in which only the lumbar catheters were exchanged, were performed with intraoperative fluoroscopy and shuntography. Their symptoms have improved again following the revisions. In the present cases, lumbar catheter misplacement into the SSES caused LP shunt malfunction, and shuntography and CT were useful to detect the abnormality. Moreover, unrecognized lumbar catheter misplacement into the SSES might potentially have occurred in some patients considered as “non-responders” to LP shunting; hence, shuntography may be useful in those patients. The Japan Neurosurgical Society 2021-06-05 /pmc/articles/PMC8769383/ /pubmed/35079461 http://dx.doi.org/10.2176/nmccrj.cr.2020-0203 Text en © 2021 The Japan Neurosurgical Society https://creativecommons.org/licenses/by-nc-nd/4.0/This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-nd/4.0/ (https://creativecommons.org/licenses/by-nc-nd/4.0/)
spellingShingle Case Report
IZUTSU, Nobuyuki
HOSOMI, Koichi
KAWAMOTO, Saki
KHOO, Hui Ming
YANAGISAWA, Takufumi
TANI, Naoki
OSHINO, Satoru
SAITOH, Youichi
KISHIMA, Haruhiko
Lumbar Catheter Misplacement into the Spinal Subdural Epiarachnoid Space Causing Lumboperitoneal Shunt Malfunction: Report of Two Cases
title Lumbar Catheter Misplacement into the Spinal Subdural Epiarachnoid Space Causing Lumboperitoneal Shunt Malfunction: Report of Two Cases
title_full Lumbar Catheter Misplacement into the Spinal Subdural Epiarachnoid Space Causing Lumboperitoneal Shunt Malfunction: Report of Two Cases
title_fullStr Lumbar Catheter Misplacement into the Spinal Subdural Epiarachnoid Space Causing Lumboperitoneal Shunt Malfunction: Report of Two Cases
title_full_unstemmed Lumbar Catheter Misplacement into the Spinal Subdural Epiarachnoid Space Causing Lumboperitoneal Shunt Malfunction: Report of Two Cases
title_short Lumbar Catheter Misplacement into the Spinal Subdural Epiarachnoid Space Causing Lumboperitoneal Shunt Malfunction: Report of Two Cases
title_sort lumbar catheter misplacement into the spinal subdural epiarachnoid space causing lumboperitoneal shunt malfunction: report of two cases
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8769383/
https://www.ncbi.nlm.nih.gov/pubmed/35079461
http://dx.doi.org/10.2176/nmccrj.cr.2020-0203
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