Equipment

In addition to the standard surgical instruments needed to open and close the peritoneal cavity, a Tuohy needle and catheter passing instrument (shunt tunneler) are used when placing a lumboperitoneal shunt. The Tuohy needle is a hollow needle used to access the spinal compartment and has a curved tip to direct the catheter. The catheter passing instrument is a hollow metal tube used to bluntly dissect through the subcutaneous tissues. Specifically, it is used to pass the catheter from the spinal access site to the flank and/or the abdominal incision.

Anesthesia

General anesthesia is typically used when placing a lumboperitoneal shunt, but other options are possible.

Positioning

The patient is placed in a lateral decubitus position with arms raised above the shoulders. Care is taken to properly support the patient’s arms in a position of comfort and to avoid localized compression. Soft gel pads are placed to maintain the patient in this position. The lateral decubitus position gives the surgeon operative access to both the spinal and peritoneal compartments, as well as the tract along which the catheter is passed.

Once in this position, the patient is widely prepared in the region to allow for access to more than one spinal level, along the lateral aspect of the patient’s flank where the catheter is passed or valve placed, and on the abdomen where the peritoneal cavity is accessed. Visibility of the superior iliac crest should be maintained as an anatomic landmark.

Monitoring & Follow-up

Maintenance of a lumbar-peritoneal shunt requires access to urgent neurosurgical care, although routine follow-up or shunt studies are probably unnecessary. Of course, a return of symptoms would typically lead to an investigation of shunt function. Radionuclide shunt studies are not routinely performed, but CT scans are often used to diagnose displacement, and a lumbar puncture can usually be used to measure CSF pressure.

Technique

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Media Gallery

Passing the catheter-tunneling instrument through the abdominal incision to the dorsal incision.
Pulling the lumboperitoneal shunt from the catheter-tunneling instrument.
The successful passing of the lumboperitoneal shunt. The catheter-tunneling instrument has been removed.
A rostral view of the catheter passed from the dorsal incision (right) to the abdominal incision (left).
The draining-slits of the lumboperitoneal shunt.