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. 2024 Oct 1;5(4):e00113.
doi: 10.1227/neuprac.0000000000000113. eCollection 2024 Dec.

Lumbocaval Shunt for Idiopathic Intracranial Hypertension: A Technical Report and Case Series

Nanthiya Sujijantarat  1 , Andrew B Koo  1 , Aladine A Elsamadicy  1 , Joseph P Antonios  1 , Daniela Renedo  1 , Joseph O Haynes  1 , Bushra Fathima  1 , Brianna C Theriault  1 , Miguel M Chavez  1 , Abdelaziz Amllay  1 , Kamil W Nowicki  1 , Matthew Kanzler  1 , Jasmine W Jiang  1 , Apurv H Shekar  1 , Ryan M Hebert  1 , Michael L DiLuna  1 , Charles C Matouk  1   2
Affiliations

Lumbocaval Shunt for Idiopathic Intracranial Hypertension: A Technical Report and Case Series

Nanthiya Sujijantarat et al. Neurosurg Pract. .

Abstract

Background and objectives: Neurosurgical management of idiopathic intracranial hypertension (IIH) can be challenging given high rates of revision associated with cerebrospinal fluid shunting. In this study, we present a technical report and early outcomes for lumbocaval shunt (LCS) placement in difficult-to-manage cases.

Methods: A literature search was performed for previous reports of LCS or lumboatrial shunt. Electronic medical records of patients who underwent placement of LCS for the treatment of IIH at a single institution were reviewed. Based on early experience and outcomes, our modified technique for LCS is described.

Results: Six patients (4 females, median age 36 years [IQR 31-43]) underwent placement of LCS between October 2023 and April 2024. LCS was completed in all cases without intraoperative complications. The median operative time was 88.5 minutes [IQR 79.5-158.8]. One patient developed low-pressure headaches that resolved after the addition of a shunt-assist device. Five of 6 patients reported improved headache at the last follow-up visit, with 4 of 5 patients reporting that their high-pressure headaches completely resolved (median time to the last follow-up of one month [IQR 1-2 months]). During the study period, one shunt revision was performed because of migration of the lumbar shunt into a suprafascial pocket. This led to modification of the surgical technique, specifically the inclusion of anchoring dips.

Conclusion: LCS may represent an alternative shunting technique in difficult-to-manage patients with IIH. Further assessment of long-term outcomes is needed.

Keywords: CSF shunt; Case series; Idiopathic intracranial hypertension; Lumboatrial shunt; Lumbocaval shunt.

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Conflict of interest statement

The authors have no personal, financial, or institutional interest in any of the drugs, materials, or devices described in this article.

Figures

FIGURE 1.
FIGURE 1.
A and B, Prone stage of the LCS procedure. C, The relationship between the flank incision, the abdominal incision, and the femoral vein access site. D-G, Supine stage of LCS. LCS, lumbocaval shunt.
FIGURE 2.
FIGURE 2.
A, Fluoroscopic image of the valve and the distal shunt catheter coursing from the upper abdomen down to the femoral vein region before being internalized into the inferior vena cava. B, Fluoroscopic confirmation of the shunt tip position proximal to the heart.
FIGURE 3.
FIGURE 3.
Final lumbocaval shunt configuration.
FIGURE 4.
FIGURE 4.
Computed tomography reconstruction with A, anteroposterior and B, posteroanterior views of the lumbocaval shunt.
See this image and copyright information in PMC

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