Clinical Value Of Lumboperitoneal Shunts For The Treatment Of Post-traumatic Communicating Hydrocephalus

Objective: To assess the effectiveness and safety of lumboperitoneal shunt for treatment of post-traumatic communicating hydrocephalus(PTCH)Methods: A retrospective analysis of medical records of patients with lumboperitoneal shunts admitted in Shanghai Tenth People’s Hospital from January 2014 to March 2017 was done.Experience with lumboperitoneal shunt placement for PTCH was reviewed.The diagnosis of PTCH was based on ventricular enlargement with the Evans’ index(EI>0.3)before shunt implantation.Patients were evaluated for improvements in Glasgow Coma Scale(GCS),Glasgow Outcome Scale(GOS),and Evans’ index and complication(malposition,obstruction,disconnection,overdrainage symptoms,infection)after shunt placement.Results: Totally,34 patients(12 women and 22 men)having PTCH were included.The average age of these patients was 49.32 years(range 9-67 years).The average follow-up period was 3.9±3.5 months.Before LP shunt,the GOS score was2(2,3),the GCS score was 8.53±3.38,and the Evans’ index score was 0.4±0.08.After shunt implantation,the GOS score was 3(2,3),the GCS score was 10.29±3.15,and the EI score was 0.34±0.13,respectively(P<0.05).Before LP shunt,24(70.58%)patients had a GOS score of 2(vegetative state),and 10(29.42%)patients had a GOS score of 3(severe disabled).After LP shunt,18(52.94%)patients had improvement in GOS(11 patients improve from GOS2 to GOS3,5 patients from GOS3 to GOS4 and 2 patients from GOS3 to GOS5),22(64.71%)patients achieved improvement in their GCS(14 patients GCS improvements ≥2 and 8 patients GCS improvement=1),21(61.76%)patients had Evans’ index improvement(18 patients with EI < 0.3).There was no complication(malposition,obstruction,disconnection,overdrainage symptoms,infection)in this study.Conclusion: Our experience suggests that when surgical candidates have chosen appropriately,lumboperitoneal shunts are effective for the treatment of PTCH.The clinical results after shunt insertion suggest significant improvement in nearly 50% of patients diagnosed with PTCH.Lumboperitoneal shunt is a safe treatment modality with lower rates of complication and can be a practical and effective alternative treatment for PTCH.LP shunt placement is safe and effective for PTCH,and serious complications(malposition,obstruction,disconnection,overdrainage symptoms,infection)were not observed.