[Post-operative complications peculiar to lumboperitoneal shunt: possible consequences due to side leakage of CSF from around the inserted spinal tube into the lumbar epidural space].

This is a report on a few possible consequences of occasional side leakage of CSF into the lumbar epidural space. In this report, we refer to such CSF side leakage from around the inserted spinal tube which occurred during the early stages following our lumboperitoneal shunt operations in two of our patients. This leakage can lead to over-drainage of CSF, and such complications as post-operative orthostatic headache, subdural effusion, and/or subdural hematoma can also result. The diagnosis of these complications can be verified if CSF components in the lumbar epidural space are visible in T2 weighted-fat saturation images captured on MRI. Commonly, CSF over-drainage is attributed to improper pressure settings of the shunt valve and/or siphon effects of shunt systems induced by the patients' postural changes. In addition to this, we strongly suggest anticipating the complications peculiar to lumboperitoneal shunt, because these are possible occurrences, although they have never been pointed out. In the surgical treatment of idiopathic normal pressure hydrocephalus, which is found mainly in elderly patients, increasing numbers of surgeons these days prefer lumboperitoneal shunt to ventriculoperitoneal shunt, as the former causes less damage to the brain. Given this trend towards lumboperitoneal shunt operations, we urge that the complications mentioned here be borne in mind as possible consequences.