63741 Creation of shunt, lumbar, subarachnoid-peritoneal, -pleural, or other; percutaneous, not requiring laminectomy

Name of the Procedure:

Creation of Shunt, Lumbar, Subarachnoid-Peritoneal, -Pleural, or Other; Percutaneous, Not Requiring Laminectomy

Summary

A lumbar subarachnoid-peritoneal or -pleural shunt is a minimally invasive procedure to create a pathway for cerebrospinal fluid (CSF) to drain from the lumbar subarachnoid space to another body cavity such as the peritoneal or pleural space, without needing to remove a portion of the vertebral bone (laminectomy).

Purpose

This procedure is designed to treat conditions related to abnormal accumulation of cerebrospinal fluid in the lumbar region of the spine, such as hydrocephalus or pseudotumor cerebri. The goal is to alleviate symptoms by reducing intracranial pressure and improving CSF flow.

Indications

• Symptoms of elevated intracranial pressure (headaches, nausea)
• Hydrocephalus
• Pseudotumor cerebri
• Failed conservative treatments for CSF malabsorption

Preparation

• Patients may need to fast for a specified period before the procedure.
• Pre-procedure imaging tests like MRI or CT scans to plan the shunt placement.
• Medication adjustments, especially if the patient is on blood thinners.

Procedure Description

1. The patient is positioned to allow access to the lumbar region.
2. Local anesthesia or regional anesthesia is administered to numb the area.
3. Using imaging guidance, the surgeon inserts a needle or catheter into the lumbar subarachnoid space percutaneously (through the skin).
4. A catheter is threaded through the needle into the subarachnoid space and tunneled under the skin to reach the peritoneal or pleural cavity.
5. The shunt is tested to ensure CSF is flowing correctly.
6. The incision sites are then closed and bandaged.

Duration

The procedure typically takes about 1 to 2 hours.

Setting

This procedure is usually performed in a hospital operating room or a specialized surgical center.

Personnel

• Neurosurgeon or specialized surgeon
• Anesthesiologist or nurse anesthetist
• Surgical nurses
• Radiologist for imaging guidance

Risks and Complications

• Infection
• Shunt malfunction or blockage
• Bleeding or hematoma
• Nerve damage
• Abdominal or thoracic complications depending on the drainage site

Benefits

• Relief from symptoms of elevated intracranial pressure
• Reduced risk of brain damage due to prolonged high-pressure CSF
• Improved quality of life and daily functioning

Recovery

• Patients may need to stay hospitalized for a short period.
• Post-procedure monitoring for signs of infection or shunt malfunction.
• Gradual return to normal activities, typically within a few weeks.
• Scheduled follow-up appointments to check shunt function.

Alternatives

• Ventriculoperitoneal shunt
• Endoscopic third ventriculostomy (ETV)
• Medical management (diuretics, acetazolamide)
• Pros: Less invasive or no surgery required for medical management.
• Cons: May not be as effective or permanent as a shunt procedure.

Patient Experience

• The procedure is generally well-tolerated with localized pain managed by anesthesia.
• Some discomfort or pain at the incision sites post-procedure, usually managed with medications.
• Patients can expect to resume normal activities gradually, with careful monitoring and follow-up.