Temporary Lumbar Subcutaneous Cerebrospinal Fluid Shunt Placement in Pediatric Patient: a Technical Note

Abstract

Background—We report the technical aspects of lumbar subcutaneous cerebrospinal fluid (CSF) shunt
for temporary CSF drainage that may be an alternative strategy to lumbar catheter placement with external
drainage system.
Case Description—A 7 years and nine-month old boy with developmental delay, intermittent episodes
of agitation, and combination of myoclonic and generalized tonic clonic seizures, associated with communicating hydrocephalus was evaluated. A temporary CSF drainage trial was contemplated to determine
whether a permanent CSF shunt would be beneficial. A temporary lumbar subcutaneous CSF shunt was
performed to avoid catheter dislodgement or drainage system disruption due to child’s agitative behavior
and seizures. The catheter was inserted into the subarachnoid space at L3–L4 vertebral level and advanced
approximately 20 cm above site of insertion and approximately 4 cm was imbedded into the subcutaneous
tissue. An ultrasound two days later demonstrated CSF collection in subcutaneous tissue measuring 3.48
cm × 0.84 cm surrounding the catheter tip. The patient’s parents reported improvement in clinical symptoms after four days of CSF drainage.
Conclusions—Lumbar subcutaneous CSF shunt may be used for temporary CSF drainage for diagnostic
purposes without the need for in patient admission and monitoring required for standard lumbar catheter
with external CSF drainage system.