Lumbo-omental shunt for treatment of communicating hydrocephalus

Many techniques have been developed for the treatment of hydrocephalus since Kausch in 1908 (1) inserted a rubber tube from the lateral ventricle of the brain into the peritoneal cavity. Most of these techniques employ tubes of rubber, plastic material, or metal to drain cerebrospinal fluid (CSF) from the CSF space to other body cavities or into a vein. Many of these shunts require mechanical valves of plastic material or metal for both interposed along the course of the conductive tubing to promote unidirectional flow of SCF and to prevent reflux of blood or other body fluids. In consequence a large number of complications are common, such as disconnection or blocking of the tubing, valve insufficiency, bacterial colonization and outgrowing the length of the catheter (2). It has also been shown that rapid decompression following ventriculoatrial or ventriculo-peritoneal shunts may result in an epidural or subdural haematoma (30). Furthermore, the rapid removal of CSF may also cause ventricular collapse with the draining cerebral shunt catheter trapped between the abutting ventricular walls with high risk of occlusion of the catheter (4). In 1963 Scarff (2) found that the incidence of severe late complications was many times greater after most shunt operations with foreign material than after those techniques where foreign material was not introduced. All this indicates that the techniques at present in routine use are far from perfect, and that further research is required.