• Yukihiro Goto, Hideki Oka, and Akihiko Hino.
• Department of Neurosurgery, Saiseikai Shiga Hospital, Rittou, Shiga, Japan. Electronic address: yoursongmysong@hotmail.com.
• World Neurosurg. 2021 Feb 1; 146: e1092-e1096.

BackgroundOne possibly problematic feature of lumboperitoneal shunt (LPS) placement involves inaccuracy in handling the shunt valve compared with ventriculoperitoneal shunt. Flushing the valve to ascertain shunt patency and adjusting the valve pressure in LPS are often more difficult than with ventriculoperitoneal shunt, particularly when the valve is routinely located in abdominal fat. To overcome this inaccuracy, we applied a simple alteration to the usual LPS procedure. We changed the valve location from the abdominal fat to a lumbar posterior site where the paravertebral spinal muscle, in contrast to the nonsupportive abdominal fat, offers a good anchoring point for valve implantation.MethodsWe retrospectively reviewed 51 consecutive patients undergoing LPS placement for normal pressure hydrocephalus. We divided the patients into 2 groups, anterior or lateral and posterior, and analyzed these 2 groups, focusing on technical features and outcomes.ResultsIn the anterior or lateral group, 1 patient showed an inverted valve position, and errors occurred when adjusting the valve pressure in 3 patients. There were no wound complications, such as skin erosion. Two patients experienced periumbilical discomfort. In the posterior group, no patients showed an inverted valve position or errors associated with adjustment of the pressure. There were no wound complications, such as skin erosion, or reports of discomfort.ConclusionsIn this series, our modification increased the accuracy of handling the valve without increasing discomfort.Copyright © 2020 Elsevier Inc. All rights reserved.

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