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

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.