Abstract
Based on preliminary experiences from the early 1970s, a patient with chronic and severe communicating hydrocephalus has been successfully treated with transposition of an omental pedicle to the lumbar subarachnoidal space. This patient, who suffered from congenital toxoplasmosis, at the age of 29 years had undergone no fewer than 82 shunt revisions. In the 5-year follow-up after treatment, she has had no further surgery or other treatment. She is in excellent condition and has demonstrated definite signs of improved CSF circulation. This case report confirms that a pedicle of the omentum may serve as an effective CSF absorber in patients presenting with persistent failures with conventional treatments of communicating hydrocephalus, avoiding the use of any implanted foreign material.
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Björn Meyerson
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Comment
This paper describes a quite unusual treatment for communicating hydrocephalus by means of a “lumbo-omental shunt.” The technique already had been utilized by the senior author as early as the 1970s with reported good results in four patients with communicating hydrocephalus. The present case report describes its utilization to treat a patient with communicating hydrocephalus who had collected the incredible number of more than 80 shunt revisions because of superimposed infectious complications. Again, the results of the operation were particularly successful, with clinical recovery and absence of any new complications over the following 5 years.
In my opinion, this case deserves publication as it suggests an alternative (and quite brilliant) way to treat hydrocephalic patients with multiple CSF shunt complications, namely those with infectious complications.
Massimo Caldarelli
Rome, Italy
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Levander, B.E., Svensson, M., Wallstedt, L. et al. Treatment of communicating hydrocephalus by a lumbo-omental shunt: case report. Acta Neurochir 152, 707–708 (2010). https://doi.org/10.1007/s00701-009-0464-5
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DOI: https://doi.org/10.1007/s00701-009-0464-5