Intraoperative fluoroscopy with contrast medium for correct lumbar catheter placement in lumboperitoneal shunts

We use intraoperative fluoroscopy with contrast medium for correct placement of lumbar catheters in lumboperitoneal (LP) shunts. The patients are in the left or right lateral decubitus position on a radiolucent operating table and a portable C-arm fluoroscope is placed vertically. After confirming the puncture level fluoroscopically, a lumbar puncture is performed. The catheter is introduced into the spinal canal, and its placement is confirmed fluoroscopically by injecting contrast medium into the catheter. If loop formation and/or caudal migration of the catheter are discovered, the catheter is placed correctly under fluoroscopy with contrast medium. Because filling the catheter with contrast medium improved visualizing it in the spinal canal, using this method, we successfully corrected all four misplaced catheters observed in 20 consecutive LP shunt patients (20%). There were no complications, such as shunt malfunction and/or migration, infection, or radiculopathy in either leg at a median follow-up of 4.5 years (range, 3.8-5.2 years). The conventional, i.e., "blind" LP shunt procedure risks incorrect placement of the lumbar catheter; therefore, intraoperative fluoroscopy with contrast medium improves the accuracy of the shunt placement and minimizes the risk of complications.