Prevention of valve reversal in lumboperitoneal shunt surgery: Effectiveness of above-the-superficial-fascia placement using an inline shunt passer.

BACKGROUND

Valve reversal following lumboperitoneal shunt (LPS) surgery can lead to valve mis adjustment or failure, potentially causing complications such as overdrainage and chronic subdural hematoma. While proper fixation and placement depth are considered important for prevention, effective strategies have not been well established.

METHODS

We retrospectively analyzed 30 LPS procedures performed at our institution from January 2021 to December 2024. The technique involved valve placement above the superficial fascia using an inline shunt passer, combined with fascial sheath formation via fascial suturing. Postoperative CT or X-ray imaging was used to assess valve position and detect reversal.

RESULTS

Among the 30 patients (17 men and 13 women; mean age, 73.3 years), no cases of valve reversal were observed (0 %). The mean distance from the skin to the valve center was 6.1 mm, and the mean distance from the spinous process to the valve was 7.9 cm.

CONCLUSIONS

Placement of the valve above the superficial fascia using an inline shunt passer, combined with fascial sheath formation, appears to be an effective strategy for preventing valve reversal after LPS surgery. This technique may offer a reliable and reproducible method to ensure valve stability regardless of anatomical positioning, with potential to improve postoperative safety.