Unintentional aortic puncture during lumboperitoneal shunt placement

Abstract

Unintentional aortic puncture has not been reported during lumboperitoneal (LP) shunt placement. A patient with normal pressure hydrocephalus (NPH) had arrest of cerebrospinal fluid (CSF) flow after each of 3 punctures for LP shunt placement. Because of that, bone was removed from 2 adjacent spinous processes to visualize the midline interlaminar space through which a 14 gauge Tuohy needle was advanced, still without obtaining any CSF. The needle was then pushed further through some resistance. Arterial blood came out when the stylet was removed. X-ray showed the needle to be through the L2-L3 disc with its tip in the aorta. Under fluoroscopy, it was slowly withdrawn. The track was then injected with Surgiflo mixed with contrast. Two aneurysm coils were deployed in it before removing the needle. The patient had no sequelae and an LP shunt was placed uneventfully through the same space four days later. Excellent resolution of NPH symptoms was maintained at 13 months postoperatively.

Keywords

• Lumboperitoneal shunt
• Dry tap
• Aortic puncture