Lumbar shunting has long been used to divert excess CSF in patients with communicating hydrocephalus. The first lumbar shunt was attributed to Ferguson in 1898. He shunted CSF from the lumbar theca to the peritoneum using a silver wire passed through a drill hole in a lumbar vertebrae. This however, was not too effective, as the patients died within 3 months.1 Following the failure of this initial LP shunt, alternative solutions were investigated. Alternative sites of draining CSF to included the omental bursa, stomach, gall bladder, ileum, the ureter and the fallopian tubes. Of these, the lumbo-ureter shunts proved to be the most successful, and was a well establish procedure by 1952. However, this was not a viable solution for patients with kidney problems, or that only have one kidney.1,2 In the 50’s, lumbo-peritoneal shunting was again brought to the fore front, when Dr. Alexander was unable to place the shunt in the ureter of a baby with only one kidney. The promising results that were demonstrated by this one LP shunt , persuaded him to do a series of LP shunts. Folowing this LP shunting was performed more often, but complications with the peritoneal tubing collapsing was a common occurance. It wasn’t until the development of silicone tubing, in the 60’s that LP shunting became a more common procedure.1,2

      There are several advantages to using an LP shunts, rather than other types of shunts. First, since the cerebral mantle is not disturbed during the surgery, there is less damage to the cerebral mantle.3,4 Second, there is no choroids plexus, epenyma or glial tissue to obstruct the lumbar catheter.3, They also lend themselves to be used in cases with vary small ventricles, to small to cannulate with a ventricular catheter. 3 Another advantage is minimizing the siphon effect which occurs with postural changes. 4 Additionally there is a lower incidence of infection with LP shunts, as opposed to VP shunts.5 And finally, the LP shunts can be placed under local anesthesia for patients who are at high risk for general anesthesia. Unfortunately, the disadvantage of using LP shunts is that they are only feasible for the treatment of communicating hydrocephalus.3 Lumbar peritoneal shunting has since been simplified by the introduction of percutaneous techniques. These techniques have included detemining shunt effectiveness in the cases on normal pressure hydrocephalus, and other cases on communicating hydrocephalus.