Lumboperitoneal shunting as a rescue strategy in the management of complex cranial wound conditions.

Objective: Complex cranial wound conditions (CCWC), particularly when associated with hydrocephalus and/or implant-related infections, pose a major challenge in neurosurgical complication management. In such cases, moving the shunt system from the cranial to the lumbar compartment appears to be a valuable salvage strategy. Research question: Can lumboperitoneal shunting (LPS) including differential pressure and gravitational valves serve as an effective rescue strategy in patients with different types of CCWC? Methods: We conducted a single-center retrospective study of 15 patients treated with LPS implantation for CCWC between March 2023 and August 2025. Clinical data were extracted from medical records, including patient demographics, CCWC type, surgical parameters, complications and outcomes. Results: The cohort included 8 female and 7 male patients, with a median age of 53 years (range, 25-87). CCWC secondary to CSF fistulas following tumor resection accounted for 9 cases, VPS-associated infection for 3 cases, and decompressive craniectomy for 3 cases. In 5 patients, wound healing was further impaired by prior radiation and chemotherapy. Median surgical time was 60 min (IQR, 47-82), and median hospitalization was 6 days (IQR, 3-15). Wound healing resolved after LPS implantation in all but one patient. Complications occurred in 2 patients, both related to overdrainage. Implant survival rate was 100 %. Conclusion: LPS implantation represents a valuable salvage strategy for patients with CCWC, particularly in the context of decompressive craniectomy, radiation-exposed tissue, or prior implant-associated infection. LPS promotes cranial wound healing while ensuring CSF diversion, with adjustable gravitational valves being essential especially in craniectomized patients.