Insertion of Ventriculoperitoneal Shunt




Indications




  • •

    Hydrocephalus, communicating or obstructive, which is not amenable to endoscopic third ventriculostomy or treatment of primary etiology (i.e., removal of fourth ventricle neoplasm)


  • •

    Failure of previously placed shunt system





Contraindications




  • •

    Fevers or any evidence of active intracranial infection


  • •

    Abnormal cerebrospinal fluid (CSF) rheology (high protein, pleocytosis, intraventricular hemorrhage)


  • •

    Body weight less than 2 kg (relative)





Planning and positioning




  • •

    All patients should have recent preoperative imaging with computed tomography (CT) or magnetic resonance imaging (MRI).


  • •

    The patient receives preoperative antibiotics before the skin incision. Hair clipping is minimized.




    Figure 52-1:


    The patient is positioned supine with the head turned to the left. A bump is placed under the shoulders to allow for straight trajectory from the right occiput, across the clavicle, to the abdomen.





Procedure





Figure 52-2:


An abdominal incision is made in a horizontal fashion in the right mid-abdomen with needle electrocautery. Fascial layers are incised sharply, and muscle fiber division is minimized.



Figure 52-3:


The peritoneum is gently elevated with mosquito clamps and incised with a No. 11 blade. Care is taken to avoid bowel injury. Visual confirmation of entry into the peritoneal cavity is made.

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Jun 15, 2019 | Posted by in NEUROSURGERY | Comments Off on Insertion of Ventriculoperitoneal Shunt

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