51 Ventricular-Peritoneal Shunt

51.2 Patient Positioning (Fig. 51.1)

• Position: The patient is positioned supine, with the head placed on the bed headboard.

• Body: The body is placed in neutral position.

• Head: The head has to be free to rotate over the headboard; a rubber ring could be used to support it.

• Shoulders: Shoulders are placed in neutral position.

• Upper limbs: Upper limbs should be kept parallel to the trunk.

51.2.1 Suggestions

• If the neck lateral curvature is wide, the head can be angled downward in order to open that angle and make tunneling maneuvers easier.

• Abdomen and thorax must be kept in neutral position, free from any device (e.g., electrocardiographic leads, patches, and bandages).

Fig. 51.1 Patient positioning and landmarks. Coronal suture crosses midline 12 cm behind the nasion. Mid-pupillary line is 2.5–3 cm lateral from the midline. Skin incision (red dotted line) runs around the intersection of mid-pupillary line and coronal suture line.
Abbreviations: CS = projection line of coronal suture; M = midline; MPL = mid-pupillary line.

• Head: C-shaped incision (Figs. 51.1, 51.2)

◦ Anatomical landmarks: Coronal suture can be palpated 12 cm behind the nasion on the midline. From this point, the center of the incision should be marked 3 cm laterally (at the mid-pupillary line) and 1 cm ahead.

◦ Side: Preferably right (nondominant) side.

◦ Starting point: Incision starts 2 cm ahead the central point, on the mid-pupillary line.

◦ Course: Incision curves medially around the central point.

◦ Ending point: It ends 2 cm behind the central point, on the mid-pupillary line.

• Abdomen: linear incision (Fig. 51.3)

◦ Anatomical landmarks: Umbilicus.

◦ Starting point: Incision starts 1 cm lateral to the umbilicus.

◦ Course: It runs straight laterally for 5 cm.

• Other incisions: Small linear incisions

Adjunctive small linear incisions can be made in the supraclavicular and/or retro-auricular areas.

• Starting and ending points: Starting and ending points are placed over the tunneler.

• Course: Incision runs 2 cm, perpendicular to the major axis of the tunneler.

51.3.1 Critical Structures

• None.

Fig. 51.2 Cranial landmarks for ventricular puncture. Burr hole must be performed 2–3 cm lateral from the midline and 1 cm anterior to the coronal suture (blue line).

Fig. 51.3 Para-umbilical skin incision with exposure of the superficial muscle fascia.
Abbreviations: R = retractor; SMF = superficial muscle fascia; U = umbilicus.

Related posts:

Training Models in Neurosurgery Frontotemporal and Pterional Approach Mini-Pterional Approach Intradural Subtemporal Approach Combined Orbito-Zygomatic Approaches Fundamentals of Cranial Neurosurgery

Stay updated, free articles. Join our Telegram channel

Join