Operative Planning

• Computed tomography (CT) scan or magnetic resonance imaging to review ventricular size and associated intracranial anatomy
  
• Prior head CT when patient’s shunt was known to be working is useful in helping to determine shunt failure via comparison of ventricular size
  
• Neuronavigation may be indicated for intraventricular shunt placement in small ventricles
  
• Shunt series to evaluate for any kinks or disconnection in the shunt system
  
• Clinical assessment with palpation of shunt bulb and shunt tapping when indicated to assist in determining site of shunt failure

Special Equipment

• Basic shunt tray
  
• Intraventricular catheter; antibiotic-impregnated catheters have been shown to decrease incidence of shunt infections
  
• Shunt valve; choice and setting is usually case specific and surgeon dependent
  
• Tunneler
  
• Distal catheter
  
• A 10-mL saline filled syringe attached to manometer with stopcock and a blunt tip needle
  
• If problem is related to the peritoneal cavity (i.e., fluid loculation secondary to adhesions), consider general surgery consult for intraoperative assistance at distal catheter fragment removal and replacement.