B15 Ventriculoperitoneal Shunting for Hydrocephalus

Abstract

John Holter – the pioneer who introduced the shunt for hydrocephalus – developed a valve that has been effective for many years. There is a vast array of shunt systems now available on the market and their description is beyond the scope of this chapter.

Ventriculoperitoneal (VP) shunting is carried out in most centres by paediatric neurosurgeons and should be in their domain; however, some paediatric surgical centres still carry out this procedure. Often the paediatric surgeon has to perform this procedure.

The patient is anaesthetised, intubated and positioned as in Fig. 1. It is essential that the positioning of the patient establishes a straight horizontal line from the skull to the abdomen. This is achieved by careful positioning and the use of rolls under the patient. It is the responsibility of the surgeon to ensure that this positioning is correct before the operation starts.

It is also the responsibility of the surgeon to select the appropriate shunt device, the ventricular cannula and peritoneal tubing. This is very often determined by the personal preference of the surgeon and the length is determined by the imaging available.

The imaging via a computerized axial tomography (CT) scan should be on view in the theatre next to the patient for the surgeon to view when attempting to insert the ventricular cannula into the ventricle.

The following rules should be applied to ensure a reduced risk of perioperative infection, the biggest complication of this procedure.