Abstract
Background
Ventriculoperitoneal shunt is among the most frequent neurosurgical procedures, complicated by infection and obstruction. The first is influenced by number of skin incisions, catheter exposure and manipulation, and the latter by catheter position.
Method
Presenting our neuronavigated laparoscopic-assisted minimal exposure shunt technique performed on 40 consecutive adults. No patient presented infection or distal catheter migration (mean follow-up 12 months). Ventricular catheter malpositioning associated with electromagnetic neuronavigation inaccuracy occurred in two patients with slit ventricles.
Conclusion
This technique demonstrates low infection/malfunction rate, postoperative pain, and cosmetic advantages. Limiting factors are availability of laparoscopic surgeons and neuronavigation if not familiar with the approach.
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This article is part of the Topical Collection on CSF Circulation
Key points
• Malfunction and infections are the most common shunt complications.
• Contact to the skin and number of incisions are associated with shunt infection.
• Single-pass tunneling decreases the infection rate.
• Catheter disconnection and/or malposition are causes of malfunction.
• Laparoscopic approach is increasingly used in shunts.
• Most laparoscopic approaches imply externalization of the distal catheter before peritoneal insertion.
• Octylcyanoacrylate, antibiotic impregnated sutures, and vancomycin powder reduce dehiscence and infection rate.
• This technique reduces the risks of infection, malpositioning, and malfunction.
• Cosmetic results, abdominal incisional pain, and length of hospital stay are improved.
• Limiting factors are availability of general surgeons and neuronavigation.
Electronic supplementary material
Parietal retroauricular incision and subgaleal pocket creation, distal catheter tunneling, abdominal laparoscopic approach, and transcutaneous peritoneal puncture under laparoscopic view. (MP4 83,526 kb)
Abdominal catheter positioning into the peritoneum, navigation-assisted ventriculostomy, system connection, verification of system functioning, overview on cranial and abdominal incisions. (MP4 31,562 kb)
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Rigante, L., Navarro, R. & Roser, F. Minimal exposure maximal precision ventriculoperitoneal shunt: how I do it. Acta Neurochir 161, 1619–1622 (2019). https://doi.org/10.1007/s00701-019-03968-4
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DOI: https://doi.org/10.1007/s00701-019-03968-4