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Minimal exposure maximal precision ventriculoperitoneal shunt: how I do it

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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References

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Author information

Correspondence to Luigi Rigante.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (name of institute/committee) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Patient consent statement

The patient next of kin has consented to the submission of this How I Do It for submission to the journal.

Additional information

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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)

Video 1

Parietal retroauricular incision and subgaleal pocket creation, distal catheter tunneling, abdominal laparoscopic approach, and transcutaneous peritoneal puncture under laparoscopic view. (MP4 83,526 kb)

Video 2

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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Cite this article

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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Keywords

  • Cerebrospinal fluid
  • General surgery
  • Hydrocephalus
  • Infection
  • Laparoscopy
  • Neuronavigation
  • Neurosurgery