Ventriculoperitoneal Shunt Implantation
Ventriculoperitoneal shunt implantation technique has benefited from the use the minimal access implantation of the shunt end in the abdomen. Re-do procedures of ventriculoperitoneal shunt implantations are better performed under endoscopic vision when ad
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42 Ventriculoperitoneal Shunt Implantation Amulya K. Saxena and Hans G. Eder
42.1
Operation Room Setup
Surgical Team Position
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Chapter 42 Ventriculoperitoneal Shunt Implantation
42.2
Patient Positioning
Supine position with arms tucked to the side.
42.4
Location of Access Points
Port Placement Sites
42.3
Special Instruments
Ventriculoperitoneal shunt system.
Amulya K. Saxena and Hans G. Eder
42.5
Indications
42.6
Relative Contraindications
Communicating and noncommunicating forms of hydrocephalus in: 1. Intraventricular hemorrhage. 2. Inflammation. 3. Neoplastic diseases. 4. Congenital malformations. 5. Trauma-associated conditions. 6. Special indication is severe adhesions after prior abdominal surgery.
Severe central nervous system malformations.
42.7
42.8
Preoperative Considerations
Technical Notes
1. The patient is draped with the head and neck exposed on the side that the shunt is to be placed. The abdomen, however, is draped in a fashion suitable for abdominal procedures. 2. Consider rifampicin- or clindamycin-impregnated silicone shunts in complicated cases. 3. Antibiotics may be administered preoperatively. 4. Efforts should be taken to avoid hypothermia during surgery in infants. 5. The scalp is shaved at the site of intended catheter placement.
1. Care is taken to minimize handling of the shunt throughout the entire surgical procedure. 2. In the case of abdominal adhesions, two ports are introduced and the adhesions are removed using conventional laparoscopic methods. 3. Using a port (peel-away sheath) to insert the shunt in the abdomen prevents direct contact of the shunt with the abdominal skin. Use of skin foil is also recommended. 4. The scope should control the placement and flow of the shunt before closure.
42.9
42.10 Laparoscopic-Assisted Ventriculoperitoneal Shunt Implantation
Procedure Variations
1. The abdominal portion of the procedure can be performed using a 5-mm trocar and a 10-Fr introducer for camera and catheter insertion. 2. Under laparoscopic control, a needle is introduced through a 5-mm incision in the right upper quadrant and the shunt tubing is tunneled to that site. A J-tipped guide wire is introduced, and the needle is exchanged for a dilator and peel-away sheath. The shunt is delivered through the sheath, which is sectioned and removed.
Please see Figs. 1–3.
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Chapter 42 Ventriculoperitoneal Shunt Implantation
Figure 42.1
After insertion of the optic port, the shunt peelaway sheath is inserted directly through the abdominal wall under visual guidance
Figure 42.2
The final location of the shunt is controlled after the shunt peel-away sheath is removed
Amulya K. Saxena and Hans G. Eder
Figure 42.3
Recommended Literature 1. Goitein D, Papasavas P, Gagne D, Ferraro D, Wilder B, Caushaj P (2006) Single trocar laparoscopically assisted placement of central nervous system – peritoneal shunts. J Laparoendosc Adv Surg Tech A 16:1–4 2. Konstantinidis H, Balogiannis I, Foroglu N, Spiliotopoulos A, Magras I, Kesisoglou I, Sel
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