Minimal exposure maximal precision ventriculoperitoneal shunt: how I do it
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.
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.
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.
KeywordsCerebrospinal fluid General surgery Hydrocephalus Infection Laparoscopy Neuronavigation Neurosurgery
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
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.
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)