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Updated: Aug 21, 2026
Neuronavigation and Laparoscopy Guided Ventriculoperitoneal Shunt Insertion for the Treatment of Hydrocephalus
Published on: October 14, 2022
Transumbilical approach for shunt insertion in the pediatric population: an improvement in cosmetic results
Didier Scavarda1, J Breaud, M Khalil
1Department of Pediatric Neurosurgery, Hôpital des Enfants La Timone, 13385 Marseille, France. didier.scavarda@ap-hm.fr
Insights
Transumbilical ventriculoperitoneal shunt insertion in children offers excellent cosmetic outcomes and is a safe, effective technique. This minimally invasive approach reduces unsightly scarring compared to traditional methods.
Area of Science:
- Pediatric Neurosurgery
- Minimally Invasive Surgery
- Hydrocephalus Management
Background:
- Ventriculoperitoneal (VP) shunts are standard for pediatric non-obstructive hydrocephalus.
- Traditional shunt insertion can lead to significant abdominal scarring and morbidity.
- Endoscopic third ventriculostomy is an alternative but VP shunts remain prevalent.
Purpose of the Study:
- To evaluate the safety and cosmetic outcomes of transumbilical VP shunt insertion in children.
- To assess the feasibility of this technique, including in re-intervention cases.
- To compare the cosmetic results with traditional shunt insertion methods.
Main Methods:
- A prospective study involving 12 VP shunt insertions in children between March and October 2003.
- All shunts were inserted via a transumbilical approach.
- Clinical follow-up included daily wound checks and post-discharge clinical controls.
Main Results:
- Eight children had follow-up exceeding 3 months (average 6 months).
- Optimal cosmetic results were achieved in seven children, with no puckered scars or dehiscence.
- One infection occurred, successfully treated, with a subsequent re-insertion via the same technique.
Conclusions:
- Transumbilical VP shunt insertion is a safe, easy, and cosmetically superior technique for pediatric hydrocephalus.
- The approach is suitable for re-interventions and does not appear to increase complications.
- Longer follow-up is necessary to fully assess infection risks.
Objective:
In spite of the recent interest in endoscopic third ventriculostomy, ventriculoperitoneal (VP) shunt is still the gold standard in treating non-obstructive hydrocephalus in children. The peritoneal cavity remains the optimal site for cerebrospinal fluid (CSF) diversion. Shunt insertion and re-interventions carry a high risk of inaesthetic abdominal scars and long-term morbidity. We report a technique of transumbilical shunt insertion, which provides better cosmetic results and without many more complications. This approach has been performed for a long period in a wide variety of intra-abdominal conditions by pediatric surgeons.
Methods:
Between March and October 2003, we inserted 12 VP shunts in children. For eight consecutively treated children the follow-up is more than 3 months. All the shunts were inserted through the umbilicus. These eight children are the subjects of this study. Indications for shunting were: communicating hydrocephalus (6 cases), subdural hematoma (1 case), and hygroma associated with an arachnoid cyst (1 case). The population consisted of 7 boys and 1 girl, ranging in age between 6 weeks and 47 months (mean age: 15 months), and their body weights varied between 2,110 g and 18,000 g (mean weight: 8,470 g). All children were examined twice a day for 3 days, and wounds were examined daily to check for the absence of sepsis or dehiscence. Clinical controls were performed 1 month after discharge. The operating surgeon was invited to comment on any difficulties encountered in making or closing this incision afterwards.
Results:
The average length of clinical follow-up was 6 months (range 4-7 months). One infection of the VP shunt occurred. It was treated with external drainage and antibiotics. After 1 week, a second VP shunt was inserted using the same technique without particular difficulty and with a nice cosmetic result. Concerning the seven other children, the cosmetic results were optimal, with no puckered abdominal scars or wound dehiscence, and with no perioperative or long-term complications related to the umbilical approach.
Conclusion:
At this early follow-up, umbilical incision for shunt insertion is a safe and easy technique. It provides an optimal cosmetic result, even in cases of re-intervention. This minimally invasive surgery does not require long specialized training. We have not shown an increase in complications associated with a "learning curve." Longer follow-up is needed to evaluate the risk of infection.