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Updated: Aug 8, 2026
Neuronavigation and Laparoscopy Guided Ventriculoperitoneal Shunt Insertion for the Treatment of Hydrocephalus
Published on: October 14, 2022
Laparoscopic guidance or revision of ventriculoperitoneal shunts in children
Sherman Yu1, Denis D Bensard, David A Partrick
1Division of Pediatric Surgery, The Children's Hospital/The University of Colorado Health Science Center, Denver, Colorado 80218, USA.
Insights
Laparoscopic revision of ventriculoperitoneal shunts in children effectively addresses shunt malfunction and dislodgement. This minimally invasive approach allows for direct visualization and improved outcomes in managing hydrocephalus complications.
Area of Science:
- Pediatric Surgery
- Minimally Invasive Surgery
- Neurosurgery
Background:
- Ventriculoperitoneal shunts are standard for hydrocephalus treatment.
- Complications include infection, obstruction, and catheter migration.
- Laparoscopy offers a minimally invasive option for shunt evaluation and revision.
Purpose of the Study:
- To evaluate the efficacy of laparoscopy in pediatric ventriculoperitoneal shunt revision.
- To assess the feasibility of laparoscopic techniques for shunt placement and complication management.
Main Methods:
- Retrospective review of 17 pediatric cases undergoing laparoscopic ventriculoperitoneal shunt procedures.
- Procedures included evaluation, revision, reinsertion, and primary placement.
- Conversion to open laparotomy was noted when dense adhesions were present.
Main Results:
- 65% of patients underwent successful laparoscopic-assisted shunt placement.
- Procedures involved lysis of adhesions, pseudocyst marsupialization, and catheter retrieval/reinsertion.
- Conversion to open surgery occurred in 35% due to adhesions; no adverse neurological events were reported.
Conclusions:
- Laparoscopy enables direct visualization of peritoneal catheter placement.
- It facilitates lysis of adhesions and repositioning of shunts.
- Laparoscopic techniques are effective for managing fractured catheters and ensuring satisfactory shunt positioning.
Background:
Ventriculoperitoneal shunt is the preferred treatment for hydrocephalus. Known complications include infection, obstruction, and disconnection with the fractured fragment migrating in the peritoneal cavity. We report 17 cases of laparoscopic evaluation and revision of ventriculoperitoneal shunts in children.
Methods:
From January 2000 through October 2002, we retrospectively reviewed our experience with laparoscopy and ventriculoperitoneal shunts.
Results:
Laparoscopy was performed in 17 children with a malfunctioning shunt, presumed shunt dislodgment or disconnection, reinsertion of a shunt after externalization, and primary shunt placement. Six patients (35%) were converted to an open laparotomy due to dense adhesions. Eleven patients (65%) underwent successful laparoscopic-assisted ventriculoperitoneal shunt placement: 5/11 (45%) had lysis of adhesions or pseudocyst marsupialization with repositioning of a functional shunt, or both; 3/11 (27%) had successful retrieval of a disconnected catheter with reinsertion of a new catheter; 2/11 (18%) had laparoscopic confirmation of satisfactory placement and function, requiring no revision; 1/11 (9%) had an initial shunt placed with laparoscopic guidance due to the obesity. Operative time for the laparoscopic procedure ranged from 30 minutes to 60 minutes. All laparoscopic procedures used 1-mm or two 5-mm ports. Perioperatively, no adverse neurological sequelae occurred due to the pneumoperitoneum.
Conclusions:
Laparoscopic guidance or revision of ventriculoperitoneal shunts permits (1) direct visualization of catheter insertion within the peritoneal cavity, (2) satisfactory positioning, (3) lysis of adhesions or marsupialization with catheter repositioning, or both, and (4) retrieval of fractured catheters.