Minimal exposure maximal precision ventriculoperitoneal shunt: how I do it

Area of Science:

• Neurosurgery
• Minimally Invasive Surgery
• Medical Device Technology

Background:

• Ventriculoperitoneal shunts are common neurosurgical procedures.
• Shunt complications include infection and obstruction.
• Infection risk is linked to skin incisions and catheter handling; obstruction to catheter position.

Purpose of the Study:

• To present a novel neuronavigated laparoscopic-assisted minimal exposure technique for ventriculoperitoneal shunt placement.
• To evaluate the efficacy and safety of this technique in adult patients.

Main Methods:

• A neuronavigated laparoscopic-assisted minimal exposure shunt technique was performed on 40 consecutive adult patients.
• Follow-up included assessment for infection, catheter migration, and malpositioning.

Main Results:

• No patients experienced shunt infection or distal catheter migration during a mean follow-up of 12 months.
• Two patients had ventricular catheter malpositioning attributed to neuronavigation inaccuracy in cases of slit ventricles.

Conclusions:

• The presented technique offers a low rate of infection and malfunction.
• Advantages include reduced postoperative pain and improved cosmetic outcomes.
• Limitations involve the availability of trained laparoscopic surgeons and neuronavigation expertise.