Practice Patterns of Canadian Neurosurgeons in Laparoscopic-Assisted Placement of Ventriculoperitoneal Shunts

Cerebrospinal fluid diversion via ventriculoperitoneal (VP) shunting is the mainstay treatment for hydrocephalus. Traditionally, neurosurgeons place the abdominal catheter through abdominal incision, which has become an efficient and standardized technique. This approach carries a 10-30% complication rate, including infection, catheter obstruction, misplacement, hemorrhage and post-operative pain. Laparoscopic assistance (LA) is an emerging alternative to mini-laparotomy, with potential benefits including reduced distal catheter malplacement and shorter operative times. Most investigations on LA are limited to single centers, with no data from Canada. This study aims to identify practice patterns in VP shunting within a Canadian context.

Practicing Canadian neurosurgeons were surveyed using a modified Delphi methodology. The survey was distributed to practicing neurosurgeons via the Canadian Neurosurgical Society and the Canadian Neurosurgery Research Collaborative.

Across two rounds, 36 neurosurgeons participated, representing all provinces with academic neurosurgical centers. Consensus was reached on five out of eight topics. Findings revealed that 65.5% of respondents had experience with LA, and 93% believed it reduced distal catheter malposition. Infection (77.8%), distal catheter obstruction (82.9%) and proximal obstruction (69.4%) were identified as the most common complications, each occurring in up to 10% of cases. In total, 71% anticipated eventual reduced operative times with increased LA experience.

Canadian neurosurgeons did not identify major barriers to LA beyond personal preference. LA is expected to improve distal catheter placement, though its broader benefits remain uncertain. Patient comorbidities were considered a greater risk factor for complications than surgical technique alone.