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Technical note
Modification of shunt introducer
Aleksander M. Vitali, Andries A. le Roux
Inkosi Albert Luthuli Central Hospital, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Mayville, Durban,
4058, KwaZulu-Natal, South Africa
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Address for Correspondence: Aleksander M. Vitali, Department of Neurosurgery, Inkosi Albert Luthuli Central Hospital, Nelson R.
Mandela School of Medicine, University of KwaZulu-Natal, 800 Bellair Avenue, P. Bag X03, Mayville, Durban, 4058, KwaZulu-Natal,
South Africa. E-mail: alex.vitali@excite.com
ABSTRACT
The insertion of a ventriculoperitoneal shunt is one of the most common pediatric neurosurgical procedures.
A majority of these operations are efficient by junior doctors. Any modification to the technique that makes
the procedure easier may decrease the number of complications. The authors describe a quick modification
to the ventriculoperitoneal shunt introducer. This enables the easy and fast tunneling for catheter insertion,
even in the patient with a massive head due to neglected hydrocephalus, thereby decreasing the operative
time and possibly the risk of infection.
Key words: Ventriculoperitoneal shunt, CSF shunt, hydrocephalus, surgical technique, technical note,
macrocephaly
Technique
Th
Introduction
Discussion
Ventriculoperitoneal shunt insertion is still one of the most
common neurosurgical procedures. It has been documented
that the duration of surgery and the surgical technique are
related to the rate/risk of infection.[3-5] The tunneling for the
insertion of the catheter can be one of the most difficult,
time-consuming and traumatic parts of the operation. Patients
with neglected hydrocephalus present with exceptionally
2007 / Jul-Dec / Volume 2 / J Pediatr Neurosci / 67
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Vitali
et al.: Modification of shunt introducer
forthisjournal
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Figure 1: Child with massive head illustrating head and neck disproportion
Acknowledgement
Th
References
1.
Figure 4: Modified shunt introducer during the procedure. Note the shape of
the introducer that follows the body contour
large heads, thin necks, very thin skin (particulary over the
neck), soft cranial bones and scaphoid abdomens. These
factors make tunneling for the passage of the peritoneal
catheter more treacherous and these children are prone to too
deep or too superficial shunt placement under the skin and
perforation of the skull, skin or lung. Proper positioning will
decrease the difficulty and risks of the procedure; however,
in young children with massive heads, it is often impossible
68 / J Pediatr Neurosci / Volume 2 / Jul-Dec / 2007
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