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Video Abstract
2020
:11;
82
doi:
10.25259/SNI_8_2020
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Ventriculoperitoneal shunt placement with ultrasound guidance and laparoscopic assistance: 2-dimensional instructional video

Departments of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA.
Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA.
Department of Bariatrics, Buffalo General Medical Center, Buffalo, New York, USA.
Department of General Surgery, John R Oishei Children’s Hospital, New York, USA.
Canon Stroke and Vascular Research Center, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA.
Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA.
Corresponding author: Adnan H. Siddiqui, Department of Neurosurgery, University at Buffalo, 100 High Street, Buffalo, New York, United States. asiddiqui@ubns.com
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This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
How to cite this article: Housley SB, Hoffman A, Siddiqui AH. Ventriculoperitoneal shunt placement with ultrasound guidance and laparoscopic assistance: 2-dimensional instructional video. Surg Neurol Int 2020;11:82.

Abstract

Background:

Postoperative communicating hydrocephalus has been described in the literature commonly associated with treatment of ruptured intracranial aneurysms; however, it is also reported to occur following other intracranial interventions such as meningioma resection and decompressive hemicraniectomy. In 2011, Burkhardt et al. reported the incidence of postoperative hydrocephalus following skull base meningioma resection was twice as high as resection of meningiomas in other regions.[1] They found that age and increased length of surgery were associated with higher rates of postoperative hydrocephalus. Our patient, a 76-year-old man, initially presented with the left-hand paresthesias and numbness before the revelation of a large sphenoid planum meningioma on workup imaging. He underwent surgical resection due to developing cranial nerve deficits and personality changes in an extensive procedure that required approximately 8 h to complete. His postoperative course, given the factors above, included the development of hydrocephalus.

Case Description:

He was taken to the operating room for ventriculoperitoneal shunt placement, as displayed in this video case report, which highlights our surgical and sterile techniques, intraoperative ultrasound to ensure appropriate ventricular placement, and a single-port laparoscopic technique for direct visualization of placement of the abdominal catheter. After shunt placement, his course was complicated by a small tract hemorrhage, which resolved without further treatment. He was observed to have an improvement in mental function that occurred over the following 2–3 days before being discharged to an outpatient rehabilitation facility for continued care.

Conclusion:

Ventriculoperitoneal shunt placement is an effective and safe procedure for the treatment of postoperative communicating hydrocephalus when performed with appropriate techniques as displayed in the associated video case report. The patient gave informed consent for surgery and video recording. Institutional Review Board approval was deemed unnecessary.

Keywords

Laparoscopy
Ultrasound
Ventriculoperitoneal shunt

Annotations[1-3]

1) 0:19 – Imaging before and following the meningioma resection after the development of hydrocephalus.

2) 4:40 – Preparation of shunt system.

3) 6:07 – Dural opening.

4) 6:50 – Ultrasound guidance of proximal catheter placement.

5) 8:05 – Single-port laparoscopic technique of distal catheter placement.

6) 9:40 – Small tract hemorrhage that resolved without further intervention.

[Video 1]-Available on:

www.surgicalneurologyint.com

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent .

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

REFERENCES

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  3. , , , , . Postoperative hydrocephalus in patients undergoing decompressive hemicraniectomy for ischemic or hemorrhagic stroke. Neurosurgery. 2007;61:489-93
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