Sample Report Ventriculoperitoneal Shunt Revision
Preoperative Diagnosis: Ventriculoperitoneal shunt failure.
Postoperative Diagnosis: Ventriculoperitoneal shunt failure.
Procedure Performed: Ventriculoperitoneal shunt revision and cranioplasty.
Anesthesia: General endotracheal.
Estimated Blood Loss: Minimal.
Complications: None.
Details of Procedure: After informed consent was obtained from the family, the patient was brought to the operating room. General anesthesia was induced. The patient was smoothly intubated. Her head was turned to the left side and her posterior scalp was prepped and draped sterilely, including her right neck, right anterior chest, and right anterior abdomen. Previous sutures were removed.
A new bur hole site was identified superior and lateral to the previous entry site to approach the lateral ventricle. Monopolar cautery dissection was used to establish the subgaleal plane. A subgaleal pocket was made.
The previous incision was opened and the shunt valve was encountered. The shunt was dismantled. There was sluggish flow through the valve into the distal system. On inspection of the valve, the valve appeared to contain some debris. Attempts were made to connect a new valve system from the new pocket to the old pocket. Because of a kink in this configuration, the entire shunt system was removed.
The abdominal incision was again explored prior to removal of the shunt. A new valve with a new distal catheter was tunneled from the new pocket. Using a ventriculoscope, the catheter was guided into the frontal horn without difficulty and connected to the distal system. Once again, a Delta performance level I valve was used. The distal catheter was cut short and then placed into the abdominal cavity without difficulty.
All wounds were copiously irrigated. The skull defect at the previous site was filled with cranioplasty material. All wounds were sutured closed. Sterile dressings were applied. The patient was awakened from anesthesia, extubated, and taken to the recovery room in excellent condition after tolerating the procedure well.
Postoperative Diagnosis: Ventriculoperitoneal shunt failure.
Procedure Performed: Ventriculoperitoneal shunt revision and cranioplasty.
Anesthesia: General endotracheal.
Estimated Blood Loss: Minimal.
Complications: None.
Details of Procedure: After informed consent was obtained from the family, the patient was brought to the operating room. General anesthesia was induced. The patient was smoothly intubated. Her head was turned to the left side and her posterior scalp was prepped and draped sterilely, including her right neck, right anterior chest, and right anterior abdomen. Previous sutures were removed.
A new bur hole site was identified superior and lateral to the previous entry site to approach the lateral ventricle. Monopolar cautery dissection was used to establish the subgaleal plane. A subgaleal pocket was made.
The previous incision was opened and the shunt valve was encountered. The shunt was dismantled. There was sluggish flow through the valve into the distal system. On inspection of the valve, the valve appeared to contain some debris. Attempts were made to connect a new valve system from the new pocket to the old pocket. Because of a kink in this configuration, the entire shunt system was removed.
The abdominal incision was again explored prior to removal of the shunt. A new valve with a new distal catheter was tunneled from the new pocket. Using a ventriculoscope, the catheter was guided into the frontal horn without difficulty and connected to the distal system. Once again, a Delta performance level I valve was used. The distal catheter was cut short and then placed into the abdominal cavity without difficulty.
All wounds were copiously irrigated. The skull defect at the previous site was filled with cranioplasty material. All wounds were sutured closed. Sterile dressings were applied. The patient was awakened from anesthesia, extubated, and taken to the recovery room in excellent condition after tolerating the procedure well.