Role of Laparoscopy in CSF Shunting

Background: Primary placement or revision of the peritoneal end of a lumboperitoneal (LPS) or a ventriculoperitoneal (VPS) shunt can be difficult in the presence of intraperitoneal adhesions, obesity or previous multiple shunt revisions. Under such circumstances, the standard mini-laparotomy may not allow precision in the peritoneal end positioning [1]. The aim of this study is to evaluate the role of laparoscopic assisted techniques to aid in the placement of the distal end of the shunt system.Patients and Methods: Thirteen patients with idiopathic intracranial hypertension and one patient with shunted hydro-cephalus were included in the study. These patients were selected for the laparoscopic guided technique because of either obesity, suspicion of peritoneal adhesions or previous shunt failure. Eight patients had lumboperitoneal shunt placed for the first time, and five patients with previously implanted lumboperitoneal shunt had their shunts revised using the laparoscopic aided technique. One hydrocephalic patient with distal ventriculoperitoneal shunt failure and abdominal pseudocyst underwent cyst drainage and revision of the ventriculoperitoneal shunt using the laparoscope.Results: The abdominal end of the shunt tube was suc¬cessfully and easily placed in all cases with a relatively short operative time. Improvement of the preoperative symptoms was noted in all cases. There were no laparoscopic related shunt complications. All patients had functioning shunts at the end of the follow-up period which extended from 5 to 29 months.Conclusions: The Laparoscopic guided technique facilitates accurate placement of the abdominal catheter into a selected region of the peritoneal cavity free from adhesions under direct vision while avoiding large laparotomy incisions, has shortened the operative time, and has diminished postoperative morbidity. With the laparoscopic equipment being available in most hospitals, the laparoscopic aided procedure can be easily applied and practiced.Recommendations: Although all patient populations benefit from the laparoscopic assisted procedure, this technique is strongly recommended for patients with previous multiple shunt revisions, prior abdominal surgery, history of peritonitis, or marked obesity.