Colonic Perforation by Ventriculoperitoneal Shunt Tubing: A Case of Suspected Silicone Allergy

Placement of a ventriculoperitoneal shunt (VPS) is a procedure comprising many small steps. Difficulties and delays can arise when passing the distal shunt tubing down the distal tunneling sheath during surgery. The authors of this report describe a simple technique for quickly passing the distal catheter of a VPS through the tunneler sheath, whereby the sheath is used as a fluid tube to allow the distal catheter to be drawn through the fluid tube under suction pressure. The plastic sheath that surrounds the shunt tunneler device is used as a fluid tube, or “straw,” with the proximal aperture submerged into a bucket of sterile irrigation liquid containing the distal catheter. Suction pressure is placed against the distal aperture of the tunneler, and the shunt catheter is quickly drawn through the sheath. No special equipment is required. In time trials, the bucket and straw technique took an average of 0.43 seconds, whereas traditional passage methods took 32.3 seconds. The “bucket and straw” method for passing distal shunt tubing through the tunneler sheath is a technique that increases surgical efficiency and reduces manual contact with shunt hardware.

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Endoscopic Coagulation of the Choroid Plexus using the Nd:YAG Laser: Initial Experience and Proposal for Management

Neurosurgery ◽

10.1227/00006123-199103000-00014 ◽

1991 ◽

Vol 28 (3) ◽

pp. 421-427 ◽

Cited By ~ 28

Author(s):

Richard D. Bucholz ◽

Thomas Pittman

Keyword(s):

Choroid Plexus ◽

Ventriculoperitoneal Shunt ◽

Quartz Fiber ◽

Daily Production ◽

Patient Response ◽

Clinical Conditions ◽

Shunt Tubing ◽

Csf Production ◽

Shunt Infections ◽

Electrolyte Abnormalities

Abstract Although most patients with hydrocephalus are treated effectively with ventriculoperitoneal shunts, a small group fails to respond to diversion procedures. In some patients within this group, hydrocephalus may be caused in part by the overproduction of the cerebrospinal fluid (CSF). In other patients, previous shunt infections may limit the ability of the peritoneum to absorb fluid, and patient response to a ventriculoperitoneal shunt may be improved by reducing CSF production. We discuss a case of a 29-month-old hydrocephalic infant with a ventriculoperitoneal shunt who had ascites. Computed tomography showed bilateral symmetrical enlargement of the choroid plexus. Repeated cultures of the CSF and shunt tubing were sterile, and the daily production of the CSF exceeded 1000 ml. Therapy with acetazolamide decreased the CSF output temporarily, but it was discontinued after serious electrolyte abnormalities occurred. The endoscopic coagulation of the choroid plexus with a neodymium:YAG laser transmitted through a flexible quartz fiber decreased CSF production effectively. This procedure may be useful in a variety of clinical conditions associated with hydrocephalus or with other intraventricular lesions.

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