Artikel
Management of ventriculoperitoneal shunt placement in children with intraperitoneal adhesions
Management der ventrikuloperitonealen Shuntanlage bei Kindern mit intraperitonealen Verwachsungen
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Autoren
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C.A. Tschan
- Neurochirurgische Klinik, Medizinische Hochschule Hannover
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E. J. Hermann
- Neurochirurgische Klinik, Medizinische Hochschule Hannover
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N. Schukfeh
- Kinderchirurgische Klinik, Medizinische Hochschule Hannover
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R. Nustede
- Kinderchirurgische Klinik, Medizinische Hochschule Hannover
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M. Rittierodt
- Neurochirurgische Klinik, Medizinische Hochschule Hannover
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J. K. Krauss
- Neurochirurgische Klinik, Medizinische Hochschule Hannover
| Veröffentlicht: | 30. Mai 2008 |
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Gliederung
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Objective: Standard therapy for hydrocephalus in children is shunting cerebrospinal fluid to the peritoneal cavity. There are different conditions leading to intraperitoneal adhesions. The placement of a ventriculoperitoneal shunt in such children is a special neurosurgical challenge. Here we present our experience in minimally-invasive endoscopic dissection of intraperitoneal adhesions and placement of the peritoneal catheter.
Methods: From 2002 to 2007 we performed 152 pediatric ventriculoperitoneal shunt operations. Additionally, 56 revisions of valves and ventricular catheters, 44 revisions of peritoneal catheters and 34 miscellaneous shunt operations were made. 14 children with intra-abdominal adhesions underwent ventriculoperitoneal shunt placement. Therefrom 8 children showed a scarred abdomen after preliminary abdominal surgery, five passed through peritonitis and one child underwent shuntrevision because of displaced catheter in an intraperitoneal adhesion. The children were prepared for both, ventriculoperitoneal and atrial shunt.
Results: The abdominal part of the operation was performed by using a 5 mm endoscope, placed paraumbilically to the intraperitoneal cavity. For dividing difficult adhesions, a second working channel was introduced laterally. To avoid dislocation with growth of the child, a long distal shunt catheter was inserted. If possible, the distal catheter tip was positioned into the lower abdomen directed to the Douglas pouch. In all of these patients endoscopic division of adhesions and placement of the peritoneal catheter was effective. There was no intraoperative or postoperative complication. Continuous follow-up examinations in our children consultation revealed no abdominal shunt-dysfunction so far.
Conclusions: Minimally-invasive endoscopic placement of ventriculoperitoneal shunts in children with intraperitoneal adhesions is possible without complications. Ventriculoatrial shunting should be considered as an alternative, but is necessary only in sporadic cases.
