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59. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
3. Joint Meeting mit der Italienischen Gesellschaft für Neurochirurgie (SINch)

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

01. - 04.06.2008, Würzburg

Management of ventriculoperitoneal shunt placement in children with intraperitoneal adhesions

Management der ventrikuloperitonealen Shuntanlage bei Kindern mit intraperitonealen Verwachsungen

Meeting Abstract

  • corresponding author C.A. Tschan - Neurochirurgische Klinik, Medizinische Hochschule Hannover
  • E. J. Hermann - Neurochirurgische Klinik, Medizinische Hochschule Hannover
  • N. Schukfeh - Kinderchirurgische Klinik, Medizinische Hochschule Hannover
  • R. Nustede - Kinderchirurgische Klinik, Medizinische Hochschule Hannover
  • M. Rittierodt - Neurochirurgische Klinik, Medizinische Hochschule Hannover
  • J. K. Krauss - Neurochirurgische Klinik, Medizinische Hochschule Hannover

Deutsche Gesellschaft für Neurochirurgie. Società Italiana di Neurochirurgia. 59. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 3. Joint Meeting mit der Italienischen Gesellschaft für Neurochirurgie (SINch). Würzburg, 01.-04.06.2008. Düsseldorf: German Medical Science GMS Publishing House; 2008. DocMO.05.03

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter: http://www.egms.de/de/meetings/dgnc2008/08dgnc069.shtml

Veröffentlicht: 30. Mai 2008

© 2008 Tschan et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielf&aauml;ltigt, verbreitet und &oauml;ffentlich zug&aauml;nglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

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.