Hydrocephalus V-P Surgery

The ventriculo-peritoneal shunt is a set of shunt devices with one-way valves placed in the body to shunt cerebrospinal fluid from the ventricles into the abdominal cavity for absorption. Referred to as VP surgery. Kausch first performed this operation in 1905, but it was not taken seriously at the time. By 1955, Jackson reported 62 such operations, which had certain effects. The ventricle-atrial shunt also has a number of shortcomings, which can lead to the death of sick children. Therefore, the ventriculo-peritoneal shunt has been re-emphasized and used more and more widely. Treating diseases: hydrocephalus Indication 1. Applicable to all types of hydrocephalus patients, including obstructive hydrocephalus, traffic hydrocephalus and normal intracranial pressure hydrocephalus. 2. Other shunt method losers. Contraindications 1. Intracranial infection has not been controlled. 2. Inflammation or ascites in the abdominal cavity. 3. The protein content of cerebrospinal fluid is too high, exceeding 500mg/L, or there is fresh bleeding. 4. The skin of the head and neck or chest and abdomen is infected. Preoperative preparation 1. Basic anesthesia or general anesthesia, take the supine position, head to the left. 2. Prepare the skin of the head, neck, chest and abdomen. Surgical procedure Scalp incision 4 to 5 cm after the right auricle, the size of the skull hole is equivalent to the reservoir base. The dura mater is cut and the anterior ventricle catheter is delivered to the anterior horn of the ventricle The catheter is cut at the appropriate length and attached to the reservoir connector. Place the reservoir in the bone hole and suture the periosteum, then connect the proximal end of the valve to the outlet of the reservoir. Note that the up and down direction of the valve cannot be reversed. The arrow on the pump chamber points to the direction of cerebrospinal fluid shunt. 2. Separating the subcutaneous tunnel The abdominal catheter is from the head incision through the apex, the back of the ear, the neck, and the chest to the upper abdomen. The subcutaneous tunnel is long and can be opened in 2 or 3 times. The first incision is under the mastoid, the second incision is under the clavicle, and the third incision is under the right upper abdomen. A subcutaneous tunnel is made by blunt-head metal guides, which are separated by subcutaneous deep separation. 3. Install abdominal catheter The proximal end of the catheter is connected to the outlet of the valve, and the distal end is passed through the subcutaneous tunnel into the incision of the right upper abdomen. Preferably, the catheter has a curved curvature in the neck to allow the neck to expand as it moves. There are two common locations for placement of the end of the abdominal catheter: 1 The abdominal tube is placed on the surface of the liver. Under the xiphoid process of the abdomen, a mid-median incision or a median incision is made, which is about 5 cm long. After the abdominal wall and the peritoneum were cut in layers, the left lobe of the liver was exposed, and the end of the abdominal catheter was placed on the surface of the liver. The length of the catheter in the abdominal cavity is about 10 cm. It is best to use a catheter with 4 slit openings on the distal wall to prevent backflow and lumen occlusion, and suture the catheter on the round ligament to prevent detachment. Once the catheter is detached, it leaves the liver and is in the abdominal cavity, which is easily blocked by the omentum (Fig. 4.13.4-1). 2 The abdominal tube is placed in the free abdominal cavity. The abdominal incision can be in the midline or the midline of the upper abdomen or lower abdomen, about 3 cm long, preferably avoiding the appendicitis incision. After entering the abdominal cavity, after confirming that there is no disease such as peritoneal adhesion, the end of the catheter can be sent to the abdominal cavity. It is preferable to have a plurality of small round opening at the end of the catheter, as far as possible from the abdominal wall incision, or to bend around the peritoneal incision. Right (or left) side of the armpit. The length of the catheter that is free in the abdominal cavity should be 20 to 30 cm or more, and the catheter can be sutured and fixed on the peritoneal incision. In recent years, laparoscopic use of the end of the catheter into the small omental sac can greatly simplify the operation, and at the same time reduce the risk of the tube end being blocked by the omentum and avoiding the broken bowel. In addition, some authors used a cannula puncture method, using a cannula with a tube, piercing the abdominal cavity in the middle of the abdomen, pulling out the tube, inserting the abdominal tube from the cannula into the abdominal cavity, removing the cannula, and fixing the catheter. The proximal end of the catheter is passed through the abdominal-chest-neck subcutaneous tunnel and is connected to the head valve tube. 4. Stitching After the catheter is fixed, the peritoneum and abdominal wall are sutured in layers. complication Gastrointestinal symptoms Infants may have symptoms such as bloating, abdominal pain, loss of appetite or nausea and vomiting after surgery. In addition to surgical disturbances, the main cause is the stimulation of the peritoneum by the cerebrospinal fluid, which usually disappears in a week or so. 2. Infection Due to the long subcutaneous route of the shunt catheter, there are many opportunities for local infection. After infection, it can cause intracranial infections such as ventriculitis and meningitis. It can also cause peritonitis, underarm abscess or abdominal abscess. Subcutaneous infection can occur under subcutaneous infection. Subcutaneous abscess. Therefore, it is necessary to strictly disinfect during surgery. It is extremely important to apply antibiotics before and after surgery. 3. Diversion catheter barrier The reasons for this are: 1 the valve is blocked, mostly due to the excessive protein in the ventricle, and the accumulation of sediment in the membrane valve. Therefore, when the ventricular fluid protein exceeds 1000 mg/L, the valve is not used, and only the slit conduit is used for shunting. The four slit openings at the end of the abdominal catheter were cut with a knife and lengthened to 1 cm to facilitate shunting. After the protein content of the cerebral ventricle is decreased, the valve is diverted by a regular valve. 2 The peritoneal tube is twisted, and the end of the tube is covered by the omentum or forms a pseudocyst (containing cerebrospinal fluid), which can cause the shunt to fail. After the discovery, it should be treated in time, and the catheter should be repositioned to other parts of the abdominal cavity, or other shunts should be used instead. 4. Abdominal catheter prolapse Most commonly, the catheter is removed from the abdominal incision, partially or even completely out of the abdominal cavity, and exposed to the skin. This is because the subcutaneous tunnel is too shallow, the catheter is rubbed and pressed for a long time with the epidermis, causing skin necrosis, or secondary infection, the suture is detached, and the catheter is taken out of the abdominal wall. When this happens, it can be handled according to the condition of the incision. If the incision is not infected, the granulation is relatively fresh, and the catheter is partially removed. After 3 days of wet application with the antibiotic solution, the catheter is redirected and placed in the abdominal cavity. The split incision is sutured in full layer, and some patients can be cured; if the incision is obviously infected, it should be immediately Replace the new abdominal tube. 5. Abdominal organ damage Some endoscopic catheters have a hard end. For example, the wall of the Raimondi catheter is fitted with a stainless steel spring. Due to surgical trauma or long-term mechanical friction at the end of the catheter, it may cause perforation of the intestine, transverse perforation and vaginal perforation. Nowadays, there is a new type of catheter, which has no metal. It is mainly made of silicone rubber. The tube is relatively strong, and it is not easy to cause mechanical collapse or distortion of the tube wall, and the chance of damage to the internal organs is greatly reduced.