Ventriculoperitoneal shunt placement technique [Neurosurgery Wiki]

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====== Ventriculoperitoneal shunt placement technique ======
[[Hair]] [[shaving]] away from the head [[incision]] site (some surgeons use minimal shaving)

Clean the [[skin]] with an [[antiseptic]]

Apply a sterile fenestrated [[drape]] over the incision sites (head, neck, chest, and abdomen)

Fenestrated drape the patient

Make a "U or C" shaped [[skin incision]] over the entry point where the [[burr hole]] is to be performed for the introduction of the [[ventricular catheter]]. If the [[frontal approach]] will be used, then [[Kocher’s point]] is used which is an entry point that is 11 cm superior and posterior from the nasion, 3 cm lateral to midline along the mid pupillary line, and 1 to 2 cm anterior to the coronal suture; catheter should then be passed to a depth of 5-5.5 cm.
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For a parieto-occipital approach, Keen’s point is used which is approximately 2.5 to 3 cm superior and posterior to the pinna and the catheter should then be passed to a depth of 4 to 5 cm or until reaching the trigone of the ipsilateral lateral ventricle, but sometimes it is aiming toward the frontal horn of the lateral ventricle.[13] Alternatively, Dandy's point can be used which is 3 cm above the inion and 2 cm left or right to the midline.
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Burr hole is performed at the desired entry point and the dura incised. A small entry point in the cortex is coagulated and incised.

Ventricular catheter is introduced directed into the ventricle and cut to the appropriate pre-measured length

CSF samples are collected

The ventricular shunt is connected to the valve and secured with a silk tie.

===== Peritoneal catheter placement =====
see [[Peritoneal catheter placement]].