LAPAROSCOPIC ASSISTED TREATMENT OF HYDROCEPHALUS IN ADULTS: OUR OWN MODIFICATION

Introduction: Laparoscopy has been used as an aid in the placement of abdominal ventriculoperitoneal (VP) shunts since 1993. Laparoscopic procedures are safe and allow direct visualization of the correct position of the catheter, and confirmation of shunt function. Aim: The aim of this study is to describe our own method of introduction of the distal catheter in the right subdiaphragmatic space using the falciform ligament, which prevents catheter migration, distal obstruction and internal organ damage and compare it with existing literature. Materials and Methods: Data was collected retrospectively for all VP shunt implantations and revisions performed in adults with hydrocephalus during the period November 2011 to November 2020. In all 51 cases of VP shunt insertion, the distal shunt catheter was implanted using our own modification of the laparoscopic method. Results: In total, there were 66 shunt procedures performed during the study period. The majority of procedures (86.3% 57/66) were implantation of a new VP shunt, and 13.6% (9/66) were revision surgeries for replacement of a VP shunt due to catheter occlusion. Median follow up was 2.5 years. Most patients (89.5%, 51/57) underwent laparoscopic surgery. Conclusions: Our modified laparoscopic method shows that this accessible, minimally invasive procedure is beneficial for patients with hydrocephalus and significantly decreases the rate of complications. The laparoscopic falciform technique significantly reduces the rate of distal VP shunt obstruction. The duration of surgery and the risk of infection have been also reduced. In addition, collaboration and simultaneous work of neurosurgeons and general surgeons strengthens companionship between departments.