2. Then position the anchoring clip on the catheter,
immediately distal to the sliding clip, as shown
in Figure 11. The introducer and ventricular end
of the shunt are then inserted through the dural
opening and compressed cerebral mantle into the
dilated ventricle.
3. Follow Steps 4 through 6 of Positioning
Ventricular End of Catheter to complete the shunt
insertion. NOTE: Adjustment of the catheter length
in the ventricle may require repositioning of the clip
along the catheter line.
Sutures may be placed over the anchoring clip with
the catheter in position to further secure placement.
WARNING: Do not use wire to suture over the
catheter; wire can cause damage to the catheter.
Positioning Distal End of Catheter
The peritoneum is opened by means of any
technique which is consistent with the surgeon’s
experiences in hydrocephalic shunting and
placement of distal catheters to allow passage
of the distal tip of the UNI-SHUNT with Reservoir
into the peritoneal cavity. The one centimeter
radiopaque markings on the sides of the
distal end of the catheter assist the surgeon in
determining exactly how far into the peritoneal
cavity the shunt tubing will be inserted; this can
be controlled radiographically.
Placement of the Anchoring Clip at
Distal End
A plastic anchoring clip is sutured to the abdominal
musculature, locking the peritoneal end of the
UNI-SHUNT with Reservoir into place, as shown
in Figure 12. With the catheter in position, sutures
may be placed over the anchoring clip to secure
further placement. WARNING: Do not use wire to
suture over the catheter; wire can cause damage
to the catheter.
Summary
Insertion of the ventriculo-peritoneal UNI-SHUNT
with Reservoir, using the subcutaneous guide, the
leader, and the introducer, consists of four basic
steps (Figure 13). The first is passage of the guide
and then the catheter from the head to abdomen.
This may be accomplished in either one or two
steps. The second step is the placement of the
ventricular end of the UNI-SHUNT with Reservoir
into the lateral ventricle by means of the introducer.
The third step is the insertion of the distal end of
the catheter into the abdominal cavity. The fourth
step is anchoring the ventricular and distal ends of
the catheter into position using the plastic clip.
References
1. Becker, D.P., and Nulsen, F.E.: Control of
hydrocephalus by valve regulated venous shunt:
Avoidance of complications in prolonged shunt
maintenance. J. Neurosurg. 28:215,1968.
2. Cone, W.V., Lewis, R.D., and Jackson, I.J.:
Shunting of cerebrospinal fluid into the peritoneal
cavity. Presented at the Meeting of the American
College of Physicians, Montreal, Canada, 1949.
3. Federal Register, Vol. 43, No. 229:55714–55716,
Tuesday, November 28, 1979.
4. Harsh, G.R., Ill: Peritoneal shunt for
hydrocephalus utilizing the fimbria of the fallopian
tube for entrance to the peritoneal cavity.
J. Neurosurg. 11:284–294,1954.
5. Jackson, I.J., and Snodgrass, S.R.: Peritoneal
shunts in the treatment of hydrocephalus and
increased intracranial pressure. Four year survey
of 62 patients. J. Neurosurg. 12:216–222, 1955.
6. Kausch, W.: Die Behandlung des Hydrocephalus
der kleinen Kinder. Arch. Klin Chir: 87:709, 1908.
7. Matson, Donald D.: Neurosurgery of lnfancy
and Childhood. Charles C. Thomas, Springfield,
Illinois, 1969.
8. Milhorat, Thomas H.: Hydrocephalus and the
Cerebrospinal Fluid. The Williams and Wilkins Co.,
Baltimore, Md., 1972.
9. Raimondi, A.J.: A critical analysis of the clinical
diagnosis, management and prognosis of the
hydrocephalic child. Advances in Pediatrics,
Vol. 18. 1971.
10. Raimondi, A.J., and Matsumoto, S.: A simplified
technique for performing the ventriculo-peritoneal
shunt. J. Neurosurg. 26:357–360, 1967.
11. Scott, M., Wycis, H.T., Murtagh, I., and
Reyes, V.: Observations in ventricular and lumbar
subarachnoid peritoneal shunts in hydrocephalus
in infants. J. Neurosurg. 12:165, 1955.
12. Hoffman, H.J.: Technical problems in shunts.
Monogr. Neural. Sci. 8:158–169, 1982.
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