Modified Tunneling (Capsule Modification Technique) for Subcutaneous Placement of Ventriculo-Peritoneal Shunt in Patients with Hydrocephalus: Technical Note

Abstract

One of the first procedures that a neurosurgical resident/trainee assists and performs is the placement of a ventriculoperitoneal shunt, the commonest being the Chhabra shunt system. However, no modification has been done or proposed in performing this procedure keeping in mind the position of the chamber of the Chhabra shunt system. As the tunneller has to pass through the subcutaneous plane having tight adhesions, it is essential to have a proper and adequate space for the chamber. Utilization of instruments such as artery forceps or Penfield dissectors for the same results in the creation of inappropriate or a roughly estimated space, which is either inadequate, causing kinking of tubing, or too roomy that results in the peri-catheter collection of cerebrospinal fluid with the risk of infection. We propose a novel method of utilizing a modified tunneller with a distal “Capsule” that provides just enough space both, at the appropriate distance and for adequate length, for the chamber to fit snugly and thus avoid procedure-related risks and complications as well as reduce the total duration of surgery, thereby decreasing the chances of infection.

Keywords

• traditional technique
• capsule modification technique
• hydrocephalus