Securing Cranial Horizontal-Vertical Valve in Proper Orientation For Use in Ventriculoperitoneal Shunting: Technical note

Abstract

Introduction: There are several options for cerebrospinal fluid diversion in patients with normal pressure hydrocephalus. Fixed and programmable valves, with or without anti-siphon devices, have been used for ventriculoperitoneal shunts and horizontal-vertical valves for lumboperitoneal shunts. Recently, a horizontal-vertical valve was developed for ventriculoperitoneal shunts and has been demonstrated to be efficacious. This series describes the surgical method we employ for securing the valve in a true vertical position. Materials and Methods: The bone of the retroauricular region above the superior nuchal line is exposed. A trough is made in the bone in the vertical orientation to seat the valve which is then secured with a titanium plate and screw. Results: The technique has been used without complications in nine patients to date. No patient has exhibited signs of shunt malfunction. Conclusion: The authors propose this method for the safe, secure maintenance of an horizontal-vertical valve used for ventriculoperitoneal shunting in the upright vertical position.