Ventriculoperitoneal shunt with the valve placed on the chest wall using a fixation technique that uses titanium screws for securing the reservoir to the cranium

Abstract

BackgroundThe adjustable shunt valves of ventriculoperitoneal shunts (VPS) produce magnetic artifacts, which could disturb magnetic resonance imaging (MRI), and should therefore be placed on the chest wall. However, some significant complications, including ventricular catheter migration, disconnection, and rupture, should be considered. This study proposed a novel method for VPS placement with the valve placed on the chest wall using a fixation technique that uses titanium screws for securing the reservoir to the cranium. MethodsAfter a right-angled ventricular catheter with reservoir was inserted into the lateral ventricle, a 4-mm self-tapping titanium screw was inserted directly through the collars of the reservoir to fix it to the cranium. Adjustable shunt valves were implanted in the infraclavicular fossa of the chest wall. The connection site between the valve and tube was fastened using 3–0 nonabsorbable braided nylon surgical sutures. ResultsIn this study, following VPS placement in 83 patients with normal-pressure hydrocephalus, the review of all postprocedural images showed that of the 83 patients, four patients (4.8%) had catheter placement complications: two patients (2.4%) had incorrect placement of the ventricular catheter and two patients (2.4%) had subcutaneous migration of the abdominal catheter. None of the patients complained of ventricular catheter migration, disconnection, or rupture. ConclusionIn adult patients, placing the VPS valve in the chest and fixing the proximal catheter to the cranium using surgical screws can be an effective way to avoid MRI artifacts and to counteract mechanical failure due to the dislodgment of the proximal catheter.