Ventriculoperitoneal (VP) Shunt

Question 1

What is the purpose of the pre-operative assessment and imaging in VP shunt surgery?

Answer 1

The purpose is to confirm the diagnosis of hydrocephalus and plan the surgical approach. Imaging such as CT scans or MRIs is used to assess the size and location of the ventricles.

Question 2

What instruments are needed for anaesthesia and patient positioning during VP shunt surgery?

Step 1

Answer 2

Instruments needed include anaesthesia equipment (anaesthesia machine, endotracheal tube, monitoring devices), positioning equipment (headrest), and surgical drapes to create a sterile field.

Question 3

What is the purpose of the scalp incision and burr hole creation in VP shunt surgery? What would be the instruments required?

Step 2

Answer 3

The purpose is to make a small incision in the scalp and create a burr hole in the skull to access the ventricles of the brain for shunt catheter insertion. Instruments required include a scalpel (*10blade), burr hole drill, rongeur, and bone wax.

Question 4

Why is an incision made in the dura mater during VP shunt surgery? What are the instruments required?

Step 3

Answer 4

The incision in the dura mater allows access to the ventricular system for the placement of the shunt catheter. Instruments used include a dura hook, dural scissors, microsurgical forceps, and surgical suction.

Question 5

What is the purpose of inserting the ventricular catheter during VP shunt surgery? What would be the instruments required?

Step 4

Answer 5

The ventricular catheter is inserted into the lateral ventricle to divert cerebrospinal fluid (CSF) from the brain. Instruments used include the ventricular catheter (shunt tube), microsurgical forceps, surgical suction, and a needle or trocar (optional).

Question 6

What is the purpose of creating a subcutaneous tunnel for the shunt tube? What are the instruments required?

Step 5

Answer 6

The subcutaneous tunnel connects the ventricular catheter to the peritoneal catheter. Instruments required include a tunnelling tool, scalpel, and surgical suction to maintain a clear working area.

Question 7

What is the role of the abdominal catheter in VP shunt surgery? What are the instruments required?

Step 6

Answer 7

The abdominal catheter is inserted into the peritoneal cavity to allow the diverted CSF to be absorbed. Instruments needed include a peritoneal catheter (shunt tube), trocar (optional), and surgical suction to clear fluids during insertion.

Question 8

How are the catheters connected during VP shunt surgery? What would be the instruments required?

Step 7

Answer 8

The ventricular catheter is connected to the peritoneal catheter using a connector tube and secured with sutures. A shunt valve may also be used to regulate CSF flow. Instruments used include the shunt valve, connector tube, suture material, and needle holder with sutures.

Question 9

What is the purpose of the final adjustment and testing of the shunt? What would be the instruments required?

Step 8

Answer 9

The final adjustment and testing ensure that the shunt is properly placed and functional. Fluoroscopy may be used for confirmation, and surgical suction is applied to keep the surgical area clear. Surgical clamps may be used for testing the CSF flow.

Question 10

What instruments are used to close the incisions after VP shunt surgery?

Step 9

Answer 10

Absorbable sutures are used to close deeper layers, non-absorbable sutures or a skin stapler are used for the skin incision, and suture scissors are used to cut excess suture material. Sterile dressings are applied to cover the incisions and reduce infection risk.