DATE OF PROCEDURE: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS:
Hydrocephalus.
POSTOPERATIVE DIAGNOSIS:
Hydrocephalus.
PROCEDURE PERFORMED:
Ventriculoperitoneal shunt.
SURGEON: John Doe, MD
ASSISTANT: Jane Doe, MD
ANESTHESIA: General.
COMPLICATION: None.
SPECIMENS: None.
INDICATION FOR PROCEDURE: The patient is a (XX)-year-old who came in with a subarachnoid hemorrhage and a ruptured aneurysm. The patient was treated and now has developed hydrocephalus. Since we have been unable to wean the patient off the external ventricular drainage, the decision was made to proceed with ventricular catheterization and placement of a ventriculoperitoneal shunt. The family understands the risks and benefits of the procedure, in particular the risks of CSF infection, shunt malfunction, replacement of the shunt, seizures, intracerebral hemorrhage, subdural hematoma, and reoperation. The patient’s family then agreed with the plan and consent was granted.
DESCRIPTION OF OPERATION: The patient was placed supine with the head tilted toward the left. An incision was marked on the right frontal area, right posterior parietal area and right abdominal wall area. All of the incisions were prepped and draped in the usual sterile fashion.
The first incision was made at the level of the frontal area, and coagulation was used to control bleeding. Then, another incision was made at the level of the abdominal wall, and by using a tunneler, the peritoneal catheter was passed from the abdominal wall to the posterior parietal, where a small incision was also made and then up to the right frontal area. The catheter was primed, and the catheter used was a Bactiseal. Then, the programmable valve was set at 180 mm of water and was connected to the peritoneal catheter. At this point, using a previous bur hole, the Bactiseal ventricular catheter was soft passed into the ventricle and connected to the programmable valve. All of these areas of connection were then verified. Then, the peritoneal catheter was inserted into the peritoneal cavity, which was dissected in layers starting from the rectus muscle and then to the peritoneum. The catheter was introduced into the peritoneal cavity after verification of the dripping of CSF.
All incisions were irrigated with antibiotic solution. The frontal incision was closed with 3-0 Vicryl and 3-0 nylon. The small posterior parietal incision was closed with staples. The abdominal wall incision was closed with 3-0 Vicryl, 2-0 Vicryl and Dermabond for the skin.
