VPシャント—新規症例

Original Ventriculoperitoneal Shunt for Pediatric Hydrocephalus

Point

・頭部から腹部までのシャントルートについて，子どもを術前に十分観察し，バルブの位置や種類，皮切の置き方などを検討する．

・小児のVPシャントにおいて，カテーテルは伸長に伴って必ず抜けてくるため，将来の成長を見越した手術の工夫が必要である．

　Although the use of newly developed procedures such as endoscopic third ventriculostomy or coagulation of the choroid plexus has gradually expanded, ventriculoperitoneal（VP）shunts are still not obsolete. They are the most commonly performed surgery for treating pediatric hydrocephalus. Young neurosurgeons may frequently encounter this CSF diversion procedure in clinical practice. However, the VP shunt remains a failure-prone procedure, as exemplified by obstruction, infection, mechanical shunt failure, over drainage, and distal catheter site-specific failures. Therefore, surgery requires exquisite techniques, especially in the pediatric population, to meet the needs of the child's growth. This article sheds light on the refined methodology for pediatric VP shunting with meticulous details of the surgical technique. Neurosurgeons must always remember that appropriate ICP control has a major impact on patient development and that a stably functioning VP shunt can deliver the full potential of children with hydrocephalus.