Shunt scissors: technical note

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OBJECTIVE

When performing ventriculoperitoneal shunt surgery it is necessary to create a subgaleal pocket that is of sufficient size to accommodate a shunt valve. In most cases the valve is placed over the posterior skull where the galea begins to transition to suboccipital neck fascia. Dense fibrous attachments in this region of the skull make it technically awkward to develop the subgaleal valve pocket using standard scissors and a blunt dissection technique. In this report the authors describe a new device that enables surgeons to create the shunt valve pocket by using a simple semi-sharp dissection technique.

METHODS

The authors analyzed the deficiencies of the standard valve pocket dissection technique and designed shunt scissors that address the identified shortcomings. These new scissors allow the surgeon to sharply dissect the subgaleal space by using an efficient hand-closing maneuver.

RESULTS

Standard surgical scissors were modified to create shunt scissors that were tested on the benchtop and used in the operating room. In all cases the shunt scissors proved easy to use and allowed the efficient and reliable creation of a subgaleal valve pocket in a technically pleasing manner.

CONCLUSIONS

Shunt scissors represent an incremental technical advance in the field of neurosurgical shunt operations.

ABBREVIATIONS VPS = ventriculoperitoneal shunt.

Article Information

Correspondence Matthew A. Howard III, University of Iowa Hospitals and Clinics, 200 Hawkins Dr., Iowa City, IA 52242. email: matthew-howard@uiowa.edu.

INCLUDE WHEN CITING Published online December 8, 2017; DOI: 10.3171/2017.6.JNS171108.

Disclosures Dr. Grady is a consultant for Integra and an investigator for the National Institute of Neurological Disorders and Stroke (NINDS).

© AANS, except where prohibited by US copyright law.

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Figures

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    Photographs of shunt scissors in the blades-closed and blades-open configurations. The handle and blade are angularly offset so that the blades are separated by 40° in the blades-open position when the handles are closed.

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    Intraoperative photographs of the shunt scissors being used in a representative posterior VPS placement procedure. A: The surgeon confirms that the blades of the scissors are appropriately scaled for the shunt valve that will be placed. B: A posterior scalp flap is created, exposing the subgaleal space. C: Scissors are advanced into the subgaleal space while in the blades-closed position. D: The scissor blades are opened to create the subgaleal pocket by closing the handles. E: Scissors are withdrawn while in the blades-open position, insuring unobstructed access to the subgaleal pocket. F: The shunt valve is advanced into the subgaleal pocket.

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