Jehuda soleman, christian a.Schneider, viktoria a pfeifle, peter zimmerman, raphael guzman.Laparoscopic-assisted ventriculoperitoneal shunt placement in children younger than the age of 1 year.World neurosurgery 99 (2017) doi: 10.1016/j.Wneu.2016.12.075 objectives: to analyze the safety and feasibility oflaparoscopic-assisted ventriculoperitoneal shunt (vps)insertion in children younger than the age of 1 year and weighing less than 5 kg.Methods: we performed a retrospective review of children receiving laparoscopic-assisted vps.Patient characteristics, complications, operation and hospitalization time, blood loss, and conversion to the standard approach were noted and analyzed.Results: laparoscopic-assisted vps was performed in 25 children.Mean age was 32 months (range 19 days to 18 years); 16 patients (64%) were younger than the age of 1 year and 10 patients (38%) weighed less than 5 kg at the time of surgery.In all cases laparoscopic insertion was possible without the need to convert to the standard approach.No intraoperative laparoscopy-associated complications occurred.Mean estimated blood volume lost was 4.52%, showing no significant difference between patients younger and older than 1 year.Mean operation time was 75.44 minutes (range 45e121 minutes), and mean hospitalization time was 37.1 days (range 4e142 days, median: 22 days).Patients younger than the age of 1 year showed significant shorter operation time (p <(><<)> 0.001) and longer hospitalization time (p [ 0.04).Complication rate within 30 days was 24% (n [ 6), and overall complication rate was 36% (n [ 9), whereas none were related to the abdominal placement of the catheter, and showed no difference between the 2 age groups.Conclusions: laparoscopic-assisted vps insertion in children seems to be safe and feasible leading to very good resultseven in patients under the age of 1 and weighing less than 5 kg.Reported event: one patient experienced an early postoperative seizure treated successfully with medication.One patient suffered from over drainage whereas a resulting bilateral chronic subdural hematomas had to be treated with burr hole drainage.
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