Longitudinal slit in the distal portion of the abdominal catheter: a technique to minimize obstructions or malfunction in ventriculoperitoneal shunts

Introduction: One of the primary reasons for ventriculoperitoneal (VP) shunt failure related to the abdominal catheter is the formation of a pseudocyst due to intraperitoneal septations. Often, it is not merely a blockage but an encasement of the catheter's tip within a closed cavity that restricts the absorption of cerebrospinal fluid (CSF), leading to pseudocyst formation. Such accumulation increases pressure, potentially exceeding the valve's threshold and causing valve malfunction, which can result in the recurrence of hydrocephalus and neurological symptoms.Objective: This paper revisits the historical development of a technique pioneered by neurosurgeon Alex Caetano de Barros, which aims to reduce failures in ventriculoperitoneal shunts.Technique: The procedure involves making one or two longitudinal incisions of approximately 3 cm each on the abdominal catheter before insertion into the peritoneal cavity, positioned 15 cm and 10 cm from the catheter's distal end. Incisions are made on only one side of the catheter. Surgeons must be cautious when handling the catheter to avoid accidents with the scalpel.Conclusion: This simple technique can enhance the performance of VP shunts by potentially preventing complications due to obstruction at the distal end of the catheter, thereby facilitating better CSF flow and reducing the risk of shunt failure.