A peritoneal marker for optimal timing of ventriculo-peritoneal shunt revision in early childhood

The ventriculo-peritoneal shunt placed in a neonate or infant needs revision to lengthen the peritoneal tube at certain times during childhood. The critical time for this revision is not exactly the same between individuals. Furthermore, the level of peritoneal insertion of the shunt tube is often unclear on x-ray films. To plan for and determine the optimal timing of revision, we applied a titanium clip on the peritoneal suture line in three infants as a marker of peritoneal insertion level. During the 31- to 37-month follow-up period, abdominal x-ray clearly demonstrated the peritoneal insertion level in all three patients, allowing accurate determination of the length of the intraperitoneal portion (i.p.) of the shunt tube. The rate of shortening of the length of i.p was 20 to 27% of the increase in body height (BH). This technique allows accurate determination of the length of i.p. and also optimal timing for revision.