Current Techniques in Canine and Feline Neurosurgery by Andy Shores & Brigitte A. Brisson

Author:Andy Shores & Brigitte A. Brisson
Language: eng
Format: epub
Published: 2017-10-16T00:00:00+00:00

Preoperative Preparation

Shunt surgery has a high failure rate and requires meticulous attention to detail. Many complications are avoidable, such as intraparenchymal placement of the ventricular catheter, extraperitoneal placement of the distal catheter, and disconnection or migration of a shunt. A number of human studies have shown that prophylactic perioperative antibiotics are effective at reducing infection [10]. One protocol is cefazolin 20 mg/kg intravenously just before surgery, repeated every 90 min during surgery and then every 6 hours until 24 hours after surgery. The urinary bladder is emptied to avoid damage when placing the distal catheter.

The patient is positioned so there is a flat plane between the cranial and abdominal incision sites. This is aided by placing a rolled towel under the neck. Using preoperative brain imaging as a guide, the site of insertion of the ventricular catheter is chosen so that the catheter tip will be placed in the center of the occipital horn or frontal horn, caudal or rostral to the choroid plexus. The distance from the surface of the skull to the center of the ventricle is measured to determine the depth of insertion. The cranial incision is located 1–3 cm lateral to the nuchal crest. The abdominal incision is located 2–3 cm caudal to the last rib, about halfway between the lumbar spine and the ventral aspect of the abdomen. The patient is measured to determine the proper shunt length, planning on placing approximately one‐third to half the shunt length into the abdomen. The distal catheter contributes a significant amount of the total resistance of the shunt system so care must be taken when shortening a distal catheter because this will affect the pressure–flow characteristics. Shunts with a distal slit valve cannot be cut to shorten them. The site of the burr‐hole and abdominal incisions are selected and marked before draping.

The skin is clipped and surgically prepared for surgery from the skull along the entire subcutaneous pathway to the site of abdominal incision. Disposable adhesive drapes are used to cover the patient and operating table except for a small band of skin from the burr‐hole site to the abdomen. A transparent adhesive sheet is applied to cover the remaining area of exposed skin (Figures 14.3 and 14.4).

Figure 14.3 Patient positioning. The skin is clipped from the skull along the entire subcutaneous pathway to the site of abdominal incision. The patient is positioned so there is a flat plane between the cranial and abdominal incision sites with a rolled towel under the neck.

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