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Subcutaneous tunneling of the distal catheter is a potentially risky part of ventriculoperitoneal shunt (VPS) insertion. We describe our institutional experience with a simple trick to improve functional and aesthetic results in VPS by reducing the distal catheter tunneling to a single passage. The one-step edge-to-edge technique has been performed in our institution over 14 years in 46 patients with a mean age of 63. 27 were female (58.7%). 7 patients suffered from post-traumatic hydrocephalus, 6 from normal pressure hydrocephalus, 15 from obstructive hydrocephalus and 18 from hydrocephalus secondary to subarachnoid hemorrhage. Operative blood loss varied from 20 to 40 cc. No complication related to the modified tunneling technique were described except a transitory peripheral VII nerve palsy (2.2%). The absence of middle skin incision is appreciated by the patient, especially in young females that not presented scars at the level of the neckline. Our technique is the first report of one step tunneling in adults. It reduces distal catheter tunneling time in VPS simplifying the procedure to a single step and using a simple reproducible trick.

The one-step edge-to-edge technique in ventriculoperitoneal shunt