A PERITONEAL MARKER FOR OPTIMAL TIMING OF VENTRICULO-PERITONEAL SHUNTREVISION IN EARLY-CHILDHOOD

The ventriculo-peritoneal shunt placed in a neonate or infant needs re vision to lengthen the peritoneal tube at certain times during childho od. The critical lime for this revision is not exactly the same betwee n individuals. Furthermore, the level of peritoneal insertion of the s hunt tube is often unclear on x-ray films. To plan for and determine t he optimal timing of revision, we applied a titanium clip on the perit oneal suture line in three infants as a marker of peritoneal insertion level. During the 31- to 37-month follow-up period, abdominal x-ray c learly demonstrated the peritoneal insertion level in all three patien ts, allowing accurate determination of the length of the intraperitone al portion (IP) of the shunt tube. The rate of shortening of the lengt h oi IP was 20 to 27% of the increase in body height (BH). Ti,is techn ique allows accurate determination of the length oi IP and also optima l timing for revision.