H.14 Neurosurgical VP Shunt Tunneler

Ventriculoperitoneal shunts (VP Shunts) are a neurosurgical operative procedure used to treat hydrocephalus (fluid build-up) and high intracranial pressure. VP shunts are simple plastic tubing that drains cerebrospinal fluid from the head to the abdominal cavity (peritoneum) with flow regulation via a simple pressure valve. The insertion of VP shunts requires tunneling the tubing from the head to the abdomen underneath the skin in the subcutaneous layer. To pass the shunt tubing underneath the skin is called tunneling, where a malleable metal rod is blindly shoved under the skin past vital structures with a plastic sheath over the metal rod. The rod is removed and the shunt tubing is passed down the plastic sheath. 

The tunneling portion of the procedure, while generally eventually effective, is cumbersome, risky, and has not changed for a century. Tunneling is achieved via “brute force” and often challenging for the surgeon particularly if the patient is too obese or too thin, if there is prior scarring, or if other medical devices are in the way (e.g. ports, tracheostomies, g tubes, etc.) as the tunneled is not steerable.  There is little precision, no steerability, and no visibility for this portion of the procedure which is perform in infants up to the elderly. Complications such as perforation of viscera (liver, lungs), major vessel damage, and malpositioned shunt catheters are not infrequent. The current solution is simple and cheap and therefore little innovation has been attempted. The current metal tunnels are no longer being manufactured and the industry alternatives are simply more flexible disposable alternatives which do not penetrate the tissue as well and are actually more challenging that the sterilizable older versions. 

The goal of this project is to design a cost-effective improved VP shunt tunneling system that addresses the limitations of the current tunneling system, improves precision placement, and avoids complications during this part of the procedure to improve patient outcomes.