Selecting the appropriate surgical shunt route in normal-pressure hydrocephalus requires careful consideration of prior abdominal history and cardiac status. This protocol addresses the specific scenario where intraperitoneal adhesions are anticipated and heart disease is absent.
The patient has undergone multiple abdominal surgeries, making intraperitoneal adhesions likely. Concurrently, there is no heart disease — a factor that directly influences shunt route selection. This combination defines a specific sub-population where standard peritoneal drainage is not the preferred pathway.
VA shunt is recommended in situations where intraperitoneal adhesions are expected, such as after multiple abdominal surgeries, but not recommended if heart disease is present.
A programmable-pressure valve is recommended.
DOI: 10.2176/nmc.st.2020-0292
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