الفهرس 
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Abstract
Hydrocephalus is an imbalance of CSF formation and absorption of sufficient magnitude to produce a net accumulation of CSF within the cerebral ventricles.
Hypothetically, the condition may arise in three ways:
• Obstruction of CSF pathways
• CSF over secretion
• Impaired venous drainage
The incidence of infantile hydrocephalus is about 3 to 4 per 1000 live births, this does not reflect the incidence of acquired hydrocephalus. Acquired hydrocephalus represents approximately 40% of the total cases of hydrocephalus.
Ventriculoperitoneal shunts are presently the mainstay of hydrocephalus treatment because of their ease of insertion and reliable long-term function. Other types of shunts as ventriculoatrial shunts are usually reserved for circumstances in which ventriculoperitoneal shunts fail or are contraindicated.
Despite their ability to control the symptoms and signs of hydrocephalus, the shunts are foreign bodies associated with several potential complications, some occur immediately, while other occur over the long term. Shunt obstruction and infection are the most common complications.
The recent studies revealed that nearly half of all shunt placements were for revision, and there are a low but real percentage of cases in which death and neurological impairment are related to shunt surgery. This clearly means that the shunt systems and the techniques in current use involve many problems that have yet to be solved.
Laparoscopic revision through retrieval of catheter parts, accomplished through 3-mm to 5-mm ports with the help of delicate laparoscopic instruments, minimizes the risk of a laparotomy, and the formation of intraperitoneal adhesions.
Laparoscopy allows visual confirmation of the adequate flow of the CSF from the end of the catheter after it is repositioned. However, the greatest advantage of laparoscopy lies in its ability to assess the entire abdominal cavity for the presence of adhesions and undertake adhesiolysis whenever necessary. This allows placement of the catheter in the quadrant of the abdomen with the maximum absorptive surface.
Also it decreases the need of distal tube revision as visualization of properly functioning tube will preserve revision of the distal tube inside peritoneum.
Using the technique of laparoscopy, excision of a portion of a CSF pseudocyst, removal of the shunt catheter from the residual cavity, and repositioned it within the peritoneal cavity is available.
Laparoscopy is safe in patients with abdominal complications of ventriculoperitoneal shunts especially in adhesions and pseudocyst formation.
Laparoscopy has many advantages; less operative time, less intraabdominal adhesion formation and limited skin-to-shunt contact, decrease the need for shunt revision due to the loss of absorptive peritoneal surface, shorter hospital stays because of less postoperative pain, the catheter is positioned under direct vision thus reducing the risk of bowel injury and the development of adhesions, can be repeated several times in case of further complications because it is less invasive. This is not the case with laparotomy, which is more traumatic, no adverse neurologic squeal occurred due to the pneumoperitoneum.
Finally laparoscopic approach allows diagnosis as well as treatment, and if shunt is fully functional to save the existing shunt and avoid the potential morbidity associated with additional VP shunt placement or revision if not properly functioning with less complications than open laparotomy.