• Deepa Danan, Christopher J Winfree, and Guy M McKhann.
• Department of Neurological Surgery, Columbia University Medical Center, New York, New York 10032, USA.
• Neurosurgery. 2008 Sep 1; 63 (3): E613; discussion E613.

ObjectiveLaparoscopic trocar injury is a relatively well-described complication of cholecystectomies and gynecological procedures. However, this type of injury has not been reported in association with adult neurological surgery. To increase awareness of this very serious risk, we report a case of intra-abdominal vascular injury during a shunt procedure involved with a common neurosurgical procedure.Clinical PresentationA 76-year-old man with no previous abdominal surgical history presented with probable normal pressure hydrocephalus.InterventionAfter an appropriate preoperative workup confirming probable normal pressure hydrocephalus, the patient consented to placement of a ventriculoperitoneal shunt with a programmable valve. During placement of the distal catheter using an abdominal trocar, the aorta was punctured inadvertently, necessitating emergency laparotomy for vascular repair.ConclusionAn abdominal trocar should be used with caution in ventriculoperitoneal shunt surgery. Even with meticulous technique, vascular injury can occur with any trocar-based abdominal procedure. The neurosurgeon who uses this technique must be prepared to initiate emergent vascular access and repair, with a vascular surgery team available should such an injury occur. Alternatively, open placement of peritoneal catheters avoids blind peritoneal instrumentation and is an effective method for minimizing potentially catastrophic vascular injuries.

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