Pattisapu JV, Trumble ER, Taylor KR, Howard PD, Kovach TM. Percutaneous endoscopic recanalization of the catheter: a new technique of proximal shunt revision.
Neurosurgery 1999;
45:1361-6; discussion 1366-7. [PMID:
10598704 DOI:
10.1097/00006123-199912000-00019]
[Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE
Proximal ventricular catheter obstruction by the choroid plexus is a frequent occurrence in children with shunted hydrocephalus. In some cases, the flow is obstructed owing to membranous occlusion by a small amount of tissue. It has been shown that only a few of the multiple catheter openings need be patent to maintain adequate shunt function. Recent advances in technology have improved our ability to perform intraluminal endoscopic catheter dissection and minimize the morbidity associated with shunt maintenance.
METHODS
Percutaneous endoscopic shunt recanalization was performed in 20 cases (18 children) under institutional review board study protocol. The mean age was 32 months, and all children had signs and symptoms of shunt malfunction, confirmed by computed tomography and magnetic resonance imaging and verified by shunt taps. Under aseptic conditions in the operating room, the Rickham reservoir was entered with a 16-gauge intravenous catheter, and the obstruction was visualized with a fiber endoscope (0.5-0.8 mm). Intraluminal dissection using electrocautery was performed with endoscopic guidance to visualize the catheter and flushing of the valve.
RESULTS
At a mean follow-up time of 20 months (range, 15-29 mo), the children are doing well, with computed tomographic and magnetic resonance imaging confirmation of adequate ventricular decompression in the 17 successful cases (85%). There were three failures in the study, necessitating a standard open shunt revision.
CONCLUSION
The percutaneous endoscopic shunt recanalization procedure can be used successfully to treat proximal shunt malfunction.
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