Percutaneous Endoscopic Recanalization of the Catheter: A New Technique of Proximal Shunt Revision

Percutaneous Endoscopic Recanalization of the Catheter: A New Technique of Proximal Shunt Revision AbstractOBJECTIVE: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. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Neurosurgery Oxford University Press

Percutaneous Endoscopic Recanalization of the Catheter: A New Technique of Proximal Shunt Revision

Percutaneous Endoscopic Recanalization of the Catheter: A New Technique of Proximal Shunt Revision

Percutaneous Endoscopic Recanalization of the Catheter: A New Technique of Proximal Shunt Revision J o g i V . P a t t i s a p u , M . D . , E r i c R . T r u m b l e , M . D . , K a y R . T a y l o r , R . N . , B . S . N . , P . D e n i s e H o w a r d , C . S . T . , T i n a M . K o v a c h , R . N . W ad e's Center for Hydrocephalus Research, Health Research Institute, Arnold Palmer Hospital for Children and Women, Orlando Regional Healthcare System, Orlando, Florida 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 re v ie w board study protocol. The mean age was 32 months, and all children had signs and symptoms of shunt m alfu n ctio n , confirm ed by computed tom ography and magnetic resonance imaging and verified by shunt taps. U n d e r aseptic conditions in the operating room, the Rickham reservoir was entered with a 16-gauge in travenous catheter, and the obstruction was visualized w ith a fiber endoscope (0.5-0.8 mm). Intralum inal dissection using electro cau tery was performed w ith 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 (8 5 % ). There w ere three failures in the study, necessitating a standard open...
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Publisher
Congress of Neurological Surgeons
Copyright
© Published by Oxford University Press.
ISSN
0148-396X
eISSN
1524-4040
D.O.I.
10.1097/00006123-199912000-00019
Publisher site
See Article on Publisher Site

Abstract

AbstractOBJECTIVE: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.

Journal

NeurosurgeryOxford University Press

Published: Dec 1, 1999

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