Ventricular Catheters for Hydrocephalus

Isolated fourth ventricle is not uncommon in complex posthemorrhagic or postinfectious hydrocephalus. When the condition is symptomatic, the current surgical treatment is endoscopic aqueductoplasty, followed by endoscope-assisted placement of a catheter in the fourth ventricle. The authors suggest a very simple method of steering the tip of standard ventricular catheters by using materials commonly available in all operating rooms. The main advantage of this method is that it permits less invasive transaqueductal drainage of trapped fourth ventricles, especially in cases of narrow third ventricle, because the scope and catheter are introduced in sequence and not in a double-barreled fashion. Two illustrative cases are reported.

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A multicenter retrospective study of heterogeneous tissue aggregates obstructing ventricular catheters explanted from patients with hydrocephalus

Fluids and Barriers of the CNS ◽

10.1186/s12987-021-00262-3 ◽

2021 ◽

Vol 18 (1) ◽

Author(s):

Prashant Hariharan ◽

Jeffrey Sondheimer ◽

Alexandra Petroj ◽

Jacob Gluski ◽

Andrew Jea ◽

...

Keyword(s):

Cerebrospinal Fluid ◽

Retrospective Study ◽

Foreign Body ◽

Foreign Body Giant Cell ◽

Clinical Factors ◽

Histological Features ◽

Ventricular Catheters ◽

Heterogeneous Tissue ◽

Histology And Immunohistochemistry ◽

Macroscopic Analysis

Abstract Background Implantation of ventricular catheters (VCs) to drain cerebrospinal fluid (CSF) is a standard approach to treat hydrocephalus. VCs fail frequently due to tissue obstructing the lumen via the drainage holes. Mechanisms driving obstruction are poorly understood. This study aimed to characterize the histological features of VC obstructions and identify links to clinical factors. Methods 343 VCs with relevant clinical data were collected from five centers. Each hole on the VCs was classified by degree of tissue obstruction after macroscopic analysis. A subgroup of 54 samples was analyzed using immunofluorescent labelling, histology and immunohistochemistry. Results 61.5% of the 343 VCs analyzed had tissue aggregates occluding at least one hole (n = 211) however the vast majority of the holes (70%) showed no tissue aggregates. Mean age at which patients with occluded VCs had their first surgeries (3.25 yrs) was lower than in patients with non-occluded VCs (5.29 yrs, p < 0.02). Mean length of time of implantation of occluded VCs, 33.22 months was greater than for non-occluded VCs, 23.8 months (p = 0.02). Patients with myelomeningocele had a greater probability of having an occluded VC (p = 0.0426). VCs with occlusions had greater numbers of macrophages and astrocytes in comparison to non-occluded VCs (p < 0.01). Microglia comprised only 2–6% of the VC-obstructing tissue aggregates. Histologic analysis showed choroid plexus occlusion in 24%, vascularized glial tissue occlusion in 24%, prevalent lymphocytic inflammation in 29%, and foreign body giant cell reactions in 5% and no ependyma. Conclusion Our data show that age of the first surgery and length of time a VC is implanted are factors that influence the degree of VC obstruction. The tissue aggregates obstructing VCs are composed predominantly of astrocytes and macrophages; microglia have a relatively small presence.

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Next generation of ventricular catheters for hydrocephalus based on parametric designs

Child s Nervous System ◽

10.1007/s00381-017-3565-0 ◽

2017 ◽

Vol 34 (2) ◽

pp. 267-276 ◽

Cited By ~ 1

Author(s):

M. Galarza ◽

A. Giménez ◽

J. M. Amigó ◽

M. Schuhmann ◽

R. Gazzeri ◽

...

Keyword(s):

Next Generation ◽

Ventricular Catheters

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A guide to placement of parietooccipital ventricular catheters

Journal of Neurosurgery ◽

10.3171/jns.1995.82.2.0300 ◽

1995 ◽

Vol 82 (2) ◽

pp. 300-304 ◽

Cited By ~ 18

Author(s):

Matthew A. Howard ◽

Jayashree Srinivasan ◽

Carl G. Bevering ◽

H. Richard Winn ◽

M. Sean Grady

Keyword(s):

Ct Scanning ◽

Catheter Placement ◽

Target Point ◽

Catheter Position ◽

Content Type ◽

Ventriculoperitoneal Shunting ◽

Frontal Horn ◽

Catheter Tip ◽

Ventricular Catheters ◽

Entire Procedure

✓ Accurate placement of parietooccipital ventricular catheters can be difficult and frustrating. To minimize the morbidity of the procedure and lengthen the duration of shunt function, the catheter tip should lie in the ipsilateral frontal horn. The authors describe a posterior ventricular guide (PVG) for placement of parietooccipital catheters that operates by mechanically coupling the posterior burr hole to the anterior target point. In a series of 38 patients who underwent ventriculoperitoneal shunting with the assistance of the guide, postoperative computerized tomography (CT) scanning revealed that 35 (92.0%) had accurate catheter placement. In comparison, a retrospective review of free-hand posterior catheter placement revealed good catheter position in only 22 of 43 patients (51.1%). The use of the guide added less than 5 minutes to the entire procedure, and there were no complications related to its use. The PVG is a simple and useful tool that aids in the placement of parietooccipital ventricular catheters.

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Removal of Adherent Ventricular Catheters

Pediatric Neurosurgery ◽

10.1159/000120453 ◽

1989 ◽

Vol 15 (2) ◽

pp. 104-104

Author(s):

William O. Bell

Keyword(s):

Ventricular Catheters

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Intraoperative Fiber-Optic Endoscopy for Ventricular Catheter Insertion

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/s0317167100052562 ◽

2001 ◽

Vol 28 (1) ◽

pp. 56-60 ◽

Cited By ~ 15

Author(s):

Philip V. Theodosopoulos ◽

Aviva Abosch ◽

Michael W. McDermott

Keyword(s):

Fiber Optic ◽

Catheter Placement ◽

Ventricular Catheter ◽

Neurosurgical Procedure ◽

Significant Difference ◽

Catheter Tip ◽

Endoscopic Guidance ◽

Ventricular Catheters ◽

Tip Position ◽

Optic Endoscopy

ABSTRACT:Objective:Ventricular catheter placement is a common neurosurgical procedure often resulting in inaccurate intraventricular positioning. We conducted a comparison of the accuracy of endoscopic and conventional ventricular catheter placement in adults.Methods:A retrospective analysis of data was performed on 37 consecutive patients undergoing ventriculo-peritoneal shunt (VPS) insertion with endoscopy and 40 randomly selected, unmatched patients undergoing VPS insertion without endoscopy, for the treatment of hydrocephalus of varied etiology. A grading system for catheter tip position was developed consisting of five intraventricular zones, V1-V5, and three intraparenchymal zones, A, B, C. Zones V1 for the frontal approaches and V1 or V2 for the occipital approaches were the optimal catheter tip locations. Postoperative scans of each patient were used to grade the accuracy of ventricular catheter placement.Results:Seventy-six percent of all endoscopic ventricular catheters were in zone V1 and 100% were within zones V1-V3. No endoscopically inserted catheters were observed in zones V4, V5 or intraparenchymally. Thirty-eight percent of the conventionally placed catheters were in zone V1, 53% in zones V1-3 and 15% intraparenchymally. There was a statistically significant difference in the percentage of catheters in optimal location versus in any other location, favoring endoscopic guidance (p<0.001).Conclusion:We conclude that endoscopic ventricular catheter placement provides improved positioning accuracy than conventional techniques.

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Three-Dimensional Ultrasound–Guided Placement of Ventricular Catheters

World Neurosurgery ◽

10.1016/j.wneu.2013.08.021 ◽

2014 ◽

Vol 82 (3-4) ◽

pp. 536.e5-536.e9 ◽

Cited By ~ 17

Author(s):

Asgeir S. Jakola ◽

Ingerid Reinertsen ◽

Tormod Selbekk ◽

Ole Solheim ◽

Frank Lindseth ◽

...

Keyword(s):

Three Dimensional ◽

Ultrasound Guided ◽

Ventricular Catheters

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Craniotomy for Fenestration of Multiloculated Hydrocephalus in Pediatric Patients

Operative Neurosurgery ◽

10.1227/01.neu.0000163489.75279.8c ◽

2005 ◽

Vol 57 (suppl_1) ◽

pp. 100-106 ◽

Cited By ~ 10

Author(s):

David I. Sandberg ◽

J. Gordon McComb ◽

Mark D. Krieger

Keyword(s):

Pediatric Patients ◽

Neurological Status ◽

Neurological Deficits ◽

Ventricular Catheter ◽

Shunt System ◽

Neurological Outcomes ◽

Multiloculated Hydrocephalus ◽

Before And After ◽

Posterior Parietal ◽

Ventricular Catheters

Abstract OBJECTIVE: To assess the treatment of progressive multiloculated hydrocephalus by craniotomy for microsurgical fenestration of cerebrospinal fluid (CSF) compartments to minimize the number of ventricular catheters. METHODS: We studied 33 pediatric patients who underwent craniotomies for fenestration of progressive multiloculated hydrocephalus between 1989 and 2003. In 20 of 33 patients, hydrocephalus was attributed to intraventricular hemorrhage associated with prematurity. Twenty-three of 33 patients had previous central nervous system infections. Craniotomy was typically performed via a posterior parietal approach. Communication between bilateral supratentorial loculated compartments and posterior fossa compartments was achieved. Surgical and neurological outcomes were assessed. RESULTS: Fenestration of loculated CSF spaces was performed successfully in all patients. No new neurological deficits were noted after surgery, and no patients required intraoperative blood transfusions. CSF infections within 3 months after surgery occurred in 4 of 33 patients. Over a median follow-up period of 3.7 years (range, 1.5 mo to 8.7 yr), 19 of 33 patients required additional fenestration procedures. The number of repeat fenestration procedures ranged from one to six, and a total of 47 additional fenestrations were performed in these 19 patients. The majority of patients (n = 25) ultimately required shunt systems with only one ventricular catheter. The neurological status of these patients was extremely poor both before and after surgery. Twenty-nine of 33 patients were severely delayed, and four were mildly delayed. CONCLUSION: Fenestration of multiloculated CSF compartments can enable most patients to function with a single ventricular catheter shunt system. Neurological status remains poor in this patient population.

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