Percutaneous management of ventricular catheter obstruction

1974 ◽  
Vol 41 (4) ◽  
pp. 511-512
Author(s):  
Errett E. Hummel ◽  
Hirohisa Ono ◽  
Anthony E. Gallo
Keyword(s):  
Shunt Revision ◽  
Ventricular Catheter ◽  
Foreign Material ◽  
Percutaneous Aspiration ◽  
Catheter Obstruction ◽  
Operative Revision ◽  
Ventricular Catheters

check; A technique is described for placement of ventricular shunt catheters which allows later nonoperative relief of obstruction within the proximal catheter. Operative revision of occluded ventricular catheters may often be avoided by percutaneous aspiration and irrigation of foreign material, thus decreasing the morbidity associated with shunt revision.

Utility of Preoperative Simulation for Ventricular Catheter Placement via a Parieto-Occipital Approach in Normal-Pressure Hydrocephalus

2018 ◽  
Vol 16 (6) ◽  
pp. 647-657 ◽  
Author(s):  
Shigeki Yamada ◽  
Masatsune Ishikawa ◽  
Kazuo Yamamoto
Keyword(s):  
Normal Pressure Hydrocephalus ◽  
Normal Pressure ◽  
Catheter Placement ◽  
Optimal Placement ◽  
Shunt Revision ◽  
Slip Angle ◽  
Ventricular Catheter ◽  
Ventricular Catheters ◽  
Preoperative Simulation ◽  
The Mean

Abstract BACKGROUND Freehand ventricular catheter placement has been reported to have poor accuracy. OBJECTIVE To investigate whether preoperative computational simulation using diagnostic images improves the accuracy of ventricular catheter placement. METHODS This study included 113 consecutive patients with normal-pressure hydrocephalus (NPH), who underwent ventriculoperitoneal shunting via a parieto-occipital approach. The locations of the ventricular catheter placement in the last 48 patients with preoperative virtual simulation on the 3-dimensional workstation were compared with those in the initial 65 patients without simulation. Catheter locations were classified into 3 categories: optimal, suboptimal, and poor placements. Additionally, slip angles were measured between the ventricular catheter and optimal direction. RESULTS All patients with preoperative simulations had optimally placed ventricular catheters; the mean slip angle for this group was 2.8°. Among the 65 patients without simulations, 46 (70.8%) had optimal placement, whereas 10 (15.4%) and 9 (13.8%) had suboptimal and poor placements, respectively; the mean slip angle for the nonsimulation group was 8.6°. The slip angles for all patients in the preoperative simulation group were within 7°, whereas those for 31 (47.7%) and 10 (15.4%) patients in the nonsimulation group were within 7° and over 14°, respectively. All patients with preoperative simulations experienced improved symptoms and did not require shunt revision during the follow-up period, whereas 5 patients (7.7%) without preoperative simulations required shunt revisions for different reasons. CONCLUSION Preoperative simulation facilitates accurate placement of ventricular catheters via a parieto-occipital approach. Minimally invasive and precise shunt catheter placement is particularly desirable for elderly patients with NPH.

What We Should Know About the Cellular and Tissue Response Causing Catheter Obstruction in the Treatment of Hydrocephalus

Neurosurgery ◽  
2011 ◽  
Vol 70 (6) ◽  
pp. 1589-1602 ◽  
Author(s):  
Carolyn A. Harris ◽  
James P. McAllister
Keyword(s):  
Cerebrospinal Fluid ◽  
Chemical Cues ◽  
Tissue Response ◽  
Ventricular Catheter ◽  
Chemical Surface ◽  
Catheter Obstruction ◽  
Ventricular Catheters ◽  
Cerebrospinal Fluid Shunting ◽  
The Brain ◽  
Improve Patient

Abstract The treatment of hydrocephalus by cerebrospinal fluid shunting is plagued by ventricular catheter obstruction. Shunts can become obstructed by cells originating from tissue normal to the brain or by pathological cells in the cerebrospinal fluid for a variety of reasons. In this review, the authors examine ventricular catheter obstruction and identify some of the modifications to the ventricular catheter that may alter the mechanical and chemical cues involved in obstruction, including alterations to the surgical strategy, modifications to the chemical surface of the catheter, and changes to the catheter architecture. It is likely a combination of catheter modifications that will improve the treatment of hydrocephalus by prolonging the life of ventricular catheters to improve patient outcome.

A 12-year single-center retrospective analysis of antisiphon devices to prevent proximal ventricular shunt obstruction for hydrocephalus

2019 ◽  
Vol 24 (6) ◽  
pp. 642-651
Author(s):  
Joyce Koueik ◽  
Mark R. Kraemer ◽  
David Hsu ◽  
Elias Rizk ◽  
Ryan Zea ◽  
...  
Keyword(s):  
Shunt Revision ◽  
Ventricular Catheter ◽  
Shunt Failure ◽  
Shunt System ◽  
Shunt Valve ◽  
Catheter Obstruction ◽  
Before And After ◽  
Observational Cohort ◽  
Shunt Obstruction

OBJECTIVERecent evidence points to gravity-dependent chronic shunt overdrainage as a significant, if not leading, cause of proximal shunt failure. Yet, shunt overdrainage or siphoning persists despite innovations in valve technology. The authors examined the effectiveness of adding resistance to flow in shunt systems via antisiphon devices (ASDs) in preventing proximal shunt obstruction.METHODSA retrospective observational cohort study was completed on patients who had an ASD (or additional valve) added to their shunt system between 2004 and 2016. Detailed clinical, radiographic, and surgical findings were examined. Shunt failure rates were compared before and after ASD addition.RESULTSSeventy-eight patients with shunted hydrocephalus were treated with placement of an ASD several centimeters distal to the primary valve. The records of 12 of these patients were analyzed separately due to a complex shunt revision history (i.e., > 10 lifetime shunt revisions). The authors found that adding an ASD decreased the 1-year ventricular catheter obstruction rates in the “simple” and “complex” groups by 67.3% and 75.8%, respectively, and the 5-year rates by 43.3% and 65.6%, respectively. The main long-term ASD complication was ASD removal for presumed valve pressure intolerance in 5 patients.CONCLUSIONSUsing an ASD may result in significant reductions in ventricular catheter shunt obstruction rates. If confirmed with prospective studies, this observation would lend further evidence that chronic shunt overdrainage is a central cause of shunt malfunction, and provide pilot data to establish clinical and laboratory studies that assess optimal ASD type, number, and position, and eventually develop shunt valve systems that are altogether resistant to siphoning.

Increased risk of distal ventriculoperitoneal shunt obstruction associated with slit valves or distal slits in the peritoneal catheter

1997 ◽  
Vol 87 (5) ◽  
pp. 682-686 ◽  
Author(s):  
Jeffrey W. Cozzens ◽  
James P. Chandler
Keyword(s):  
Shunt Revision ◽  
Ventricular Catheter ◽  
Peritoneal Catheter ◽  
Distal Catheter ◽  
Content Type ◽  
Vp Shunt ◽  
Increased Risk ◽  
Catheter Obstruction ◽  
Shunt Obstruction ◽  
Fine Print

✓ The authors describe a relationship between the presence of distal shunt catheter side-wall slits and distal catheter obstruction in a single-surgeon series of ventriculoperitoneal (VP) shunt revisions. Between 1985 and 1996, 168 operations for VP shunt revision were performed by the senior author (J.W.C.) in 71 patients. Indications for shunt revision included obstruction in 140 operations; overdrainage or underdrainage requiring a change of valve in 17 operations; inadequate length of distal shunt tubing resulting in the distal end no longer reaching the peritoneum in five operations; the ventricular catheter in the wrong ventricle or space, requiring repositioning in five operations; and a disconnected or broken shunt in one operation. Of the 140 instances of shunt obstruction, the blockage occurred at the ventricular end in 108 instances (77.1%), the peritoneal end in 17 (12.1%), the ventricular and the peritoneal end in 14 (10%), and in the valve mechanism (not including distal slit valves) in one (0.8%). Thus, the peritoneal end was obstructed in 31 (22.1%) of 140 cases of shunt malfunction. In every case in which the peritoneal end was obstructed, some form of distal slit was found: either a distal slit valve in an otherwise closed catheter or slits in the side of an open catheter. No instances were found of distal peritoneal catheter obstruction when the peritoneal catheter was a simple open-ended tube with no accompanying side slits (0 of 55). It is concluded that side slits in the distal peritoneal catheters of VP shunts are associated with a greater incidence of distal shunt obstruction.

Electromagnetic-guided neuronavigation for safe placement of intraventricular catheters in pediatric neurosurgery

2012 ◽  
Vol 10 (4) ◽  
pp. 327-333 ◽  
Author(s):  
Elvis J. Hermann ◽  
Hans-Holger Capelle ◽  
Christoph A. Tschan ◽  
Joachim K. Krauss
Keyword(s):  
Premature Infants ◽  
Therapeutic Option ◽  
Operative Procedure ◽  
Catheter Placement ◽  
Shunt Revision ◽  
Ventricular Catheter ◽  
Shunt Failure ◽  
Stereotactic Techniques ◽  
Shunt Placement ◽  
Operative Revision

Object Ventricular catheter shunt malfunction is the most common reason for shunt revision. Optimal ventricular catheter placement can be exceedingly difficult in patients with small ventricles or abnormal ventricular anatomy. Particularly in children and in premature infants with small head size, satisfactory positioning of the ventricular catheter can be a challenge. Navigation with electromagnetic tracking technology is an attractive and innovative therapeutic option. In this study, the authors demonstrate the advantages of using this technology for shunt placement in children. Methods Twenty-six children ranging in age from 4 days to 14 years (mean 3.8 years) with hydrocephalus and difficult ventricular anatomy or slit ventricles underwent electromagnetic-guided neuronavigated intraventricular catheter placement in a total of 29 procedures. Results The single-coil technology allows one to use flexible instruments, in this case the ventricular catheter stylet, to be tracked at the tip. Head movement during the operative procedure is possible without loss of navigation precision. The intraoperative catheter placement documented by screenshots correlated exactly with the position on the postoperative CT scan. There was no need for repeated ventricular punctures. There were no operative complications. Postoperatively, all children had accurate shunt placement. The overall shunt failure rate in our group was 15%, including 3 shunt infections (after 1 month, 5 months, and 10 months) requiring operative revision and 1 distal shunt failure. There were no proximal shunt malfunctions during follow-up (mean 23.5 months). Conclusions The electromagnetic-guided neuronavigation system enables safe and optimal catheter placement, especially in children and premature infants, alleviating the need for repeated cannulation attempts for ventricular puncture. In contrast to stereotactic techniques and conventional neuronavigation, there is no need for sharp head fixation using a Mayfield clamp. This technique may present the possibility of reducing proximal shunt failure rates and costs for hydrocephalus treatment in this age cohort.

scholarly journals Overdrainage-related ependymal bands: a postulated cause of proximal shunt obstruction

2018 ◽  
Vol 22 (5) ◽  
pp. 567-577 ◽  
Author(s):  
Mark R. Kraemer ◽  
Joyce Koueik ◽  
Susan Rebsamen ◽  
David A. Hsu ◽  
M. Shahriar Salamat ◽  
...  
Keyword(s):  
Senior Author ◽  
Surrounding Tissue ◽  
Shunt Revision ◽  
Ventricular Catheter ◽  
Ventricular Wall ◽  
Ventricular Tissue ◽  
Cellular Aggregation ◽  
Catheter Tip ◽  
Ventricular Catheters ◽  
Shunt Obstruction

OBJECTIVEVentricular shunts have an unacceptably high failure rate, which approaches 50% of patients at 2 years. Most shunt failures are related to ventricular catheter obstruction. The literature suggests that obstructions are caused by in-growth of choroid plexus and/or reactive cellular aggregation. The authors report endoscopic evidence of overdrainage-related ventricular tissue protrusions (“ependymal bands”) that cause partial or complete obstruction of the ventricular catheter.METHODSA retrospective review was completed on patients undergoing shunt revision surgery between 2008 and 2015, identifying all cases in which the senior author reported endoscopic evidence of ependymal tissue in-growth into ventricular catheters. Detailed clinical, radiological, and surgical findings are described.RESULTSFifty patients underwent 83 endoscopic shunt revision procedures that revealed in-growth of ventricular wall tissue into the catheter tip orifices (ependymal bands), producing partial, complete, or intermittent shunt obstructions. Endoscopic ventricular explorations revealed ependymal bands at various stages of development, which appear to form secondarily to siphoning. Ependymal bands are associated with small ventricles when the shunt is functional, but may dilate at the time of obstruction.CONCLUSIONSVentricular wall protrusions are a significant cause of proximal shunt obstruction, and they appear to be caused by siphoning of surrounding tissue into the ventricular catheter orifices.

Radiographic assessment of snap-shunt failure

2010 ◽  
Vol 6 (3) ◽  
pp. 299-302 ◽  
Author(s):  
Anand I. Rughani ◽  
Bruce I. Tranmer ◽  
Jeffrey E. Florman ◽  
James T. Wilson
Keyword(s):  
Normal Values ◽  
Clinical Symptoms ◽  
Type System ◽  
Shunt Malfunction ◽  
Ct Scans ◽  
Shunt Revision ◽  
Ventricular Catheter ◽  
Shunt Failure ◽  
Shunt System ◽  
Ct Finding

Accurate assessment of imaging studies in patients with ventriculoperitoneal shunts can be aided by empirical findings. The authors characterize an objective measurement easily performed on head CT scans with the goal of producing clear evidence of shunt fracture or disconnection in patients with a snap shunt–type system. The authors describe 2 cases of ventriculoperitoneal shunt failure involving a fracture and a disconnection associated with a snap-shunt assembly. In both cases the initial clinical symptoms were not convincing for shunt malfunction, and the interpretation of the CT finding failed to immediately identify the abnormality. As the clinical picture became more convincing for shunt malfunction, each patient subsequently underwent successful shunt revision. The authors reviewed the CT scans of 10 patients with an intact and functioning snap-shunt system to characterize the normal appearance of the snap-shunt connection. On CT scans the distance between the radiopaque portion of the ventricular catheter and the radiopaque portion of the reservoir dome measures an average of 4.72 mm (range 4.6–4.9 mm, 95% CI 4.63–4.81 mm). In the authors' patient with a fractured ventricular catheter, this interval measured 7.8 mm, and in the patient with a disconnection it measured 7.7 mm. In comparison with the range of normal values, a radiolucent interval significantly greater than 4.9 mm should promptly raise concern for a disconnected or fractured shunt in this system. This measurement may prove particularly useful when serial imaging is not readily available.

scholarly journals Intraoperative Fiber-Optic Endoscopy for Ventricular Catheter Insertion

2001 ◽  
Vol 28 (1) ◽  
pp. 56-60 ◽  
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.

Craniotomy for Fenestration of Multiloculated Hydrocephalus in Pediatric Patients

2005 ◽  
Vol 57 (suppl_1) ◽  
pp. 100-106 ◽  
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.

Computational and experimental study of proximal flow in ventricular catheters

2003 ◽  
Vol 99 (2) ◽  
pp. 426-431 ◽  
Author(s):  
Julian Lin ◽  
Martin Morris ◽  
William Olivero ◽  
Frederick Boop ◽  
Robert A. Sanford
Keyword(s):  
Water Table ◽  
Three Dimensional ◽  
Automated Testing ◽  
Ventricular Catheter ◽  
Shunt Insertion ◽  
Content Type ◽  
Testing Apparatus ◽  
Table Model ◽  
Catheter Tip ◽  
Ventricular Catheters

✓ The treatment of hydrocephalus with shunt insertion is fraught with high failure rates. Evidence indicates that the proximal holes in a catheter are the primary sites of blockage. The authors have studied ventricular catheter designs by using computational fluid dynamics (CFD), two-dimensional water table experiments, and a three-dimensional (3D) automated testing apparatus together with an actual catheter. With the CFD model, the authors calculated that 58% of the total fluid mass flows into the catheter's most proximal holes and that greater than 80% flows into the two most proximal sets of holes within an eight-hole catheter. In fact, most of the holes in the catheters were ineffective. These findings were experimentally verified using two completely different methodologies: a water table model of a shunt catheter and a 3D automated testing apparatus with an actual catheter to visualize flow patterns with the aid of ink. Because the majority of flow enters the catheter's most proximal holes, blockages typically occur at this position, and unlike blockages at distal holes, occlusion of proximal holes results in complete catheter failure. Given this finding, new designs that incorporated varying hole pattern distributions and size dimensions of the ventricular catheter were conceived and tested using two models. These changes in the geometrical features significantly changed the entering mass flow rate distribution. In conclusion, new designs in proximal ventricular catheters with variable hole diameters along the catheter tip allowed fluid to enter the catheter more uniformly along its length, thereby reducing the probability of its becoming occluded.

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