gms | German Medical Science

Objective: The long-term function of a cerebral shunt is directly influenced by the placement of the ventricle catheter. In this study, an intra-luminal endoscope for best possible catheter positioning was used. Postoperative imaging and shunt failure rates were retrospectively evaluated.

Methods: Between January 2012 and June 2016, an intra-catheter endoscope was applied in 71 procedures. Endoscopic technique was used for catheter placement in first-time shunting or cerebrospinal fluid reservoir insertion (n=38), revision surgery in proximal shunt failure (n=13) and various intraventricluar stenting procedures (n=20). Catheter positioning was graded on postoperative imaging using a 4-point scale. All patients were regularly followed up (mean, 31.6 months) to recognize ventricle catheter failures.

Results: Endoscopic application could be completed as intended in 68 of 71 procedures. Postoperative imaging could exclude complete misplacement of all catheters, but optimal positioning was only achieved in 64.7 % (44 of 68 cases). Four catheters had to be revised due to malfunction (failure rate, 5.8 %). Another five catheters had to be removed due to infectious complications or wound healing disorders. Direct correlations between catheter complications and suboptimal catheter positioning were not seen. Slit or distorted ventricles did also not prove to be a risk factor for the observed complications.

Conclusion: Complete misplacements can be avoided by using an intra-catheter endoscope. Confirmation of intraventricular location by direct view attributes to the low malfunction rate, especially in slit or distorted ventricles.