gms | German Medical Science

61st Annual Meeting of the German Society of Neurosurgery (DGNC) as part of the Neurowoche 2010
Joint Meeting with the Brazilian Society of Neurosurgery on the 20 September 2010

German Society of Neurosurgery (DGNC)

21 - 25 September 2010, Mannheim

Reduction of shunt obstructions using “contactless” ventricle puncture? Results of a randomized prospective multicenter study

Meeting Abstract

  • Uwe Kehler - Neurochirurgie, Asklepios Klinik Hamburg Altona, Deutschland
  • Niels Langer - Neurochirurgie, Asklepios Klinik Hamburg Altona, Deutschland
  • Jan Gliemroth - Neurochirurgie, Universitätsklinikum Lübeck, Deutschland
  • Michael Kiefer - Neurochirurgie, Universitätsklinikum des Saarlandes, Homburg/Saar, Deutschland
  • Regina Eymann - Neurochirurgie, Universitätsklinikum des Saarlandes, Homburg/Saar, Deutschland
  • Ullrich Meier - Neurochirurgie Unfallkrankenhaus Berlin Marzahn, Deutschland
  • Johannes Lemcke - Neurochirurgie Unfallkrankenhaus Berlin Marzahn, Deutschland
  • Christian Sprung - Neurochirurgie, Charité Berlin, Deutschland
  • Hans-Georg Schlosser - Neurochirurgie, Charité Berlin, Deutschland
  • Oliver Heese - Neurochirurgie Universitätsklinik Hamburg-Eppendorf, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 61. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC) im Rahmen der Neurowoche 2010. Mannheim, 21.-25.09.2010. Düsseldorf: German Medical Science GMS Publishing House; 2010. DocV1616

DOI: 10.3205/10dgnc089, URN: urn:nbn:de:0183-10dgnc0894

Published: September 16, 2010

© 2010 Kehler et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.


Outline

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Objective: Shunt obstructions are caused partially by brain tissue particles, which intrude into the ventricular catheter during ventricle puncture. Avoiding the contact between the catheter and the brain tissue using a peel-away-sheath should reduce shunt failures due to obstruction. To prove this hypothesis a randomized prospective multicenter study was performed – approved by the ethical committee of the medical association Hamburg (Reg.No: OB/IV/03).

Methods: From 2004 to 2008 201 patients receiving a ventriculo-peritoneal shunt were included in six different centers. One hundred seventy-seven patients completed the one year follow-up. Surgery with or without the peel-away-sheath was randomized, from the 177 surgeries 91 were performed with, 86 without a peel-away-sheath. The rate of shunt obstructions within 12 months was recorded. The statistical analysis was done with nonparametric Mann-Whitney-Test.

Results: Within 1 year after surgery we observed 17 shunt obstructions (9.6%) leading to shunt revision. There was no difference using a peel-away-sheath (n=9 of 91, 9.89%) or not (n=8 of 86, 9.30%). The overall shunt infection rate was 2.82% and the revision-rate for overdrainage was 3.95%.

Conclusions: Despite the theoretical benefit of using a peel-away-sheath for introducing the ventricle catheter, its advantage over standard procedure could not be proved in this study. The described mechanism of shunt obstruction might be overestimated.