gms | German Medical Science

Objective: Optimal shunt function depends on the correct placement of the ventricular catheter. Nearly 4% of ventricular catheters are misplaced. There are already many tools to optimize the insertion, such as neuronavigation or stereotactic techniques. In this study, the new Shuntscope was applied for shunt inspection to exclude occlusions and for the correct placement of a new ventricular catheter.

Method: The new semi-rigid fiber-endoscope (Karl Storz, Germany) with a resolution of 10.000 pixels and an outer diameter of 1.0 mm can be inserted in conventional ventricular catheters. Subsequently, these catheters can be placed and guided under endoscopic view. Between January and November 2012, the Shuntscope was applied for shunt surgery in 31 patients aged 11 to 78 years (mean age: 45 years). Twenty-four patients presented with slit ventricles or difficult anatomic ventricular configurations.

Results: The postoperative neuroradiological imaging showed a catheter tip placement analogous to the intra-operative findings and video recording analyses. The semi-rigid endoscope allowed a safe intraoperative correction of the catheter placement due to a cover-sheet function of the ventricular catheter. This new endoscopic technique also allows the inspection of the third ventricle and the aqueduct. In cases of shunt revisions, a total of 6 catheters showed ingrowth of brain tissue or blood vessels. There was no significant extension of surgery time, any severe bleeding complication or contusion of nearby located brain structures.

Conclusions: The Shuntscope is very useful for optimal placement of the ventricular catheter in difficult anatomy. This is the first optic that allows an amazing view through the small diameter of ventricular catheters. With this new technique misplacements of shunt catheters are completely avoidable.