Artikel
The ShuntScope for ventricle catheter placement in complex cases of hydrocephalus
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Autoren
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Mohamed Salah
- Klinik für Neurochirurgie, Universitätsklinikum des Saarlandes, Homburg/Saar, Deutschland
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Sebastian Antes
- Klinik für Neurochirurgie, Universitätsklinikum des Saarlandes, Homburg/Saar, Deutschland
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Christoph A. Tschan
- Klinik für Neurochirurgie, Universitätsklinikum des Saarlandes, Homburg/Saar, Deutschland
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Joachim Oertel
- Klinik für Neurochirurgie, Universitätsklinikum des Saarlandes, Homburg/Saar, Deutschland
| Veröffentlicht: | 2. Juni 2015 |
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Gliederung
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Objective: Ventriculoperitoneal (VP) shunting remains the main treatment for hydrocephalus. Shunt-related complications pose a major burden on the patient and his family. Long-term VP shunt function is directly influenced by the position of the ventricle catheter tip. Many methods, such as neuronavigation or stereotaxy have been already described for improvement of catheter placement. Here, the ShuntScope (Karl Storz GmbH & Co.KG, Tuttlingen, Germany) was used for catheter positioning under direct view and also as a diagnostic tool to exclude obstruction of the ventricle catheter.
Method: The semi-rigid ShuntScope (Karl Storz GmbH & Co.KG, Tuttlingen, Germany) with an outer diameter of 1.0 mm and an image resolution of 10,000 pixels was used in 56 patients between January 2012 and February 2014. The patient cohort consisted of 30 females and 26 males aged from 2 months to 82 years. The indications included pseudotumor cerebri, slit ventricles, cystic lesions, CSF reservoir placements, difficult anatomic ventricular configurations, revision operations due to catheter obstruction and for aqueductoplasty. For intraoperative use the ShuntScope was inserted into the ventricle catheter, which was slitted at the distal end. Protrusion of the intra-catheter endoscope beyond the tip allowed intraventricular inspection.
Results: The ShuntScope was successfully used in all surgical procedures without any technical restrictions. Furthermore, none of the endoscopic ventricle catheter placements had to be abandoned. Intraventricular image quality was always sufficient to recognize anatomical structures for orientation. The ShuntScope was also used for inspection of the third ventricle and the aqueduct. Ventricle catheter obstructions with blood vessels or brain tissue could be diagnosed. Due to catheter covering of the endoscope, no parenchymal damage or bleeding occurred.
Conclusions: The ShuntScope is a very useful tool for optimal placement of the ventricle catheter in complicated cases of hydrocephalus. A misplacement of the catheter can be completely avoided.
