gms | German Medical Science

Objective: The long-term preserving of ventriculoperitoneal shunt function depends on the correct placement of the ventricle catheter. The incidence of catheter misplacement ranges from 8 % to 45 %. This poses a major burden on the patient and his family. To avoid a misplacement of the shunt catheter the ShuntScope (Karl Storz GmbH & Co.KG, Tuttlingen, Germany) was used for correct placement 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 from January 2012 to September 2014 in a series of 18 children, who were scheduled for hydrocephalus surgery. Small diameter of the endoscope fitted to the lumen of all used ventricle catheters. The patient cohort consisted of 8 females and 10 males (range, 2 months - 13 years). The indications included slit ventricles, cystic lesions, CSF reservoir placement in cases of brain tumors, difficult anatomic ventricular configurations and in cases of aqueductoplasty.

Results: The main value of the intra-catheter endoscope is the ability to place the catheter tip accurately within distorted or small ventricles. Even controlled and guided placement in the fourth ventricle for aqueductoplasty was possible. No parenchymal or intraventricular bleeding occurred. Intraventricular image quality was always sufficient to recognize the anatomical structures. The postoperative neuroradiological imaging could demonstrate the catheter tip placement analogous to the intraoperative findings and video recording analysis.

Conclusions: The ShuntScope is very useful and safe for catheter placement in complex cases of hydrocephalus. Misplacements of shunt catheters are avoidable with this intra-catheter technique. The ShuntScope is recommended to be implemented in pediatric neurosurgery.