gms | German Medical Science

Objective: Ventricular catheter placement in children for shunting reasons can be challenging e.g. in slit ventricles. The study was implemented to justify a higher accuracy in ventricular shunt catheter placement by the means of endoscopic guidance.

Methods: Occipital or frontal ventricles were localised via ultrasound and punctured by a 3 mm peel away catheter (Braun/Melsungen) under neuronavigation if required. When intraventricular the inner tube of the catheter was removed and a 2 mm 30 degree optic (Aesculap Minop 2) was introduced and the outer sheath was then endoscopically guided either to Foramen of Monroi (frontal route) or forwarded to occipital horn entering the ventricle from Frazier’s point. All procedures were complication free (no infection / no bleeding from plexus), All catheters were controlled postoperatively either with ultrasound, CT or MRI scan and showed high accuracy with no malpositioning.

Results: We report a series of n= 45 pat. with non occlusive hydrocephalus from 2008 until present. The youngest was 2 months, the oldest 14 years old. Most of the catheters were placed occipitally, a minor rate was done from Kocher’s point. Only a few of them received Rickham devices for posthämorrhagic or chemotherapeutic reasons.

Conclusion: In conclusion this minimally invasive technique is secure and easy to perform, showing the point of entry as well as the final catheter position avoiding intraventricular lesion by guiding the peel away catheter endoscopically above the plexus choiroideus. In general terms even postoperative CT or MRI scan can be withdrawn avoiding obsolete radiation for children. In difficult Chiari scenarios were ventricular catheter placement with slit ventricles might be difficult this is a precise procedure under accurate endoscopic visualisation.