Article
Shuntoscope-guided versus free hand ventricular catheter placement – pilot study
Shuntoskop-gestützte versus freie Handtechnik bei Ventrikelkatheter-Anlage – Pilotstudie
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Authors
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Ahmed El Damaty
- Universitätsklinikum Heidelberg, Neurochirurgische Klinik, Heidelberg, Deutschland
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Heidi Bächli
- Universitätsklinikum Heidelberg, Neurochirurgische Klinik, Heidelberg, Deutschland
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Andreas W. Unterberg
- Universitätsklinikum Heidelberg, Neurochirurgische Klinik, Heidelberg, Deutschland
| Published: | June 26, 2020 |
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Outline
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Objective: Despite the widespread use of external ventricular drainage, revision rates, and associated complications are reported between 10 and 40%. Current available image-guided techniques using stereotaxy, endoscopy, or ultrasound for catheter placements remain time-consuming techniques. We aimed to assess in a small cohort the usage of shuntoscope in ventricular catheter placement.
Methods: The study was prospectively started in July 2018. We divided the patients randomly into two groups where the catheter is either placed using free hand technique according to anatomical landmarks or with the aid of a shuntoscope. All patients were operated by the same neurosurgeon. We included only patients who received a ventricular puncture in a "virgin" ventricle which was never punctured before to avoid misleading previous tracts even if it was a shunt revision including placement of a new ventricular catheter in the other side. We reviewed the operative time, position of the catheter tip (three-point scales):
- 1.
- Grade I; optimal catheter tip position free-floating in CSF.
- 2.
- Grade II; catheter tip touching choroid plexus or ventricular lining wall.
- 3.
- Grade III; tip within parenchyma or failure to reach the intraventricular space, infection, need for revision surgery within 12 months after placement.
Results: We totally collected 30 patients. 16 patients were operated using shuntoscope and 14 patients using free hand technique. The mean operative time for complete shunt OP using shuntoscope group was 40 minutes vs 36 minutes in free hand group. We found in all cases of shuntoscope a Grade I catheter placement (100%), in comparison to 11 patients with Grade I (78.6%), 3 with Grade II (21.4%) in free hand group. 2 patients in shuntoscope group suffered from a shunt infection (12.5%) and needed revision surgery within 12 months. A single patient in the free hand group required surgery due to development of subdural hygroma as a sequel of overdrainage (7%).
Conclusion: We think that the use of shuntoscope could significantly improve the placement of ventricular catheter specially in difficult cases without significant prolongation of the operative time. A larger study recruiting more patients is needed to prove the validity of the primary results.
