Intra-catheter endoscopy for various shunting procedures—a retrospective analysis on surgical practicability, catheter placement, and failure rates
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The long-term function of a cerebral shunt is directly influenced by the placement of the ventricle catheter. In this work, an intra-luminal endoscope for best possible catheter positioning was used. Practicability, postoperative imaging, and shunt failure rates were retrospectively evaluated.
Between January 2012 and June 2016, an intra-catheter endoscope was applied in 71 procedures. Endoscopic technique was used for catheter placement in first-time shunting or cerebrospinal fluid reservoir insertion (n = 38), revision surgery in proximal shunt failure (n = 13), and various intraventricular stenting procedures (n = 20). Catheter positioning was graded on postoperative imaging using a four-point scale. All patients were regularly followed up (mean, 31.6 months) to recognize shunt failures.
Endoscopic application could be completed as intended in 68 of 71 procedures. Postoperative imaging could exclude complete misplacement of all catheters, but optimal positioning was only achieved in 64.7% (44/68 cases). Four catheters had to be revised due to malfunction (failure rate, 5.8%). Another five catheters had to be removed due to infectious complications or wound-healing disorders. Direct correlations between catheter complications and suboptimal catheter positioning were not seen. Slit or distorted ventricles also did not prove to be a risk factor for the observed complications.
Versatile application possibilities of the intra-catheter endoscope reflect the advantages of the technique. Independent of the performed procedure, unintended positionings or even complete catheter misplacements could be avoided. However, in more than one-third of all cases, suboptimal catheter placements became obvious. Interestingly, negative influences on later shunt failures were not seen.
KeywordsShunt scope Neuroendoscopy Ventricle catheter placement Hydrocephalus Shunt failure
We thank Mr. Rüdiger Koop (Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg/Saar, Germany) for taking and processing the pictures of this article.
Compliance with ethical standards
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Conflict of interest
Joachim Oertel acts as consultant to the Karl Storz GmbH & Co.KG, Tuttlingen, Germany. Stefan Linsler has received honorarium for presentations from Karl Storz company. Relationships did not influence the results of the presented work. The authors finally declare that there have been no financial donations associated with this article.
For this type of study formal consent is not required.
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