Control of Hydrocephalus by Valve-Regulated Venous Shunt: Avoidance of Complications in Prolonged Shunt Maintenance

Becker, Donald P.; Nulsen, Frank E.

doi:10.3171/jns.1968.28.3.0215

Cited by 181 publications

(70 citation statements)

References 17 publications

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“…This concern is reflect in a number of proximal catheter design variations, such as fins or slots. Placement of the catheter to keep it away from the choroid plexus has also been recommended [1, 2, 3]. To accomplish this, specific techniques have been described for ventricular catheter placement.…”

Section: Discussionmentioning

confidence: 99%

Ventricular Anatomy and Shunt Catheters

Kaufman

Park

1999

Pediatr Neurosurg

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A functioning shunt must have a patent proximal catheter within the cerebrospinal fluid space. Occlusion with choroid plexus or ependymal tissue might be expected if these tissues are in contact with the proximal inlets. This study was undertaken to define the intraventricular distances available for a standard-placement shunt cather and to compare the available distances with actual ventricular catheter inlets. In 52 normal subjects (age range from 1 month to 20 years; median 7.7 years) magnetic resonance imaging was used to measure the dimensions of the anterior horn in planes typically used for cather placement. For anterior placements, the intraventricular length (ventricle entry to the foramen of Monro) was measured for a standardized catheter route ('As') and for a route yielding a maximum lenght ('Amax'). For posterior placements, the length (ventricle tip to foramen of Monro) was obtained for a standardized catheter placement to the ipsilateral ('Pi') and the contralateral ventricle ('Pc') as well as measuring a maximum length in a curved trajectory ('Pmax'). The average length (and range) in centimeters for the various trajectories was: As = 1.5 (1.1-1.9), Amax = 1.7 (1.2-2.2), Pi = 1.6 (1.2-2.1), Pc = 2.0 (1.4-2.9), and Pmax = 2.8/3.1 (2.1-3.6). Minor variations from a standard shunt insertion site did not affect the length of catheter within the ventricle. Current ventricular catheters have proximal inlets extending 1.6-2.4 cm from the catheter tip. Variations in standard ventricular catheter placement should have no measurable effect on how much ventricle is available for the proximal catheter. It may not be possible to place a standard ventricular catheter and keep the inlets within the ventricle and placed consistently away from choroid plexus and ependyma, regardless of approach. This may contribute to the similar proximal occlusion rates reported for the differing placements. Subsequent studies of shunt placement should correlate proximal occlusion rates with ventricular size. To prevent ventricular size from directly affecting proximal conclusion, consideration should be given to altering the design of ventricular catheters by placing inlets over a shorter distance (1.0 cm) from the tip.

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Section: Discussionmentioning

confidence: 99%

Ventricular Anatomy and Shunt Catheters

Kaufman

Park

1999

Pediatr Neurosurg

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“…Many other articles have dealt separately with revisions and complica tions of VA shunts [2,4,11,12,14,18,22,31,33,47,48] or VP shunts [1,7,13,15,19,28,37,46,49,51,52]. Revision rates for VA shunts, in large series, varied between 46 and 78% [4,33], against 44-58% for VP shunts [17,38].…”

Section: Discussionmentioning

confidence: 99%

Results of Treatment with Ventriculoatrial and Ventriculoperitoneal Shunt in Infantile Nontumoral Hydrocephalus

Pasqualin¹,

Mazza²,

Pian³

1980

Pediatr Neurosurg

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The technique of femoral-cerebral catheterization in infants and children is described, and a series of 1,869 procedures is analyzed for complications. Clinical complications occurred in 12 of 678 or 1.8% of examinations while radiographic complications were discovered in 38 of 1,869 or 1.1% of procedures. The results are compared to a similar retrospective study of a large series (2,184 procedures) of direct puncture/retrograde brachial studies in a similar patient population at the same institution in which there was a 2.6% clinical complication rate and a 4.3% radiographic complication rate. Those factors which predispose to complications, clinical or radiographic, are more pronounced in the younger age groups but affect the direct puncture/retrograde brachial technique to a greater degree. The lower morbidity, greater selectivity and improved comfort make the femoral-cerebral route preferable for neuroangiographic studies in infants and children.

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“…Cerebrospinal fluid shunting requires placement of the catheter in the anterior horn of the lateral ventricle, [1][2][3]6) for maintenance of shunt function and prevention of complications, mainly related to the choroid plexus, a vascular rich and fragile tissue. These complications include intraventricular hemorrhage (IVH) due to direct injury by ventricular catheter insertion, 17) obstruction of the catheter by hypertrophic tissue as a foreign body reaction, 8,19) and IVH 5) or more rarely pseudoaneurysm formation caused by avulsion of the anterior choroidal artery 20) on removal of an obstructed catheter.…”

Section: Introductionmentioning

confidence: 99%

Manual Occipital Ventricular Puncture for Cerebrospinal Fluid Shunt Surgery: Can Aiming Be Standardized?

Shimizu

Tanaka²,

Iida

et al. 2004

Neurol. Med. Chir.(Tokyo)

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The manual occipital ventricular puncture is a standard surgical procedure, but specific targeting has not received sufficient attention despite the experience of anatomical disorientation. This study tried to identify an exact site for the ideal trajectory with this method, especially in the sagittal plane, which avoids contact with the choroid plexus that may be the major source of complications. A total of 44 consecutive adult cases undergoing cerebrospinal fluid shunting through the occipital route for hydrocephalus were retrospectively reviewed for the following: correlations between burr hole site, direction of puncture, and location of the ventricular catheter based on postsurgical radiological studies; calculation of the ideal trajectory to place the catheter tip in the anterior horn of the lateral ventricle without contact with the choroid plexus through the standard occipital burr hole. In addition, the relationships between the location of the ventricular structure, the cranial base line connecting the nasion and inion, and the size of the ventricle were evaluated. Incorrect catheter emplacement was found in five cases, which suggested that this procedure using the standard burr hole site and aim point might result in incorrect catheter placement. The ideal external aim points were widely distributed because of the variable heights of ventricular structures from the cranial baseline. No correlation between the locations of the anatomical points and ventricular size was found. The present study could not define a standard external aim point. Tailored preoperative planning of the trajectory is recommended.

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Control of Hydrocephalus by Valve-Regulated Venous Shunt: Avoidance of Complications in Prolonged Shunt Maintenance

Cited by 181 publications

References 17 publications

Ventricular Anatomy and Shunt Catheters

Ventricular Anatomy and Shunt Catheters

Results of Treatment with Ventriculoatrial and Ventriculoperitoneal Shunt in Infantile Nontumoral Hydrocephalus

Manual Occipital Ventricular Puncture for Cerebrospinal Fluid Shunt Surgery: Can Aiming Be Standardized?

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