Endoluminal shuntscope-guided ventricular catheter placement: Early experience

Abstract

Background:Placement of ventricular catheter (VC) in an optimal position is the most important factor in determining the outcome of shunt surgery. VC obstruction due to shunt tube placement in brain parenchyma, across the septa, tangled in the choroid plexuses and clogging of VC due to brain matter or other debris are common reasons resulting in shunt complete or partial dysfunction. To resolve these hurdles, many technical advancements have been made including navigation, stereotaxy, sonography, and ventriculoscope-guided VC placement.Objective:To report early experience, technique, and result of placing VC with shuntscope.Methods:We are publishing our experience of shuntscope-guided ventriculoperitoneal shunt in 9 cases done from June 2015 to April 2016. Shuntscope is a 1 mm outer diameter semi-rigid scope from Karl Storz with 10000 pixel of magnification. It has a fiber optic lens system with camera and light source attachment away from the scope to make it light weight and easily maneuverable.Results:In all cases, VC was placed in the ipsilateral frontal horn away from choroid plexuses, septae, or membranes. Septum pellucidum perforation and placement to opposite side of ventricle was identified with shunt scope assistance and corrected.Conclusion:Although our initial results are encouraging, larger case series would be helpful. Complications and cost due to shunt dysfunction can thus be reduced to a great extent with shuntscope.

Endoscopic Placement of Intracystic Catheters: A Technical Note

“…Endoscopy-assisted placement of intraventricular catheters using an endoluminal endoscope was reported in various modifications, allowing even for the placement of preassembled catheter-reservoir systems. [17][18][19] Although this technique has been demonstrated to allow for the precise placement of intraventricular catheters, its application is limited to a single purpose. In circumstances of decreased visibility secondary to bleeding, high protein contents or tissue debris, constant irrigation, and even active suctioning might be necessary, limiting the use of endoluminal endoscopy.…”

Image quality and related outcomes of the ShuntScope for catheter implantation in pediatric hydrocephalus—experience of 65 procedures

“…Regardless of advances in improving valve design and prevention of infection, the failure rate by the placement of a ventricular catheter during the shunting procedure has not been changed. The shunt failure in the first year after placement reported in the literature varies from 20 to 50% [ 14 , 19 – 22 ]. Catheter obstruction due to in-grow of the choroid plexus and occlusion of the proximal catheter lumen is estimated as one of the causes leading to shunting dysfunction [ 1 , 7 , 17 , 22 , 23 ].…”

ShuntScope-Guided Versus Free-Hand Technique for Ventricular Catheter Placement: A Retrospective Comparative Study of Intraventricular Catheter Tip Position and Complication Rate

“…In comparison to our results, we had a proper placement in 90% in SG group compared to 65% in FH group. Several studies reported good success rates, especially with difficult ventricular configurations 20,22,23,26,27 . However, these studies did not include a control group.…”

“…This allows the tip of the VC to be placed in the cerebrospinal fluid (CSF) system under visual control while avoiding touching the ventricular wall or the plexus. In addition, many authors recommend the use of a narrow or wide endoscope tube in difficult ventricular anatomy, where other methods cannot achieve an optimal position [20][21][22][23][24][25][26][27] .…”