The Use of Shunting Devices for Cerebrospinal Fluid in Canada

Comparison of ventricular drain location and infusion test in hydrocephalus

“…The results of this study support the previous arguments of ensuring optimal ventricular catheter tip positioning. We propose that the success of shunt patency in these optimal locations is due to the higher likelihood, anatomically, of the catheter tip being completely surrounded by CSF.…”

“…This may be due to the anatomy of the body and trigone of the lateral ventricles in having smaller dimensions than the frontal horns and also containing choroid plexus, which has been implicated in causing shunt blockage. The suggestions for ‘optimal’ tip location to be anterior to the foramen of Monro in the ipsilateral frontal horn of the lateral ventricle are supported by the findings of this study. All catheter tips in this optimal position that were completely surrounded by CSF were found to be patent on infusion test; 40/40 (100%) of optimally positioned catheters were completely surrounded by CSF, but only 52/266 (21%) of suboptimally positioned were completely surrounded by CSF.…”

“…Furthermore, this study uses a new, simple and reliable classification system to assess the position of ventricular catheter tips on CT head imaging, based on the prior hypotheses of previous works to suggest optimal catheter tip targets . It is the unambiguous nature of this classification system, which has determined the effect of positioning factors on shunt patency.…”

“…Electron microscopic and histological evidence from blocked ventricular and peritoneal catheters show that the cause of occlusion is often debris from choroid plexus and ependyma . Therefore, it has been suggested that the optimal position for the tip of the ventricular catheter ought to be in the ipsilateral frontal horn anterior to the foramen of Monro , as the choroid plexus is absent from this part of the ventricle.…”

Endoscopic Retrieval of Flanged Ventricular Catheters

“…Rather, flanged shunt catheters proved problematic when a shunt revision was required, due to the adhesions that form around the flanges, leading to an increased risk of choroid plexus avulsion when removed 3 . By the mid-1980s, the use of flanged catheters was being discouraged 4 . Flanged catheters are now used infrequently, but were being sold in Canada as recently as 2018 (personal communication with Medtronic sales and marketing representatives).…”