In a previous well-controlled study, routine endoscopic-guided placement of ventricular catheters did not seem to decrease the rate of shunt failure or proximal shunt malfunction. Since this study was published, this technique does not seem to gain much acceptance. However, in selected cases, it may assist in accuracy and safety. We therefore have analyzed our experience with selective intra-catheter endoscopic use for ventricular hardware placement. We retrospectively collected clinical and radiological data on all children undergoing intra-catheter endoscopic-assisted ventricular catheter placement. During 25 months, 16 children (ages 3 months–18 years) underwent 18 procedures using the above technique. Indications for surgery were: proximal shunt malfunction with relatively small ventricles (ten children), proximal shunt malfunction with intraventricular membranes (one child), proximal shunt malfunction with distorted ventricles (one child), new shunt with small to medium sized ventricles (two children), or large ventricles and a loculated fourth ventricle secondary to an aqueductal web (two children). Fourteen procedures were technically successful. The catheter was properly located on postoperative imaging in 13 procedures. Frameless navigation was used in three cases. Selective use of intra-catheter endoscopic-assisted proximal shunt placement is useful and may be indicated in small or distorted ventricles and in cases when fenestration of an intraventricular membrane or aqueductal web is indicated. The main value of such a technique is the ability to accurately place the catheter tip within distorted or small ventricles. Larger series are needed to refine these indications.
5 Figures and Tables
Fig. 1 Preoperative scans showing relatively small ventricles during proximal shunt malfunction (a, c, e, g, i, k). Postoperative MRI scans showing the drained ventricles (b, d, f, h, j, l)
Fig. 2 An intraventricular membrane fenestrated with the endoscope
Fig. 3 Child #15. Postoperative midsagittal T2 image showing an isolated fourth ventricle after placement of a transventricular transaqueductal shunt
Fig. 4 Child #12. A left temporal tumoral cyst and leftsided hydrocephalus. The planned route is marked (a). Intraoperative picture showing the bulge of the cyst into the atrium (b). Final VC location (arrow) (c)
Fig. 5 AVC located in the contralateral ventricle (a preoperative CT, b postoperative MRI). AVC located intraparenchymally (c)
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