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Harold D. Portnoy

A major cause for failure of ventriculoatrial and ventriculoperitoneal shunts is occlusion of the ventricular catheter by brain debris, contact of the catheter with the ventricular wall or choroid plexus, penetration of the catheter tip into brain parenchyma, and particulate matter within the ventricular fluid. With the Pudenz shunt, an additional problem is loss of the catheter into the ventricle either during attachment of the catheter to the angled connector at surgery, or by the subsequent disconnection of the catheter from the connector. Catheter

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Sofy H. Weisenberg, Stephanie C. TerMaath, Chad E. Seaver, and James A. Killeffer

T he most common treatment for both congenital and acquired hydrocephalus is the placement of a CSF shunt that diverts excess CSF from the ventricles to a part of the body in which it can be readily absorbed. While effective, newly placed shunts require on average 2 to 4 revision surgeries within the first 10 years after implantation. 57 , 62 A large percentage of these revisions occur within the 1st year after placement, and most 62 are required within the first 2 years. 26 , 42 , 84 Ventricular catheter (VC) obstruction is the cause of nearly one

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David A. Omahen, Stephen J. Hentschel, and G. Stuart Cameron

T he need to replace a ventricular catheter in the setting of a proximal shunt occlusion or malfunctioning external ventricular drain is a commonly encountered phenomenon in neurosurgical practice. We describe a method to easily replace a ventricular catheter. This method has been used with great success by the senior author (G.S.C.). It seems especially valuable in the presence of small ventricles. Methods Materials The technique requires a previously placed standardsized ventricular catheter, the white sheath of a 9.5 Fr St. Jude peel

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Dachling Pang and Paul A. Grabb

P roximal cerebrospinal fluid (CSF) shunt malfunction due to ventricular catheter occlusion remains the most common source of shunt problems, occurring in 17% of all shunts placed in one recent series. 1 For coronal CSF shunts, long-term patency of the ventricular catheter depends on accurate placement of the hole-bearing segment of the catheter tip in the ventricle, away from injured ependyma and the choroid plexus. 3 Accurate placement in turn depends on proper insertion trajectory and on catheter length. In this report, we describe the technique used by

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Reizo Shirane, Takeo Kondo, Yasuko K. Yoshida, Susumu Furuta, and Takashi Yoshimoto

V entriculoperitoneal (VP) shunt placement is a commonly used technique for the treatment of hydrocephalus. Revision of the shunt is often required because of shunt malfunction, which is most frequently caused by ventricular catheter obstruction. 7, 8, 10 Removal of the ventricular catheter during shunt revision is associated with various complications, especially in children. 2, 3, 5, 8, 9 Most of these cases involve intraventricular hemorrhage (IVH) caused by injury to the choroid plexus. We describe a case of pseudoaneurysm formation at the internal carotid

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Thomas J. Wilson, William R. Stetler Jr., Wajd N. Al-Holou, and Stephen E. Sullivan

should help reduce this risk. In pediatric patients, this factor has been examined by comparing endoscopically versus nonendoscopically placed ventricular catheters. Data has shown that endoscopic ventricular catheter placement reduces the odds of proximal obstruction, although it did not decrease the overall failure rate. 10 Given the high rate of failure, it intuitively makes sense that everything should be done to optimize catheter placement. Most ventricular catheters are placed using anatomical landmarks in a freehand fashion, although adjuncts are available

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Frederick A. Boop, Azedine Medhkour, John Honeycutt, Charles James, W. Bruce Cherny, and Christopher Duntsch

O ne of the most devastating complications of proximal shunt revision is intraventricular hemorrhage caused by avulsion of the choroid plexus at the time of intraventricular catheter removal. To minimize this risk, the application of monopolar current to a stylet placed down a ventricular catheter for the purpose of coagulating the choroid plexus was introduced by Chambi and Hendrick 1 in 1988. Despite this method’s widespread acceptance, there has been little study of the most appropriate current intensity to be applied to the catheter to prevent

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Thomas J. Wilson, Kathleen E. McCoy, Wajd N. Al-Holou, Sergio L. Molina, Matthew D. Smyth, and Stephen E. Sullivan

intraoperative guidance with either frameless stereotaxy or ultrasonography improves the accuracy of catheter placement, which in turn reduces the rate of proximal failure in adult patients. 12 This is supported by previous data suggesting that endoscopic placement of ventricular catheters in pediatric patients reduced the risk of proximal failure, although it did not have any significant effect on overall failure rate. 11 Taken together, these data suggest the importance of optimal catheter placement in reducing proximal failure. Our previous data were limited to adult

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Sofy H. Weisenberg, Stephanie C. TerMaath, Charlotte N. Barbier, Judith C. Hill, and James A. Killeffer

after the original shunt is implanted. 1 , 5 , 26 One major cause of shunt failure is obstruction of the ventricular catheter. 2 , 6 , 12 , 13 , 15 , 17 , 22 , 24 Studies investigating shunt survival rates have quantified that between 30% and 40% of pediatric shunt failures are caused by some form of shunt obstruction, the majority of which occur in the ventricular catheter. 2 , 5 , 18 , 26 These obstructions are typically the result of migration and invasion of the choroid plexus into the inlet holes of the ventricular catheter, or less often, the result of

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Jamshid B. G. Ghajar

the base of the tripod. Although the Codman Accu-flo ventricular catheter (2.5 mm in outer diameter) † was used with the prototype guide, other catheters of different caliber can be used with appropriate changes in the diameter of the guide tube. Fig. 1. Side view of the guide device. Fig. 2. Anteroposterior view of the cranium and ventricular system showing the position of the ventricular catheter and the guidance device. Clinical Results The efficacy of the guide was studied in 17 patients who required ventriculostomy. The