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Ventricular catheter misplacement

To avoid shunt dysfunction, it is essential to place the ventricular catheter tip above the foramen of Monro. But the free-hand technique for ventricular catheter passage is not consistent.

Supposing that a convex of skull matches to a sphere, in which the foramen of Monro is the center, a perpendicular direction from the surface of the sphere to inside always directs toward the center. The authors identified the range of skull where corresponded to the sphere by magnetic resonance imaging assessment and utilized tripod to achieve exactly perpendicular insertion of ventricular catheter. And an optimal length of catheter insertion was investigated by navigation system.

The anterior-posterior range of the spherical portion was from coronal suture to 20mm anterior, and the lateral range of it was between 15 and 35mm lateral from sagittal suture. The optimal catheter length for insertion was between 55 and 58mm from the brain surface. Ideal placement of a ventricular catheter tip was achieved in more than 90% of cases (31/34) with this technique 1).

Ventricular catheter misplacement occurs in 40 % with freehand technique and is a risk factor for shunt failure.

A analysis demonstrated an improvement of catheter positioning with ultrasound guidance. In the absence of additional burden or risks, this method should be favored over freehand technique. It remains to be demonstrated in a randomized controlled fashion to what extent improved catheter position translates into improved outcome 2).

Yamada SM, Yamada S, Goto Y, Nakaguchi H, Murakami M, Hoya K, Matsuno A. A simple and consistent technique for ventricular catheter insertion using a tripod. Clin Neurol Neurosurg. 2012 Jul;114(6):622-6. doi: 10.1016/j.clineuro.2011.12.025. Epub 2012 Jan 11. PubMed PMID: 22244253.
Beez T, Sarikaya-Seiwert S, Steiger HJ, Hänggi D. Real-time ultrasound guidance for ventricular catheter placement in pediatric cerebrospinal fluid shunts. Childs Nerv Syst. 2015 Feb;31(2):235-41. doi: 10.1007/s00381-014-2611-4. Epub 2015 Jan 7. PubMed PMID: 25564197.
ventricular_catheter_misplacement.txt · Last modified: 2017/09/29 13:20 by administrador