Percutaneous Endoscopic Recanalization of the Catheter: A New Technique of Proximal Shunt Revision

Pattisapu, Jogi V.; Trumble, Eric R.; Taylor, K R; Howard, Paul; Kovach, T M

doi:10.1097/00006123-199912000-00019

Cited by 24 publications

(11 citation statements)

References 10 publications

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“…These early decades of the 20th century also saw many other innovations in the treatment of hydrocephalus, including the first descriptions of Kocher's point and Frazier's point, the optimal cranial sites for catheter insertion that are still used today. 56 Although these early attempts created the foundation for the modern VC, the mid-20th century would see the first truly successful breakthroughs in its implementation.…”

Section: Historical Overview Of the Pre-shunt Eramentioning

confidence: 99%

“…These techniques include pulsed laser energy delivered via a flexible optical fiber, 12 ultrasound waves transmitted over a fine wire, 24 and percutaneous endoscopic recanalization via electrocautery. 56 However, focus has more recently turned to finding noninvasive treatments. When an occlusion is suspected, a new noninvasive imaging method combining pulsed laser light and ultrasound techniques has been proposed to allow surgeons to view the occluded catheter through the skull.…”

Section: Design Considerationsmentioning

confidence: 99%

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Ventricular catheter development: past, present, and future

Weisenberg

TerMaath

Seaver

et al. 2016

JNS

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Cerebrospinal fluid diversion via ventricular shunting is the prevailing contemporary treatment for hydrocephalus. The CSF shunt appeared in its current form in the 1950s, and modern CSF shunts are the result of 6 decades of significant progress in neurosurgery and biomedical engineering. However, despite revolutionary advances in material science, computational design optimization, manufacturing, and sensors, the ventricular catheter (VC) component of CSF shunts today remains largely unchanged in its functionality and capabilities from its original design, even though VC obstruction remains a primary cause of shunt failure. The objective of this paper is to investigate the history of VCs, including successful and failed alterations in mechanical design and material composition, to better understand the challenges that hinder development of a more effective design.

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Section: Historical Overview Of the Pre-shunt Eramentioning

confidence: 99%

Section: Design Considerationsmentioning

confidence: 99%

Ventricular catheter development: past, present, and future

Weisenberg

TerMaath

Seaver

et al. 2016

JNS

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“…Researchers have investigated methods to restore the patency of ventricular catheters using various techniques such as electrocautery [14], laser [15], or ultrasound [16]. However, these recanalization techniques still require invasive surgical intervention to access the occluded catheter.…”

Section: Introductionmentioning

confidence: 99%

Mechanical Evaluation of Unobstructing Magnetic Microactuators for Implantable Ventricular Catheters

Lee

Kolahi

Bergsneider

et al. 2014

J. Microelectromech. Syst.

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Here, we report on the development and evaluation of novel unobstructing magnetic microactuators for maintaining the patency of implantable ventricular catheters used in hydrocephalus application. The treatment of hydrocephalus requires chronic implantation of a shunt system to divert excess cerebrospinal fluid from the brain. These shunt systems suffer from a high failure rate (>40%) within the first year of implantation, often due to biological accumulation. Previously, we have shown that magnetic microactuators can be used to remove biological blockage. The new cantilever-based magnetic microactuator presented in this paper improves upon the previous torsional design using a bimorph to induce a postrelease out-of-plane deflection that will prevent the device from occluding the pore at rest. The mechanical evaluations (i.e., postrelease deflection, static and dynamic responses) of fabricated devices are reported and compared with theoretical values.

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“…[1111417] In most centers, the ratio of shunt revision to initial shunt surgery is 2:1. [2] Several studies have examined the surgical technique, [61216] shunt hardware, [315] and postoperative management [7813] of cerebrospinal fluid (CSF) shunting procedures in an attempt to improve shunt survival. However, only a few studies are available, which examine the consequences of replacing the entire shunt system versus a single component for the revision of a failed CSF shunt.…”

Section: Introductionmentioning

confidence: 99%

Comparison of total versus partial revision of primary ventriculoperitoneal shunt failures

Singh

Rohilla²,

Kumawat³

et al. 2013

Surg Neurol Int

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Background:Optimal surgical management of patients presenting with primary shunt failure in the era of neuroendoscopy remains complex. The value of replacing the entire shunt system as opposed to a single shunt component has not been assessed extensively.Methods:In a retrospective study, the records of all patients who underwent their first shunt revision due to mechanical obstruction between September 2007 and December 2011 were reviewed. Shunt revisions were classified as total (entire shunt replaced) or partial (only malfunctioning component replaced). Patients having a minimum follow-up of 1 year after primary shunt revision were included in the study. Kaplan-Meier (shunt survival curves) and log-rank analysis were used to compare failure rates between partially and totally revised shunts.Results:Records of 62 patients in whom cause of primary shunt failure was obstruction (P roximal or distal) were analyzed retrospectively. At the end of follow-up period, 26 out of 28 partial revision group and 22 out of 34 total revision group had shunt failure. The median survival of the shunt in the partial revision and total revision groups was 60 and 270 days, respectively. The method (partial/total revision) related difference in shunt survival duration was statistically significant as shown by log-rank analysis (log-rank test value = 5.94 and P < 0.05).Conclusion:Partial revision of shunt predisposes to accelerated shunt failure as compared with total revision in cases of obstructed ventriculoperitoneal shunt.

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Percutaneous Endoscopic Recanalization of the Catheter: A New Technique of Proximal Shunt Revision

Abstract: The percutaneous endoscopic shunt recanalization procedure can be used successfully to treat proximal shunt malfunction.

Cited by 24 publications

References 10 publications

Ventricular catheter development: past, present, and future

Ventricular catheter development: past, present, and future

Mechanical Evaluation of Unobstructing Magnetic Microactuators for Implantable Ventricular Catheters

Comparison of total versus partial revision of primary ventriculoperitoneal shunt failures

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