[Endoscope-guided placement of the ventriculoperitoneal shunt: technique and applications]

The routine surgical procedure for placement of the ventricular shunt catheter is straightforward. However, the topography of the ventricular system in complex hydrocephalus is so distorted that orientation on the basis of standard external topographic points does not ensure satisfactory positioning of the drain.

1. To test the clinical efficiency of endoscope-guided placement of the ventricular catheter in cases of complex hydrocephalus. 2. To present and popularize the surgical technique of endoscope-guided placement of the ventricular shunt catheter which hitherto was not published in the Polish literature.

This study was done in 38 patients aged 2 days to 45 years (mean 7 years and 5 months). Multiloculated hydrocephalus was found in 7, lateral ventricle isolation in 14, fourth ventricle isolation in 3, intraventricular cyst accompanied hydrocephalus in 6, and adherent ventricular catheter of the shunt implanted previously in 8 cases. Endoscopy was performed through coronal or occipital burr hole. Peelaway sheath was used for placement of the catheter in the desired position. Computerized tomography was performed within 24 hours after surgery, after 6 months, and subsequently every 12 months during follow-up. The time of follow-up ranged from 1 to 5 years (mean 27 months). There were eight cases (15.78%) of postoperative occlusion of the ventricular catheter. In two of them, occlusion was caused by catheter tip displacement. In the remaining cases, occlusion was caused by growing membranes of the multiloculated hydrocephalus (four cases) or by infection (two cases) and was not related to the catheter position. There were no cases of catheter position change during follow-up.

In complex hydrocephalus, proper placement of the ventricular catheter without direct visual control is very difficult if not impossible. Therefore, use of the endoscope facilitates proper catheter placement in multiloculated hydrocephalus, hydrocephalus complicated by isolation of the ventricle or intraventricular cyst.

1. The technique of endoscope-guided placement of the ventricular catheter is relatively simple and useful for reliable positioning of the drain in the right location. 2. Our cases show that the method is clinically effective. However, comparison with the conventional method will require a controlled and matched trial.