Reduction of shunt obstructions by using a peel-away sheath technique? A multicenter prospective randomized trial

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• 作者：Uwe Kehler^a ; ¹ ; ^{u.kehler@asklepios.com} ; Niels Langer^a ; ¹ ; ^{n.langer@asklepios.com} ; Jan Gliemroth^b ; ² ; ^{jan.gliemroth@t-online.de} ; Ullrich Meier^c ; ³ ; ^{Ullrich.meier@ukb.de} ; Johannes Lemcke^c ; ³ ; ^{Johannes.Lemcke@ukb.de} ; Christian Sprung^d ; ⁴ ; ^{christian.sprung@charite.de} ; Hans-Georg Schlosser^d ; ⁴ ; ^{hans-georg.schlosser@charite.de} ; Michael Kiefer^e ; ⁵ ; ^{Michael.Kiefer@uks.eu} ; Regina Eymann^e ; ⁵ ; ^{Regina.Eymann@uks.eu} ; Oliver Heese^f ; ^{heese@uke.uni-hamburg.de}
• 关键词：ASD ; antisiphon device ; CSF ; cerebrospinal fluid ; ICP ; intracranial pressure ; NPH ; normal pressure hydrocephalus ; SVS ; slit ventricle syndrome ; PAS ; peel-away sheath
• 刊名：Clinical Neurology and Neurosurgery
• 出版年：2012
• 出版时间：May, 2012
• 年：2012
• 卷：114
• 期：4
• 页码：381-384
• 全文大小：309 K

文摘

Objective

Shunt obstructions may partly be caused by brain debris, which intrude into the ventricular catheter during ventricle puncture. Avoiding contact between the catheter and brain tissue, by using a peel-away sheath, should reduce the number of shunt failures caused by obstruction. To test this hypothesis, we conducted a randomized, prospective multicenter study.

Methods

201 patients from 6 different neurosurgical centers in Germany receiving a ventriculo-peritoneal shunt were included in this study. Of these, 177 patients completed a 1-year follow-up period. Surgery was randomized in a 1 to 1 fashion, such that out of 177 procedures, 91 were performed using a peel-away sheath and 86 were performed without. The rate of surgical re-interventions and shunt obstructions within a 12-month period was recorded.

Results

Within 1 year post-surgery, 17 shunt obstructions (9.6 % ) leading to shunt revisions were recorded. However, no difference was found between surgeries performed using a peel-away sheath (9.9 % ) or not (9.3 % ). The overall shunt infection rate was 2.8 % and the shunt revision rate for overdrainage was 3.9 % .

Conclusions

The theoretical advantages attributed to the use of a peel-away sheath to introduce a ventricular catheter could not be confirmed in this randomized study, suggesting that the proposed role of brain debris in shunt obstructions may be overestimated.