PREVENTION OF POSTSHUNTING VENTRICULAR ASYMMETRY BY TRANSSEPTAL PLACEMENT OF VENTRICULAR CATHETERS - A RANDOMIZED STUDY

Ventricular asymmetry is common after ventricular shunting, and occasi onally isolation of the contralateral ventricle necessitates a second shunt. The following study was performed to determine whether contrala teral placement of the ventricular catheter via ultrasound-guided perf oration of the septum pellucidum would decrease the incidence of posts hunting ventricular asymmetry which might predispose to symptomatic is olation of a lateral ventricle. Fifty-eight children with hydrocephalu s and an open fontanel, who were having a ventriculo-peritoneal shunt via a parieto-occipital approach, were randomized to have the ventricu lar catheter tip placed into either the ipsilateral or the contralater al frontal hem. Ventricular asymmetry occurred in 23% of the patients with contralateral versus 54% with ipsilateral placement ((chi)2 = 5.5 3; p = 0.019). In 7 patients with contralateral placement, in whom a s pecial catheter with two sets of holes was used, such that holes were located in both ventricles, no shunt-related ventricular asymmetry occ urred. In 2 children with ipsilateral placement, a second shunt was re quired for a symptomatic isolated lateral ventricle. Perforation of th e septum pellucidum with placement of the ventricular catheter in the contralateral ventricle, using a specially designed catheter with two sets of holes, may decrease the incidence of postshunting ventricular asymmetry and symptomatic isolation of a lateral ventricle.