Percutaneous endoscopic recanalization of the catheter: A new technique ofproximal shunt revision

OBJECTIVE: Proximal ventricular catheter obstruction by the choroid plexus is a frequent occurrence in children with shunted hydrocephalus. In some ca ses, the flow is obstructed owing to membranous occlusion by a small amount of tissue. It has been shown that only a few of the multiple catheter open ings need be patent to maintain adequate shunt function. Recent advances in technology have improved our ability to perform intraluminal endoscopic ca theter dissection and minimize the morbidity associated with shunt maintena nce. METHODS: Percutaneous endoscopic shunt recanalization was performed in 20 c ases (18 children) under institutional review board study protocol. The mea n age was 32 months, and all children had signs and symptoms of shunt malfu nction, confirmed by computed tomography and magnetic resonance imaging and verified by shunt taps. Under aseptic conditions in the operating room, th e Rickham reservoir was entered with a 16-gauge intravenous catheter, and t he obstruction was visualized with a fiber endoscope (0.5-0.8 mm). Intralum inal dissection using electrocautery was performed with endoscopic guidance to visualize the catheter and flushing of the valve. RESULTS: At a mean follow-up time of 20 months (range, 15-29 mo), the child ren are doing well, with computed tomographic and magnetic resonance imagin g confirmation of adequate ventricular decompression in the 17 successful c ases (85%). There were three failures in the study, necessitating a standar d open shunt revision. CONCLUSION: The percutaneous endoscopic shunt recanalization procedure can be used successfully to treat proximal shunt malfunction.