Article
Reduction of shunt obstructions using “contactless” ventricle puncture? Results of a randomized prospective multicenter study
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Published: | September 16, 2010 |
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Outline
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Objective: Shunt obstructions are caused partially by brain tissue particles, which intrude into the ventricular catheter during ventricle puncture. Avoiding the contact between the catheter and the brain tissue using a peel-away-sheath should reduce shunt failures due to obstruction. To prove this hypothesis a randomized prospective multicenter study was performed – approved by the ethical committee of the medical association Hamburg (Reg.No: OB/IV/03).
Methods: From 2004 to 2008 201 patients receiving a ventriculo-peritoneal shunt were included in six different centers. One hundred seventy-seven patients completed the one year follow-up. Surgery with or without the peel-away-sheath was randomized, from the 177 surgeries 91 were performed with, 86 without a peel-away-sheath. The rate of shunt obstructions within 12 months was recorded. The statistical analysis was done with nonparametric Mann-Whitney-Test.
Results: Within 1 year after surgery we observed 17 shunt obstructions (9.6%) leading to shunt revision. There was no difference using a peel-away-sheath (n=9 of 91, 9.89%) or not (n=8 of 86, 9.30%). The overall shunt infection rate was 2.82% and the revision-rate for overdrainage was 3.95%.
Conclusions: Despite the theoretical benefit of using a peel-away-sheath for introducing the ventricle catheter, its advantage over standard procedure could not be proved in this study. The described mechanism of shunt obstruction might be overestimated.