Image-Guided Placement of Ventriculoperitoneal Shunt Catheter in Hydrocephalic Pediatric Patients
Keywords:
hydrocephalus, ventriculoperitoneal shunt, ultrasonography, endoscopyAbstract
Introduction: The ventriculoperitoneal shunt is the therapeutic procedure required in the majority of hydrocephalic patients. However, shunt system dysfunctions are mainly caused by obstruction of the catheter at the ventricular end due to its suboptimal or incorrect placement, which prevents partial or total drainage of cerebrospinal fluid.
Objective: To demonstrate that the real-time image-guided ventriculoperitoneal shunt surgical procedure contributes to optimal placement of the ventricular tip of the catheter in pediatric patients with hydrocephalus.
Methods: A descriptive study was carried out in a series of cases, whose results of the placement of the ventricular end of the ventriculoperitoneal shunt were evaluated by endoscopy, in patients with bregmatic fontanelle closure, and through ultrasonographic guidance, in patients with patent fontanelle. The sample consisted of 27 patients, diagnosed with hydrocephalus, operated on from February 2021 to February 2022.
Results: Ultrasonography-guided ventriculostomy was performed in 11 patients and endoscopy was performed in 16. The age range was established from 0 days of birth to 18 years, the average age for the patients operated with ultrasonographic guidance was 9 months meanwhile it was 8 years for those operated with endoscopic visualization. In 10 of the patients in whom ultrasonographic guidance was used, optimal catheter placement was achieved in 90.9%, while endoscopy-guided interventions reached 100%. An average distance covered by the intracranial catheter of 10.22 cm was observed in ultrasound-guided surgeries, while the distance under endoscopic vision was 10.6 cm.
Conclusions: Real-time image-guided ventriculoperitoneal shunting in pediatric patients with hydrocephalus was a neurosurgical technique that guaranteed optimal positioning of the ventricular catheter in most cases.Downloads
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