I n 1890, W. W. Keen 6 used skull landmarks to cannulate the lateral ventricle in order to relieve hydrocephalus. Dandy 1 published in 1918 a technique involving anterior and occipitalventricularhorn punctures for air ventriculography. At present, ventriculostomy is widely used for the instillation of drugs in the treatment of carcinomatous and fungal meningitis, for intracranial pressure (ICP) monitoring, and for cerebrospinal fluid (CSF) drainage in hydrocephalus. 3, 4, 7–9 Usually, acatheteris placed in the anterior horn of the lateral ventricle

A major cause for failure of ventriculoatrial and ventriculoperitoneal shunts is occlusion of theventricularcatheterby brain debris, contact of thecatheterwith theventricularwall or choroid plexus, penetration of thecathetertip into brain parenchyma, and particulate matter within theventricularfluid. With the Pudenz shunt, an additional problem is loss of thecatheterinto the ventricle either during attachment of thecatheterto the angled connector at surgery, or by the subsequent disconnection of thecatheterfrom the connector.Catheter

T he need to replace aventricularcatheterin the setting of a proximal shunt occlusion or malfunctioning externalventriculardrain is a commonly encountered phenomenon in neurosurgical practice. We describe a method to easily replace aventricularcatheter. This method has been used with great success by the senior author (G.S.C.). It seems especially valuable in the presence of small ventricles. Methods Materials The technique requires a previously placed standardsizedventricularcatheter, the white sheath of a 9.5 Fr St. Jude peel

O ur experience has been that the recommended forceful irrigation of the proximal reservoir portions in various shunt systems is not only ineffective, but often dangerous. The patient with increased intracranial pressure secondary to a nonfunctioning shunt cannot tolerate even small increments of instilledventricularfluid without serious neurological dysfunction. We therefore used the Rickham reservoir and Holterventricularcatheterin a system which allows later nonoperative relief ofventricularcatheterobstruction. Technique Placement With the

T he most frequent complication following the use of intracranial shunts in the treatment of hydrocephalus is universally agreed to be obstruction of theventricularcatheter. With the scanning electron microscope (SEM) we have examined material occluding suchcathetersthat were removed at operation for shunt revisions. The surface ultrastructure of ependyma and choroid plexus has been previously described in normal and hydrocephalic animals. 2, 12, 15–17 Its description in humans has been limited to postmortem 5 or fetal material. 18 With the use of a

A ccurateventricularcatheterplacement is an important variable influencing shunt surgery outcome. 2, 5, 8 Correctcatheterplacement rates of approximately 90% are reported in cases in which a posteriorcatheterguide (PCG) is used. 4 This represents a significant improvement compared with free-hand methods; however, selection of a propercathetertrajectory is critical to successful placement. The technique of manually measuring and calculating a burr-hole site relative to the external occipital protuberance is prone to error. In the current report a

因斯截止到1950年代早期,装有阀的并联系统provided effective management for tens of thousands of individuals with hydrocephalus. However, these shunts generate a series of problems that must be managed in addition to the original etiology of the hydrocephalus and the hydrocephalus itself. 2–6 Malfunction at the proximal end of the device may be due to blockage of theventricularcatheterby the choroid plexus, intraventricular debris, or glial tissue growing into the lumen of thecatheter. Another cause ofventricularcatheterfailure arises from the

T he treatment of hydrocephalus with the insertion of a shunt is fraught with high failure rates. Evidence indicates that the proximal end of acatheteris the primary site of blockage. 1, 2, 4, 9 Obstructing agents generally include debris such as blood clots, cell clusters, and normal tissues such as choroid plexus and ependymal tissues. 2, 3, 10 Other entrance conditions such as the CSF environment,ventricularsize, andcathetertip location are also identified to be important factors. 4, 6, 9, 11 In a recent randomized trial, researchers found that a

V entriculoperitoneal (VP) shunt placement in patients with hydrocephalus is one of the most commonly performed operations in neurological surgery. Despite the relative simplicity of this procedure, the complication rate can be significant. Surgical technique, from proper tissue handling to accuratecatheterplacement, plays a major role in reducing complications associated with VP shunts. Improper placement of theventricularcathetermay result in neurological injury from the misplacedcatheteror early proximal shunt obstruction. Thus, to obtain optimum