1. Reduction of shunt obstructions by using a peel-away sheath technique? A multicenter prospective randomized trial
- Author
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Regina Eymann, Christian Sprung, Johannes Lemcke, Niels Langer, Ullrich Meier, Oliver Heese, Uwe Kehler, Jan Gliemroth, Hans-Georg Schlosser, and Michael Kiefer
- Subjects
Adult ,Male ,Reoperation ,medicine.medical_specialty ,Catheters ,Adolescent ,Ventriculoperitoneal Shunt ,Neurosurgical Procedures ,Slit Ventricle Syndrome ,law.invention ,Young Adult ,Randomized controlled trial ,law ,Normal pressure hydrocephalus ,Humans ,Medicine ,Prospective Studies ,Child ,Aged ,Intracranial pressure ,Aged, 80 and over ,business.industry ,Equipment Design ,General Medicine ,Middle Aged ,medicine.disease ,Cerebrospinal Fluid Shunts ,Hydrocephalus ,Surgery ,Shunt (medical) ,Catheter ,medicine.anatomical_structure ,Ventricle ,Child, Preschool ,Equipment Failure ,Female ,Neurology (clinical) ,business - Abstract
Objective Shunt obstructions may partly be caused by brain debris, which intrude into the ventricular catheter during ventricle puncture. Avoiding contact between the catheter and brain tissue, by using a peel-away sheath, should reduce the number of shunt failures caused by obstruction. To test this hypothesis, we conducted a randomized, prospective multicenter study. Methods 201 patients from 6 different neurosurgical centers in Germany receiving a ventriculo-peritoneal shunt were included in this study. Of these, 177 patients completed a 1-year follow-up period. Surgery was randomized in a 1 to 1 fashion, such that out of 177 procedures, 91 were performed using a peel-away sheath and 86 were performed without. The rate of surgical re-interventions and shunt obstructions within a 12-month period was recorded. Results Within 1 year post-surgery, 17 shunt obstructions (9.6%) leading to shunt revisions were recorded. However, no difference was found between surgeries performed using a peel-away sheath (9.9%) or not (9.3%). The overall shunt infection rate was 2.8% and the shunt revision rate for overdrainage was 3.9%. Conclusions The theoretical advantages attributed to the use of a peel-away sheath to introduce a ventricular catheter could not be confirmed in this randomized study, suggesting that the proposed role of brain debris in shunt obstructions may be overestimated.
- Published
- 2012