Preventing Ventricular Catheter Displacement and Infection with the "Catheter-Locking Device-Assisted" Technique: A Retrospective Study of 231 Patients

Manolo Piccirilli; Anthony Kevin Scafa; Enrico Marchese; Marco Gallo; Antonio Santoro

doi:10.1016/j.wneu.2023.11.089

Preventing Ventricular Catheter Displacement and Infection with the "Catheter-Locking Device-Assisted" Technique: A Retrospective Study of 231 Patients

World Neurosurg. 2024 Feb:182:e236-e244. doi: 10.1016/j.wneu.2023.11.089. Epub 2023 Nov 23.

Authors

Manolo Piccirilli¹, Anthony Kevin Scafa², Enrico Marchese³, Marco Gallo¹, Antonio Santoro¹

Affiliations

¹ Department of Neurological Sciences, Neurosurgery, "La Sapienza" University of Rome, Rome, Italy.
² Department of Neurological Sciences, Neurosurgery, "La Sapienza" University of Rome, Rome, Italy. Electronic address: anthonykevin.scafa@uniroma1.it.
³ Department of Neurosurgery, Fondazione Policlinico Agostino Gemelli IRCCS, Rome, Italy; Department of Neurosurgery, Institute of Neurosurgery, Catholic University of the Sacred Heart, Rome, Italy.

PMID: 38006938
DOI: 10.1016/j.wneu.2023.11.089

Abstract

Background: Inserting cerebrospinal fluid diversion devices such as external ventricular drains (EVDs) and ventriculoperitoneal shunts (VPSs) is a critical procedure. Unfortunately, complications such as catheter misplacement, dislocation, or infection can occur. Various surgical strategies aim to reduce these risks. One recent innovation is the "catheter-locking device-assisted" technique for EVD surgery. In this study, we examined its application in a larger group of cases encompassing both EVDs and VPSs over a 30-month period, with a focus on these complications.

Methods: All adult patients who underwent a shunt procedure for noninfectious hydrocephalus at our institution from January 2021 to June 2023 were reviewed. We compared complications between those treated with the "standard" technique (subgroup A) and those managed with the "catheter-locking device-assisted" approach (subgroup B).

Results: In the EVD surgical group (initial procedures, n = 161), 6 patients (3.7%) required reoperation owing to the catheter misplacement caused by inadvertent migration of the ventricular catheter within the operating room ("early" migration), while 11 patients (6.8%) experienced unintentional postoperative dislodgement ("delayed" migration). Seven patients (4.3%) developed an EVD-related infection after an average duration of 7.4 days. None of these complications were observed in subgroup B patients (P < 0.05). Among VPS patients (n = 137), 4 (2.9%), all in subgroup A, required reoperation due to intraoperative migration of the catheter (P = 0.121); no other complications were identified.

Conclusions: The "catheter-locking device-assisted" technique may significantly decrease the occurrence of the most common EVD complications and can also prove beneficial in VPS surgery. However, further investigation is necessary.

Keywords: Complications; External ventricular drain; Hydrocephalus; Infection; Neurosurgical technical advance; Ventriculoperitoneal shunt.

MeSH terms

Adult
Catheters
Cerebrospinal Fluid Shunts / adverse effects
Drainage / methods
Humans
Hydrocephalus* / etiology
Hydrocephalus* / surgery
Retrospective Studies
Ventriculoperitoneal Shunt* / adverse effects
Ventriculostomy / adverse effects
Ventriculostomy / methods