Background and purpose: To evaluate the method of endoscopic-assisted revision of adherent ventricular catheters.
Material and methods: 29 cases (26 patients) of endoscopic revision of adherent ventricular catheter were analyzed. The cause of hydrocephalus was intraventricular hemorrhage in 17 cases, myelomeningocele in 3 cases, ventriculitis in 4 cases, aqueductal stenosis in 1 case and holoprosencephaly in 1 case. Multiloculated hydrocephalus comprised 38.5% (10 patients) of cases. Depending on the catheter location, an approach through its burr hole, a new burr hole on the same side or opposite side was used. The mean time of follow up was 12 months.
Results: In 13 cases ventricular catheter was tethered in the choroid plexus, in 7 cases -- under the ependyma and in 9 cases -- in septum pellucidum. In 5 cases it was adherent to the blood vessel. An entity of active ingrowth of choroid plexus, ependyma and subependymal elements into the catheter lumen was observed. Reocclusion of the catheter occurred in 3 cases. In all these cases there was multiloculated hydrocephalus. In the remaining cases there were no signs of shunt malfunction during the time of follow up.
Conclusions: The use of endoscope during revision of adherent ventricular catheter reduces the risk of bleeding. Due to a possibility of direct observation of catheter surroundings, a decision regarding catheter replacement and its placement in an optimal position can be taken. This method gives better results than traditional methods used during revisions of occluded, adherent ventricular catheters.