Document Detail


Percutaneous proximal shunt revision: a real-time metric to measure effectiveness.
MedLine Citation:
PMID:  18377293     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
Introduction The great majority of shunt failures are due to proximal obstruction. Percutaneous reopening of the obstructed catheter by radiofrequency or ultrasound techniques has been suggested as a minimally invasive approach of maintenance rather than replacement. The obvious benefit is a decreased risk of removal and repositioning into an often slitlike ventricle. While reopening can be achieved, longevity of benefit appears shorter probably due to incomplete cleaning of obstructed holes in the proximal catheter and no change in the local environment of the tip. Methods We have developed a bench model of progressive proximal obstruction that shows the gradual obliteration of the ICP waveform in the proximal catheter compared to an external ICP waveform reference (tympanic membrane displacement). Alternatively the waveform of a pulse oximeter off of the finger can be employed. Results Real-time cross-correlation between waveforms allows a bar graph display to the neurosurgeon, which correlates to one of three patterns: all holes obstructed and a correlation of zero (range 0-1.0); one row of holes open and a correlation of 0.3; all holes open and a correlation of 0.9-1.0. As the proximal catheter is re-opened by RF, restoration of the cross-correlation to >0.9 confirms restored patency. Conclusion Waveform correlation is a new technique that allows the neurosurgeon to assess shunt functionality and the effectiveness of restoration. It opens the door to a much simpler cost-effective approach to revision-that is, maintenance rather than replacement.
Authors:
Kim Manwaring; Kate Klas; Mark Manwaring
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of neurosurgery. Pediatrics     Volume:  1     ISSN:  1933-0707     ISO Abbreviation:  -     Publication Date:  2008 Apr 
Date Detail:
Created Date:  2008-04-01     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101463759     Medline TA:  J Neurosurg Pediatrics     Country:  United States    
Other Details:
Languages:  eng     Pagination:  A356     Citation Subset:  IM    
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