Sribnick Eric A, Sklar Frederick H, Wrubel David M
*Department of Neurosurgery, Emory University, Atlanta, Georgia; ‡Children's Healthcare of Atlanta, Atlanta, Georgia; §University of Texas Southwestern Medical Center, Dallas, Texas.
Neurosurgery. 2015 Sep;11 Suppl 3:367-70; discussion 370. doi: 10.1227/NEU.0000000000000793.
Ventriculoperitoneal shunt revision is a common procedure. Disconnection and fracture of the distal catheter remain a common cause of ventriculoperitoneal shunt malfunction.
To describe a novel procedure for peritoneal replacement of the distal catheter by using a guidewire and a modified Seldinger technique (guidewire-assisted distal catheter replacement) and retrospectively evaluate the results of the surgical procedure.
Between September 2005 and December 2013, 68 patients were treated by a single surgeon (DMW) with distal catheter replacement using our technique. In brief, the previously placed distal catheter was exposed at its entry site into the abdomen. A soft guidewire with hydrophilic coating was inserted down the distal catheter into the peritoneum. The distal catheter was then removed over the guidewire, leaving the guidewire in place. A peel-away sheath and dilator were then inserted over the guidewire, and the dilator and guidewire were removed. The new distal catheter was then passed from the valve to the abdomen and was then fed through the peel-away sheath into the peritoneum. Charts were retrospectively reviewed for preoperative presentation, operative technique, and postoperative outcome. Records were specifically examined for any early or late complications.
The mean patient age at surgery was 13 years. No immediate acute complications were noted. Of the 68 total patients, 45 patients had more than 6 months of follow-up. Of the 68 patients, 7 patients required another distal revision after guidewire-assisted distal catheter replacement.
Distal shunt malfunction due to a mechanical failure is a common reason for shunt revision. We describe a technique for guidewire-assisted distal catheter replacement.
脑室腹腔分流术的翻修是一种常见的手术。远端导管的断开和断裂仍然是脑室腹腔分流术故障的常见原因。
描述一种使用导丝和改良的Seldinger技术进行远端导管腹膜置换的新手术方法（导丝辅助远端导管置换术），并回顾性评估该手术的结果。
2005年9月至2013年12月期间，由一位外科医生（DMW）使用我们的技术对68例患者进行了远端导管置换。简而言之，将先前放置的远端导管在其进入腹部的部位暴露出来。将带有亲水涂层的软导丝沿远端导管插入腹膜。然后将远端导管沿导丝取出，导丝留在原位。然后将可剥离鞘管和扩张器沿导丝插入，取出扩张器和导丝。然后将新的远端导管从阀门传至腹部，再通过可剥离鞘管送入腹膜。对病历进行回顾性分析，以了解术前表现、手术技术和术后结果。特别检查记录中是否有任何早期或晚期并发症。
手术时患者的平均年龄为13岁。未发现即刻急性并发症。在68例患者中，45例患者进行了超过6个月的随访。在68例患者中，7例患者在导丝辅助远端导管置换术后需要再次进行远端翻修。
机械故障导致的远端分流故障是分流翻修的常见原因。我们描述了一种导丝辅助远端导管置换技术。
