Ananthanandorn Anant
J Med Assoc Thai. 2017 Feb;100 Suppl 1:S27-32.
The VP shunt operation is one of the most common in neurosurgical practice for treatment of hydrocephalus. However, malfunction due to proximal obstruction of the ventricular catheter caused by improper placement of the ventricular catheter tip is still a common occurrence. This retrospective study aimed to provide information on proper placement for problem evaluation and further planning in order to improve surgical outcomes in Rajavithi Hospital.
The present research in Rajavithi Hospital, Bangkok, examined the outcomes of ventricular catheter tip position in patients undergoing VP shunt operations using the parietal approach and parameters related to improper placement.
This was a retrospective study of 42 adult patients who underwent VP shunt operations via the parietal route. Only post-operative images (CT or MRI) obtained from Rajavithi Hospital’s PACS between November 2012 and September 2014 were included. Baseline characteristics (sex, age, etiologies of hydrocephalus) and associated parameters (burr hole location, ventricular size, angle of catheter to midline, length of catheter) were recorded and analyzed. From postoperative images, the positions of ventricular catheter tips were evaluated and graded on a 3-point scale as: 1) grade 1 - optimal position, free-floating in cerebrospinal fluid in frontal horn; 2) grade 2 - touching choroid plexus or ventricular wall; and 3) grade 3 - tip within or passing through brain parenchyma.
From 42 parietal approach operations, grade 1 placement was found in 15 cases (35.7%), grade 2 in 11 (26.2%) and grade 3 in 16 cases (38.1%). Length of ventricular catheter and ventricular size were significant parameters in this study (p<0.001). The average length of catheter in grade 3 placements was significantly greater (139.04 mm) and ventricular size was significantly larger (22.59 mm) than in the other two grades.
Overlong ventricular catheter and large ventricular size were significant variables in poor placement outcomes in the present study. Pre-operative planning from CT or MRI can be used to determine the optimal length in order to improve the outcomes.
脑室腹腔分流术是神经外科治疗脑积水最常用的手术之一。然而，由于脑室导管尖端放置不当导致脑室导管近端梗阻引起的分流装置故障仍然很常见。这项回顾性研究旨在提供有关正确放置的信息，以便进行问题评估和进一步规划，从而改善拉贾维蒂医院的手术效果。
泰国曼谷拉贾维蒂医院的这项研究，探讨了采用顶叶入路进行脑室腹腔分流术患者的脑室导管尖端位置的结果以及与放置不当相关的参数。
这是一项对42例通过顶叶入路进行脑室腹腔分流术的成年患者的回顾性研究。仅纳入2012年11月至2014年9月期间从拉贾维蒂医院的PACS系统获取的术后影像（CT或MRI）。记录并分析基线特征（性别、年龄、脑积水病因）和相关参数（骨孔位置、脑室大小、导管与中线的角度、导管长度）。从术后影像中，对脑室导管尖端的位置进行评估并按3分制分级：1）1级——最佳位置，在额叶角的脑脊液中自由漂浮；2）2级——接触脉络丛或脑室壁；3）3级——尖端位于脑实质内或穿过脑实质。
在42例顶叶入路手术中，1级放置15例（35.7%），2级11例（26.2%），3级16例（38.1%）。脑室导管长度和脑室大小是本研究中的显著参数（p<0.001）。3级放置的导管平均长度（139.04毫米）和脑室大小（22.59毫米）明显大于其他两级。
在本研究中，脑室导管过长和脑室过大是放置效果不佳的显著变量。术前通过CT或MRI进行规划可用于确定最佳长度，以改善手术效果。
