Department of Neurosurgery, Saarland University Medical Center, Homburg, Germany.
J Neurol Surg A Cent Eur Neurosurg. 2024 Jul;85(4):340-348. doi: 10.1055/s-0043-1769126. Epub 2023 Aug 21.
Ventricular catheter (VC) placement in the selected subset of adult hydrocephalus can be highly challenging due to abnormal anatomical configuration or the need for trans-aqueductal stent placement. Transluminal endoscopy with the ShuntScope has been invented to increase the success rate of catheter placement. This study evaluates the image qualities of ShuntScope and related surgical outcomes in adults.
A retrospective analysis of all adult patients undergoing VC placement using the ShuntScope from November 2011 to July 2022 in the authors' department was performed. Demographic, clinical, and radiologic data were evaluated. The visualization quality of the intraoperative endoscopy was stratified into excellent, medium, and poor, and compared to the postoperative catheter tip placement. Follow-up evaluation included the surgical revision rate due to proximal catheter misplacement.
A total of 63 ShuntScope-assisted surgeries have been performed on 60 adults. The mean age of the patients was 48.43 years. The most common underlying pathology was a tumor- or cyst-related cerebrospinal fluid (CSF) impairment in 38.33%, followed by a pseudotumor cerebri in 21.66%. The achieved image quality was excellent in 39.68%, medium in 47.62%, and poor in 12.7%. Ideal catheter placement was achieved in 79.37%. There were no intraoperative complications associated with the use of the ShuntScope. The revision rate due to suboptimal proximal VC placement was 4.76% during a mean follow-up period of 27.75 months. A statistical correlation between the image quality and accuracy of the catheter position was observed ( < 0.001).
The ShuntScope can be considered an important addition to standard surgical tools in treating a selected subset of adult hydrocephalus. Direct visualization might even help achieve correct placement of the catheter in the cases with blurred vision and limited visual overview.
由于解剖结构异常或需要进行跨导水管支架放置，在成人脑积水的特定亚组中，脑室导管（VC）的放置可能极具挑战性。ShuntScope 经腔内镜的发明提高了导管放置的成功率。本研究评估了 ShuntScope 的图像质量及其在成人中的相关手术结果。
对作者科室 2011 年 11 月至 2022 年 7 月期间使用 ShuntScope 进行 VC 放置的所有成年患者进行回顾性分析。评估了人口统计学、临床和影像学数据。将术中内镜的可视化质量分为优秀、中等和差，并与术后导管尖端放置进行比较。随访评估包括因近端导管错位而进行手术修正的比率。
共对 60 名成人进行了 63 次 ShuntScope 辅助手术。患者的平均年龄为 48.43 岁。最常见的基础病理是 38.33%与肿瘤或囊肿相关的脑脊液（CSF）障碍，其次是 21.66%的假性脑瘤。获得的图像质量优秀占 39.68%，中等占 47.62%，差占 12.7%。理想的导管放置率为 79.37%。使用 ShuntScope 无术中并发症。在平均 27.75 个月的随访期间，因近端 VC 放置不理想而进行修正的比率为 4.76%。观察到图像质量与导管位置准确性之间存在统计学相关性（<0.001）。
ShuntScope 可被视为治疗成人脑积水特定亚组的标准手术工具的重要补充。在视力模糊和视野有限的情况下，直接可视化甚至有助于正确放置导管。
