Prevention of intraventricular hemorrhage during CSF shunt revisions by means of a flexible coagulating electrode. A preliminary report.

We report the preliminary results of a prospective study in 19 patients (22 procedures) undergoing ventricular catheter replacement at the time of CSF shunt revision to determine the value of intraluminal coagulation by means of a flexible monopolar coagulating electrode in preventing ventricular hemorrhage following catheter removal. These patients had their first shunt implanted during infancy, and underwent shunt revision during the 1-year period between October 1996 and October 1997. Sixteen patients were found to have adherent ventricular catheters, that necessitated the use of diathermy for their removal. In 10 procedures electrocoagulation was applied to the stylet of the ventricular catheter thus permitting tube extraction. In the remaining 8 shunt revisions catheter removal was readily accomplished by coagulation applied to a flexible monopolar endoscopic electrode introduced into the lumen of the tube. Two patients developed mild intraventricular hemorrhage following the use of each of the two methods described above. Both coagulation techniques used during the routine withdrawal of ventricular catheters seem to be equally effective. The flexible coagulating electrode has the additional advantage over the stylet of being moldable, allowing its use in cases in which the catheter does not follow a straight course within the ventricular cavity.