Elsevier

Surgical Neurology

Volume 64, Issue 3, September 2005, Pages 270-271
Surgical Neurology

Technique
Ventricular catheter tack-down suture: Technical note

https://doi.org/10.1016/j.surneu.2004.12.024Get rights and content

Abstract

Tubing migration accounts for a significant number of shunt complications. In an attempt to reduce the likelihood of disconnection and tubing migration, we have developed a technique to rigidly fix the proximal catheter to the skull. The method involves the placement of a small twist drill hole adjacent to the catheter burr hole through which a suture is passed. The suture is then used to rigidly bind the proximal shunt tubing and valve to the skull. This approach provides an efficient and effective means for reducing complications related to shunt tubing migration.

Introduction

Malfunction of cerebrospinal fluid shunts is a common neurosurgical problem with estimates reported as high as 29% in the first year after shunt placement [1], [2]. Approximately 12% to 13% of shunt malfunctions result from disconnection and tubing migration [1], [2], [3], [4], [5]. In an effort to reduce the potential problem of proximal shunt disconnection and migration, we developed a technique to apply rigid fixation to the skull at the point of connection between the ventricular catheter and the proximal portion of the shunt valve. This fixation can theoretically reduce the mobility of the shunt apparatus and thereby decrease the potential for disconnection or migration.

Section snippets

Surgical technique

After placement of a burr hole in the desired location for subsequent passage of a ventricular catheter, a pneumatic drill with a fine-tipped drill bit (eg, the Midas Rex drill with the C1 drill bit from the Midas Rex division of Medtronic, Minneapolis, MN) is used to make a small twist drill hole. This twist drill hole is akin to a hole for a craniotomy dural tack-up stitch and is made in the skull 1 to 2 mm from the burr hole at the point where the ventricular tubing will pass over the bone

References (5)

  • L. Basauri et al.

    Shunts and shunt problems

    Monogr Neural Sci

    (1982)
  • C. Di Rocco et al.

    A survey of the first complication of newly implanted CSF shunt devices for the treatment of nontumoral hydrocephalus. Cooperative survey of the 1991-1992 Education Committee of the ISPN

    Childs Nerv Syst

    (1994)
There are more references available in the full text version of this article.

Cited by (2)

View full text