Prevention of postshunting ventricular asymmetry by transseptal placement of ventricular catheters. A randomized study.
Ventricular asymmetry is common after ventricular shunting, and occasionally isolation of the contralateral ventricle necessitates a second shunt. The following study was performed to determine whether contralateral placement of the ventricular catheter via ultrasound-guided perforation of the septum pellucidum would decrease the incidence of postshunting ventricular asymmetry which might predispose to symptomatic isolation of a lateral ventricle. Fifty-eight children with hydrocephalus and an open fontanel, who were having a ventriculo-peritoneal shunt via a parieto-occipital approach, were randomized to have the ventricular catheter tip placed into either the ipsilateral or the contralateral frontal horn. Ventricular asymmetry occurred in 23% of the patients with contralateral versus 54% with ipsilateral placement (chi 2 = 5.53; p = 0.019). In 7 patients with contralateral placement, in whom a special catheter with two sets of holes was used, such that holes were located in both ventricles, no shunt-related ventricular asymmetry occurred. In 2 children with ipsilateral placement, a second shunt was required for a symptomatic isolated lateral ventricle. Perforation of the septum pellucidum with placement of the ventricular catheter in the contralateral ventricle, using a specially designed catheter with two sets of holes, may decrease the incidence of postshunting ventricular asymmetry and symptomatic isolation of a lateral ventricle.
Steinbok
P
P
Division of Paediatric Neurosurgery, British Columbia Children's Hospital, University of British Columbia, Vancouver, Canada.
Poskitt
K J
KJ
Cochrane
D D
DD
Kestle
J R
JR
D002552:Cerebral Ventricles / Q000601:surgery*; D006801:Humans; D006849:Hydrocephalus / Q000601:surgery*; D007231:Infant, Newborn; D009778:Occipital Lobe / Q000601:surgery; D010296:Parietal Lobe / Q000601:surgery; D018658:Ventricular Septal Rupture / Q000209:etiology; D017287:Ventriculoperitoneal Shunt / Q000009:adverse effects*