Percutaneous coagulation of choroid plexus to unblock the ventricular catheter using the Seldinger technique: preliminary report.
BACKGROUND
Blockage of the ventricular catheter is the most common reason for shunt malfunction and is usually due to ingrowth of choroid plexus into the catheter lumen. The authors describe a simple technique to unblock the ventricular catheter in situ.


METHODS
In children with symptoms and radiological evidence of shunt malfunction, the Rickham reservoir was tapped under a general anesthetic. Manometry with saline was performed to confirm isolated proximal blockage of shunt. A guide wire, insulated to the scalp, was passed into the ventricular catheter using the Seldinger technique. Bursts of monopolar diathermy were applied to the guide wire to coagulate choroids plexus and manometry was repeated. In this preliminary study, all ventricular catheters were subsequently revised.


RESULTS
This percutaneous technique was undertaken in 7 children with confirmed proximal shunt malfunction. Successful unblocking of the ventricular catheter was established by increased flow of cerebrospinal fluid around the guide wire. The mean +/- SEM manometry reading post-diathermy (21.9 +/- 5 cm) was higher than the pre-diathermy value (0.6 +/- 0.6 cm; P < .01).


CONCLUSIONS
Percutaneous coagulation of the choroids plexus using the Seldinger technique is a simple, inexpensive, minimally invasive method to unblock ventricular catheters and it may be suitable as a stand-alone technique in selected patients.
Gnanalingham
Kanna K
KK
Department of Neurosurgery, Great Ormond Street Hospital for Children, Great Ormond Street, W3 OHR London, UK. kannagnana@doctors.org.uk
Lafuente
Jesus
J
Brew
Stefan
S
Thompson
Dominic
D
Harkness
William
W
Hayward
Richard
R
D000293:Adolescent; D000768:Anesthesia, General; D002648:Child; D002675:Child, Preschool; D002831:Choroid Plexus / Q000254:growth & development*; D003972:Diathermy; D004868:Equipment Failure; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000601:surgery; D008297:Male; D008365:Manometry; D017287:Ventriculoperitoneal Shunt