title: Can using a peel-away sheath in shunt implantation prevent ventricular catheter obstruction?
abstract: OBJECTIVE
  Shunt obstruction is the most common shunt complication. In 2003, Kehler et al. used peel-away sheath while implanting the ventricular catheter in 20 patients. They found less revision rate in the peel-away sheath group. We aimed to test the efficacy of this technique in cadavers.
  
  
  METHODS
  We used 100 fresh brains obtained from medicolegal autopsies. Posterior parietal and frontal approaches were used to puncture the lateral ventricle in each cerebral hemisphere. The ventricle is punctured with a peel-away sheath system. After the ventricle is reached, the mandarin is retracted and the ventricular catheter is introduced through the opening. The ventricular catheter was removed from the ventricle, the opening at the tip of the ventricular catheter was checked out for obstruction, and the number of patent and plugged openings was recorded. This procedure was repeated four times for each location with and without using peel-away sheath. The control group consisted of the procedures done without using peel-away sheath.
  
  
  RESULTS
  The number of the plugged openings in the peel-away sheath group was significantly smaller than the control group. There was no significant difference between the two groups in terms of gender and left and right cerebral hemispheres. The obstruction rate was significantly lower in the posterior parietal approach. Pearson's correlation showed that increasing age was associated with less obstruction rate.
  
  
  CONCLUSIONS
  Peel-away sheath decreases the number of plugged openings of the ventricular catheter. A clinical cooperative study is needed to prove that a peel-away sheath should be included in the ventricular shunt systems in the market.
authors.affiliation: Department of Neurosurgery, Izmir Education and Research Hospital, Izmir, Turkey.
authors.forename: Mahmut
authors.initials: M
authors.lastname: Camlar
authors.forename: Yusuf
authors.initials: Y
authors.lastname: Ersahin
authors.forename: Fusun Demirçivi
authors.initials: FD
authors.lastname: Ozer
authors.forename: Fatih
authors.initials: F
authors.lastname: Sen
authors.forename: Mehmet
authors.initials: M
authors.lastname: Orman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002102:Cadaver; D002408:Catheters, Indwelling / Q000009:adverse effects*; D002557:Cerebrospinal Fluid Shunts / Q000295:instrumentation*; D002648:Child; D002675:Child, Preschool; D004867:Equipment Design; D004868:Equipment Failure; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000295:instrumentation*; D055815:Young Adult