Reduction of shunt obstructions by using a peel-away sheath technique? A multicenter prospective randomized trial.
OBJECTIVE
Shunt obstructions may partly be caused by brain debris, which intrude into the ventricular catheter during ventricle puncture. Avoiding contact between the catheter and brain tissue, by using a peel-away sheath, should reduce the number of shunt failures caused by obstruction. To test this hypothesis, we conducted a randomized, prospective multicenter study.


METHODS
201 patients from 6 different neurosurgical centers in Germany receiving a ventriculo-peritoneal shunt were included in this study. Of these, 177 patients completed a 1-year follow-up period. Surgery was randomized in a 1 to 1 fashion, such that out of 177 procedures, 91 were performed using a peel-away sheath and 86 were performed without. The rate of surgical re-interventions and shunt obstructions within a 12-month period was recorded.


RESULTS
Within 1 year post-surgery, 17 shunt obstructions (9.6%) leading to shunt revisions were recorded. However, no difference was found between surgeries performed using a peel-away sheath (9.9%) or not (9.3%). The overall shunt infection rate was 2.8% and the shunt revision rate for overdrainage was 3.9%.


CONCLUSIONS
The theoretical advantages attributed to the use of a peel-away sheath to introduce a ventricular catheter could not be confirmed in this randomized study, suggesting that the proposed role of brain debris in shunt obstructions may be overestimated.
Department of Neurosurgery, Asklepios Hospital Hamburg, Paul-Ehrlich Str. 1, 22763 Hamburg, Germany. u.kehler@asklepios.com
Uwe
U
Kehler
Niels
N
Langer
Jan
J
Gliemroth
Ullrich
U
Meier
Johannes
J
Lemcke
Christian
C
Sprung
Hans-Georg
HG
Schlosser
Michael
M
Kiefer
Regina
R
Eymann
Oliver
O
Heese
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057785:Catheters; D002557:Cerebrospinal Fluid Shunts / Q000009:adverse effects* / Q000295:instrumentation; D002648:Child; D002675:Child, Preschool; D004867:Equipment Design; D004868:Equipment Failure; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000295:instrumentation* / Q000379:methods*; D011446:Prospective Studies; D012086:Reoperation; D017287:Ventriculoperitoneal Shunt / Q000009:adverse effects / Q000295:instrumentation; D055815:Young Adult