TY - JOUR
T1 - Reduction of shunt obstructions by using a peel-away sheath technique? A multicenter prospective randomized trial
AU - Kehler, Uwe
AU - Langer, Niels
AU - Gliemroth, Jan
AU - Meier, Ullrich
AU - Lemcke, Johannes
AU - Sprung, Christian
AU - Schlosser, Hans Georg
AU - Kiefer, Michael
AU - Eymann, Regina
AU - Heese, Oliver
PY - 2012/5/1
Y1 - 2012/5/1
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=84859420889&partnerID=8YFLogxK
U2 - 10.1016/j.clineuro.2011.11.020
DO - 10.1016/j.clineuro.2011.11.020
M3 - Journal articles
C2 - 22311000
AN - SCOPUS:84859420889
SN - 0303-8467
VL - 114
SP - 381
EP - 384
JO - Clinical Neurology and Neurosurgery
JF - Clinical Neurology and Neurosurgery
IS - 4
ER -