Reduction of shunt obstructions by using a peel-away sheath technique? A multicenter prospective randomized trial

Uwe Kehler, Niels Langer, Jan Gliemroth, Ullrich Meier, Johannes Lemcke, Christian Sprung, Hans Georg Schlosser, Michael Kiefer, Regina Eymann, Oliver Heese*

*Corresponding author for this work
5 Citations (Scopus)


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.

Original languageEnglish
JournalClinical Neurology and Neurosurgery
Issue number4
Pages (from-to)381-384
Number of pages4
Publication statusPublished - 01.05.2012


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