Value of the Application of Neuroendoscope in the Treatment of Ventriculoperitoneal Shunt Blockage

• Published in: World neurosurgery 2018-08, Vol.116, p.e469-e475
• Main Authors: Wei, Quantang, Xu, Yimin, Peng, Kaiwen, Qi, Songtao, Peng, Yuping, Ji, Huangyi, Li, Yu, Qiu, Mingxing, Ying, Yanyi, Qiu, Xiaoyu
• Format: Article
• Language: English
• Subjects: Hydrocephalus; Neuroendoscope; Revision; Shunt blockage; Ventriculoperitoneal shunt
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2018.05.007

To explore the value of the application of neuroendoscopy techniques in the treatment of ventriculoperitoneal (VP) shunt blockage. Our study included 3 plans for revision surgeries for VP shunt blockage. In plan A, the choroid plexus or ependyma growing inside the ventricular catheter was completely removed. In plan B, the terminal part of the ventricular catheter was clipped and removed. In plan C, the ventricular catheter was carefully extracted with the aid of neuroendoscopy, and the tissues blocking the catheter were removed. The ventricular catheter was then reinserted into the lateral ventricle. The side holes of the tube may be blocked by cerebral tissue, granulation tissue, newly formed blood vessels, choroid plexus, or ependyma. Five patients successfully underwent plan A revision surgery, 8 patients underwent plan B revision surgery, and the remaining 22 patients underwent plan C revision surgery. After the operation, 34 patients experienced relief of symptoms of elevated intracranial pressure. In all patients, the shunt obstruction was resolved. Neuroendoscopy techniques can be used to reveal the various causes of shunt obstruction. Any attempt to extract the tube should be performed with the aid of a neuroendoscope. The 3 surgical revision strategies for a blocked catheter are described for the first time in the literature. These approaches can reduce the operation time, the incidence of intraventricular hemorrhage, and the risk of infection. •We explore the value of the application of neuroendoscope techniques in the treatment of ventriculoperitoneal (VP) shunt blockage.•We propose 3 plans for revision surgeries for VP shunt blockage.•These methods could reduce the operation time, decrease the incidence of intraventricular hemorrhage, and lower the risk of infection.