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

Abstract：

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.

journal_name

Clin Neurol Neurosurg

journal_title

Clinical neurology and neurosurgery

authors

Kehler U,Langer N,Gliemroth J,Meier U,Lemcke J,Sprung C,Schlosser HG,Kiefer M,Eymann R,Heese O

doi

10.1016/j.clineuro.2011.11.020

subject

Has Abstract

pub_date

2012-05-01 00:00:00

pages

381-4

issue

4

eissn

0303-8467

issn

1872-6968

pii

S0303-8467(11)00386-6

journal_volume

114

pub_type

杂志文章,多中心研究,随机对照试验

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