Percutaneous proximal shunt revision: a real-time metric to measure effectiveness.

Percutaneous proximal shunt revision: a real-time metric to measure effectiveness. Research Abstract Details 

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Percutaneous proximal shunt revision: a real-time metric to measure effectiveness. Abstract Text:

Kim Manwaring,Kate Klas,Mark Manwaring,

Introduction The great majority of shunt failures are due to proximal obstruction. Percutaneous reopening of the obstructed catheter by radiofrequency or ultrasound techniques has been suggested as a minimally invasive approach of maintenance rather than replacement. The obvious benefit is a decreased risk of removal and repositioning into an often slitlike ventricle. While reopening can be achieved, longevity of benefit appears shorter probably due to incomplete cleaning of obstructed holes in the proximal catheter and no change in the local environment of the tip. Methods We have developed a bench model of progressive proximal obstruction that shows the gradual obliteration of the ICP waveform in the proximal catheter compared to an external ICP waveform reference (tympanic membrane displacement). Alternatively the waveform of a pulse oximeter off of the finger can be employed. Results Real-time cross-correlation between waveforms allows a bar graph display to the neurosurgeon, which correlates to one of three patterns: all holes obstructed and a correlation of zero (range 0-1.0); one row of holes open and a correlation of 0.3; all holes open and a correlation of 0.9-1.0. As the proximal catheter is re-opened by RF, restoration of the cross-correlation to >0.9 confirms restored patency. Conclusion Waveform correlation is a new technique that allows the neurosurgeon to assess shunt functionality and the effectiveness of restoration. It opens the door to a much simpler cost-effective approach to revision-that is, maintenance rather than replacement.

Percutaneous proximal shunt revision: a real-time metric to measure effectiveness. Publishing Authors By Initials

K Manwaring,K Klas,M Manwaring,

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Percutaneous proximal shunt revision: a real-time metric to measure effectiveness. Journal Published:

PUBLICATION TYPE: Journal Article

Journal: Journal of neurosurgery. Pediatrics

VOLUME: 1

Page Numbers: A356

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ISSN: 1933-0707

DAY: 1

MONTH: Apr

YEAR: 2008

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LANGUAGE: eng

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Country: United States

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MEDLINETA: J Neurosurg Pediatrics

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