Real-time transfontanellar ultrasound-guided biventricular catheter placement for revision surgery: technical note

Abstract

Abstract Background Proximal catheterization failure is believed to be the result of obstruction of the catheter by the choroid plexus. Optimal catheter placement can reduce proximal catheter failure. It has been reported that placement of ventricular catheters with stereotaxy, ultrasound, and endoscopic methods can help to reduce proximal catheterization failure. Aim In cases with an open fontanelle that require VP shunt revision, proximal catheter failure can be reduced with transfontanellar ultrasound guidance. Case description A ventricular catheter had been placed via right parietooccipital burr hole with free-hand method. Three months later, the left lateral ventricle, particularly the frontal horn of the left lateral ventricle, was observed to be asymmetrically larger, so revision surgery was planned. The revision surgery was performed under transfontanellar ultrasound guidance to advance the existing catheter to the frontal horn of the contralateral ventricle. In revision cases, particularly those with an open fontanelle, the proximal catheter can be placed in the desired region without any issues under intraoperative transfontanellar ultrasound guidance. Conclusion In cases with an open fontanelle that require external ventricular drainage, VP shunt placement, or revision, proximal catheter failure can be reduced with transfontanellar ultrasound guidance.

Keywords

• Transfontanellar ultrasound
• VP shunt
• Revision