Background: Ventriculo-peritoneal shunts (VPS) still remain a diffuse treatment modality for hydrocephalus. The pediatric neurosurgical community is aware of the fact that, in some cases, the distal catheters may present some alterations in the external surface and consistency. The authors have performed an anatomic and microscopical study of the changes found on the catheter, after many years of shunt placement. They also studied these morphological and structural changes as compared with a new catheter. Materials and methods: We studied 10 catheters, implanted for 3 months to 9 years, for the treatment of pediatric hydrocephalus. These catheters were collected during shunt revisions. The catheter and its fibrous covering were observed by stereomicroscopy linked to PC software for image analysis, and by SEM to identify changes on the external and internal surfaces. We also observed a new ventriculoperitoneal distal catheter to assess differences from the retrieved catheters. Results: Around catheters that have been in place for a long time we observed the presence of a film of irregular, hardened tissue similar to fibrous scar tissue. We also observed that the irregular surface of the catheters exhibited microscopic cracks and structural irregularities that may be attributed to local inflammatory reaction, indicating cell-mediated immunity. We have also compared these observations with images of a new catheter that appear intact and regular. The study of fibrous scar tissue around the catheter confirmed the hypothesys that, although fractured, the VPS remain functional as CSF cannot escape and can reach the peritoneal cavity. Conclusions: The confirmation of the possible substitutive role of fibrous tunnel allows new stratergies to be prepared in the treatment of shunt failure caused by breakage of the catheter, even in absence of clinical and neurological signs. The study of the changes in the VPS that are host-induced should be a guide for the research of new biological material.

Anatomic and microscopic study of 10 ventriculoperitoneal distal catheters

CAFFO, Maria;GERMANO', Antonino Francesco
2004

Abstract

Background: Ventriculo-peritoneal shunts (VPS) still remain a diffuse treatment modality for hydrocephalus. The pediatric neurosurgical community is aware of the fact that, in some cases, the distal catheters may present some alterations in the external surface and consistency. The authors have performed an anatomic and microscopical study of the changes found on the catheter, after many years of shunt placement. They also studied these morphological and structural changes as compared with a new catheter. Materials and methods: We studied 10 catheters, implanted for 3 months to 9 years, for the treatment of pediatric hydrocephalus. These catheters were collected during shunt revisions. The catheter and its fibrous covering were observed by stereomicroscopy linked to PC software for image analysis, and by SEM to identify changes on the external and internal surfaces. We also observed a new ventriculoperitoneal distal catheter to assess differences from the retrieved catheters. Results: Around catheters that have been in place for a long time we observed the presence of a film of irregular, hardened tissue similar to fibrous scar tissue. We also observed that the irregular surface of the catheters exhibited microscopic cracks and structural irregularities that may be attributed to local inflammatory reaction, indicating cell-mediated immunity. We have also compared these observations with images of a new catheter that appear intact and regular. The study of fibrous scar tissue around the catheter confirmed the hypothesys that, although fractured, the VPS remain functional as CSF cannot escape and can reach the peritoneal cavity. Conclusions: The confirmation of the possible substitutive role of fibrous tunnel allows new stratergies to be prepared in the treatment of shunt failure caused by breakage of the catheter, even in absence of clinical and neurological signs. The study of the changes in the VPS that are host-induced should be a guide for the research of new biological material.
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11570/1590484
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