gms | German Medical Science

73. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Griechischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

29.05. - 01.06.2022, Köln

Article

Send article

Prediction of distal catheter dislocation from ultra-low-dose CT scan after placement of ventriculoperitoneal shunt

Prädiktion der Bauchkatheter-Dislokation basierend auf Ultra-low-dose CT nach VP-Shunt-Anlage

Meeting Abstract

Search Medline for

  • presenting/speaker Rastislav Pjontek - Universitätsklinikum RWTH Aachen, Klinik für Neurochirurgie, Aachen, Deutschland
  • Hani Ridwan - Universitätsklinikum RWTH Aachen, Klinik für Diagnostische und Interventionelle Neuroradiologie, Aachen, Deutschland
  • Sonny Kian Hwie Tan - Universitätsklinikum RWTH Aachen, Klinik für Neurochirurgie, Aachen, Deutschland
  • Anke Höllig - Universitätsklinikum RWTH Aachen, Klinik für Neurochirurgie, Aachen, Deutschland
  • Hans Clusmann - Universitätsklinikum RWTH Aachen, Klinik für Neurochirurgie, Aachen, Deutschland
  • Hussam Aldin Hamou - Universitätsklinikum RWTH Aachen, Klinik für Neurochirurgie, Aachen, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 73. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Griechischen Gesellschaft für Neurochirurgie. Köln, 29.05.-01.06.2022. Düsseldorf: German Medical Science GMS Publishing House; 2022. DocV119

doi: 10.3205/22dgnc120, urn:nbn:de:0183-22dgnc1207

Published: May 25, 2022

© 2022 Pjontek et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

Text

Objective: Subcutaneous migration of the peritoneal catheter belongs to common complications after ventriculoperitoneal (VP) shunt placement. Obesity and previous shunt procedures are known risk factors for distal catheter dislocation. Whole body ultra-low-dose CT (ULD-CT) is replacing the radiographic shunt series as standard imaging method for VP shunts. We retrospectively analyzed the feasibility of ULD-CT for prediction of distal catheter migration and subcutaneous pseudocyst formation.

Methods: A total of 115 consecutive ULD-CTs (100kV, 10mAs, care dose) of VP shunts were performed at our institution between January 2020 and June 2021. The amount of subcutaneous adipose tissue (SAT) at L3/4 level, the distance of the shunt catheter within its subcutaneous course from the abdominal fascia, the thickness, and the density of subcutaneous tissue at intraperitoneal entry point of the shunt catheter were recorded for all cases. The characteristics of cases which developed a dislocation of peritoneal catheter were compared with cases without any mechanical complications of distal catheter.

Results: Migration of distal catheter into subcutaneous space occurred in twelve cases. The amount of SAT (583 vs 270 cm2), the distance of the extraperitoneal shunt catheter from the abdominal fascia (22 vs 11 mm), the thickness (49 vs 28 mm) and the density (-41 vs -84 HU) of subcutaneous tissue at intraperitoneal entry point of the catheter were significantly (p<0.001) greater in cases with distal shunt dislocation in comparison with controls.

Conclusion: The obesity, quantified by SAT and fat layer thickness, could be verified as leading risk factor for dislocation of peritoneal catheter. Higher density of the subcutaneous tissue at the intraperitoneal entry point may indicate infiltration of CSF. We recommend stable closure of abdominal fascia and pulling the distal catheter through abdominal subcutaneous tissue tight at the fascia.