Objective: Shunt failure is a frequent problem seen in pediatric patients. A significant amount of these shunt failure cases are due to misplacement or occlusion of the ventricular catheter. It is known that up to 45% of all ventricular catheters are placed in a suboptimal position. Transluminal endoscopy with the ShuntScope has been invented to increase the rate of successful catheter placements.Here the authors present the ShuntScope system and the results gained with its application in pediatric hydrocephalus. Illustrative cases are selected and discussed in detail.

Method: A retrospective analysis of all pediatric patients undergoing ventricular catheter placement using the ShuntScope from 01/2012 – 01/2022 in the author’s department was performed. Demographic, clinical, and radiological data were evaluated. The visualization quality of the intraoperative endoscopy was stratified into the categories excellent, medium, and poor and compared to the postoperative catheter tip placement.  Follow-up evaluation included the surgical revision rate due to proximal catheter occlusion. 

Results: A total of 65 ShuntScope-assisted surgeries have been performed on 51 children. The mean age was 5.1 years. The most common underlying pathology was a tumor- or cyst-related hydrocephalus in 51%. Achieved image quality was excellent in 41,5%, medium in 43%, and poor in 15,5%. Ideal catheter placement was achieved in 77%. There were no intraoperative complications associated with the ShuntScope. The revision rate due to proximal occlusion was 4,61% during a mean follow-up period of 39.7 months. In two cases of aqueduct stenting, the intended therapy strategy had to be abandoned and switched to VC placement into the lateral ventricle because of unmanageable anatomical circumstances.

Conclusion:

The data show that the ShuntScope can be a beneficial addition to the neurosurgical armamentarium in selected cases of hydrocephalus.