PMC8419424_01
T1FLAIR (A,B) brain MRI showing the narrowed sulcal spaces at the vertex (oval) and the enlarged ventricles of the brain and lateral cracks(asterisk) (DESH); Evans Index was 0.32. Two-month CT-(C), 6-month CT-(D) and 16-month CT-(E) brain scan showing the catheter in position and the hydrocephalus is relieved. One-week three-dimensional reconstructed CT- (F,G) scan of the thorax showing the distal catheter in situ. Two-month CT- (H,I) and 16-month CT-(J) thorax scan showing the sternum is intact and the distal catheter in situ.
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F1
Magnetic resonance imaging (MRI) showed disproportionately enlarged subarachnoid space hydrocephalus (Figures 1A,B) and dilated cerebral ventricles and cisterns, with no apparent obstacle (Figure 1B). Evans Index was 0.32 (Figure 1B). The three-dimensional reconstructed thoracic CT scan suggested that the distal catheter was located in an intraosseous tunnel, and there was no complication, such as manubrium sternal fracture, pneumothorax, or mediastinal gas (Figures 1F,G). The CT brain scan showed the ventricle size did not dramatically change, and the ventricular catheter was in place (Figure 1C). The CT thorax scan showed sternum was intact, and there were no shunt-related complications(Figures 1H,I). The patient remained in good condition and was free of shunt-related complications at the 6-month and 16-month follow-up (Figures 1D,E,J).
(A) An arc skin incision for a right-sided shunt is marked. (B) Drilling of a 3 cm long tunnel parallel to the long axis of the sternum at its midline. (C) Indwelling needle placement to confirm the length of the tunnel and intraosseous absorption of 10 ml saline. (D) Placement of sternal catheter with a loop fixed at the sternum tendon of the sternocleidomastoid muscle.
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F2
After skin preparation and draping, an arc skin incision was made at the sternal notch (Figure 2A), and then subcutaneous tissues were separated until the anterior edge of the bilateral sternocleidomastoid muscle and the superior border of the sternum were exposed. Next, a tunnel, approximately 3 cm long and parallel to the sternum, was drilled through the sternal manubrium by a high-speed drill (Figure 2B). An indwelling needle containing 10 mL of saline was used to confirm the length of the tunnel and test the intraosseous absorbability (10 mL injected in 3 min; Figure 2C). The distal catheter was placed into the sternal manubrium, and a reserved loop was fixed at the sternum tendon of the sternocleidomastoid muscle (Figure 2D).
A timeline of the follow-up of the patient.
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F3
The episode of care is organized as a timeline in Figure 3.