PMC8739909_01
Preoperative cranial CT. (a-c) Axial slices demonstrate ventriculomegaly, enlargement of the temporal horns, and transependymal edema suggesting VPS obstruction. The ventricular catheter is positioned inside the temporal horn.
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The cranial CT scan demonstrated ventriculomegaly, enlargement of the temporal horns, and transependymal edema (Figures 1(a)-1(c)).
Axial section of the abdominal CT. The asterisk represents the pseudocyst inside the abdominal cavity. This seems to be the cause of the system malfunctioning.
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The lesion was compatible with a purely inflammatory abdominal pseudocyst, according to Mallereau et al. classification (Figure 2).
Ventricular catheter removal technique. (a) The monopolar wire being introduced inside the ventricular catheter. Two Kelly forceps were used to fix the catheter. (b) Introduction of the monopolar wire into the existing proximal catheter. (c) Previous catheter removal. The new catheter was positioned very close to the burr hole. (d) The ventricular catheter was inserted using the previous trajectory.
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Tuttilingen, Germany) was advanced into the ventricular catheter (Figure 3(a)). Great care was taken to prevent CSF leakage. Kelly forceps were used to fix the ventricular catheter in order to avoid pushing it along with the monopolar wire. The monopolar wire was advanced until the end of the ventricular catheter (Figure 3(b)). Then, with the monopolar wire connected to a Valleylab Force FX Electrosurgical Generator (Covidien, Walpole, United States), with power setting at 8 W, a back-and-forth movement was applied to coagulate and liberate inner catheter adhesions. At the same time, a slight pulling force was applied to the ventricular catheter until it was released (Figure 3(c)). Finally, the retained catheter was removed, and a new one was placed through the same route (Figure 3(d)).
The previous ventricular catheter after removal. This figure demonstrates the choroid plexus adhesions around the original catheter.
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Adhesions of the choroid plexus passing through catheter holes were identified (Figure 4).
Distal catheter insertion. (a) Insertion of the distal catheter in the right atrium through the left linguofacial trunk. (b) Chest X-ray confirming atrial catheter position.
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The new ventricular catheter was connected to the remaining VAS system (Figure 5(a)). Then, the appropriate positioning of the atrial catheter was confirmed by fluoroscopy (Figure 5(b)).
(a-c) Postoperative cranial CT demonstrating the reduction of ventricle sizes. The ventricle catheter is well positioned.
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The comparison of the pre- and postoperative cranial CT demonstrated that the new ventricular catheter was functional, well-positioned, and without adjacent bleeding (Figures 6(a)-6(f)).