neurosurgeryНейрохирургияRussian journal of neurosurgery1683-32952587-7569Издательский дом "МедИНК"10.17650/1683-3295-2021-23-4-82-86neurosurgery-1123Research ArticleНАБЛЮДЕНИЕ ИЗ ПРАКТИКИFROM PRACTICEЭндоскопическое удаление желудочкового катетера у пациента группы высокого рискаEndoscopic-assisted removal of ventricular catheter in high-risk patientsPuzzolanteA.PuzzolanteA.

Via Giardini 1355, 41121 Modena

Via Giardini 1355, 41121 Modena

PavesiG.PavesiG.

Via Giardini 1355, 41121 Modena

Via Giardini 1355, 41121 Modena

https://orcid.org/0000-0001-6285-3648FelettiA.FelettiA.

Alberto Feletti 

Piazzale Stefani 1, 37126 Verona

Alberto Feletti 

Piazzale Stefani 1, 37126 Verona

alberto.feletti@univr.itDepartment of Neurosciences, Unit of Neurosurgery, OCSAE Modena HospitalИталияDepartment of Neurosciences, Unit of Neurosurgery, OCSAE Modena HospitalItalyDepartment of Neurosciences, Biomedicine, and Movement Sciences, Institute of Neurosurgery, University of VeronaИталияDepartment of Neurosciences, Biomedicine, and Movement Sciences, Institute of Neurosurgery, University of VeronaItaly2021180120222348286Copyright © Puzzolante A., Pavesi G., Feletti A., 20222022Puzzolante A., Pavesi G., Feletti A.Puzzolante A., Pavesi G., Feletti A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.therjn.com/jour/article/view/1123

Введение. Вентрикулоперитонеальное шунтирование ассоциировано с достаточно высоким риском осложнений, которые могут потребовать проведения нескольких повторных хирургических вмешательств в течение жизни пациента. Наиболее частым осложнением является обструкция желудочкового катетера, который может врастать в спайки с сосудистым сплетением, эпендимальной тканью, участками фиброза. В подобных случаях, а также при наличии внутрижелудочковой опухоли удаление желудочкового катетера необходимо проводить с особой осторожностью. Образование спаек с наконечником желудочкового катетера значительно повышает риск опасного для жизни кровотечения.Материалы и методы. В статье представлен случай проксимальной ревизии вентрикулоперитонеального шунта у пациента с болезнью Гиппеля–Линдау. Нейроэндоскопическое обследование, направленное на восстановление проходимости желудочковой системы, позволило обнаружить фиброзную адгезию между кончиком катетера и гемангиобластомой гипофиза, примыкающей к III желудочку.Обсуждение. Гемангиобластома редко поражает стебель гипофиза, однако эта локализация является наиболее частой супратенториальной локализацией у пациентов с болезнью Гиппеля–Линдау. В описанном и подобных ему клинических наблюдениях ревизия шунта с помощью эндоскопа позволяет визуализировать кончик желудочкового катетера и возможные спайки, которые могут быть коагулированы и рассечены простыми методами без риска осложнений для пациентов.Заключение. При выполнении ревизии вентрикулоперитонеального шунта у пациентов с сопутствующими внутрижелудочковыми опухолями или при наличии участков с высоким риском кровотечения необходим нейроэндоскопический контроль для снижения риска внутрижелудочкового кровоизлияния.

Introduction. Ventriculoperitoneal shunt carries a non-negligible failure rate often requiring multiple surgical procedures during patient’s lifetime. The most common cause is obstruction of the ventricular catheter that can be embedded in adhesions with choroid plexus, ependymal tissue, and fibrous material. In such cases, or when an intraventricular tumor is present, particular attention must be paid when removal of the ventricular catheter is required. The potential adhesions with the tip of the ventricular catheter results in an increased risk of life-threatening hemorrhage.Materials and methods. We present the case of a ventriculoperitoneal shunt proximal revision in a von Hippel–Lindau affected patient. The neuroendoscopic exploration to restore the patency of the ventricular system made it possible to notice a fibrous adhesion between the tip of the catheter and a pituitary hemangioblastoma abutting into the third ventricle. Discussion. Pituitary stalk hemangioblastoma is an infrequent localization, although it represents the most common supratentorial site of hemangioblastoma in patients affected by von Hippel–Lindau syndrome. In this and in similar cases, endoscopic-assisted shunt revision allows visualizing the tip of the ventricular catheter and eventual adhesions that can be coagulated and cut by simple maneuvers, without any morbidity for patients.Conclusion. In a ventriculoperitoneal shunt revision with the concomitant presence of an intraventricular tumor or lesion at risk of bleeding, the surgical procedure should be performed under neuroendoscopic observation to reduce the risk of intraventricular hemorrhage.

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The authors declare that there are no conflicts of interest present.