Background-objective. The optimum cranial site for ventricular catheter
insertion in CSF shunts is still under debate and there has been no
general consensus as far as surgical technicalities are concerned.
Furthermore, there have been no reports dealing with appropriate cranial
site selection in debilitated patients. The aim of this report is to
stress the need to utilize a frontal approach when dealing with patients
who are likely to remain bed-bound for long periods and to emphasize the
well-known prerequisites such as meticulous surgical technique and
perioperative general and local care.
Method. A retrospective analysis of all shunt operations and revisions
performed in our department during the last 6 years.
Findings. This analysis revealed 8 long-term recumbent patients with
late valve extrusion (N1 = 5) or primary wound breakdown (N2 = 3), all
through the occipital area. Extended periods of bed rest due to
neurological disease combined with poor nursing and dietary intake had
led to either chronic valve extrusion or wound breakdown. Shunt revision
was performed successfully by a frontal approach in 5 whereas 2
tolerated shunt removal and one died of meningitis.
Conclusion. In debilitated patients or those who are likely to remain
bed-bound for long periods, a frontal approach for proximal catheter
insertion may help prevent immediate postoperative wound breakdown or
late valve extrusion
