• Quantang Wei, Yimin Xu, Kaiwen Peng, Songtao Qi, Yuping Peng, Huangyi Ji, Yu Li, Mingxing Qiu, Yanyi Ying, and Xiaoyu Qiu.
• Department of Neurosurgery, The First Affiliated Hospital of Shantou University, Shantou, Guangdong, China.
• World Neurosurg. 2018 Aug 1; 116: e469-e475.

ObjectiveTo explore the value of the application of neuroendoscopy techniques in the treatment of ventriculoperitoneal (VP) shunt blockage.MethodsOur study included 3 plans for revision surgeries for VP shunt blockage. In plan A, the choroid plexus or ependyma growing inside the ventricular catheter was completely removed. In plan B, the terminal part of the ventricular catheter was clipped and removed. In plan C, the ventricular catheter was carefully extracted with the aid of neuroendoscopy, and the tissues blocking the catheter were removed. The ventricular catheter was then reinserted into the lateral ventricle.ResultsThe side holes of the tube may be blocked by cerebral tissue, granulation tissue, newly formed blood vessels, choroid plexus, or ependyma. Five patients successfully underwent plan A revision surgery, 8 patients underwent plan B revision surgery, and the remaining 22 patients underwent plan C revision surgery. After the operation, 34 patients experienced relief of symptoms of elevated intracranial pressure. In all patients, the shunt obstruction was resolved.ConclusionsNeuroendoscopy techniques can be used to reveal the various causes of shunt obstruction. Any attempt to extract the tube should be performed with the aid of a neuroendoscope. The 3 surgical revision strategies for a blocked catheter are described for the first time in the literature. These approaches can reduce the operation time, the incidence of intraventricular hemorrhage, and the risk of infection.Copyright © 2018 Elsevier Inc. All rights reserved.

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