Preventing ventricular catheter displacement and infection with the “catheter-locking device-assisted” technique: a retrospective study of 231 patients

Background: Inserting cerebrospinal fluid diversion devices like external ventricular drains (EVDs) and ventriculoperitoneal shunts (VPSs) is a critical procedure. Unfortunately, complications such as catheter misplacement, dislocation, or infection can occur. Various surgical strategies aim to reduce these risks. One recent innovation is the "catheter-locking device (CLD)-assisted" technique for EVD surgery. In this study, we examined its application in a larger group of cases encompassing both EVDs and VPSs over a 30-month period, with a focus on these complications. Methods: All adult patients who underwent a shunt procedure for non-infectious hydrocephalus at our Institution from January 2021 to June 2023 were reviewed. We compared complications between those treated with the "standard" technique (subgroup A) and those managed with the "CLD-assisted" approach (subgroup B). Results: In the EVD surgical group (initial procedures, n = 161), 6 patients (3.7%) required reoperation due to catheter misplacement due to inadvertent migration of the ventricular catheter within the operating room ("early" migration), while 11 patients (6.8%) experienced unintentional postoperative dislodgement ("delayed" migration). Seven patients (4.3%) developed an EVD-related infection after an average duration of 7.4 days. None of these complications were observed in subgroup B patients (p < .05). Among VPS patients (n = 137), 4 (2.9%), all in subgroup A, required reoperation due to intraoperative migration of the catheter (p = .121); no other complications were identified. Conclusions: The "CLD-assisted" technique may significantly decrease the occurrence of the most common EVD complications and can also prove beneficial in VPS surgery. However, further investigation is necessary.