The Seldinger technique for insertion of difficult to place ventricular catheters

Background: Multiloculated ventricular hydrocephalus is a difficult pathology for neurosurgeons to treat. Not only are the shunts for this condition prone to malfunction, but they are also difficult to place. Methods: The Seldinger technique is used in combination with a rigid scope with a working channel. A soft filiform wire or a thick suture is inserted through the channel. The scope is withdrawn and a ventricular catheter is slid down the wire. The remainder of the shunt is inserted in the usual fashion. Results: We have not encountered any neurologic compromise from this technique. No bleeding was encountered with the described technique. Conclusion: The Seldinger technique with appropriate types of guide wires and in combination with an endoscope is a useful technique for difficult to place shunts.