Integra LifeSciences Codman RICKHAM Manual página 8

With HOLTER Valve System
Remove the stainless steel or nylon plug from lumen of the side
1.
arm.
Cut a 2.5 cm long gutter running downwards from the burr hole to
2.
the planned location of the valve.
NOTE: The gutter must not extend beyond the proximal metal
portion of the valve, because the pumping chamber should rest on
the skull.
Place an appropriate number of small holes on both sides of the
3.
gutter to accommodate sutures to fix the valve when positioned.
Adjacent soft tissue may also be used for fixation. Pre-position the
sutures.
Make the appropriate connections to the HOLTER Valve and
4.
distal catheter.
Fix the valve with the previously placed sutures. Ensure that
5.
the sutures are not in a position to place pressure on the pumping
chamber, because this will restrict flow.
Pull the pericranium over the reservoir and valve, and suture in
6.
place to maintain their position in the skull. Close the scalp using
suture material of the surgeon's choice.
Injection
To inhibit coring of the reservoir cap, a HUBER™ point needle
(24- or 26-gauge) should be used to penetrate the dome. Insert the
needle at an oblique angle to achieve the greatest yield of CSF and
to prevent the needle point from piercing the ventricular catheter
(Figure 2).
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References
Rickham PP, Penn IA: The place of the ventriculostomy reservoir
1.
in the treatment of myelomeningoceles and hydrocephalus. Dev
Med Child Neurol 7:296–301, 1965.
Ratcheson RA, Ommaya AK: Experience with the subcutaneous
2.
cerebrospinal fluid reservoir. N Engl J Med 279:1025–1031, 1968.
Diamond RD, Bennett JE: A subcutaneous reservoir for
3.
intrathecal therapy of fungal meningitis. N Engl J Med 288:186–188,
1973.
Thomas GG, Cudmore RE: The advantages of a ventriculostomy
4.
reservoir with a HOLTER valve system. J Pediatr Surg 11:63–67,
1976.
Forrest DM, Cooper DGW: Complications of ventriculo-atrial
5.
shunts. J Neurosurg. 21:506–512, 1968.
Becker DP, Nulsen FE: Control of hydrocephalus by valve-
6.
regulated venous shunt: avoidance of complications in prolonged
shunt maintenance. J Neurosurg. 27:215–226, 1968.
Yonekawa Y, Nishikawa M, Egli M, et al: A clinical and
7.
experimental study of meglumine iocarmate: a complication of
positive contrast ventriculography. Surg Neurol 5:167–170, 1976.
Sommers M, "Examination of the physical and imaging effects
8.
of non-ferromagnetic neurosurgical implants on magnetic
resonance imaging scans (M.R.l.)," (July, 1984). A report based on
comprehensive studies at Children's Hospital, Chicago, IL.
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