"Do Not Follow the Tail": A Practical Approach to Remove a Sheared Lumbar Catheter Fragment Avoiding Its Migration into the Spinal Canal.

BACKGROUND

Catheter shearing is one of the most common complications of various neurosurgical modalities that use an intrathecal lumbar catheter. The sheared catheter fragment often can spontaneously migrate into the spinal canal; however, in some cases, the end of the fragment will remain outside the spinal canal. In this situation, the consulting neurosurgeons may try to retrieve the catheter fragment by approaching it directly through the catheter tract. This simple maneuver, however, can cause the fragment to slip into the spinal canal before it is secured, as we experienced recently in 2 cases. Because the fragment of the sheared catheter slipped while manipulating it within the catheter tract, we suggest that surgeons not approach the fragment along the tract to prevent it from migrating downward.

METHODS

Using the operative findings of an illustrative case, we describe how to avoid downward migration of the catheter fragment when retrieving a sheared lumbar catheter.

RESULTS

We found that the sheared catheter of a lumbar-peritoneal shunt was slowly slipping along with the pulsatile movement of cerebrospinal fluid within the catheter tract. We successfully retrieved the fragment by approaching it from outside the catheter tract.

CONCLUSIONS

We propose that surgeons approach the fragment from outside of the catheter tract. One should keep in mind a simple phrase, 'Do not follow the tail', when retrieving the sheared lumbar catheter fragment.