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Bue EL, Morello A, Bellomo J, Bradaschia L, Lacatena F, Colonna S, Fiumefreddo A, Stieglitz L, Regli L, Lanotte MM, Garbossa D, Cofano F. Ventriculoatrial shunt remains a safe surgical alternative for hydrocephalus: a systematic review and meta-analysis. Sci Rep 2024; 14:18460. [PMID: 39117692 PMCID: PMC11310213 DOI: 10.1038/s41598-024-62366-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 05/16/2024] [Indexed: 08/10/2024] Open
Abstract
Hydrocephalus is a commonly encountered pathology in the neurosurgical practice. Since the first permanent ventriculo-subarachnoid-subgaleal shunt described by Mikulicz in 1893, there were multiple attempts to find solutions for draining the excess production/less reabsorption of the cerebrospinal fluid (CSF) from the brain. Nowadays, the most common technique is the ventriculoperitoneal shunt (VPS), whereas the ventriculoatrial shunt (VAS) is applied only in some rare conditions. To date there are still no specific guidelines or strong evidence in literature that guide the surgeon in the choice between the two methods, and the decision usually relies on the confidence and expertise of the surgeon. Considering the lack of established recommendations, this systematic review and meta-analysis aims to evaluate the effectiveness and safety of these two shunting techniques. This systematic review was conducted following the PRISMA protocol (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). No chronological limits of study publications were included. Prospective and retrospective clinical studies, and reports of case series with at least five patients per group and reporting data on comparison between VAS and VPS techniques were eligible for inclusion. Nine studies reporting 3197 patients meeting the inclusion and exclusion criteria were identified and included in the quantitative synthesis. The risk of shunt dysfunction/obstruction was significantly lower in the VAS group [odds ratio (OR) 0.49, 95%-CI 0.34-0.70, I2 0%]. The risk of infection was not significantly different between the two groups (OR 1.02, 95%-CI 0.59-1.74, I2 0%). The risk of revision was not significantly different between the two groups; however, the heterogeneity between the studies was significant (OR 0.73, 95%-CI 0.36-1.49, I2 91%). Additionally, the risk of death was not significantly different between the two groups; however, the heterogeneity between the studies was high (OR 1.93, 95%-CI 0.81-4.62, I2 64%). VAS remains a safe surgical alternative for hydrocephalus. The results of this study highlight a lower risk of shunt dysfunction/obstruction variable in the VAS group, with no significant statistical differences regarding the occurrence of at least one infection-related complication. In consequence, the choice between these two techniques must be tailored to the specific characteristics of the patient.Protocol Registration: The review protocol was registered and published in Prospective Register of Systematic Reviews (PROSPERO) ( www.crd.york.ac.uk/PROSPERO ) website with registration number: CRD42023479365.
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Affiliation(s)
- Enrico Lo Bue
- Neurosurgery Unit, Department of Neuroscience "Rita Levi Montalcini", AOU Città della Salute e della Scienza di Torino, University Hospital, University of Turin, 10124, Turin, Italy
| | - Alberto Morello
- Neurosurgery Unit, Department of Neuroscience "Rita Levi Montalcini", AOU Città della Salute e della Scienza di Torino, University Hospital, University of Turin, 10124, Turin, Italy.
| | - Jacopo Bellomo
- Department of Neurosurgery, University Hospital Zurich, Zurich, Switzerland
- Clinical Neuroscience Center, University of Zurich and Swiss Federal Institute of Technology Zurich, Zurich, Switzerland
| | - Leonardo Bradaschia
- Neurosurgery Unit, Department of Neuroscience "Rita Levi Montalcini", AOU Città della Salute e della Scienza di Torino, University Hospital, University of Turin, 10124, Turin, Italy
| | - Filippo Lacatena
- Neurosurgery Unit, Department of Neuroscience "Rita Levi Montalcini", AOU Città della Salute e della Scienza di Torino, University Hospital, University of Turin, 10124, Turin, Italy
| | - Stefano Colonna
- Neurosurgery Unit, Department of Neuroscience "Rita Levi Montalcini", AOU Città della Salute e della Scienza di Torino, University Hospital, University of Turin, 10124, Turin, Italy
| | - Alessandro Fiumefreddo
- Neurosurgery Unit, Department of Neuroscience "Rita Levi Montalcini", AOU Città della Salute e della Scienza di Torino, University Hospital, University of Turin, 10124, Turin, Italy
| | - Lennart Stieglitz
- Department of Neurosurgery, University Hospital Zurich, Zurich, Switzerland
- Clinical Neuroscience Center, University of Zurich and Swiss Federal Institute of Technology Zurich, Zurich, Switzerland
| | - Luca Regli
- Department of Neurosurgery, University Hospital Zurich, Zurich, Switzerland
- Clinical Neuroscience Center, University of Zurich and Swiss Federal Institute of Technology Zurich, Zurich, Switzerland
| | - Michele Maria Lanotte
- Stereotactic and Functional Neurosurgery Unit, Department of Neuroscience "Rita Levi Montalcini", AOU Città della Salute e della Scienza di Torino, University Hospital, University of Turin, Turin, Italy
| | - Diego Garbossa
- Neurosurgery Unit, Department of Neuroscience "Rita Levi Montalcini", AOU Città della Salute e della Scienza di Torino, University Hospital, University of Turin, 10124, Turin, Italy
| | - Fabio Cofano
- Neurosurgery Unit, Department of Neuroscience "Rita Levi Montalcini", AOU Città della Salute e della Scienza di Torino, University Hospital, University of Turin, 10124, Turin, Italy
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De John BG, Figaji AA, Enslin JMN. Analysis of non-ventriculoperitoneal shunts at Red Cross War Memorial Children's Hospital. Childs Nerv Syst 2024; 40:1099-1110. [PMID: 38091072 DOI: 10.1007/s00381-023-06242-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 11/28/2023] [Indexed: 03/28/2024]
Abstract
BACKGROUND At Red Cross War Memorial Children's Hospital (RCCH), it is the preferred practice to use non-ventriculoperitoneal (non-VP) shunts when the peritoneum is ineffective or contraindicated for cerebrospinal fluid (CSF) diversion and when endoscopy is not an option. The objective of this study is to evaluate the clinical course of patients having undergone these procedures. METHOD A single-centre retrospective review at RCCH wherein 43 children with a total of 59 episodes of non-VP shunt placement over a 12-year period were identified for inclusion. RESULTS Twenty-five ventriculoatrial (VA) and 32 ventriculopleural (VPL) shunts were analysed with a median age at insertion of 2.9 (0.3-14.9) and 5.3 years (0.5-13.4), respectively. The median number of previous shunt procedures prior to VA or VPL shunt insertion was 6.0 (2-28) versus 4.5 (2-17), respectively. Three VA (12.0%) and three VPL (9.4%) shunt patients were lost to follow-up. Of those remaining, 10 VA shunts (45.5%) compared to 19 (65,5%) VPL shunts required revision. One ventriculovesical shunt and one ventriculocholecystic shunt were placed in the same patient after 21 and 25 shunt-related procedures, respectively, and both were revised within 3 weeks of insertion. Median shunt survival was 8 months longer for the VA compared to the VPL shunts, being 13.5 (0-67) and 5 months (0-118), respectively. Complications for VA shunts were low, with the overall shunt sepsis rate in the VA group at 4% (n = 1) compared to 15.6% (n = 5) in the VPL group. CONCLUSION Our findings support that VA and VPL shunts are acceptable second-line options in an already compromised group of patients where safe treatment options are limited, provided attention is paid to the technical details specific to their placement.
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Affiliation(s)
- B G De John
- Department of Surgery, Division of Neurosurgery, University of Cape Town, Cape Town, South Africa.
- Division of Neurosurgery, Red Cross War Memorial Children's Hospital, Cape Town, South Africa.
| | - A A Figaji
- Department of Surgery, Division of Neurosurgery, University of Cape Town, Cape Town, South Africa
- Division of Neurosurgery, Red Cross War Memorial Children's Hospital, Cape Town, South Africa
| | - J M N Enslin
- Department of Surgery, Division of Neurosurgery, University of Cape Town, Cape Town, South Africa
- Division of Neurosurgery, Red Cross War Memorial Children's Hospital, Cape Town, South Africa
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Still MEH, Moor RSF, Stanton AN, Hilliard JD, Jacobs BN, Governale LS. Ventriculo-inferior-venacaval shunt salvage via endovascular surgery. Br J Neurosurg 2023:1-3. [PMID: 37424104 DOI: 10.1080/02688697.2023.2233619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 07/02/2023] [Indexed: 07/11/2023]
Abstract
INTRODUCTION Hydrocephalus treatment can be very challenging. While some hydrocephalic patients can be treated endoscopically, many will require ventricular shunting. Frequent shunt issues over a lifetime is not uncommon. Although most shunt malfunctions are of the ventricular catheter or valve, distal failures occur as well. A subset of patients will accumulate non-functioning distal drainage sites. CASE DESCRIPTION We present a 27-year-old male with developmental delay who was shunted perinatally for hydrocephalus from intraventricular hemorrhage of prematurity. After failure of the peritoneum, pleura, superior vena cava (SVC), gallbladder, and endoscopy, an inferior vena cava (IVC) shunt was placed minimally-invasively via the common femoral vein. We believe this is only the eighth reported ventriculo-inferior-venacaval shunt. IVC occlusion years later was successfully treated with endovascular angioplasty and stenting followed by anticoagulation. To our knowledge, a ventriculo-inferior-venacaval shunt salvaged by endovascular surgery has not been previously described in the literature. CONCLUSION After failure of the peritoneum, pleura, SVC, gallbladder, and endoscopy, IVC shunt placement is an option. Subsequent IVC occlusion can be rescued by endovascular angioplasty and stenting. Anticoagulation after stenting (and potentially after initial IVC placement) is advised.
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Affiliation(s)
- Megan E H Still
- Division of Pediatric Neurosurgery, Department of Neurosurgery, University of Florida, Gainesville, FL, USA
| | - Rachel S F Moor
- Division of Pediatric Neurosurgery, Department of Neurosurgery, University of Florida, Gainesville, FL, USA
| | - Amanda N Stanton
- Division of Pediatric Neurosurgery, Department of Neurosurgery, University of Florida, Gainesville, FL, USA
| | - Justin D Hilliard
- Department of Neurosurgery, University of Florida, Gainesville, FL, USA
| | - Benjamin N Jacobs
- Division of Vascular Surgery & Endovascular Therapy, Department of Surgery, University of Florida, Gainesville, FL, USA
| | - Lance S Governale
- Division of Pediatric Neurosurgery, Department of Neurosurgery, University of Florida, Gainesville, FL, USA
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Waack AL, Hoyt AT, Schroeder JL. Ventriculoureteral shunt: Narrative review of contemporary cases and its historical role in the development of renal transplantation. J Neurosci Rural Pract 2023; 14:210-213. [PMID: 37181164 PMCID: PMC10174142 DOI: 10.25259/jnrp_68_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 01/01/2023] [Indexed: 02/25/2023] Open
Abstract
Ventriculo-ureteral (VU) shunting is a little-known method of managing hydrocephalus. This paper reviews contemporary uses of this shunting technique and describes its historical significance to the field of organ transplantation. The ureter may serve as a possible backup, or alternative, distal drainage site compared to the more common peritoneum, atrium, and pleural space. Sporadic contemporary uses of the VU shunt have been reported in unique situations, demonstrating a possible utility in modern neurosurgery. Interestingly, the VU shunt played an important role in the development of kidney transplantation. In the late 1940s and early 1950s, David Hume, a general surgery resident, and colleagues at the PBBH undertook a series of human kidney transplantations. Concurrently, Donald Matson, a pediatric neurosurgeon at Peter Bent Brigham, was utilizing the VU shunt in hydrocephalic patients. Dr. Matson's VU shunt technique involved total nephrectomy, and some of the kidneys harvested from Dr. Matson's were used by his general surgery colleagues in their transplantation trials. Although none of the transplanted kidneys from this series were successful, the transplant team in Boston, minus David Hume, went on to perform the world's first kidney transplant a few years later. This relatively unfamiliar procedure may be applicable to specific situations, and it is of historical importance to the field of transplantation.
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Affiliation(s)
- Andrew Leland Waack
- Department of Surgery, Division of Neurosurgery, University of Toledo, Toledo, Ohio, United States
| | - Alastair T. Hoyt
- Department of Surgery, Division of Neurosurgery, University of Toledo, Toledo, Ohio, United States
| | - Jason L. Schroeder
- Department of Surgery, Division of Neurosurgery, University of Toledo, Toledo, Ohio, United States
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Morosanu CO, Priscu A, Rahota RG, Florian IS. Ventriculorenal shunts in the treatment of pediatric and adult hydrocephalus-historical perspective and analysis of current practice. Childs Nerv Syst 2023; 39:403-415. [PMID: 36264381 DOI: 10.1007/s00381-022-05684-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 09/19/2022] [Indexed: 11/28/2022]
Abstract
Hydrocephalus is a complex pathology that can have a significant impact on the quality of life in all age groups. Cerebrospinal fluid (CSF) diversions from the lateral ventricle to the peritoneal cavity are regarded as the treatment of first intent, but they have a high revision rate, and there are multiple factors which can impair their proper insertion and function. One of the many alternatives to peritoneal shunting is redirecting the CSF towards the renal system. A literature search was conducted to identify the particularities of these types of shunts and what clinical context rendered them feasible in pediatric and adult patient populations. Twenty-eight studies were found to meet the selection criteria. The shunts were classified into ventriculopyeloureteral, ventriculoureteral, and ventriculovesical. Their main advantage was that they did not depend on absorption properties of the tissues, like in the case of the peritoneum. However, several issues with ascending infections, bladder pressure imbalance, distal shunt migration, and calculus formation were noted. Literature suggests that the urinary tract can have the potential of diverting CSF when the peritoneum or atrium is not available, but further research is required to establish their proper role in current practice.
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Affiliation(s)
- Cezar Octavian Morosanu
- Department of Neurosurgery, Royal Preston Hospital, Preston, UK. .,Human Anatomy Resource Centre, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK.
| | - Adelina Priscu
- Department of Internal Medicine, Indiana University Health Ball Memorial Hospital, Muncie, IN, USA
| | - Razvan George Rahota
- Department of Urology, La Croix du Sud Hospital, 31130 Quint Fonsegrives, Toulouse, France
| | - Ioan Stefan Florian
- Department of Neurosurgery, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Transylvania, Romania
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Sandvik U, Bartek J, Edström E, Jönsson M, Stenman J. Percutaneously inserted ventriculo-ureteral shunt as a salvage treatment in paediatric hydrocephalus: a technical note. Childs Nerv Syst 2023; 39:249-254. [PMID: 36129546 PMCID: PMC9968682 DOI: 10.1007/s00381-022-05673-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 09/09/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Hydrocephalus is a challenge for paediatric neurosurgeons. When the abdominal cavity and heart fail as diversion sites for cerebrospinal fluid (CSF), many of the otherwise used alternative diversion sites are not feasible due to the smaller physical body size of children and infants. Using the urinary system as a site of diversion has been described in adults primarily. OBJECTIVE To describe a minimally invasive procedure to percutaneously access the ureter for placement of a distal catheter in the treatment of paediatric hydrocephalus. METHODS A percutaneous ultrasound-assisted technique was used to access the renal pelvis for catheter placement into the distal ureter. RESULTS Fifteen months after the surgery, the child has a stable neurological condition and adequately managed hydrocephalus. CONCLUSION The urinary tract should be considered a viable option for CSF diversion in complex paediatric hydrocephalus. A multidisciplinary approach consisting of interventional radiologists, urologists and neurosurgeons should be involved in the evaluation of potential candidates.
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Affiliation(s)
- Ulrika Sandvik
- Department of Neurosurgery, Karolinska University Hospital, 171 76, Stockholm, Sweden. .,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
| | - Jiri Bartek
- grid.24381.3c0000 0000 9241 5705Department of Neurosurgery, Karolinska University Hospital, 171 76 Stockholm, Sweden ,grid.4714.60000 0004 1937 0626Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden ,grid.475435.4Department of Neurosurgery, Rigshospitalet, Copenhagen, Denmark
| | - Erik Edström
- grid.24381.3c0000 0000 9241 5705Department of Neurosurgery, Karolinska University Hospital, 171 76 Stockholm, Sweden ,grid.4714.60000 0004 1937 0626Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Mattias Jönsson
- grid.24381.3c0000 0000 9241 5705Department of Pediatric Radiology, Karolinska University Hospital, Stockholm, Sweden
| | - Jakob Stenman
- grid.24381.3c0000 0000 9241 5705Department of Pediatric Surgery, Karolinska University Hospital, Stockholm, Sweden ,grid.4714.60000 0004 1937 0626Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
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Tankam CS, Padmanaban V, Pazniokas J, Lane J, Clark JB, Rizk EB. Direct ventriculoatrial shunt in a pediatric patient: case report and technical note. Childs Nerv Syst 2023; 39:255-259. [PMID: 36282305 DOI: 10.1007/s00381-022-05717-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 10/19/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND /IMPORTANCE The safety of direct cardiac shunts has been historically described in the pediatric population before the introduction of silastic catheters but are rarely utilized in modern practice. Herein, we describe several technical nuances regarding the placement of a direct ventriculoatrial catheter in a pediatric patient, including the creation of a sternal divot to accommodate for the movement of the catheter during growth. CLINICAL PRESENTATION We report a complex case of a 2-year-old former premature infant with multiple systemic congenital abnormalities, including tracheal atresia (type 2), complete atrioventricular septal defect status post repair, and shunted hydrocephalus. She developed multiple shunt malfunctions secondary to abdominal malabsorption and shunt infections. CONCLUSION Multiple options for distal shunt placement, including the atrium via open and endovascular techniques, the abdomen, gallbladder, and pleura, were considered, but the direct cardiac placement was felt to be the safest option given the patient's coexisting conditions. Placement requires a multidisciplinary team. Special consideration should be made for linear growth in children.
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Affiliation(s)
- Cyril S Tankam
- Department of Neurosurgery, Penn State Hershey Medical Center, Penn State Children's Hospital, 30 Hope Drive, Suite 1200, Building B, Hershey, PA, 1733, USA.
| | - Varun Padmanaban
- Department of Neurosurgery, Penn State Hershey Medical Center, Penn State Children's Hospital, 30 Hope Drive, Suite 1200, Building B, Hershey, PA, 1733, USA
| | - Julia Pazniokas
- Department of Neurosurgery, University of Colorado, Aurora, CO, USA
| | - Jessica Lane
- Department of Neurosurgery, Penn State Hershey Medical Center, Penn State Children's Hospital, 30 Hope Drive, Suite 1200, Building B, Hershey, PA, 1733, USA
| | - Joseph B Clark
- Department of Surgery, Penn State Children's Hospital, Hershey, PA, USA
| | - Elias B Rizk
- Department of Neurosurgery, Penn State Hershey Medical Center, Penn State Children's Hospital, 30 Hope Drive, Suite 1200, Building B, Hershey, PA, 1733, USA
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Muacevic A, Adler JR, Lynch FC, Simon SD. Minimally Invasive Ventriculo-Cholecystic Shunt Placement Utilizing Combined Ultrasound and Fluoroscopic Guidance. Cureus 2022; 14:e31830. [PMID: 36579196 PMCID: PMC9788798 DOI: 10.7759/cureus.31830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 11/23/2022] [Indexed: 11/24/2022] Open
Abstract
For the management of hydrocephalus with ventricular cerebrospinal fluid (CSF) shunting, multiple therapeutic options are available. Among these routes, the most commonly used are ventriculo-peritoneal, ventriculo-atrial, and ventriculo-pleural, while ventriculo-cholecystic is a less common option. Although ventriculo-peritoneal is accepted as the first option, ventriculo-cholecystic shunting may be performed in patients who are poor candidates for other routes of shunt placement. Open cholecystic shunt placement may be contraindicated in patients who have undergone previous surgeries or other comorbidities. Here, we present the case of a 25-year-old female with a complex medical history who presented with a posterior fossa intraparenchymal hemorrhage and subsequent hydrocephalus. She was unable to undergo a ventriculo-peritoneal, atrial, or pleural shunt placement, and thus, a cholecystic shunt placement was chosen. Due to a history of previous surgeries and comorbidities as well as a large volume of idiopathic and recurrent ascites, open placement was contraindicated in this patient. To the best of our knowledge, we present the first successful adult case of a minimally invasive ventriculo-cholecystic shunt placement under ultrasound and fluoroscopic guidance.
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Morosanu CO, Nita AR, Florian IS. Intra-osseous cerebrospinal fluid shunts-Overview of past and present clinical and experimental evidence. Neurochirurgie 2022; 68:e84-e96. [PMID: 36087694 DOI: 10.1016/j.neuchi.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 08/08/2022] [Accepted: 08/21/2022] [Indexed: 10/14/2022]
Abstract
In the history of hydrocephalus treatment, a variety of diversion sites have been explored to ensure an adequate alternative when the peritoneum was not a feasible option. An interesting choice was the elimination of excessive cerebrospinal fluid (CSF) in the skeletal system. The purpose of this review was to evaluate all shunting systems that have been implemented in bone structures and to determine their therapeutic potential. All articles pertaining to bone derivations were selected from PubMed, Medline, EBSCO and Scopus, using relevant search terms. The search revealed 6 types of osseous shunts that have been used throughout history: vertebral, diploic, ventriculomastoid, ventriculoiliac, ventriculosternal and ventriculohumeral. Some of them are purely of historical significance, but data from more recent clinical and experimental studies have rendered this type of receptacle a potential site for diverting CSF. Having knowledge of all the alternatives used in cases of refractory hydrocephalus is vital for choosing the appropriate surgical intervention.
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Affiliation(s)
- C O Morosanu
- Department of Neurosurgery, Royal Preston Hospital, Preston, UK; Human Anatomy Resource Centre, Faculty of Life and Health Sciences, University of Liverpool, Liverpool, UK.
| | - A R Nita
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - I S Florian
- Department of Neurosurgery, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania
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Morosanu CO, Priscu A, Florian IS. Evaluation of the ventriculocholecystic shunt-an overview of present practice in adult and pediatric hydrocephalus. Neurosurg Rev 2021; 44:2533-2543. [PMID: 33481136 PMCID: PMC8490219 DOI: 10.1007/s10143-021-01472-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 12/30/2020] [Accepted: 01/04/2021] [Indexed: 01/14/2023]
Abstract
In the context of hydrocephalus, there are a multitude of therapeutic options that can be explored in order to improve patient outcomes. Although the peritoneum is the current elected clinical solution, various receptacles have been utilized when experiencing contraindications. Along with the ventriculoatrial or ventriculopleural, the ventriculocholecystic shunt was also described as an alternative. In order to make a decision on a place for drainage, the surgeon must be knowledgeable on details from modern literature. The main target of this review was to summarize the currently available information on this topic and assess the status of the gallbladder as a viable option for cerebrospinal fluid diversion.
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Affiliation(s)
| | - Adelina Priscu
- Department of Internal Medicine, Indiana University Health Ball Memorial Hospital, Muncie, IN, USA
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