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Ramasy Razafindratovo RM, Chevret S, Champeaux-Depond C. Failure of Internal Cerebrospinal Fluid Shunt: A Systematic Review and Meta-Analysis of the Overall Prevalence in Adults. World Neurosurg 2023; 169:20-30. [PMID: 36309337 DOI: 10.1016/j.wneu.2022.10.073] [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: 09/19/2022] [Accepted: 10/19/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Reported rates of failures of internal cerebrospinal fluid shunt (ICSFS) vary greatly from less than 5% to more than 50% and no meta-analysis to assess the overall prevalence has been performed. We estimated the failure rate after ICSFS insertion and searched for associated factors. METHODS Six databases were searched from January 1990 to February 2022. Only original articles reporting the rate of adult shunt failure were included. Random-effects meta-analysis with a generalized linear mixed model method and logit transformation was used to compute the overall failure prevalence. Subgroup analysis and meta-regression were implemented to search for associated factors. RESULTS Of 1763 identified articles, 46 were selected, comprising 70,859 ICSFS implantations and 13,603 shunt failures, suggesting an accumulated incidence of 19.2%. However, the calculated pooled prevalence value and its 95% confidence interval (CI) were 22.7% (95% CI, 19.8-5.8). The CI of the different estimates did not overlap, indicating a strong heterogeneity confirmed by a high I2 of 97.5% (95% CI, 97.1-97.8; P < 0.001; τ2 = 0.3). Ninety-five percent prediction interval of shunt failure prevalence ranged from 8.75% to 47.36%. A meta-regression of prevalence of publication found a barely significant decreasing failure rate of about 2% per year (-2.11; 95% CI, -4.02 to -0.2; P = 0.031). CONCLUSIONS Despite being a simple neurosurgical procedure, ICSFS insertion has one of the highest risk of complications, with failure prevalence involving more than 1 patient of 5. Nonetheless, all efforts to lower this high level of shunt failure seem to be effective.
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Affiliation(s)
- Rado Malalatiana Ramasy Razafindratovo
- Service de biostatistique et information médicale, Hôpital Saint-Louis, Paris, France; INSERM U1153, Statistic and Epidemiologic Research Center Sorbonne Paris Cité (CRESS), ECSTRRA Team, Université de Paris, Paris, France
| | - Sylvie Chevret
- Service de biostatistique et information médicale, Hôpital Saint-Louis, Paris, France; INSERM U1153, Statistic and Epidemiologic Research Center Sorbonne Paris Cité (CRESS), ECSTRRA Team, Université de Paris, Paris, France
| | - Charles Champeaux-Depond
- Service de biostatistique et information médicale, Hôpital Saint-Louis, Paris, France; INSERM U1153, Statistic and Epidemiologic Research Center Sorbonne Paris Cité (CRESS), ECSTRRA Team, Université de Paris, Paris, France; Department of Neurosurgery, Larbiboisière Hospital, Paris, France.
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Transformation of neurosurgical training from “see one, do one, teach one” to AR/VR & simulation – A survey by the EANS Young Neurosurgeons. BRAIN AND SPINE 2022; 2:100929. [PMID: 36248173 PMCID: PMC9560525 DOI: 10.1016/j.bas.2022.100929] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 08/10/2022] [Indexed: 11/21/2022]
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Debs LH, Rahimi SY, Rutkowski MJ, Macomson SD. Endoscopic third ventriculostomy may decrease shunt-dependency in patients with post-hemorrhagic hydrocephalus following aneurysmal subarachnoid hemorrhage. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2021.101300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Joswig H, Staudt MD, MacDougall KW, Parrent AG. Effect of Training on Percutaneous Glycerol Rhizotomy for Trigeminal Neuralgia: A Long-Term, Retrospective Comparison of Staff Neurosurgeon and Trainee Complications and Efficacy. World Neurosurg 2019; 134:e1001-e1007. [PMID: 31756505 DOI: 10.1016/j.wneu.2019.11.058] [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: 09/14/2019] [Revised: 11/09/2019] [Accepted: 11/11/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The role of trainee involvement in lesioning procedures for trigeminal neuralgia (TN) has not yet been investigated in reported studies. The objective of the present study was to compare the complications and efficacy of percutaneous glycerol rhizotomy (GR) when performed by staff neurosurgeons and trainees. METHODS A retrospective medical record analysis of 165 patients with medically refractory TN who had undergone 293 GR procedures by either a staff attending (n = 156) or trainee (n = 137) from 2007 to 2018 was performed. The data were analyzed with respect to procedure time, fluoroscopy time and radiation exposure, complication rates and outcomes. RESULTS No difference was found in procedure duration between the teaching and nonteaching cases and only a nonsignificant trend was found toward a longer fluoroscopy time for the latter. The initial response rates to GR were equal for staff attending (88.7%) and trainee (87.2%) cases (P = 0.708). Similarly, no statistically significant difference (P = 0.48) was found between the median time to recurrence for the staff attending cases (1.6 ± 0.3 years) compared with that of the trainee cases (1.7 ± 0.3 years). The overall incidence of complications was low (7.5%). The occurrence of facial hypoesthesia correlated with the amount of glycerol injected (P < 0.01). CONCLUSIONS GR for the treatment of TN can safely be performed by senior residents and fellows under supervision.
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Affiliation(s)
- Holger Joswig
- Division of Neurosurgery, Department of Clinical Neurological Sciences, London Health Sciences Centre, Western University, London, Ontario, Canada; Department of Neurosurgery, Ernst von Bergmann Hospital, Potsdam, Germany.
| | - Michael D Staudt
- Division of Neurosurgery, Department of Clinical Neurological Sciences, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Keith W MacDougall
- Division of Neurosurgery, Department of Clinical Neurological Sciences, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Andrew G Parrent
- Division of Neurosurgery, Department of Clinical Neurological Sciences, London Health Sciences Centre, Western University, London, Ontario, Canada
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Stienen MN, Bartek J, Czabanka MA, Freyschlag CF, Kolias A, Krieg SM, Moojen W, Renovanz M, Sampron N, Adib SD, Schubert GA, Demetriades AK, Ringel F, Regli L, Schaller K, Meling TR. Neurosurgical procedures performed during residency in Europe—preliminary numbers and time trends. Acta Neurochir (Wien) 2019; 161:843-853. [PMID: 30927157 DOI: 10.1007/s00701-019-03888-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Accepted: 03/20/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Martin N Stienen
- Department of Neurosurgery, University Hospital Zurich, Zurich, Switzerland.
- Clinical Neuroscience Center, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland.
| | - Jiri Bartek
- Department of Clinical Neuroscience and Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Neurosurgery, Rigshospitalet, Copenhagen, Denmark
| | - Marcus A Czabanka
- Department of Neurosurgery, Charité University Hospital, Berlin, Germany
| | | | - Angelos Kolias
- Department of Clinical Neurosciences, University of Cambridge, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK
| | - Sandro M Krieg
- Department of Neurosurgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Wouter Moojen
- HAGA Teaching Hospital and Medical Center Haaglanden, The Hague & Leiden University Medical Center, Leiden, Netherlands
| | - Mirjam Renovanz
- Department of Neurosurgery, University Hospital Tübingen, Tübingen, Germany
| | - Nicolas Sampron
- Servicio de Neurocirugía, Hospital Universitario Donostia, San Sebastián, Guipúzcoa, Spain
| | - Sasan D Adib
- Department of Neurosurgery, University Hospital Tübingen, Tübingen, Germany
| | | | | | - Florian Ringel
- Department of Neurosurgery, University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Luca Regli
- Department of Neurosurgery, University Hospital Zurich, Zurich, Switzerland
- Clinical Neuroscience Center, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
| | - Karl Schaller
- Neurosurgery Division, Department of Clinical Neurosciences, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Torstein R Meling
- Neurosurgery Division, Department of Clinical Neurosciences, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland
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Vasella F, Velz J, Neidert MC, Henzi S, Sarnthein J, Krayenbühl N, Bozinov O, Regli L, Stienen MN. Safety of resident training in the microsurgical resection of intracranial tumors: Data from a prospective registry of complications and outcome. Sci Rep 2019; 9:954. [PMID: 30700746 PMCID: PMC6353994 DOI: 10.1038/s41598-018-37533-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 12/07/2018] [Indexed: 12/12/2022] Open
Abstract
The aim of the present study was to assess the safety of microsurgical resection of intracranial tumors performed by supervised neurosurgical residents. We analyzed prospectively collected data from our institutional patient registry and dichotomized between procedures performed by supervised neurosurgery residents (defined as teaching procedures) or board-certified faculty neurosurgeons (defined as non-teaching procedures). The primary endpoint was morbidity at discharge, defined as a postoperative decrease of ≥10 points on the Karnofsky Performance Scale (KPS). Secondary endpoints included 3-month (M3) morbidity, mortality, the in-hospital complication rate, and complication type and severity. Of 1,446 consecutive procedures, 221 (15.3%) were teaching procedures. Patients in the teaching group were as likely as patients in the non-teaching group to experience discharge morbidity in both uni- (OR 0.85, 95%CI 0.60-1.22, p = 0.391) and multivariate analysis (adjusted OR 1.08, 95%CI 0.74-1.58, p = 0.680). The results were consistent at time of the M3 follow-up and in subgroup analyses. In-hospital mortality was equally low (0.24 vs. 0%, p = 0.461) and the likelihood (p = 0.499), type (p = 0.581) and severity of complications (p = 0.373) were similar. These results suggest that microsurgical resection of carefully selected intracranial tumors can be performed safely by supervised neurosurgical residents without increasing the risk of morbidity, mortality or perioperative complications. Appropriate allocation of operations according to case complexity and the resident's experience level, however, appears essential.
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Affiliation(s)
- Flavio Vasella
- University Hospital Zurich, Department of Neurosurgery, Zurich, Switzerland
- Clinical Neuroscience Center, University of Zurich, Zurich, Switzerland
| | - Julia Velz
- University Hospital Zurich, Department of Neurosurgery, Zurich, Switzerland
- Clinical Neuroscience Center, University of Zurich, Zurich, Switzerland
| | - Marian C Neidert
- University Hospital Zurich, Department of Neurosurgery, Zurich, Switzerland
- Clinical Neuroscience Center, University of Zurich, Zurich, Switzerland
| | - Stephanie Henzi
- University Hospital Zurich, Department of Neurosurgery, Zurich, Switzerland
- Clinical Neuroscience Center, University of Zurich, Zurich, Switzerland
| | - Johannes Sarnthein
- University Hospital Zurich, Department of Neurosurgery, Zurich, Switzerland
- Clinical Neuroscience Center, University of Zurich, Zurich, Switzerland
| | - Niklaus Krayenbühl
- University Hospital Zurich, Department of Neurosurgery, Zurich, Switzerland
- Clinical Neuroscience Center, University of Zurich, Zurich, Switzerland
| | - Oliver Bozinov
- University Hospital Zurich, Department of Neurosurgery, Zurich, Switzerland
- Clinical Neuroscience Center, University of Zurich, Zurich, Switzerland
| | - Luca Regli
- University Hospital Zurich, Department of Neurosurgery, Zurich, Switzerland
- Clinical Neuroscience Center, University of Zurich, Zurich, Switzerland
| | - Martin N Stienen
- University Hospital Zurich, Department of Neurosurgery, Zurich, Switzerland.
- Clinical Neuroscience Center, University of Zurich, Zurich, Switzerland.
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Behmanesh B, Keil F, Dubinski D, Won SY, Quick-Weller J, Seifert V, Gessler F. The Value of Computed Tomography Imaging of the Head After Ventriculoperitoneal Shunt Surgery in Adults. World Neurosurg 2019; 121:e159-e164. [DOI: 10.1016/j.wneu.2018.09.063] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 09/07/2018] [Accepted: 09/11/2018] [Indexed: 10/28/2022]
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Burr hole trepanation for chronic subdural hematomas: is surgical education safe? Acta Neurochir (Wien) 2018; 160:901-911. [PMID: 29313100 DOI: 10.1007/s00701-017-3458-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Accepted: 12/28/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND There is a paucity of data concerning the safety and efficacy of surgical education for neurosurgical residents in the evacuation of chronic subdural hematomas (cSDH) by burr hole trepanation. METHODS This is a retrospective analysis of prospectively collected data on consecutive patients receiving burr hole trepanation for uni- or bilateral cSDH. Patients operated by a supervised neurosurgery resident (teaching cases) were compared to patients operated by a board-certified faculty neurosurgeon (BCFN; non-teaching cases). The primary endpoint was surgical revision for any reason until the last follow-up. The secondary endpoint was occurrence of any complication until the last follow-up. Clinical status, type of complications, mortality, length of surgery (LOS), and hospitalization (LOH) were tertiary endpoints. RESULTS A total of n = 253 cases were analyzed, of which n = 217 (85.8%) were teaching and n = 36 (14.2%) non-teaching cases. The study groups were balanced in terms of age, sex, surgical risk (ASA score), and preoperative status (Karnofsky Performance Scale (KPS), modified Rankin Scale (mRS), National Institute of Health Stroke Scale (NIHSS)). The cohort was followed for a mean of 242 days (standard deviation 302). In multivariate analysis, teaching cases were as likely as non-teaching cases to require revision surgery (OR 0.65, 95% CI 0.27-1.59; p = 0.348) as well as to experience any complication until the last follow-up (OR 0.79, 95% CI 0.37-1.67; p = 0.532). Mean LOS was about 10 min longer in teaching cases (53.0 ± 26.1 min vs. 43.5 ± 17.8 min; p = 0.036), but LOH was similar. There were no group differences in clinical status, mortality and type of complication at discharge, and the last follow-up. CONCLUSIONS Burr hole trepanation for cSDH can be safely performed by supervised neurosurgical residents enrolled in a structured training program, without increasing the risk for revision surgery, perioperative complications, or worse outcome.
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Schenker P, Stieglitz LH, Sick B, Stienen MN, Regli L, Sarnthein J. Patients with a Normal Pressure Hydrocephalus Shunt Have Fewer Complications than Do Patients with Other Shunts. World Neurosurg 2018; 110:e249-e257. [DOI: 10.1016/j.wneu.2017.10.151] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 10/25/2017] [Accepted: 10/26/2017] [Indexed: 01/31/2023]
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