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Li X, Wang Y, Xia B, Che H, Yan Z. Lumboperitoneal shunt and ventriculoperitoneal shunt for chronic hydrocephalus after aneurysmal subarachnoid hemorrhage: a comparison. Front Surg 2024; 11:1368493. [PMID: 38533091 PMCID: PMC10963422 DOI: 10.3389/fsurg.2024.1368493] [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: 01/17/2024] [Accepted: 03/04/2024] [Indexed: 03/28/2024] Open
Abstract
Objective Chronic hydrocephalus after aneurysmal subarachnoid hemorrhage (aSAH) results in poor neurological outcomes and cognitive deficits. Currently, the main treatments for chronic hydrocephalus include ventriculoperitoneal shunt (VPS) and lumboperitoneal shunt (LPS); however, the optimal treatment for chronic hydrocephalus after aSAH remains controversial. Method The records of 82 patients were retrospectively analyzed, and the patients were divided into VPS and LPS groups based on surgical methods. The efficacy, shunt successful rate and complications were compared. The assessments of treatment efficacy included the Evans index score (EIS), Keifer's hydrocephalus score (KHS), Mini-Mental State Examination (MMSE) score and functional independence measure (FIM). Patients were followed up for three months to observe the postoperative curative effects and complications. Results The rate of shunt obstruction was significantly higher in the LPS group than that in the VPS group (p < 0.05), and the shunt successful rate was significantly higher in the VPS group than that in the LPS group (p < 0.05). The total rate of complications was 24.4% for LPS and 39% for VPS. The improvements in EIS, KHS, MMSE, and FIM within each group after the shunt were significantly different compared to those before shunt (p < 0.05). Compared to those in the LPS group, the improvements in EIS, KHS, MMSE, and FIM were significantly different in the VPS group after shunt (p < 0.05). Conclusion Compared with LPS, VPS in the treatment for chronic hydrocephalus after aSAH had greater therapeutic efficacy, as indicated by improved radiological outcomes, improved shunt successful rate, improved clinical outcomes, and improved quality of life. Therefore, we believe that VPS is the preferred treatment option for chronic hydrocephalus after aSAH, while LPS should only be used as an alternative to VPS.
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Affiliation(s)
| | | | | | | | - Zhongnan Yan
- Department of Neurosurgery, Xi’an Gaoxin Hospital, Xi’an, Shaanxi, China
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Foo NP, Tun YC, Chang CC, Lin HL, Cheng CH, Chuang HY. Clinical Outcome and Safety of Lumboperitoneal Shunt in the Treatment of Non-Obstructive Hydrocephalus. Clin Interv Aging 2023; 18:477-483. [PMID: 36994429 PMCID: PMC10041980 DOI: 10.2147/cia.s401116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 03/04/2023] [Indexed: 03/31/2023] Open
Abstract
Objective This study aimed to evaluate the functional outcomes of lumboperitoneal (LP) shunt for the treatment of non-obstructive hydrocephalus. Methods We retrospectively studied the clinical surgical results of 172 adult patients with hydrocephalus who underwent LP shunt surgery between June 2014 and June 2019. Data regarding the following were collected: pre- and postoperative symptom status, third ventricle width changes, Evans index, and postoperative complications. Additionally, the baseline and follow-up Glasgow Coma Scale (GCS) score, Glasgow Outcome Scale (GOS), and Modified Rankin Scale (mRS) scores were investigated. All patients were followed up for ≥12 months using clinical interview and braining imaging using computed tomography (CT) scan or magnetic resonance imaging (MRI). Results Majority of patients presented with normal pressure hydrocephalus as the etiology of their disease (48.8%), followed by cardiovascular accident (28.5%), trauma (19.7%), and brain tumor (3%). The mean GCS, GOS, and mRS improved postoperatively. The average period from symptomatic onset to surgery was 402 days. The average width of the third ventricle on CT scan or MRI was 11.43 mm preoperatively and 10.8 mm postoperatively (P<0.001). The Evans index improved from 0.258 to 0.222 after operation. The symptomatic improvement score was 7.0, with a complication rate of 7%. Conclusion Significant improvement was observed in the functional score and brain image after LP shunt placement. Moreover, the satisfaction with symptomatic improvement after surgery remains high. LP shunt operation is a viable alternative in the treatment of non-obstructive hydrocephalus due to the low complication rate, fast recovery, and high satisfaction.
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Affiliation(s)
- Ning-Ping Foo
- Department of Emergency, An Nan Hospital, China Medical University, Tainan, 70965Taiwan
- Graduate Institute of Medical Sciences, Chang Jung Christian University, Tainan, 71101Taiwan
| | - Yang Chien Tun
- Department of Neurosurgery, China Medical University Hospital, Taichung, 40447Taiwan
| | - Che Chao Chang
- Department of Neurosurgery, An Nan Hospital, China Medical University, Tainan, 70965Taiwan
- Neurophysiology Laboratory, Department of Surgery, National Cheng Kung University Medical Center and Medical School, Tainan, 70101Taiwan
| | - Hung-Lin Lin
- Department of Neurosurgery, China Medical University Hospital, Taichung, 40447Taiwan
| | - Cheng-Hsin Cheng
- Graduate Institute of Medical Sciences, Chang Jung Christian University, Tainan, 71101Taiwan
- Department of Neurosurgery, An Nan Hospital, China Medical University, Tainan, 70965Taiwan
- Correspondence: Cheng-Hsin Cheng; Hao-Yu Chuang, Department of Neurosurgery, An-Nan Hospital, China Medical University, No. 66, Sec. 2, Changhe Road, Annan District, Tainan City, Taiwan, Tel +886-6-3553111, Email ;
| | - Hao-Yu Chuang
- Department of Neurosurgery, An Nan Hospital, China Medical University, Tainan, 70965Taiwan
- Department of Neurosurgery, China Medical University Beigang Hospital, Beigang, Yunlin County, 65152Taiwan
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Sun T, Cui W, Chen S, Yuan Y, Yang J, Zhou Y, Li X, Yu H, You C, Guan J. Association of Preoperative Cerebrospinal Fluids Parameters With Early Shunt Obstruction in Patients With Post-hemorrhagic Hydrocephalus Treated by Lumboperitoneal Shunt. Front Neurol 2021; 12:693554. [PMID: 34526955 PMCID: PMC8435900 DOI: 10.3389/fneur.2021.693554] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 08/04/2021] [Indexed: 02/05/2023] Open
Abstract
Background: Early shunt obstruction (SO) remains the most common cause of lumboperitoneal shunt (LPS) failure. Although there is anecdotal evidence that the level of cerebrospinal fluid (CSF) parameters might affect shunt performance, its association with early LPS obstruction in adults with post-hemorrhagic hydrocephalus (PHH) is unclear. Methods: The retrospective study was performed by reviewing the adults with PHH treated by LPS from years 2014 to 2018. We included patients with CSF samples analyzed within 1 week prior to shunt insertion or at the time of shunt insertion. Baseline characteristics of each patient were collected. The primary outcomes were the incidence rate and associated factors of SO occurring within 3 months of shunt placement. The secondary outcomes included scores on the National Institute of Health Stroke Scale (NIHSS) and Evans Index at discharge. Results: A total of 76 eligible patients were analyzed, of whom 61 were obstruction-free and 15 were early SO. The overall rate of early SO was 15.6%. The RBCs count and nucleated cells count in preoperative CSF were actually higher in patients with early SO, compared to patients in the control group. Multivariate analysis identified RBC elevation (>0 × 106/L; OR: 10.629, 95% CI: 1.238–91.224, p = 0.031) as a dependent risk factor for early SO. NIHSS dramatically decreased at discharge while the alteration of ventricular size was not observed. Conclusions: This study suggested that the presence of RBCs in preoperative CSF was associated with early SO in patients with PHH treated by LPS.
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Affiliation(s)
- Tong Sun
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Wenyao Cui
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Siyang Chen
- Health Management Center, West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Yikai Yuan
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Jingguo Yang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Yicheng Zhou
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Xuepei Li
- Medical Simulation Center, Chengdu First People's Hospital, Chengdu, China
| | - Hang Yu
- Department of Neurology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Chao You
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China.,West China Brain Research Center, West China Hospital, Sichuan University, Chengdu, China
| | - Junwen Guan
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
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Sun T, Cui W, Yang J, Yuan Y, Li X, Yu H, Zhou Y, You C, Guan J. Shunting outcomes in communicating hydrocephalus: protocol for a multicentre, open-label, randomised controlled trial. BMJ Open 2021; 11:e051127. [PMID: 34446499 PMCID: PMC8395273 DOI: 10.1136/bmjopen-2021-051127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 08/17/2021] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Ventriculoperitoneal shunt (VPS) remains the most widely used methods to treat communicating hydrocephalus. More recently, lumboperitoneal shunt (LPS) has been suggested as a reasonable option in some studies. However, there is lack of high-quality studies comparing these two techniques in order to certain the benefits and harms to use one of these two methods. The purpose of the current study is to determine the effectiveness and safety of the LPS versus the VPS in patients with communicating hydrocephalus. METHODS AND ANALYSIS All eligible patients aged 18-90 years with communicating hydrocephalus will be recruited and then randomly allocated into LPS or VPS group in a ratio of 1:1. All patients will be analysed before shunt insertion, at the time of discharge, 1 month, 6 months, 12 months and 24 months postoperatively. The primary outcome measure is the rate of shunt failure at a 2-year follow-up term. The secondary outcomes include Keifer's Hydrocephalus Scale, National Institute of Health Stroke Scale, Glasgow Outcome Scale Extended, Evans index, safety endpoints and cost-effectiveness of hospital stay. ETHICS AND DISSEMINATION The study will be performed in compliance with the Declaration of Helsinki (2002) of the World Medical Association. The study was approved by Institutional Review Board of West China Hospital. All patients will be fully informed the potential benefits, potential risks and responsibilities, those who will sign the informed consents once they are included. Preliminary and final results will be published in peer-reviewed journals and presented at national and international congresses. TRIAL REGISTRATION NUMBER ChiCTR2100043839.
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Affiliation(s)
- Tong Sun
- Department of Neurosurgery, Sichuan University West China Hospital, Chengdu, Sichuan, China
| | - Wenyao Cui
- Department of Neurosurgery, Sichuan University West China Hospital, Chengdu, Sichuan, China
| | - Jingguo Yang
- Department of Neurosurgery, Sichuan University West China Hospital, Chengdu, Sichuan, China
| | - Yikai Yuan
- Department of Neurosurgery, Sichuan University West China Hospital, Chengdu, Sichuan, China
| | - Xuepei Li
- Medical Simulation Center, Chengdu First People's Hospital, Chengdu, Sichuan, China
| | - Hang Yu
- Department of Neurology, Sichuan Provincial People's Hospital, Chengdu, Sichuan, China
| | - Yicheng Zhou
- Department of Neurosurgery, Sichuan University West China Hospital, Chengdu, Sichuan, China
| | - Chao You
- Department of Neurosurgery, Sichuan University West China Hospital, Chengdu, Sichuan, China
- Neurosurgery Research Laboratory, Sichuan University West China Hospital, Chengdu, Sichuan, China
| | - Junwen Guan
- Department of Neurosurgery, Sichuan University West China Hospital, Chengdu, Sichuan, China
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Sun T, Guan J, Yang J, Yuan Y, Zhou Y, You C. Preoperative evaluation using external lumbar drainage for patients with posthemorrhagic hydrocephalus: A prospective, monocentric, randomized controlled trial. Medicine (Baltimore) 2020; 99:e21872. [PMID: 32871913 PMCID: PMC7458255 DOI: 10.1097/md.0000000000021872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND External lumbar drainage (ELD) remains the most common used methods with a higher sensitivity before lumboperitoneal shunt (LPS) implantation to predict the shunt outcomes in the treatment of idiopathic normal pressure hydrocephalus. However, the benefits of such supplemental test have not been tested in the treatment of post-hemorrhagic hydrocephalus (PHH). METHODS AND DESIGN In the current trial, 100 eligible patients with PHH will be recruited and randomly assigned to the ELD group (study group) and non-ELD group (control group). Lumbar puncture (LP) will be performed for participants in non-ELD group. LP plus ELD will be performed for participants in ELD group, those who will then be investigated the suitability of potential LPS 4 days after ELD. Two independent and practiced assessors will collect the baseline data and evaluate each participant 4 days after ELD or LP, 1 day after LPS, at the time of discharge and 1 month after LPS. The primary outcome is the shunting outcomes 1 month after surgery. The secondary outcomes include the complications related to ELD, complications related to LPS, and Evens index at each evaluation point. Meanwhile, serious adverse events occurring at any time is recorded to determine the safety of this trial. DISCUSSION The results of this trial will demonstrate whether preoperative evaluation using temporary ELD for patients with PHH could attenuate the risk of LPS failure. TRIAL REGISTRATION NUMBER ChiCTR2000034094; Pre-results.
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Affiliation(s)
| | | | | | | | | | - Chao You
- Department of Neurosurgery
- West China Brain Research Center
- Neurosurgery Research Laboratory, West China Hospital, Sichuan University, Chengdu, Sichuan, P.R China
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Sun T, Guan J, You C, Yang J, Li X, Yuan Y, Zhou Y. Shunting outcomes in post-hemorrhagic hydrocephalus: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2020; 99:e21640. [PMID: 32769930 PMCID: PMC7593010 DOI: 10.1097/md.0000000000021640] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The best treatment option for patients with post-hemorrhagic hydrocephalus (PHH) remains controversial. The objective of the current meta-analysis is to systematically evaluate the long-term outcomes of patients with PHH treated by ventriculoperitoneal shunt (VPS) and lumboperitoneal shunt (LPS). METHODS We search literatures through PubMed, Web of Science, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), the Chinese Science and Technology Periodical Database (VIP) and Wan fang databases, and Chinese Biomedical Literature Database (CBM) from its beginning to June 15, 2020. Randomized controlled trials (RCTs) and non-RCTs in English or Chinese studies will be considered. The primary outcome is the rate of shunt failure after shunt implantationThe secondary outcome is the rate of complications that are associated with shunt surgery. RESULTS AND CONCLUSION The study will compare the 2 types of shunt surgery in the treatment of PHH, providing evidence for the treatment option for the patients with PHH. STUDY REGISTRATION NUMBER The study is priorly registered through International Platform of Registered Systematic Review and Meta-analysis Protocols on June 17, 2020 (INPLASY202060063).
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Affiliation(s)
| | | | - Chao You
- Department of Neurosurgery
- West China Brain Research Center, West China Hospital
| | | | - Xuepei Li
- Health Ministry Key Laboratory of Chronobiology, West China Medical Center, Sichuan University, Chengdu, Sichuan, PR China
| | | | - Yicheng Zhou
- Department of Neurosurgery
- West China Brain Research Center, West China Hospital
- Health Ministry Key Laboratory of Chronobiology, West China Medical Center, Sichuan University, Chengdu, Sichuan, PR China
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Sun T, You C, Ma L, Yuan Y, Yang J, Tian M, Zhou Y, Guan J. Comparison of ventriculoperitoneal shunt to lumboperitoneal shunt in the treatment of posthemorrhagic hydrocephalus: A prospective, monocentric, non-randomized controlled trial. Medicine (Baltimore) 2020; 99:e20528. [PMID: 32629633 PMCID: PMC7337583 DOI: 10.1097/md.0000000000020528] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Ventriculoperitoneal shunt (VPS) surgery remains the most widely accepted and used option method to treat post-hemorrhagic hydrocephalus (PHH) worldwide while lumboperitoneal shunt (LPS) serves as an effectively alternative treatment. However, the outcomes of VPS and LPS in the treatment of PHH have not been compared in a prospective trial. METHODS AND DESIGN In this monocentric, assessor-blinded, non-randomized controlled trial, 75 eligible patients with PHH for each group will be recruited to compare the outcomes of VPS cohort with that of LPS cohort. Each participant is evaluated before surgery, at the time of discharge, 3, and 6 months after surgery by experienced and practiced assessors. The primary outcome is the rate of shunt failure 6 months after shunt surgery. The secondary measure of efficacy is National Institute of Health stroke scale, together along with Glasgow coma scale, modified Rankin Scale, and Evans index at the evaluation point. A favorable outcome is defined as shunt success with an improvement of more than 1 point in the National Institute of Health stroke scale. Complication events occurring within 6 months after surgery are investigated. A serious adverse events throughout the study are recorded regarding the safety of shunts. DISCUSSION The results of this trial will provide evidence for the treatment options for patients with PHH.
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Affiliation(s)
| | - Chao You
- Department of Neurosurgery
- West China Brain Research Center
| | - Lu Ma
- Department of Neurosurgery
| | | | | | - Meng Tian
- Department of Neurosurgery
- Neurosurgery Research Laboratory, West China Hospital, Sichuan University, Chengdu, Sichuan, P.R. China
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Sun T, Guan J. Letter: A Comparison of Ventriculoperitoneal and Ventriculoatrial Shunts in a Population of 544 Consecutive Pediatric Patients. Neurosurgery 2020; 86:E583. [DOI: 10.1093/neuros/nyaa030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Affiliation(s)
- Tong Sun
- Department of Neurosurgery West China Hospital Sichuan University Chengdu, Sichuan, P. R. China
| | - Junwen Guan
- Department of Neurosurgery West China Hospital Sichuan University Chengdu, Sichuan, P. R. China
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Sun T, Li X, Zhang Q, Zhou Y, Guan J. Efficacy and Safety of Lumboperitoneal Shunt in the Treatment of All-Cause Communicating Hydrocephalus: Analysis of Risk Factors of Shunt Failure. World Neurosurg 2019; 132:e956-e962. [DOI: 10.1016/j.wneu.2019.06.070] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Revised: 06/09/2019] [Accepted: 06/10/2019] [Indexed: 11/30/2022]
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