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Valença MM, Valença MA, Valença MF, Almeida LCA, Serra SMB, Da Cunha AHGB. Practical techniques for safely removing long-term implanted ventricular catheters to minimize bleeding. Childs Nerv Syst 2024; 40:2659-2665. [PMID: 39028349 DOI: 10.1007/s00381-024-06533-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2024] [Accepted: 07/01/2024] [Indexed: 07/20/2024]
Abstract
INTRODUCTION Removing ventricular catheters, particularly those implanted for extended periods, poses significant challenges for neurosurgeons due to potential complications such as bleeding from adhesions to the ependyma or choroid plexus. OBJECTIVE This study aimed to review various techniques for safely removing ventricular catheters, emphasizing methods that minimize the risk of hemorrhagic complications. METHODS A comprehensive narrative review focused on techniques developed and documented in the literature for safely detaching ventricular catheters adhered to brain structures. RESULTS Various techniques have been identified that enhance the safety of catheter removal. Notably, the use of monopolar diathermy to coagulate and release adhesions has proven effective. Innovations such as insulated suction devices and the strategic use of flexible endoscopes have also contributed to safer removal procedures, minimizing the risk of damaging surrounding cerebral tissue and preventing catastrophic hemorrhage. CONCLUSION The removal of ventricular catheters, especially those with long-term implantation, requires precise and cautious techniques to avoid severe complications. The study underscores the importance of adopting advanced surgical techniques and the continuous evolution of safer practices in neurosurgery. These methods not only ensure patient safety but also facilitate the handling of potentially complex and life-threatening situations during catheter removal.
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Afat S, Pjontek R, Nikoubashman O, Kunz WG, Brockmann MA, Ridwan H, Wiesmann M, Clusmann H, Othman AE, Hamou HA. Diagnostic Performance of Whole-Body Ultra-Low-Dose CT for Detection of Mechanical Ventriculoperitoneal Shunt Complications: A Retrospective Analysis. AJNR Am J Neuroradiol 2022; 43:1597-1602. [PMID: 36229165 PMCID: PMC9731254 DOI: 10.3174/ajnr.a7672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 09/07/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND AND PURPOSE Radiographic shunt series are still the imaging technique of choice for radiologic evaluation of VP-shunt complications. Radiographic shunt series are associated with high radiation exposure and have a low diagnostic performance. Our aim was to investigate the diagnostic performance of whole-body ultra-low-dose CT for detecting mechanical ventriculoperitoneal shunt complications. MATERIALS AND METHODS This retrospective study included 186 patients (mean age, 54.8 years) who underwent whole-body ultra-low-dose CT (100 kV[peak]; reference, 10 mAs). Two radiologists reviewed the images for the presence of ventriculoperitoneal shunt complications, image quality, and diagnostic confidence. On a 5-point Likert scale, readers scored image quality and diagnostic confidence (1 = very low, 5 = very high). Sensitivity, specificity, positive predictive value, and negative predictive value were calculated. Radiation dose estimation of whole-body ultra-low-dose CT was calculated and compared with the radiation dose of a radiographic shunt series. RESULTS 34 patients positive for VP-shunt complications were correctly identified on whole-body ultra-low-dose CT by both readers. No false-positive or -negative cases were recorded by any of the readers, yielding a sensitivity of 100% (95% CI, 87.3%-100%), a specificity of 100% (95% CI, 96.9%-100%), and perfect agreement (κ = 1). Positive and negative predictive values were high at 100%. Shunt-specific image quality and diagnostic confidence were very high (median score, 5; range, 5-5). Interobserver agreement was substantial for image quality (κ = 0.73) and diagnostic confidence (κ = 0.78). The mean radiation dose of whole-body ultra-low-dose CT was significantly lower than the radiation dose of a conventional radiographic shunt series (0.67 [SD, 0.4] mSv versus 1.57 [SD, 0.6] mSv; 95% CI, 0.79-1.0 mSv; P < .001). CONCLUSIONS Whole-body ultra-low-dose CT allows detection of ventriculoperitoneal shunt complications with excellent diagnostic accuracy and diagnostic confidence. With concomitant radiation dose reduction on contemporary CT scanners, whole-body ultra-low-dose CT should be considered an alternative to the radiographic shunt series.
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Affiliation(s)
- S Afat
- From the Department for Diagnostic and Interventional Radiology (S.A., A.E.O.), University Hospital Tuebingen, Tuebingen, Germany
| | - R Pjontek
- Department of Neurosurgery (R.P., H.C., H.A.H.)
| | - O Nikoubashman
- Diagnostic and Interventional Neuroradiology (O.N., H.R., M.W.), University Hospital RWTH Aachen, Aachen, Germany
| | - W G Kunz
- Department of Radiology (W.G.K.), University Hospital Ludwig-Maximilians-University, Munich, Germany
| | - M A Brockmann
- Department of Neuroradiology (M.A.B., A.E.O.), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - H Ridwan
- Diagnostic and Interventional Neuroradiology (O.N., H.R., M.W.), University Hospital RWTH Aachen, Aachen, Germany
| | - M Wiesmann
- Diagnostic and Interventional Neuroradiology (O.N., H.R., M.W.), University Hospital RWTH Aachen, Aachen, Germany
| | - H Clusmann
- Department of Neurosurgery (R.P., H.C., H.A.H.)
| | - A E Othman
- From the Department for Diagnostic and Interventional Radiology (S.A., A.E.O.), University Hospital Tuebingen, Tuebingen, Germany
- Department of Neuroradiology (M.A.B., A.E.O.), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - H A Hamou
- Department of Neurosurgery (R.P., H.C., H.A.H.)
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Coll G, Arrighi M, Berton Q, Coste A, de Schlichting E, Chazal J, Sakka L, Abed Rabbo F. Mechanical Complications of Sophysa SM8 Shunt in Adult Hydrocephalus: A Monocentric Experience. Oper Neurosurg (Hagerstown) 2022; 23:318-325. [PMID: 36001762 DOI: 10.1227/ons.0000000000000337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 04/25/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Sophysa SM8 is widely used by neurosurgeons in France. Published studies report shunt malfunction rates in adults between 18% and 29%. However, these studies included multiple valve types and thus entailed a serious confounding factor. OBJECTIVE To ascertain the incidence the Sophysa SM8 cerebrospinal fluid (CSF) shunt malfunctions in adults. METHODS We present a retrospective series of adult patients who underwent CSF shunt placement between 2000 and 2013 with Sophysa SM8. RESULTS In total, 599 patients (329 males and 270 females) were included. The mean age at surgery was 64.15 years (19-90) (SD 16.17; median 68.0). The causes of hydrocephalus were normal pressure hydrocephalus (49%), traumatic hemorrhages (26.5%), tumors (15.7%), cerebral aqueduct stenoses (3%), and arachnoid cysts (2%). The mean follow-up was 3.9 years (0-16) (SD 4.10; median 3 years). The rate of complications was 22.04% (132 of 599). Most frequent causes of complications were disconnection (25%), migration (12.9%), overdrainage (9.1%), and proximal obstruction (6.8%). In 17 cases (12.9%), no failure was diagnosed during revision. Seven infections (5.3%) were reported. The mean delay for the first revision was 1.70 years (0-13.93) (SD 2.67, median 0.35). The risk of shunt failure was 36% at 10 years. Seventeen percent of revisions occurred during the first year after shunt placement. CONCLUSION Disconnections are a very frequent complication of Sophysa SM8 valve. They are related to the 2-connector system of this valve. Based on these results, we recommend using 1-piece valves.
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Affiliation(s)
- Guillaume Coll
- Service de Neurochirurgie B, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Marta Arrighi
- Service de Neurochirurgie B, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Quentin Berton
- Service de Neurochirurgie B, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Aurélien Coste
- Service de Neurochirurgie, CHU Grenoble-Alpes, Grenoble, France
| | | | - Jean Chazal
- Service de Neurochirurgie B, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Laurent Sakka
- Département d'Anatomie et d'Organogenèse, NeuroDol UMR INSERM 1107 CNRS, UFR de Médecine et des Professions Paramédicales, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Francis Abed Rabbo
- Service de Neurochirurgie B, CHU Clermont-Ferrand, Clermont-Ferrand, France
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Jibia A, Oumarou BN, Adoum M, Abogo S, Nga Nomo S, Chewa G. Repeat fracture of shunts in ventriculoperitoneal shunting with pelvic migration: An African teen case report with literature review. INTERDISCIPLINARY NEUROSURGERY 2022. [DOI: 10.1016/j.inat.2021.101381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Yamaguchi T. Hydrocephalus owing to ventriculoperitoneal shunt dysfunction. J Gen Fam Med 2022; 23:197-198. [PMID: 35509328 PMCID: PMC9062545 DOI: 10.1002/jgf2.525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 01/26/2022] [Indexed: 11/09/2022] Open
Affiliation(s)
- Toshimasa Yamaguchi
- Primary Care and Advanced Triage Section Osaka City General Hospital Osaka Japan
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Sergej R, Leonie G, Holger A, Pawel G, Ullrich M, Johannes L. The role of shuntography in diagnosis of mechanic complications after implantation of ventriculoperitoneal shunts in patients with idiopathic normal pressure hydrocephalus: a retrospective clinical evaluation. Neuroradiology 2021; 64:745-752. [PMID: 34825966 PMCID: PMC8907103 DOI: 10.1007/s00234-021-02834-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 10/11/2021] [Indexed: 11/26/2022]
Abstract
Background Mechanical obstruction of ventriculoperitoneal shunt (VPS) during the first year after shunt implantation is a common complication and is widely described in the literature. In this paper, we evaluated the suitability of the shuntography for the diagnosis of mechanical complications of the VPS in patients with idiopathic normal pressure hydrocephalus (iNPH). Methods We retrospectively identified 49 patients with pathologic shuntography over of a period of 20 years in our hospital. The percentage of procedure-associated complications was determined. Results Ninety-eight percent (n = 48) of the patients who underwent shuntography showed clinical and radiographic signs of underdrainage prior to examination. Shuntography revealed mechanical complications of the VP shunt in 37% (n = 18) as a cause of clinical deterioration and following revision operation. During shuntography, mechanical obstruction was discovered in 78% (n = 14) and disconnection of shunt components in 22% (n = 4). In the obstruction group, in 50% (n = 7) the closure was detected in the ventricular catheter, in 29% (n = 4) in the distal catheter of the VPS, and in 21% (n = 3) in both sides of the VPS. In the case of an inconspicuous shuntography (63%, n = 31), the patients received symptomatic therapy (32%, n = 10) or re-adjustment of the valve setting (68%, n = 21). Fifty-seven percent of the patients who underwent surgical treatment improved clinically by at least one point according to the Kiefer score. Conclusion Shuntography can produce valuable clinical information uncovering mechanic complications after implantation VPS in patients with idiopathic normal-pressure hydrocephalus. Patients with mechanical complications of their VPS needed revision surgery and showed clinical benefit after treatment.
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Affiliation(s)
- Rot Sergej
- Department of Neurosurgery, Unfallkrankenhaus Berlin, Warener Str. 7, 12683, Berlin, Germany.
| | - Goelz Leonie
- Institute of Radiology and Neuroradiology, Unfallkrankenhaus Berlin, Warener Str. 7, 12683, Berlin, Germany
| | - Arndt Holger
- Institute of Radiology and Neuroradiology, Unfallkrankenhaus Berlin, Warener Str. 7, 12683, Berlin, Germany
| | - Gutowski Pawel
- Department of Neurosurgery, Unfallkrankenhaus Berlin, Warener Str. 7, 12683, Berlin, Germany.,Department of Neurosurgery, Brodno Masovian Hospital, Warsaw Postgraduate Medical Centre, Warsaw, Poland
| | - Meier Ullrich
- Department of Neurosurgery, Unfallkrankenhaus Berlin, Warener Str. 7, 12683, Berlin, Germany
| | - Lemcke Johannes
- Department of Neurosurgery, Unfallkrankenhaus Berlin, Warener Str. 7, 12683, Berlin, Germany
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Wubie AB, Teshome GS, Ayele WE, Abebe F, Nigussie TM, Alemu YB, Mekonnen MS. Survival status and predictors of mortality among children who underwent ventriculoperitoneal shunt surgery at public hospitals in Addis Ababa, Ethiopia. Int J Neurosci 2021:1-9. [PMID: 34643151 DOI: 10.1080/00207454.2021.1986492] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Background: Despite the increase in ventriculoperitoneal shunt surgeries performed for children with hydrocephalus, the potential complications and survival of patients after the procedure remains the major challenge for both clinical and public health aspects. This study intends to assess the survival status and scrutinize the predictive factors of mortality among children after a ventriculoperitoneal shunt.Methods: A retrospective cohort study was employed by reviewing charts of 337 systematically selected children who have undergone a ventriculoperitoneal shunt from 2016 to 2018 in Addis Ababa. The extraction tool was used for data collection, Epi-data version 4.4.2 for data entry, and Stata version-14 for cleaning and analysis. Kaplan-Meier curve, log-rank test, and life table were used to describe the data. Cox proportional hazard regression model was used for analysis. Any variable at p < 0.25 in the bi-variable analysis was fitted to multivariate analysis, and significance was declared at p ≤ 0.05. Then, AHR with 95% CI was used to report the association and test the statistical significance. Finally, texts and tables were used to present the results.Results and Conclusion: The incidence rate of mortality was 58.4 per 1000 child-months of observation with a median survival time of 12 months (95%CI: 9.04-14.96). Communicative hydrocephalus (AHR: 1.99, 95% CI: 1.18-3.36), post-traumatic brain injury (AHR: 7.43, 95% CI: 3.21-16.88), emergency surgery (AHR: 1.86, 95% CI: 1.17-3.13) as well as revised shunt procedure (AHR: 8.01, 95% CI: 6.12-13.43) were independent predictors of death. Besides, sunset eye (ARH: 2.01; 95% CI: 1.17-3.47), rapidly increased head size (ARH: 2.05, 95% CI: 1.14-3.37), prolonged antibiotics treatment (AHR: 2.46, 95% CI: 1.82-7.37), and gram-negative infections (AHR: 1.95, 95% CI: 1.60-12.64) were also significantly associated. Hence, health professionals ought to give special attention to patients with identified predictors.
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Affiliation(s)
- Azene Bantie Wubie
- College of Health Science, Debre Markos University, Debre Markos, Ethiopia
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Just Stick a Scope in: Laparoscopic Ventriculoperitoneal Shunt Placement in the Pediatric Reoperative Abdomen. J Surg Res 2021; 269:212-217. [PMID: 34600330 DOI: 10.1016/j.jss.2021.07.045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 06/23/2021] [Accepted: 07/22/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Ventriculoperitoneal shunt (VPS) placement into the reoperative abdomen can be challenging due to intraperitoneal adhesions. Laparoscopic guidance may provide safe abdominal access and identify an area for optimal cerebrospinal fluid drainage. The study aim was to compare laparoscopic-assisted VPS placement to an "open" approach in patients with prior abdominal surgery. MATERIALS AND METHODS A retrospective review was performed of children undergoing VPS placement into a reoperative abdomen from 2009-2019. Clinical data were collected, and patients undergoing laparoscopy (LAP) were compared to those undergoing an open approach (OPEN). RESULTS A total of 120 children underwent 169 VPS placements at a median age of 8 y (IQR 2-15 y), and a mean number of two prior abdominal operations (IQR 1-2). Laparoscopy was used in 24% of cases. Shunt-related complications within 30 d were lower in the LAP group (0% versus 19%, P = 0.001), as were VPS-related postoperative emergency department visits (0% versus 13%, P = 0.003) and readmissions (0% versus 13%, P = 0.013). Shunt malfunction rates were higher (42% OPEN versus 25% LAP, P = 0.03) and occurred sooner in the OPEN group (median 26 versus 78 wk, P = 0.01). The LAP group demonstrated shorter operative times (63 versus 100 min, P < 0.0001), and the only bowel injury. Time to feeds, length of stay, and mortality were similar between groups. CONCLUSIONS Laparoscopic guidance during VPS placement into the reoperative abdomen is associated with a decrease in shunt-related complications, longer shunt patency, and shorter operative times. Prospective study may clarify the potential benefits of laparoscopy in this setting.
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Chaurasia A, Shinde A, Baveja S. Bacteriological Profile and Antimicrobial Susceptibility Pattern of Cerebrospinal Fluid Shunt Infections in Infants and Children. J Pediatr Neurosci 2021; 16:143-148. [PMID: 35018183 PMCID: PMC8706585 DOI: 10.4103/jpn.jpn_216_20] [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: 08/22/2020] [Revised: 10/03/2020] [Accepted: 10/20/2020] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Despite the advent of modern neurosurgical techniques, new antibiotics, and modern imaging techniques, infection after ventriculoperitoneal (VP) shunt insertion and/or ventriculostomy is still a serious issue. AIM The aim of this work was to study bacteriological profile and antimicrobial susceptibility pattern of cerebrospinal fluid shunt infections in infants and children. MATERIALS AND METHODS A total of 90 patients under the age of 12 years undergoing cerebrospinal fluid shunt procedures were included. The CSF shunt fluid, external ventricular drain (EVD), shunt tube tip specimens were processed as per standard microbiological techniques. The organisms isolated were subjected to antimicrobial susceptibility using the Kirby-Bauer disk diffusion method. RESULTS Of 20 infected patients 10 (50%) were culture positive. Most common organisms isolated were Acinetobacter baumannii 03 (30%) followed by Enterococcus faecalis 2 (20%). Two isolates of A. baumannii and one isolate of Klebsiella pneumoniae showed carbapenem resistance, which were sensitive to colistin. All Gram-positive isolates were sensitive to vancomycin and linezolid. Reinfection was found only in one (8.33%) patient. In 12 (60%) infected cases with shunt failure, revision of shunt was done. The shunt related mortality in this study was 1.11%. CONCLUSION Most common organisms isolated were A. baumannii followed by E. faecalis. Carbapenem resistance was noted in these isolates which were sensitive to colistin. All Gram-positive isolates were sensitive to vancomycin and linezolid.
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Affiliation(s)
- Ankita Chaurasia
- Department of Microbiology, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, Maharashtra, India
| | - Alka Shinde
- Department of Microbiology, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, Maharashtra, India
| | - Sujata Baveja
- Department of Microbiology, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, Maharashtra, India
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Suryaningtyas W, Ranuh IGMAR, Parenrengi MA. Shunt exposure as a ventriculoperitoneal shunt complication: A case series. Int J Surg Case Rep 2021; 79:484-491. [PMID: 33757268 PMCID: PMC7873374 DOI: 10.1016/j.ijscr.2021.01.084] [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: 12/16/2020] [Revised: 01/20/2021] [Accepted: 01/20/2021] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Shunting is a technique in neurosurgery for treating hydrocephalus. Shunting is an effective choice for both cases of obstructive or communicative hydrocephalus. However, in some rare cases, complications, such as exposed shunt, can occur. In this case series, the author discusses 6 cases of hydrocephalus patients with exposed shunts. The risk factors, diagnosis, and management of exposed VP shunt will be discussed further in this case series report. METHODS This study was an analysis of all cases treated in a period of 1 year from January to December 2018 with an inclusion criterion of history of exposed shunt of any age group. This study is a single-centre retrospective report of the clinical presentation and radiology examination before and after treatment. Clinical and radiology evaluation were performed in immediate post procedural period. A detailed clinical examination was performed to look for exposed shunt complication. RESULTS In this series of studies 6 patients with hydrocephalus who had shunts were reported. All patients were pediatric patients. Six patients had exposed shunt on the scalp or abdomen. Radiological examinations including CT scan, chest X-ray or babygram were performed to evaluate the location of the shunt. The data reported was from January to December 2018 and there were 301 VP shunt installment cases. Management included surgical revisions and treatments to prevent further complications. CONCLUSION Shunting is still a routine therapy in the field of neurosurgery, although other modalities such as endoscopic third ventriculostomy (ETV) have started to be performed more frequently. Complications such as exposed shunt are rare in the treatment of pediatrics with hydrocephalus. We presented that exposed shunt is a rare complication (2.3% incidence rate) which might be caused by certain risk factors, such as age of patient when the shunting was performed, and nutritional status. Early diagnosis and treatment are important to prevent further complications, especially infections. Subpericranial technique for shunt tunneling might be useful in preventing exposure of shunts with associated morbidity factors.
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Affiliation(s)
- Wihasto Suryaningtyas
- Department of Neurosurgery, Faculty of Medicine, Universitas Airlangga, Dr Soetomo Academic Medical Center Hospital, Indonesia
| | - I G M Aswin R Ranuh
- Department of Neurosurgery, Faculty of Medicine, Universitas Airlangga, Dr Soetomo Academic Medical Center Hospital, Indonesia.
| | - Muhammad Arifin Parenrengi
- Department of Neurosurgery, Faculty of Medicine, Universitas Airlangga, Dr Soetomo Academic Medical Center Hospital, Indonesia.
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Gupta R, Sharma P, Bhandari A, Chaturvedi V, Gupta A, Tanger R, Shukla A, Raipuria G, Mathur P. Hydrocephalus in pediatric patients: A clinical audit. JOURNAL OF DR. NTR UNIVERSITY OF HEALTH SCIENCES 2021. [DOI: 10.4103/jdrntruhs.jdrntruhs_177_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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12
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Yu Q, Lou C, Feng T, Liu Y. Ventriculoperitoneal shunt malfunction due to chronic cholecystitis: A case report. Medicine (Baltimore) 2020; 99:e20565. [PMID: 32569180 PMCID: PMC7310882 DOI: 10.1097/md.0000000000020565] [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: 11/26/2022] Open
Abstract
RATIONALE Ventriculoperitoneal shunt (VPS) is the most common treatment for idiopathic normal pressure hydrocephalus, a subtype of hydrocephalus characterized by gait disturbance, dementia, and urinary incontinence. However, while the malfunction of VPS is reported at a high rate, the involvement of chronic cholecystitis in shunt malfunction is rare. PATIENT CONCERNS A 73-year-old woman with idiopathic normal pressure hydrocephalus who received a VPS but subsequently developed chronic cholecystitis. The patient suffered from drowsiness and was unable to walk. Her family found that she presented with poor appetite and was bloated. DIAGNOSES Chronic cholecystitis was confirmed through abdominal computed tomography, which showed a swollen, and enlarged gallbladder, and flatulence. A head computed tomography scan indicated hydrocephalus with enlarged ventricular system and paraventricular edema. INTERVENTIONS Laparoscopic cholecystectomy was performed successfully, requiring no further shunt manipulation. OUTCOMES The patient's memory and cognitive ability were slightly impaired without a positive sign in the abdomen. No catheter or abdominal infection signs were observed during the following 3 months of follow-up. CONCLUSION To the best of our knowledge, this report is the first to reveal that shunt malfunction may result from chronic cholecystitis, which induced the presently observed intra-abdominal hypertension.
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Affiliation(s)
- Qi Yu
- Department of Neurosurgery, Shengjing Hospital of China Medical University
- Liaoning Clinical Medical Research Center in Nervous System Disease
- Liaoning Key Laboratory of Neuro-Oncology, Shenyang, China
| | - Chengjian Lou
- Department of Neurosurgery, Shengjing Hospital of China Medical University
- Liaoning Clinical Medical Research Center in Nervous System Disease
- Liaoning Key Laboratory of Neuro-Oncology, Shenyang, China
| | - Tianda Feng
- Department of Neurosurgery, Shengjing Hospital of China Medical University
- Liaoning Clinical Medical Research Center in Nervous System Disease
- Liaoning Key Laboratory of Neuro-Oncology, Shenyang, China
| | - Yunhui Liu
- Department of Neurosurgery, Shengjing Hospital of China Medical University
- Liaoning Clinical Medical Research Center in Nervous System Disease
- Liaoning Key Laboratory of Neuro-Oncology, Shenyang, China
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Xu J, Poole C, Sahyouni R, Chen J. Noninvasive thermal evaluation for shunt failure in the emergency room. Surg Neurol Int 2019; 10:254. [PMID: 31893155 PMCID: PMC6935949 DOI: 10.25259/sni_324_2019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Accepted: 12/03/2019] [Indexed: 11/22/2022] Open
Abstract
Background: Ventriculoperitoneal shunts (VPSs) have been the mainstay of treating hydrocephalus since the 1950s. However, shunts have a reported complication rate reaching nearly 50%. Devices have been developed that utilize noninvasive thermal transcutaneous diffusion technology. These shunt evaluation devices measure temperature gradients to detect shunt cerebrospinal fluid flow. We assessed the utility using a thermal diffusion technique to work up shunt failure in the emergency room (ER). Methods: This was a retrospective case series at a single medical center ER. We included consecutive patients with possible VPS malfunction who were evaluated with a thermal sensor. The time period of data collection included September 2015–April 2018. Results: Eight patients were reviewed, including four males and four females. The average age of reviewed patients was 35.1 (+/− ; 16.5). In our case series, three patients had adequate shunt flow as assessed by the shunt evaluation device, and the decision was made to discharge the patient and follow-up in clinic. In two patients, the flow was diminished, but due to other reassuring signs, the patients were still discharged with follow-up. Two patients were noted to have poor flow and were admitted for shunt revision. Conclusion: It is important to determine whether a malfunction is present and whether an intervention is necessary for patients who present to the emergency department with possible symptoms of shunt failure. A thermal sensor is a fast and noninvasive tool in the evaluation of shunt flow and helps determine whether it is safe to send a patient home or intervene appropriately.
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Affiliation(s)
- Jordan Xu
- Department of Neurosurgery, University of California, Irvine Medical Center, Orange, California
| | - Cassie Poole
- Department of Neurosurgery, University of California, Irvine Medical Center, Orange, California
| | - Ronald Sahyouni
- Department of Biomedical Engineering, University of California, Irvine School of Medicine, Irvine
| | - Jefferson Chen
- Department of Neurosurgery, University of California, Irvine Medical Center, Orange, California
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Leibold AT, Weyhenmeyer J, Rodgers R, Lee A. Ventriculoperitoneal shunt valve fracture after traumatic motor vehicle collision. INTERDISCIPLINARY NEUROSURGERY 2019. [DOI: 10.1016/j.inat.2018.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Zanaty M, Roa JA, Piscopo AJ, Kritikos ME, Teferi N, Howard MA. Methods and Devices for Posterior Ventriculoperitoneal Shunt Placement Surgery: 25 Years of Iterative Refinement. World Neurosurg 2019; 129:514-521.e3. [PMID: 31132499 DOI: 10.1016/j.wneu.2019.05.148] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 05/15/2019] [Accepted: 05/16/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND The posterior ventriculoperitoneal shunt (VPS) placement procedure is technically efficient and cosmetically appealing. The main limitations of the posterior approach relate to the technical challenges associated with accurately placing the ventricular catheter. In this report, we describe methods and simple devices used for posterior VPS surgery that have evolved over a >25-year period to enhance catheter placement accuracy and reduce complication rates. OBJECTIVE We describe the combination of methods and customized devices used at a single institution to perform posterior VPS surgery. Results are presented for the most recent 11-year epoch, along with a description of sources of technical errors and plans for further methodologic refinements. MATERIALS AND METHODS The medical records and imaging studies of 468 patients undergoing posterior VPS, from 2007 to 2018 were reviewed. Ventricular catheter placement accuracy data were collected and complications were identified and recorded. RESULTS Optimal ventricular catheter placement was achieved in 98.29%. Of the remaining 1.71%, one half (0.85%) required acute revision surgery. Four patients (0.85%) developed new neurologic deficits following surgery; 2 were related to intraparenchymal hemorrhages and 2 (0.43%) as a result of a misplaced catheter. The deficits resulting from poor catheter placement were transient. The complication rates due to causes other than catheter placement accuracy compared favorably with those reported previously in the literature. CONCLUSIONS Using the methods and devices described in this series, posterior VPS operations can be performed safely with a high degree of ventricular catheter placement accuracy.
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Affiliation(s)
- Mario Zanaty
- Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Jorge A Roa
- Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Anthony J Piscopo
- Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Michael E Kritikos
- Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Nahom Teferi
- Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Matthew A Howard
- Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.
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Nakajima M, Hara T, Miyajima M, Akiba C, Kawamura K, Sugano H, Tange Y, Shimoji K, Karagiozov K, Arai H. Shunt Malfunction and Calcification of Abdominal Fascia Tissue Resulting in Obstruction of Abdominal Catheter. World Neurosurg 2019; 126:96-98. [PMID: 30831288 DOI: 10.1016/j.wneu.2019.01.285] [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: 09/24/2018] [Revised: 01/27/2019] [Accepted: 01/30/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Experiencing a ventriculoperitoneal (VP) shunt complication is a major obstacle in the management of hydrocephalus. Degradation of a shunt catheter associated with surrounding tissue calcification could be 1 reason for a difference in facture rates. Furthermore, tissue reactions around cerebrospinal fluid shunts may be a sign of bacterial shunt infection, which is not uncommon. CASE DESCRIPTION A 31-year-old man was living with a ventriculoperitoneal shunt since childhood. Consequently, his cerebrospinal fluid absorption was supposed to be modified by the shunt. Shunt malfunction later occurred concomitant with symptoms of headache and repeated vomiting. He had undergone shunt revision a year before presentation, but examination revealed that a new, extremely rare calcified lesion had formed in the aponeurosis of the abdomen, compressing the shunt tube. We removed it and replaced the shunt tube, thus relieving his symptoms. CONCLUSIONS We treated a rare case of shunt dysfunction caused by calcification of the aponeurosis coinciding with significant weight gain over the course of a year. To the best of our knowledge, this is the first report to describe a case of shunt malfunction caused by calcification of the aponeurosis.
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Affiliation(s)
- Madoka Nakajima
- Department of Neurosurgery, Juntendo University Faculty of Medicine, Tokyo, Japan.
| | - Takeshi Hara
- Department of Neurosurgery, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Masakazu Miyajima
- Department of Neurosurgery, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Chihiro Akiba
- Department of Neurosurgery, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Kaito Kawamura
- Department of Neurosurgery, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Hidenori Sugano
- Department of Neurosurgery, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Yuichi Tange
- Department of Neurosurgery, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Kazuaki Shimoji
- Department of Neurosurgery, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Kostadin Karagiozov
- Department of Neurosurgery, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Hajime Arai
- Department of Neurosurgery, Juntendo University Faculty of Medicine, Tokyo, Japan
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Gradner G, Kaefinger R, Dupré G. Complications associated with ventriculoperitoneal shunts in dogs and cats with idiopathic hydrocephalus: A systematic review. J Vet Intern Med 2019; 33:403-412. [PMID: 30747447 PMCID: PMC6430919 DOI: 10.1111/jvim.15422] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 01/09/2019] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Several case series and case reports have been published about idiopathic hydrocephalus treatment in dogs and cats using ventriculoperitoneal shunts (VPS). OBJECTIVES To determine the risk and type of complications in dogs and cats after VPS placement. ANIMALS Sixteen papers were included. Sixty dogs and 13 cats with idiopathic hydrocephalus treated by VPS placement were identified. METHODS The databases CAB, Scopus, and Medline were used. Idiopathic/congenital hydrocephalus, feline/canine patients, ventriculoperitoneal shunting, complications, and outcomes were inclusion criteria. The focus was on complication type and time frame within which they arose. RESULTS Complications in dogs (n = 60) were shunt obstruction (6/60; 10%), pain (4/60; 5.5%), shunt infection (3/60; 4.1%), disconnection (3/60; 4.1%), excessive shunting (2/60; 2.7%), and kinking (1/60; 1.6%). Complications in cats (n = 13) were coiling of the shunt in the SC tissue (2/13; 15.4%); kinking (1/13; 7.7%); and shunt obstruction (1/13; 7.7%). Complications were most likely during the first 6 months after shunt placement. CONCLUSION AND CLINICAL IMPORTANCE Ventriculoperitoneal shunting is considered a viable treatment option for patients with hydrocephalus. Potential complications should be discussed with the owner. Early diagnosis of complications is essential.
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Affiliation(s)
- Gabriele Gradner
- Department of Small Animal SurgeryClinic of Small Animal SurgeryViennaAustria
| | - Rose Kaefinger
- Department of Small Animal SurgeryClinic of Small Animal SurgeryViennaAustria
| | - Gilles Dupré
- Department of Small Animal SurgeryClinic of Small Animal SurgeryViennaAustria
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18
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Orrego-González E, Enriquez-Marulanda A, Ravindran K, Celin-Varcalcel D, Parrado-Sánchez L, Lobato-Polo J. Factors Associated with Ventriculoperitoneal Shunt Failures in the First 30 Postoperative Days in Pediatric Patients. World Neurosurg 2019; 124:e517-e526. [PMID: 30611949 DOI: 10.1016/j.wneu.2018.12.125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 12/16/2018] [Accepted: 12/18/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Placing of a ventriculoperitoneal shunt (VPS) is one of the most common procedures performed by neurosurgeons. Surgical revision of VPS is a significant cause of patient morbidity and mortality. This study was aimed to provide an analysis of factors related to VPS failures in the first 30 postoperative days in a pediatric cohort. METHODS This was a retrospective cohort study of 83 pediatric patients (<18 years old), shunted for the first time at a referral care center, between January 2012 and December 2016. Univariate analysis was used to detect potential predictors of VPS failures within the first 30 postoperative days and in the first 6 months of follow-up. Kaplan-Meier survival curves were used to examine the occurrence of VPS failures over time. RESULTS During the first 30 postoperative days, VPS failures occurred in 21 patients (25.3%). Intraventricular hemorrhage (IVH) (odds ratio [OR], 4.41; 95% confidence interval [CI], 1.44-13.48), cerebrospinal fluid (CSF) alterations (OR, 5.11; 95% CI, 1.37-19.1), and previous external ventricular drain (EVD) (OR, 7.05; 95% CI, 1.18-41.8) were significantly associated with shunt failure during the first postoperative month. Kaplan-Meier survival analysis showed decreased shunt survival for patients with IVH, both during the first 30 days after surgery (P = 0.005, log-rank), and during the 6 months after surgery (P = 0.005, log-rank). CONCLUSIONS In this study, we found that in pediatric patients, IVH was associated with VPS failure within the first 30 postoperative days and decreased shunt survival over time. Further larger prospective randomized studies are needed to better understand these results.
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Affiliation(s)
| | - Alejandro Enriquez-Marulanda
- Fundacion Valle del Lili, Cali, Colombia, USA; Centro de Investigación Clinica, Cali, Colombia, USA; Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Krishnan Ravindran
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Daniel Celin-Varcalcel
- Fundacion Valle del Lili, Cali, Colombia, USA; Centro de Investigación Clinica, Cali, Colombia, USA
| | - Laura Parrado-Sánchez
- Fundacion Valle del Lili, Cali, Colombia, USA; Universidad ICESI, Cali, Colombia, USA
| | - Javier Lobato-Polo
- Fundacion Valle del Lili, Cali, Colombia, USA; Universidad ICESI, Cali, Colombia, USA; Centro de Investigación Clinica, Cali, Colombia, USA.
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Anderson IA, Saukila LF, Robins JMW, Akhunbay-Fudge CY, Goodden JR, Tyagi AK, Phillips N, Chumas PD. Factors associated with 30-day ventriculoperitoneal shunt failure in pediatric and adult patients. J Neurosurg 2019; 130:145-153. [PMID: 29521592 DOI: 10.3171/2017.8.jns17399] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 08/28/2017] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The aim of this study was to provide a comprehensive benchmark of 30-day ventriculoperitoneal (VP) shunt failure rates for a single institution over a 5-year study period for both adult and pediatric patients, to compare this with the results in previously published literature, and to establish factors associated with shunt failure. METHODS A retrospective database search was undertaken to identify all VP shunt operations performed in a single, regional neurosurgical unit during a 5-year period. Data were collected regarding patient age, sex, origin of hydrocephalus, and whether the shunt was a primary or secondary shunt. Operative notes were used to ascertain the type of valve inserted, which components of the shunt were adjusted/replaced (in revision cases), level of seniority of the most senior surgeon who participated in the operation, and number of surgeons involved in the operation. Where appropriate and where available, postoperative imaging was assessed for grade of shunt placement, using a recognized grading system. Univariate and multivariate models were used to establish factors associated with early (30-day) shunt failure. RESULTS Six hundred eighty-three VP shunt operations were performed, of which 321 were pediatric and 362 were adult. The median duration of postoperative follow-up for nonfailed shunts (excluding deaths) was 1263 days (range 525-2226 days). The pediatric 30-day shunt failure rates in the authors' institution were 8.8% for primary shunts and 23.4% for revisions. In adults, the 30-day shunt failure rates are 17.7% for primary shunts and 25.6% for revisions. In pediatric procedures, the number of surgeons involved in the operating theater was significantly associated with shunt failure rate. In adults, the origin of hydrocephalus was a statistically significant variable. Primary shunts lasted longer than revision shunts, irrespective of patient age. CONCLUSIONS A benchmark of 30-day failures is presented and is consistent with current national databases and previously published data by other groups. The number of surgeons involved in shunt operations and the origin of the patient's hydrocephalus should be described in future studies and should be controlled for in any prospective work. The choice of shunt valve was not a significant predictor of shunt failure. Most previous studies on shunts have concentrated on primary shunts, but the high rate of early shunt failure in revision cases (in both adults and children) is perhaps where future research efforts should be concentrated.
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20
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Gigliotti MJ, Mao G, Dupré DA, Wilberger J. Vagal Nerve Stimulation: Indications for Revision in Adult Refractory Epilepsy. World Neurosurg 2018; 120:e1047-e1053. [DOI: 10.1016/j.wneu.2018.09.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Revised: 08/31/2018] [Accepted: 09/02/2018] [Indexed: 11/26/2022]
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Kamenova M, Rychen J, Guzman R, Mariani L, Soleman J. Yield of early postoperative computed tomography after frontal ventriculoperitoneal shunt placement. PLoS One 2018; 13:e0198752. [PMID: 29920522 PMCID: PMC6007904 DOI: 10.1371/journal.pone.0198752] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 05/24/2018] [Indexed: 11/19/2022] Open
Abstract
Despite being widely used, ventriculoperitoneal (VP) shunt placement is a procedure often associated with complications and revision surgeries. Many neurosurgical centers routinely perform early postoperative cranial computer tomography (CT) to detect postoperative complications (e.g., catheter malposition, postoperative bleed, over-drainage). Because guidelines are lacking, our study aimed to evaluate the yield of early routine postoperative CT after shunt placement for adult hydrocephalus. We retrospectively reviewed 173 patients who underwent frontal VP shunting for various neurosurgical conditions. Radiological outcomes were proximal catheter malposition, and ventricular width in preoperative and postoperative imaging. Clinical outcomes included postoperative neurological outcome, revision surgery because of catheter malposition or other causes, mortality, and finally surgical, non-surgical, and overall morbidity. In only 3 (1.7%) patients did the early routine postoperative CT lead to revision surgery. Diagnostic ratios for CT finding 1 asymptomatic patient who eventually underwent revision surgery per total number to scan were 1:58 for shunt malposition, 1:86 for hygroma, and 1:173 for a cranial bleed. Five (2.9%) patients with clinically asymptomatic shunt malposition or hygroma underwent intervention based on early postoperative CT (diagnostic ratio 1:25). Shunt malposition occurred in no patient with normal pressure hydrocephalus and 2 (40%) patients with stroke. Lower preoperative Evans’ Index was a statistically significant predictor for high-grade shunt malposition. We found a rather low yield for early routine postoperative cranial CT after frontal VP-shunt placement. Therefore, careful selection of patients who might benefit, considering the underlying disease and preoperative radiological findings, could reduce unnecessary costs and exposure to radiation.
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Affiliation(s)
- Maria Kamenova
- Department of Neurosurgery, University Hospital of Basel, Basel, Switzerland
- * E-mail:
| | - Jonathan Rychen
- Department of Neurosurgery, University Hospital of Basel, Basel, Switzerland
| | - Raphael Guzman
- Department of Neurosurgery, University Hospital of Basel, Basel, Switzerland
| | - Luigi Mariani
- Department of Neurosurgery, University Hospital of Basel, Basel, Switzerland
| | - Jehuda Soleman
- Department of Neurosurgery, University Hospital of Basel, Basel, Switzerland
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22
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Qin B, Chen G, Chen J. Shunt infection in a single institute: a retrospective study. Chin Neurosurg J 2018; 4:8. [PMID: 32922869 PMCID: PMC7398261 DOI: 10.1186/s41016-018-0115-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 04/02/2018] [Indexed: 11/25/2022] Open
Abstract
Background Shunt infection (SI) is a dreaded and major complication in the management of hydrocephalus after cerebral fluid shunts. We reviewed retrospectively shunted for hydrocephalus during the last 2 years to evaluate the incidence of SI, including the risk factors and types of infection. Methods Patients who had undergone a shunt operation from January 2013 to December 2014 in our hospital were observed, study clinical data and a 6-24 months follow-up. Patients with infection complications were found and investigated. Results Among 343 cases of shunt surgery performed in our hospital, 6–24 months follow-up was done. 13 patients (10 men and 3 women) were found shunt infections, 11 (3.7%) were post-operation of ventriculo-peritoneal shunt and 2 (4.2%) of lumbo-peritoneal shunt.92.3% cases of shunt infections were present within 2 months after shunt surgery, gram positive cocci accounted for 90% of the bacteria. After different surgery and antibiotic treatment, 8 patients became better and 5 worse. Conclusions The data in our single institution shows no significant differences between sex and shunt surgery. Infections more likely to present within the first 2 months after shunt placement, and gram-positive cocci account for a great proportion in detected bacteria.
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Affiliation(s)
- Bing Qin
- Department of Neurosurgery, the Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Gao Chen
- Department of Neurosurgery, the Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Jingyin Chen
- Department of Neurosurgery, the Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
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Pan P. Outcome Analysis of Ventriculoperitoneal Shunt Surgery in Pediatric Hydrocephalus. J Pediatr Neurosci 2018; 13:176-181. [PMID: 30090131 PMCID: PMC6057192 DOI: 10.4103/jpn.jpn_29_18] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIM To study the clinical outcome of shunt surgeries in children with hydrocephalus and evaluate the risk factors for ventriculoperitoneal (VP) shunt failure. MATERIALS AND METHODS Patients who underwent VP shunt surgery for hydrocephalus were included. Medical charts, operative reports, imaging studies, and clinical follow-up evaluations were reviewed and analyzed retrospectively. RESULTS A total of 137 patients with the average age of 20.7 months, range from 1.5 months to 8.5 years at the time of VP shunt surgery were included. The incidence of overall shunt complications was 35.76%; incidence of shunt revision was 27%, shunt blockade 45.94%, shunt infection 16.21%, shunt migration 10.81%, and shunt malfunction due to abdominal pseudocyst 10.81%. The mortality rate was 5.10%. The shunt revisions in the first 6 months after shunt placement was observed in n = 9 (24%). Hydrocephalus was associated with post-tubercular meningitis and intraventricular hemorrhage (IVH) in shunt placement was associated with multiple shunt revisions (n = 13, 35.13%) (n = 5, 45.4%), respectively. CONCLUSION The findings of this study indicate that etiology of hydrocephalus, were associated with the shunt survival. Further prospective controlled studies are required to address the observed associations.
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Affiliation(s)
- Pradyumna Pan
- Pediatric Surgery Unit, Ashish Hospital and Research Centre, Jabalpur, Madhya Pradesh, India
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24
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Jeon T, Park KS, Park SH, Hwang JH, Hwang SK. Expression of Aquaporin 1 and 4 in the Choroid Plexus and Brain Parenchyma of Kaolin-Induced Hydrocephalic Rats. Korean J Neurotrauma 2017; 13:68-75. [PMID: 29201837 PMCID: PMC5702761 DOI: 10.13004/kjnt.2017.13.2.68] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 07/09/2017] [Accepted: 07/14/2017] [Indexed: 11/15/2022] Open
Abstract
Objective Aquaporin (AQP) is a recently discovered protein that regulates water homeostasis. The present study examines changes in AQP 1 and 4 in kaolin induced experimental hydrocephalic rats to elucidate the pathophysiology of water homeostasis in the disease. Methods Hydrocephalus was induced by percutaneous intracisternal injection of kaolin. The brain parenchyma and choroid plexus were obtained at 3, 7, 14 and 30 days after injection. Protein expressions of AQP 1 and 4 were measured by western blot, immunohistochemistry (IHC) and immunofluorescence (IF) stains. Results In the choroid plexus of the kaolin-induced hydrocephalus group, AQP 1 expression identified by western blot exhibited sharp decrease in the early stage (55% by the 3rd day and 22% by the 7th day), but indicated a 2.2-fold increase in the later stage (30th day) in comparison with control groups. In the parenchyma, a quantitative measurement of AQP 4 expression revealed variable results on the 3rd and 7th days, but indicated expression 2.1 times higher than the control in the later stage (30th day). In addition, the IHC and IF findings supported the patterns of expression of AQP 1 in the choroid plexus and AQP 4 in the parenchyma. Conclusion Expression of AQP 1 decreased sharply in the choroid plexus of acute hydrocephalus rats and increased at later stages. Expression of AQP 4 in the brain parenchyma was variable in the early stage in the hydrocephalus group, but was higher than in the control in the later stage. These findings suggest a compensating role of AQPs in water physiology in hydrocephalus.
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Affiliation(s)
- Taehyung Jeon
- Department of Neurosurgery, Kyungpook National Univeristy Hospital, Daegu, Korea
| | - Ki-Su Park
- Department of Neurosurgery, Kyungpook National Univeristy Hospital, Daegu, Korea
| | - Seong-Hyun Park
- Department of Neurosurgery, Kyungpook National Univeristy Hospital, Daegu, Korea
| | - Jeong-Hyun Hwang
- Department of Neurosurgery, Kyungpook National Univeristy Hospital, Daegu, Korea
| | - Sung Kyoo Hwang
- Department of Neurosurgery, Kyungpook National Univeristy Hospital, Daegu, Korea
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25
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Tervonen J, Leinonen V, Jääskeläinen JE, Koponen S, Huttunen TJ. Rate and Risk Factors for Shunt Revision in Pediatric Patients with Hydrocephalus—A Population-Based Study. World Neurosurg 2017; 101:615-622. [DOI: 10.1016/j.wneu.2017.02.030] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 02/06/2017] [Accepted: 02/07/2017] [Indexed: 10/20/2022]
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26
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Burks JD, Conner AK, Briggs RG, Glenn CA, Bonney PA, Cheema AA, Chen S, Gross NL, Mapstone TB. Risk of failure in pediatric ventriculoperitoneal shunts placed after abdominal surgery. J Neurosurg Pediatr 2017; 19:571-577. [PMID: 28291419 DOI: 10.3171/2016.10.peds16377] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Experience has led us to suspect an association between shunt malfunction and recent abdominal surgery, yet information about this potential relationship has not been explored in the literature. The authors compared shunt survival in patients who underwent abdominal surgery to shunt survival in our general pediatric shunt population to determine whether such a relationship exists. METHODS The authors performed a retrospective review of all cases in which pediatric patients underwent ventriculoperitoneal shunt operations at their institution during a 7-year period. Survival time in shunt operations that followed abdominal surgery was compared with survival time of shunt operations in patients with no history of abdominal surgery. Univariate and multivariate analyses were used to identify factors associated with failure. RESULTS A total of 141 patients who underwent 468 shunt operations during the period of study were included; 107 of these 141 patients had no history of abdominal surgery and 34 had undergone a shunt operation after abdominal surgery. Shunt surgery performed more than 2 weeks after abdominal surgery was not associated with time to shunt failure (p = 0.86). Shunt surgery performed within 2 weeks after abdominal surgery was associated with time to failure (adjusted HR 3.6, 95% CI 1.3-9.6). CONCLUSIONS Undergoing shunt surgery shortly after abdominal surgery appears to be associated with shorter shunt survival. When possible, some patients may benefit from shunt placement utilizing alternative termini.
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Affiliation(s)
| | | | | | | | | | | | - Sixia Chen
- Biostatistics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
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27
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Dupepe EB, Hopson B, Johnston JM, Rozzelle CJ, Jerry Oakes W, Blount JP, Rocque BG. Rate of shunt revision as a function of age in patients with shunted hydrocephalus due to myelomeningocele. Neurosurg Focus 2017; 41:E6. [PMID: 27798984 DOI: 10.3171/2016.8.focus16257] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE It is generally accepted that cerebrospinal fluid shunts fail most frequently in the first years of life. The purpose of this study was to describe the risk of shunt failure for a given patient age in a well-defined cohort with shunted hydrocephalus due to myelomeningocele (MMC). METHODS The authors analyzed data from their institutional spina bifida research database including all patients with MMC and shunted hydrocephalus. For the entire population, the number of shunt revisions in each year of life was determined. Then the number of patients at risk for shunt revision during each year of life was calculated, thus enabling them to calculate the rate of shunt revision per patient in each year of life. In this way, the timing of all shunt revision operations for the entire clinic population and the likelihood of having a shunt revision during each year of life were calculated. RESULTS A total of 655 patients were enrolled in the spina bifida research database, 519 of whom had a diagnosis of MMC and whose mean age was 17.48 ± 11.7 years (median 16 years, range 0-63 years). Four hundred seventeen patients had had a CSF shunt for the treatment of hydrocephalus and thus are included in this analysis. There were 94 shunt revisions in the 1st year of life, which represents a rate of 0.23 revisions per patient in that year. The rate of shunt revision per patient-year initially decreased as age increased, except for an increase in revision frequency in the early teen years. Shunt revisions continued to occur as late as 43 years of age. CONCLUSIONS These data substantiate the idea that shunt revision surgeries in patients with MMC are most common in the 1st year of life and decrease thereafter, except for an increase in the early teen years. A persistent risk of shunt failure was observed well into adult life. These findings underscore the importance of routine follow-up of all MMC patients with shunted hydrocephalus and will aid in counseling patients and families.
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Affiliation(s)
| | - Betsy Hopson
- Section of Pediatric Neurosurgery, Children's Hospital of Alabama and the University of Alabama at Birmingham, Alabama
| | - James M Johnston
- Department of Neurosurgery, and.,Section of Pediatric Neurosurgery, Children's Hospital of Alabama and the University of Alabama at Birmingham, Alabama
| | - Curtis J Rozzelle
- Department of Neurosurgery, and.,Section of Pediatric Neurosurgery, Children's Hospital of Alabama and the University of Alabama at Birmingham, Alabama
| | - W Jerry Oakes
- Department of Neurosurgery, and.,Section of Pediatric Neurosurgery, Children's Hospital of Alabama and the University of Alabama at Birmingham, Alabama
| | - Jeffrey P Blount
- Department of Neurosurgery, and.,Section of Pediatric Neurosurgery, Children's Hospital of Alabama and the University of Alabama at Birmingham, Alabama
| | - Brandon G Rocque
- Department of Neurosurgery, and.,Section of Pediatric Neurosurgery, Children's Hospital of Alabama and the University of Alabama at Birmingham, Alabama
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28
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Erol FS, Ozturk S, Akgun B, Kaplan M. Ventriculoperitoneal shunt malfunction caused by fractures and disconnections over 10 years of follow-up. Childs Nerv Syst 2017; 33:475-481. [PMID: 28097382 DOI: 10.1007/s00381-017-3342-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Accepted: 01/10/2017] [Indexed: 11/24/2022]
Abstract
PURPOSE We have discussed the diagnosis and treatment approaches in patients with discontinued (disconnected or fractured) ventriculoperitoneal (VP) shunts that caused mechanical dysfunction. METHODS Between 2006 and 2016, VP shunt surgery was performed on 1357 pediatric patients in our clinic. In follow-up examinations, we retrospectively reviewed patients who underwent revision surgery. Except for diagnosis of discontinued VP shunt, by excluding revision-surgery patients, only those patients who underwent surgical treatment owing to discontinued (fracture or disconnection) catheter were included in the study. Age at first surgery, sex, reason for shunt discontinuity, anatomical region of pathology, time to discontinuity diagnosis after first surgery, and presence or absence of symptoms were evaluated. RESULTS One thousand three hundred fifty-seven VP shunt surgeries were performed in total, with 305 (22.4%) patients requiring revision surgery. Of these 305 patients, after accounting for other complications like obstruction, infection, overdrainage, and so on, 25 (8.1%) patients (14 male, 11 female) required re-surgery due to discontinuity. The mean age of these patients was 5.4 ± 2.1 months during the first VP shunt surgery, and the mean age during revision surgery was 71.7 months. The mean duration until discontinuity was diagnosed was 66.3 ± 24.1 months (76.1 months for catheter fractures and 45.6 months for disconnections (p 0.021)). CONCLUSION Disconnection and fracture are two significant mechanical VP shunt dysfunctions and must be adequately researched and understood even during routine follow-ups. A disconnected or fractured shunt may be working and it is not safe to state that the shunt is no longer needed.
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Affiliation(s)
- Fatih Serhat Erol
- School of Medicine, Department of Neurosurgery, Firat University, Elazig, Turkey
| | - Sait Ozturk
- School of Medicine, Department of Neurosurgery, Firat University, Elazig, Turkey.
| | - Bekir Akgun
- School of Medicine, Department of Neurosurgery, Firat University, Elazig, Turkey
| | - Metin Kaplan
- School of Medicine, Department of Neurosurgery, Firat University, Elazig, Turkey
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Ibáñez-Botella G, González-García L, Carrasco-Brenes A, Ros-López B, Arráez-Sánchez MÁ. LOVA: the role of endoscopic third ventriculostomy and a new proposal for diagnostic criteria. Neurosurg Rev 2017; 40:605-611. [DOI: 10.1007/s10143-017-0813-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 12/19/2016] [Accepted: 01/08/2017] [Indexed: 11/27/2022]
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30
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Lee L, Low S, Low D, Ng LP, Nolan C, Seow WT. Late pediatric ventriculoperitoneal shunt failures: a Singapore tertiary institution's experience. Neurosurg Focus 2016; 41:E7. [DOI: 10.3171/2016.8.focus16277] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE
The introduction of ventriculoperitoneal shunts changed the way hydrocephalus was treated. Whereas much is known about the causes of shunt failure in the first few years, there is a paucity of data in the literature regarding the cause of late shunt failures. The authors conducted a study to find out the different causes of late shunt failures in their institution.
METHODS
A 10-year retrospective study of all the patients who were treated in the authors' hospital between 2006 and 2015 was conducted. Late shunt failures included those in patients who had to undergo shunt revision more than 5 years after their initial shunt insertion. The patient's notes and scans were reviewed to obtain the age and sex of the patient, the time it took for the shunt to fail, the reason for failure, and the patient's follow-up.
RESULTS
Forty-six patients in the authors' institution experienced 48 late shunt failures in the last 10 years. Their ages ranged from 7 to 26 years (12.23 ± 4.459 years [mean ± SD]). The time it took for the shunts to fail was between 6 and 24 years (mean 10.25 ± 3.77 years). Reasons for failure resulting in shunt revision include shunt fracture in 24 patients (50%), shunt blockage in 14 patients (29.2%), tract fibrosis in 6 patients (12.5%), shunt dislodgement in 2 patients (4.2%), and shunt erosion in 2 patients (4.2%). Postoperative follow-up for the patients ranged from 6 to 138 months (mean 45.15 ± 33.26 months).
CONCLUSIONS
Late shunt failure is caused by the effects of aging on the shunt, and the complications are different from early shunt failure. A large proportion are complications associated with shunt calcification. The authors advocate a long follow-up for pediatric patients with shunts in situ to monitor them for various causes of late shunt failure.
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Affiliation(s)
- Lester Lee
- 1Neurosurgical Service, KKH Women's and Children's Hospital
- 2Department of Neurosurgery, National Neuroscience Institute (Singapore); and
| | - Sharon Low
- 1Neurosurgical Service, KKH Women's and Children's Hospital
- 2Department of Neurosurgery, National Neuroscience Institute (Singapore); and
| | - David Low
- 1Neurosurgical Service, KKH Women's and Children's Hospital
- 2Department of Neurosurgery, National Neuroscience Institute (Singapore); and
- 3SingHealth Duke-NUS Neuroscience Academic Clinical Program, Singapore
| | - Lee Ping Ng
- 1Neurosurgical Service, KKH Women's and Children's Hospital
| | - Colum Nolan
- 1Neurosurgical Service, KKH Women's and Children's Hospital
- 2Department of Neurosurgery, National Neuroscience Institute (Singapore); and
- 3SingHealth Duke-NUS Neuroscience Academic Clinical Program, Singapore
| | - Wan Tew Seow
- 1Neurosurgical Service, KKH Women's and Children's Hospital
- 2Department of Neurosurgery, National Neuroscience Institute (Singapore); and
- 3SingHealth Duke-NUS Neuroscience Academic Clinical Program, Singapore
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31
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Hung AL, Moran D, Vakili S, Fialho H, Sankey EW, Jusué-Torres I, Elder BD, Goodwin CR, Lu J, Robison J, Rigamonti D. Predictors of Ventriculoperitoneal Shunt Revision in Patients with Idiopathic Normal Pressure Hydrocephalus. World Neurosurg 2016; 90:76-81. [DOI: 10.1016/j.wneu.2016.02.061] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 02/12/2016] [Accepted: 02/12/2016] [Indexed: 11/16/2022]
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32
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McCracken JA, Bahl A, McMullan J. Percutaneous ultrasound-guided insertion of ventriculo-atrial shunts. Br J Neurosurg 2016; 30:411-3. [PMID: 27025913 DOI: 10.3109/02688697.2016.1161169] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Ventriculo-atrial (VA) shunts have been in use for >60 years but less frequently so of late. This is due to a combination of the risk of cardiac complications, lack of expertise and a lengthy operation. We present our consecutive prospective series of 10 VA shunts inserted using a percutaneous method employing the Sonowand Invite™ neuronavigation system for both the distal and proximal catheters, over a 13-month period. We had two complications of cases needing revision, but our series highlights a safe and reproducible method of inserting a VA shunt. About 30% of the procedures were carried out by a trainee as the primary surgeon. This technique does not necessarily require the expertise of a complex hydrocephalus surgeon and is thus able to be in the armoury of any neurosurgeon needing to do a VA shunt procedure. The indications, operative data and outcomes of our patients are discussed.
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Affiliation(s)
| | - Anuj Bahl
- b Department of Neurosurgery , Sheffield Teaching Hospitals , Sheffield , UK ;,c Department of Neurosurgery , Hull and East Yorkshire Hospitals , Hull , UK
| | - John McMullan
- b Department of Neurosurgery , Sheffield Teaching Hospitals , Sheffield , UK
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33
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Moran D, Hung A, Vakili S, Fialho H, Jeon L, Sankey EW, Jusué-Torres I, Lu J, Goodwin CR, Elder BD, Rigamonti D. Comparison of outcomes between patients with idiopathic normal pressure hydrocephalus who received a primary versus a salvage shunt. J Clin Neurosci 2016; 29:117-20. [PMID: 26898583 DOI: 10.1016/j.jocn.2015.12.009] [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: 12/08/2015] [Accepted: 12/17/2015] [Indexed: 10/22/2022]
Abstract
Placement of a ventriculoperitoneal (VP) shunt is the treatment of choice for communicating hydrocephalus; however, the extent to which VP shunting is able to relieve symptoms in patients who had previously been treated with cerebrospinal fluid diverting therapy at an outside institution remains unclear. A retrospective review of patients with idiopathic normal pressure hydrocephalus treated with VP shunts at a single institution between 1993 and 2013 was conducted. Patients were classified as having received a primary VP shunt if they had not been previously treated with a VP shunt, ventriculoatrial shunt, lumboperitoneal shunt, or endoscopic third ventriculostomy. Patients were classified as having received a salvage VP shunt if they had been previously treated by one of these four modalities at an outside institution prior to their presentation to our institution. There were 357 patients who received a primary shunt and 33 patients who received a salvage shunt. Patients who had a salvage shunt placed had significantly higher odds of requiring a future revision (54% versus 41%; odds ratio=2.85; 95% confidence interval [CI]: 1.24-6.57; p=0.014). Patients who received a salvage shunt had statistically significantly lower rates of gait improvement at 6months in comparison to patients who received a primary shunt (relative risk=0.35; 95% CI: 0.14-0.87; p=0.025). Despite these findings, there was no significant difference at last follow-up in improvement in gait, continence, and cognition, indicating that outcomes for patients requiring a salvage shunt were comparable to patients receiving a primary shunt.
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Affiliation(s)
- Dane Moran
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, MD 21287, USA
| | - Alice Hung
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, MD 21287, USA
| | - Sharif Vakili
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, MD 21287, USA
| | - Hugo Fialho
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, MD 21287, USA
| | - Lee Jeon
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, MD 21287, USA
| | - Eric W Sankey
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, MD 21287, USA
| | - Ignacio Jusué-Torres
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, MD 21287, USA
| | - Jennifer Lu
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, MD 21287, USA
| | - C Rory Goodwin
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, MD 21287, USA
| | - Benjamin D Elder
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, MD 21287, USA.
| | - Daniele Rigamonti
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, MD 21287, USA
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