Incidence of and Causes for Ventriculoperitoneal Shunt Failure in Children Younger Than 2 Years: A Systematic Review

Objectives Ventriculoperitoneal (VP) shunting is commonly used to treat pediatric hydrocephalus, but failure rates are high. VP shunt failure in children is mostly caused by infection and/or proximal/distal shunt obstruction. However, to our knowledge, no previous reviews have discussed this topic using only clinical studies when age-related data could be obtained. This systematic review aimed at reevaluating what is already known as the most common causes of shunt failure and to determine the incidence and causes of VP shunt failure during the first 2 years of life as a step to establish solid evidence-based guidelines to avoid VP shunt failure in infants. Methods We performed a search using the search terms “Cerebrospinal Fluid Shunts” (Medical Subject Headings [MeSH]) AND failure [All Fields] AND (“humans” [MeSH] AND English [lang] AND “infant” [MeSH]). Only articles that specifically discussed VP shunt complications in children < 2 years were included. Results We found that the most common causes of VP shunt failure in children < 2 years were shunt obstruction and infection, both observed in a range. Conclusion VP shunt failure is very common in infants, mostly resulting from obstruction and infection. Future studies should focus on methods designed to avoid these complications or on alternative treatments for hydrocephalus.

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Pediatric hydrocephalus: systematic literature review and evidence-based guidelines. Part 3: Endoscopic computer-assisted electromagnetic navigation and ultrasonography as technical adjuvants for shunt placement

Journal of Neurosurgery Pediatrics ◽

10.3171/2014.7.peds14323 ◽

2014 ◽

Vol 14 (Supplement_1) ◽

pp. 24-29 ◽

Cited By ~ 24

Author(s):

Ann Marie Flannery ◽

Ann-Christine Duhaime ◽

Mandeep S. Tamber ◽

Joanna Kemp

Keyword(s):

Systematic Review ◽

Task Force ◽

Catheter Placement ◽

Computer Assisted ◽

Ventricular Catheter ◽

Evidence Based ◽

Electromagnetic Navigation ◽

Shunt Placement ◽

Pediatric Hydrocephalus ◽

Evidence Based Guidelines

Object This systematic review was undertaken to answer the following question: Do technical adjuvants such as ventricular endoscopic placement, computer-assisted electromagnetic guidance, or ultrasound guidance improve ventricular shunt function and survival? Methods The US National Library of Medicine PubMed/MEDLINE database and the Cochrane Database of Systematic Reviews were queried using MeSH headings and key words specifically chosen to identify published articles detailing the use of cerebrospinal fluid shunts for the treatment of pediatric hydrocephalus. Articles meeting specific criteria that had been delineated a priori were then examined, and data were abstracted and compiled in evidentiary tables. These data were then analyzed by the Pediatric Hydrocephalus Systematic Review and Evidence-Based Guidelines Task Force to consider evidence-based treatment recommendations. Results The search yielded 163 abstracts, which were screened for potential relevance to the application of technical adjuvants in shunt placement. Fourteen articles were selected for full-text review. One additional article was selected during a review of literature citations. Eight of these articles were included in the final recommendations concerning the use of endoscopy, ultrasonography, and electromagnetic image guidance during shunt placement, whereas the remaining articles were excluded due to poor evidence or lack of relevance. The evidence included 1 Class I, 1 Class II, and 6 Class III papers. An evidentiary table of relevant articles was created. Conclusions Recommendation: There is insufficient evidence to recommend the use of endoscopic guidance for routine ventricular catheter placement. Strength of Recommendation: Level I, high degree of clinical certainty. Recommendation: The routine use of ultrasound-assisted catheter placement is an option. Strength of Recommendation: Level III, unclear clinical certainty. Recommendation: The routine use of computer-assisted electromagnetic (EM) navigation is an option. Strength of Recommendation: Level III, unclear clinical certainty.

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Pediatric hydrocephalus: systematic literature review and evidence-based guidelines. Part 1: Introduction and methodology

Journal of Neurosurgery Pediatrics ◽

10.3171/2014.7.peds14321 ◽

2014 ◽

Vol 14 (Supplement_1) ◽

pp. 3-7 ◽

Cited By ~ 28

Author(s):

Ann Marie Flannery ◽

Laura Mitchell

Keyword(s):

Systematic Review ◽

Literature Review ◽

Systematic Literature Review ◽

Task Force ◽

Clinical Information ◽

Evidence Based ◽

Educational Tool ◽

Pediatric Hydrocephalus ◽

Appropriate Treatment ◽

Evidence Based Guidelines

This clinical systematic review of and evidence-based guidelines for the treatment of pediatric hydrocephalus were developed by a physician volunteer task force. They are provided as an educational tool based on an assessment of current scientific and clinical information as well as accepted approaches to treatment. They are not intended to be a fixed protocol, because some patients may require more or less treatment. In Part 1, the authors introduce the reader to the complex topic of hydrocephalus and the lack of consensus on its appropriate treatment. The authors describe the development of the Pediatric Hydrocephalus Systematic Review and Evidence-Based Guidelines Task Force charged with reviewing the literature and recommending treatments for hydrocephalus, and they set out the basic methodology used throughout the specific topics covered in later chapters.

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Laparoscopic versus open insertion of the peritoneal catheter in ventriculoperitoneal shunt placement: review of 810 consecutive cases

Journal of Neurosurgery ◽

10.3171/2011.1.jns101492 ◽

2011 ◽

Vol 115 (1) ◽

pp. 151-158 ◽

Cited By ~ 45

Author(s):

Robert P. Naftel ◽

Joshua L. Argo ◽

Chevis N. Shannon ◽

Tracy H. Taylor ◽

R. Shane Tubbs ◽

...

Keyword(s):

Blood Loss ◽

Catheter Insertion ◽

Shunt Failure ◽

Shunt Surgery ◽

Distal Catheter ◽

Vp Shunt ◽

Shunt Placement ◽

Asa Score ◽

Distal Obstruction ◽

Shunt Obstruction

Object Traditional ventriculoperitoneal (VP) shunt surgery involves insertion of the distal catheter by minilaparotomy. However, minilaparotomy may be a significant source of morbidity during shunt surgery. Laparoscopic insertion of the distal catheter is an alternative technique that may simplify and improve the safety of shunt surgery. Methods The authors performed a retrospective review of hospital records of all patients undergoing new VP shunt insertion at a tertiary care center between 2004 and 2009. Patient characteristics and outcomes were compared between patients undergoing open or laparoscopic insertion of the distal catheter. Independent variables in the analysis included age, sex, race, body mass index, surgical technique, previous VP shunt placement, previous abdominal procedures, American Society of Anesthesiology (ASA) score, and indication for shunt placement. Dependent variables included the occurrence of shunt failure, cause of shunt failure, complications, length of stay (LOS), LOS after shunt placement, estimated blood loss, and operative time. Results The authors identified 810 patients who met the inclusion criteria; open or laparoscopic distal catheter insertion was performed in 335 and 475 patients, respectively. There were no significant differences between the groups regarding age, race, ASA score, or indication for shunt placement. The most common indication was hydrocephalus due to subarachnoid hemorrhage, followed by tumor-associated hydrocephalus, normal pressure hydrocephalus (NPH), and hydrocephalus due to trauma. The incidence of shunt failure was not statistically different between cohorts, occurring in 20.0% of laparoscopic and 20.9% of open catheter placement cases (p = 0.791). With analysis of causes of shunt failure, shunt obstruction occurred significantly more often in the open surgery cohort (p = 0.012). In patients with a known cause shunt obstruction, distal obstruction occurred in 35.7% of the open cohort obstructions and 4.8% of the laparoscopic cohort obstructions (p = 0.014). The relative risk of distal obstruction in open cases compared with laparoscopic cases was 7.50. Infections occurred in 8.2% of laparoscopic cases compared with 6.6% of open cases (p = 0.419). Within the NPH subgroup, the laparoscopically treated patients had significantly more overdrainage (p = 0.040), whereas those in the open cohort experienced significantly more shunt obstructions (p = 0.034). Laparoscopically treated patients had shorter operative times (p < 0.0005), inpatient LOS (p < 0.001), and inpatient LOS after VP shunt placement (p = 0.01) as well as less blood loss (p = 0.058). Conclusions To our knowledge this is the largest reported comparison of distal VP shunt catheter insertion techniques. Compared with minilaparotomy, the laparoscopic approach was associated with decreased time in the operating room and a decreased LOS. Moreover, laparoscopy was associated with fewer distal shunt obstructions. Laparoscopic shunt surgery is a viable alternative to traditional shunt surgery.

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Erratum: Pediatric hydrocephalus: systematic literature review and evidence-based guidelines. Part 6: Preoperative antibiotics for shunt surgery in children with hydrocephalus: a systematic review and meta-analysis

Journal of Neurosurgery Pediatrics ◽

10.3171/2014.7.peds14326a ◽

2015 ◽

Vol 16 (2) ◽

pp. 237-239 ◽

Cited By ~ 2

Author(s):

Paul Klimo ◽

Ann Marie Flannery

Keyword(s):

Systematic Review ◽

Literature Review ◽

Systematic Literature Review ◽

Meta Analysis ◽

Evidence Based ◽

Shunt Surgery ◽

Pediatric Hydrocephalus ◽

Preoperative Antibiotics ◽

Evidence Based Guidelines

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Pediatric hydrocephalus: systematic literature review and evidence-based guidelines. Part 5: Effect of valve type on cerebrospinal fluid shunt efficacy

Journal of Neurosurgery Pediatrics ◽

10.3171/2014.7.peds14325 ◽

2014 ◽

Vol 14 (Supplement_1) ◽

pp. 35-43 ◽

Cited By ~ 29

Author(s):

Lissa C. Baird ◽

Catherine A. Mazzola ◽

Kurtis I. Auguste ◽

Paul Klimo ◽

Ann Marie Flannery

Keyword(s):

Systematic Review ◽

Task Force ◽

Treatment Options ◽

Evidence Based ◽

Moderate Degree ◽

Class Iii ◽

Insufficient Evidence ◽

Pediatric Hydrocephalus ◽

Programmable Valve ◽

Evidence Based Guidelines

Object The objective of this systematic review was to examine the existing literature to compare differing shunt components used to treat hydrocephalus in children, find whether there is a superior shunt design for the treatment of pediatric hydrocephalus, and make evidence-based recommendations for the selection of shunt implants when placing shunts. Methods Both the US National Library of Medicine PubMed/MEDLINE database and the Cochrane Database of Systematic Reviews were queried using MeSH headings and key words chosen to identify publications comparing the use of shunt implant components. Abstracts of these publications were reviewed, after which studies meeting the inclusion criteria were selected. An evidentiary table was compiled summarizing the selected articles and quality of evidence. These data were then analyzed by the Pediatric Hydrocephalus Systematic Review and Evidence-Based Guidelines Task Force to consider evidence-based treatment recommendations. Results Two hundred sixty-nine articles were identified using the search parameters, and 43 articles were recalled for full-text review. Of these, 22 papers met the study criteria for a comparison of shunt components and were included in the evidentiary table. The included studies consisted of 1 Class I study, 11 Class II studies, and 10 Class III studies. The remaining 21 articles were excluded. Conclusions An analysis of the evidence did not demonstrate a clear advantage for any specific shunt component, mechanism, or valve design over another. Recommendation: There is insufficient evidence to demonstrate an advantage for one shunt hardware design over another in the treatment of pediatric hydrocephalus. Current designs described in the evidentiary tables are all treatment options. Strength of Recommendation: Level I, high degree of clinical certainty. Recommendation: There is insufficient evidence to recommend the use of a programmable valve versus a nonprogrammable valve. Programmable and nonprogrammable valves are both options for the treatment of pediatric hydrocephalus. Strength of Recommendation: Level II, moderate degree of clinical certainty.

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Pediatric hydrocephalus: systematic literature review and evidence-based guidelines. Part 4: Cerebrospinal fluid shunt or endoscopic third ventriculostomy for the treatment of hydrocephalus in children

Journal of Neurosurgery Pediatrics ◽

10.3171/2014.7.peds14324 ◽

2014 ◽

Vol 14 (Supplement_1) ◽

pp. 30-34 ◽

Cited By ~ 46

Author(s):

David D. Limbrick ◽

Lissa C. Baird ◽

Paul Klimo ◽

Jay Riva-Cambrin ◽

Ann Marie Flannery

Keyword(s):

Systematic Review ◽

Cerebrospinal Fluid ◽

Endoscopic Third Ventriculostomy ◽

Task Force ◽

Third Ventriculostomy ◽

Evidence Based ◽

Class Iii ◽

Csf Shunts ◽

Pediatric Hydrocephalus ◽

Evidence Based Guidelines

Object The objective of this systematic review was to examine the existing literature comparing CSF shunts and endoscopic third ventriculostomy (ETV) for the treatment of pediatric hydrocephalus and to make evidence-based recommendations regarding the selection of surgical technique for this condition. Methods Both the US National Library of Medicine and the Cochrane Database of Systematic Reviews were queried using MeSH headings and key words specifically chosen to identify published articles detailing the use of CSF shunts and ETV for the treatment of pediatric hydrocephalus. Articles meeting specific criteria that had been determined a priori were examined, and data were abstracted and compiled in evidentiary tables. These data were then analyzed by the Pediatric Hydrocephalus Systematic Review and Evidence-Based Guidelines Task Force to consider treatment recommendations based on the evidence. Results Of the 122 articles identified using optimized search parameters, 52 were recalled for full-text review. One additional article, originally not retrieved in the search, was also reviewed. Fourteen articles met all study criteria and contained comparative data on CSF shunts and ETV. In total, 6 articles (1 Class II and 5 Class III) were accepted for inclusion in the evidentiary table; 8 articles were excluded for various reasons. The tabulated evidence supported the evaluation of CSF shunts versus ETV. Conclusions Cerebrospinal fluid shunts and ETV demonstrated equivalent outcomes in the clinical etiologies studied. Recommendation: Both CSF shunts and ETV are options in the treatment of pediatric hydrocephalus. Strength of Recommendation: Level II, moderate clinical certainty.

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Changes in aqueous and vitreous inflammatory cytokine levels in neovascular age-related macular degeneration: A systematic review and meta-analysis

10.26226/morressier.5e61463c250f7ee26aeb41ed ◽

2020 ◽

Author(s):

Samuel Minaker

Keyword(s):

Systematic Review ◽

Macular Degeneration ◽

Inflammatory Cytokine ◽

Meta Analysis ◽

Age Related Macular Degeneration ◽

Age Related ◽

Cytokine Levels

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Faculty of 1000 evaluation for A systematic review on zinc for the prevention and treatment of age-related macular degeneration.

F1000 - Post-publication peer review of the biomedical literature ◽

10.3410/f.718008525.793478652 ◽

2013 ◽

Author(s):

David Boyer

Keyword(s):

Systematic Review ◽

Macular Degeneration ◽

Age Related Macular Degeneration ◽

Age Related ◽

Prevention And Treatment

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Pathogenesis of Age-related Cataract: a systematic review of proteomic studies

Current Proteomics ◽

10.2174/1570164617999201020205100 ◽

2020 ◽

Vol 17 ◽

Author(s):

Christina Karakosta ◽

Argyrios Tzamalis ◽

Michalis Aivaliotis ◽

Ioannis Tsinopoulos

Keyword(s):

Systematic Review ◽

Oxidant Stress ◽

Critical Role ◽

Human Lens ◽

Nuclear Cataract ◽

Cataract Formation ◽

Post Translational Modification ◽

Ability To Act ◽

Age Related

Background/Objective:: The aim of this systematic review is to identify all the available data on human lens proteomics with a critical role to age-related cataract formation in order to elucidate the physiopathology of the aging lens. Materials and Methods:: We searched on Medline and Cochrane databases. The search generated 328 manuscripts. We included nine original proteomic studies that investigated human cataractous lenses. Results:: Deamidation was the major age-related post-translational modification. There was a significant increase in the amount of αA-crystallin D-isoAsp58 present at all ages, while an increase in the extent of Trp oxidation was apparent in cataract lenses when compared to aged normal lenses. During aging, enzymes with oxidized cysteine at critical sites included GAPDH, glutathione synthase, aldehyde dehydrogenase, sorbitol dehydrogenase, and PARK7. Conclusion:: D-isoAsp in αA crystallin could be associated with the development of age-related cataract in human, by contributing to the denaturation of a crystallin, and decreasing its ability to act as a chaperone. Oxidation of Trp may be associated with nuclear cataract formation in human, while the role of oxidant stress in age-related cataract formation is dominant.

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