Simple Removal of Ventriculoatrial Shunt and Simultaneous Ventriculoperitoneal Shunt Revision: Short Communication

Abstract Background Ventriculoatrial shunt (VAS) is a common alternative treatment option for hydrocephalus in patients with ventriculoperitoneal shunt (VPS) failure. Most previous reports on VAS discuss the atrial-related complications and none focus on simple removal (i.e., without specialized equipment). We report a case of simple VAS removal and simultaneous VPS revision, with no obvious shunt-related cardiac complications. Case presentation The patient was an 87-year-old female who had received a VAS for idiopathic normal pressure hydrocephalus 6 years prior. She developed a right thalamic hemorrhage with intraventricular hemorrhage and was admitted to our hospital. She had a recurrence of the hydrocephalus and was diagnosed with shunt malfunction, due to simple obstruction without obvious shunt-related cardiac complications. The VAS was simply and safely removed, and a VPS was simultaneously placed, as per the usual procedure in our institution. She remains well with no evidence of complications on postoperative day 10. Discussion Since VAS is mostly used in pediatric cases that are difficult to treat with VPS, the duration of time elapsed allows VAS catheters to form strong adhesions with the surrounding cardiac tissue. Therefore, the simple removal of VAS is usually not straightforward. Conclusion If the follow-up period is short and there are no specific cardiac complications at the time of replacement, VAS can be safely removed and VPS can be spontaneously placed, without any specialized surgical techniques or equipment.

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RADIONUCLIDE SHUNT PATENCY STUDY FOR EVALUATION OF SUSPECTED VENTRICULOPERITONEAL SHUNT MALFUNCTION IN ADULTS WITH NORMAL PRESSURE HYDROCEPHALUS

Neurosurgery ◽

10.1227/01.neu.0000343545.93153.eb ◽

2009 ◽

Vol 64 (5) ◽

pp. 909-918 ◽

Cited By ~ 12

Author(s):

Siddharth Kharkar ◽

John Shuck ◽

Sumit Kapoor ◽

Sachin Batra ◽

Michael A. Williams ◽

...

Keyword(s):

Ventriculoperitoneal Shunt ◽

Revision Surgery ◽

Diagnostic Algorithm ◽

Normal Pressure ◽

Shunt Revision ◽

Ventriculoatrial Shunt ◽

Partial Obstruction ◽

Factors Associated ◽

Simpler Algorithm ◽

Shunt Obstruction

Abstract OBJECTIVE Shunt patency studies are performed to determine whether shunt revision surgery is needed in malfunctioned ventriculoperitoneal shunt. The aim of our study was to develop a simple diagnostic algorithm in the diagnostic workup and identify factors associated with improvement after revision surgery. METHODS A retrospective review of patients with confirmed shunt obstruction who underwent a revision surgery and were followed for 6 to 12 months was performed. A simpler algorithm to identify shunt obstruction was created and compared with the 4-variable algorithm. RESULTS Of the 63 patients in whom shunt obstruction was suspected, 39 were diagnosed with complete or partial obstruction. Thirty-seven patients underwent shunt revision surgery that included removal of shunt (n = 2), conversion to a ventriculoatrial shunt (n = 8), and relocation of the distal end of the catheter into a different part of the peritoneal cavity (n = 27). Improvements were seen in 63.3% (n = 19) of patients evaluated at 6 months and 63.6% (n = 14) of patients evaluated at 12 months. The positive predictive value of the study was 80%. A simpler 1-variable algorithm using T1/2 (half-time) could correctly classify 86.9% of patients with shunt obstruction, compared with a 4-variable algorithm that correctly classified 80% of patients. CONCLUSION Shunt patency studies are very useful for evaluation of shunt patency. Their results can be interpreted using a single-variable (T1/2) algorithm. Patients most likely to respond to a revision surgery are those who had a good response to original placement of a ventriculoperitoneal shunt.

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Shunt Revision to Ventriculoatrial Shunt Due to Long-Term Abdominal Distension Complicated by Neonatal Necrotizing Enterocolitis and Cerebrospinal Fluid Overproduction after Ventriculoperitoneal Shunt for the Management of Post-Hemorrhagic Hydrocephalus: A Case Report

The Nerve ◽

10.21129/nerve.2019.5.2.90 ◽

2019 ◽

Vol 5 (2) ◽

pp. 90-93

Author(s):

Kyoung Jae Park ◽

Yong Cheol Lim ◽

Soo Han Yoon

Keyword(s):

Cerebrospinal Fluid ◽

Case Report ◽

Necrotizing Enterocolitis ◽

Ventriculoperitoneal Shunt ◽

Abdominal Distension ◽

Shunt Revision ◽

Ventriculoatrial Shunt ◽

Neonatal Necrotizing Enterocolitis

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Predictors of Ventriculoperitoneal Shunt Revision in Patients with Idiopathic Normal Pressure Hydrocephalus

World Neurosurgery ◽

10.1016/j.wneu.2016.02.061 ◽

2016 ◽

Vol 90 ◽

pp. 76-81 ◽

Cited By ~ 3

Author(s):

Alice L. Hung ◽

Dane Moran ◽

Sharif Vakili ◽

Hugo Fialho ◽

Eric W. Sankey ◽

...

Keyword(s):

Normal Pressure Hydrocephalus ◽

Ventriculoperitoneal Shunt ◽

Normal Pressure ◽

Idiopathic Normal Pressure Hydrocephalus ◽

Shunt Revision

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Predictors of Ventriculoperitoneal Shunt Revision in Patients with Idiopathic Normal Pressure Hydrocephalus

10.1055/s-0038-1672418 ◽

2018 ◽

Author(s):

Hugo Fialho ◽

Alice Hung ◽

Dane Moran ◽

Sharif Vakili ◽

Eric Sankey ◽

...

Keyword(s):

Normal Pressure Hydrocephalus ◽

Ventriculoperitoneal Shunt ◽

Normal Pressure ◽

Idiopathic Normal Pressure Hydrocephalus ◽

Shunt Revision

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Hemorrhagic abdominal pseudocyst following ventriculoperitoneal shunt: a case report

BMC Surgery ◽

10.1186/s12893-021-01161-y ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Hong-Cai Wang ◽

Yi-Lei Tong ◽

Shi-Wei Li ◽

Mao-Song Chen ◽

Bo-Ding Wang ◽

...

Keyword(s):

Fibrous Tissue ◽

Clinical Signs ◽

Chronic Subdural Hematoma ◽

Normal Pressure ◽

Cystic Mass ◽

Shunt Revision ◽

Subdural Effusion ◽

Palpable Mass ◽

Vp Shunt ◽

Abdominal Pseudocyst

Abstract Background Abdominal cerebrospinal fluid (CSF) pseudocyst is an uncommon but important complication of ventriculoperitoneal (VP) shunts. While individual articles have reported many cases of abdominal CSF pseudocyst following VP shunts, no case of a hemorrhagic abdominal pseudocyst after VP shunts has been reported so far. Case presentation This article reports a 68-year-old woman with a 4-month history of progressive abdominal pain and distention. She denied any additional symptoms. A VP shunt was performed 15 years earlier to treat idiopathic normal pressure hydrocephalus and no other abdominal surgery was performed. Physical examination revealed an elastic palpable mass in her right lower abdomen, which was dull to percussion. Abdominal computed tomography (CT) scan indicated a large cystic collection of homogenous iso-density fluid in the right lower abdominal region with clear margins. The distal segment of the peritoneal shunt catheter was located within the cystic mass. Abdominal CSF pseudocyst was highly suspected as a diagnosis. Laparoscopic cyst drainage with removal of the whole cystic mass was performed, 15-cm cyst which found with thick walls and organized chronic hematic content. No responsible vessel for the cyst hemorrhage was identified. No further shunt revision was placed. Histological examination showed that the cyst wall consisted of outer fibrous tissue and inner granulation tissue without epithelial lining, and the cystic content was chronic hematoma. The patient had an uneventful postoperative course and remained asymptomatic for 8-mo follow-up. Conclusion To the best of our knowledge, this is the first report of hemorrhagic onset in the abdominal pseudocyst following VP shunt. Such special condition can accelerate the appearance of clinical signs of the abdominal pseudocyst after VP shunts, and its mechanisms may be similar to the evolution of subdural effusion into chronic subdural hematoma (CSDH).

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Neurogenic pulmonary oedema complicating ventriculoperitoneal shunt revision in a child

Pediatric Anesthesia ◽

10.1111/j.1460-9592.1994.tb00175.x ◽

1994 ◽

Vol 4 (4) ◽

pp. 259-262

Author(s):

JOHN B. ROSE

Keyword(s):

Pulmonary Oedema ◽

Ventriculoperitoneal Shunt ◽

Shunt Revision ◽

Neurogenic Pulmonary Oedema

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Distal Ventriculoatrial Shunt Revision in Adult Myelomeningocele Patient Performed via Endovascular Transvenous Approach

World Neurosurgery ◽

10.1016/j.wneu.2018.09.129 ◽

2019 ◽

Vol 121 ◽

pp. 24-27

Author(s):

Abigail J. Rao ◽

Zoe Teton ◽

Victor Rodriguez ◽

Brandon H. Tieu ◽

Ahmed M. Raslan

Keyword(s):

Shunt Revision ◽

Ventriculoatrial Shunt ◽

Transvenous Approach

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Stenotrophomonas maltophilia as a rare cause of meningitis and ventriculoperitoneal shunt infection

Access Microbiology ◽

10.1099/acmi.0.000266 ◽

2021 ◽

Vol 3 (10) ◽

Author(s):

Adarsh Manuel ◽

Akarsh Jayachandran ◽

Srinivasan Harish ◽

Thenozhi Sunil ◽

Vishnu Das K. R. ◽

...

Keyword(s):

Ventriculoperitoneal Shunt ◽

Stenotrophomonas Maltophilia ◽

Type Species ◽

Shunt Infection ◽

Young Female ◽

Shunt Revision ◽

Content Type ◽

Shunt Tube ◽

Link Type ◽

Ventriculoperitoneal Shunt Infection

Stenotrophomonas maltophilia is an extremely rare pathogen responsible for ventriculoperitoneal shunt infection and meningitis. This young female patient with history of multiple shunt revisions in the past, came to us with shunt dysfunction and exposure of the ventriculoperitoneal shunt tube in the neck. The abdominal end of the shunt tube was seen migrating into the bowel during shunt revision. The cerebrospinal fluid analysis showed evidence of Stenotrophomonas maltophilia growth. This is the first reported case of Stenotrophomonas maltophilia meningitis associated with ventriculoperitoneal shunt migration into the bowel.

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