710 A Novel Ventriculoperitoneal Shunt Design Aiming to Reduce Shunt Failure Rates

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
L McColm ◽  
E E Asbalaili ◽  
T Khandakar ◽  
N A Razak ◽  
A T Yuyi ◽  
...  
Keyword(s):  
Shunt Insertion ◽  
Vp Shunt ◽  
Design Concepts ◽  
Common Causes ◽  
Patient Health ◽  
Subsequent Revision ◽  
Financial Burdens ◽  
Different Diameters ◽  
Alternative Routes ◽  
Revision Operations

Abstract Introduction Ventriculoperitoneal (VP) shunt insertion is the most common surgical treatment for hydrocephalus. While shunt obstructions are frequent and subsequent revision operations carry significant morbidity, there is limited advancement in shunt design to address this problem. Method A literature review of aetiology and mechanism of shunt blockage was performed. Design concepts of current medical and non-medical grade devices were studied. Design improvements to VP shunt were focused on the proximal catheter and lumen configuration. Concept dimensions and computer flow simulations using different diameters were generated. Results An improved prototype VP shunt design was proposed. It has multiple lumens and communicating channels between neighbouring lumens to provide alternative routes for cerebrospinal fluid drainage in the event of individual lumen obstruction. Our design also features a novel cone-shaped proximal end to minimise occlusion by nearby choroid plexus. Conclusions By targeting common causes of VP shunt blockage through proposed novel design, the mean service-life of shunts can be extended, necessitating fewer revision procedures and reducing both patient health and financial burdens. Further investigation, optimisation, and validation of this proposed shunt design is required before further product development.

ENDOSCOPIC THIRD VENTRICULOSTOMY (ETV) IS A BETTER ALTERNATIVE FOR VP SHUNT FAILURE IN NON-COMMUNICATING HYDROCEPHALUS

2021 ◽  
pp. 65-67
Author(s):  
Ramesh Tanger ◽  
Dinesh Kumar Barolia ◽  
Arka Chatterjee ◽  
Punit Singh Parihar ◽  
Arun Gupta
Keyword(s):  
Success Rate ◽  
Endoscopic Third Ventriculostomy ◽  
Obstructive Hydrocephalus ◽  
Shunt Revision ◽  
Third Ventriculostomy ◽  
Communicating Hydrocephalus ◽  
Shunt Failure ◽  
Shunt Insertion ◽  
Vp Shunt

CONTEXT: VP Shunt is most commonly used procedure for hydrocephalus but shunt failure is also the common complication in many patients. Endoscopic third ventriculostomy (ETV) is an accepted procedure for the treatment of obstructive hydrocephalus. The aim of our study is to evaluate the success rate AIM AND OBJECTIVE - of ETV in patients of obstructive hydrocephalus formerly treated by ventriculo-peritoneal (VP shunt) shunt. The failure VP shunt was removed before ETV. MATERIALS AND METHOD: This study was conducted between June 2015 and December 2019 in single unit of our department. Twenty one (n=21) patients were enrolled for this study. All patients were admitted with failure of VP shunt. They were known case of non-communicating hydrocephalus previously operated for VP shunt. Six patients were excluded for ETV because CT/MRI show grossly distorted anatomy of ventricles. Endoscopic third ventriculostomy was attempted in 15 patients, but ventriculostomy was done successfully in 10 patients, rests were treated with revision of VP shunt. All patients in this study were radiologically diagnosed RESULTS: case of hydrocephalus due to aqueduct stenosis. They were experienced VP shunt insertion but there were failure of shunt due to any reason. ETV procedures were done successfully in 10 patients. Out of 10 patients one patient needed shunt insertion due ineffective ETV. Shunt revision was done in 11 patients. There was no serious complication during and after ETV procedures. The follow-up period of patients with successful ETV was 6–60 months. This follow-up was uneventful and peaceful for their parents. ETV can be considered as an alternative treatment for the patients w CONCLUSION: ith VP shunt failure with an acceptable success rate of 80%, although long-term follow-up is needed for these patients.

Differences in Outcome Between Open vs Laparoscopic Insertion of Ventriculoperitoneal Shunts

2021 ◽  
pp. 000313482110505
Author(s):  
Aaron B. Lopacinski ◽  
Kevin M. Guy ◽  
Jessica R. Burgess ◽  
Jay N. Collins
Keyword(s):  
Abdominal Surgery ◽  
General Surgery ◽  
Operation Time ◽  
Laparoscopic Group ◽  
Prior History ◽  
Team Approach ◽  
Tertiary Referral Hospital ◽  
Shunt Insertion ◽  
Vp Shunt ◽  
History Of

Background Abdominal access during ventriculoperitoneal (VP) shunt insertion has historically been obtained by neurosurgeons via an open abdominal approach. With recent advances in laparoscopy, neurosurgeons frequently consult general surgery for aid during the procedure. The goal of this study is to identify if laparoscopic assistance improves the overall outcomes of the procedure. Methods This retrospective study included all patients who underwent open or laparoscopic VP shunt placement between September 2012 and August 2020 at our tertiary referral hospital. Patient demographics, comorbidities, prior history of abdominal surgery, open vs. laparoscopic insertion, operation time, and complications within 30 days were obtained. Results Neurosurgery placed 107 shunts using an open abdominal technique and general surgery placed 78 using laparoscopy. The average OR time in minutes was 75.5 minutes for the open cohort and 61.8 for the laparoscopic cohort ( p = 0.006). In patients without a history of abdominal surgery, the average OR time in minutes was 79.4 in the open cohort and 57.1 in the laparoscopic cohort ( p = 0.015). The postoperative shunt infection rate was 10.2% in the open group and 3.8% in the laparoscopic group ( p = 0.077). Discussion Laparoscopic placement of VP shunts is a reasonable alternative to open placement and results in shorter OR times. There is also a trend toward few infections in the laparoscopic placement. There appears to be an advantage with a team approach and laparoscopic placement of the peritoneal portion of the shunt.

Ventriculoperitoneal Shunt versus Endoscopic Third Ventriculostomy in the treatment of Obstructive Hydrocephalus in Pediatric Midline Posterior Fossa tumors

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Mohammed Tarek ◽  
Hamdy Ibrahim ◽  
H Jalalod'din ◽  
SR Tawadros
Keyword(s):  
Posterior Fossa ◽  
Ventriculoperitoneal Shunt ◽  
Endoscopic Third Ventriculostomy ◽  
Obstructive Hydrocephalus ◽  
Clinical Findings ◽  
Third Ventriculostomy ◽  
Posterior Fossa Tumors ◽  
Shunt Insertion ◽  
Vp Shunt ◽  
Csf Diversion

Abstract Background Treatment of secondary hydrocephalus due to posterior fossa tumors in these children is still a matter of controversy, although preoperative ventriculo-peritoneal shunt (VP shunt) insertion before tumor excision is widely accepted among neurosurgeons but many attempts are rising to minimize permanent VP shunt insertion and associated complications and introducing third endoscopic ventriculostomy (ETV) as one of the options of 2ry hydrocephalus. Objectives Comparing the post-operative clinical success with resolution of the manifestations and post-operative complications between endoscopic third ventriculostomy and ventriculoperitoneal shunt as different modes of CSF diversion in children with 2ry hydrocephalus due to midline posterior fossa tumors. Methods The following electronic databases were searched from June 2009 to june2019: PubMed, Google scholar search engine. Cochrane database of systematic reviews, EMBASE and science Direct, using the keywords ―hydrocephalus; posterior fossa tumors; pediatrics; ventriculoperitoneal shunt; endoscopic third ventriculostomy‖. Studies were eligible if they contain the target keywords in title or abstract, addressing the Pediatric age group with 2ry hydrocephalus due to de novo posterior fossa tumor manifested by signs of increase the intra cranial tension including persistent headache and vomiting, blurred vision, 6th nerve palsy, papilledema in fundus examination, acute DCL and 2ry hydrocephalus confirmed by brain imaging. Exclusion criteria included studies including age group below 1yr or above 18 yr, or patients with recurrent post fossa tumors and operated before or patients presented by failed previously attempt of CSF diversion. Results: A total of 1255 citations were screened for eligibility,6 studies were included in our systematic review discussing, comparing and evaluating the durability of ETV versus VP shunt in treatment the 2ry hydrocephalusdue to pediatric posterior fossa tumor.. Overall study population reached 474 patients. the overall clinical findings at presentation and postoperative outcomes regarding the clinical findings improvement, radiological improvement and postoperative complications between ETV and VP shunt are compared and showing that ETV should be considered as an alternative procedure to VP shunt in controlling severe hydrocephalus related to posterior fossa tumors to relieve symptoms quickly during the preoperative period when patients should wait for their definite tumor excision. Conclusion The shorter duration of surgery, the lower incidence of morbidity, the absence of mortality, the lower incidence of procedure failure of endoscopic third ventriculostomy as compared to ventriculoperitoneal shunt, and the significant advantage of not becoming shunt dependent make endoscopic third ventriculostomy to be recommended as the first choice in the treatment of pediatric patients with marked obstructive hydrocephalus due to posterior fossa tumors. It is a preliminary, simple, safe, effective, physiological, minimally invasive procedure for the relief of elevated intracranial pressure before direct tumor removal.

Breastfeeding: a potential protective factor against ventriculoperitoneal shunt infection in young infants

2008 ◽  
Vol 1 (2) ◽  
pp. 138-141 ◽  
Author(s):  
Farideh Nejat ◽  
Parvin Tajik ◽  
Syed Mohammad Ghodsi ◽  
Banafsheh Golestan ◽  
Reza Majdzadeh ◽  
...  
Keyword(s):  
Human Milk ◽  
Protective Factor ◽  
Medical Center ◽  
Shunt Infection ◽  
Trend Test ◽  
Shunt Insertion ◽  
Vp Shunt ◽  
Young Infants ◽  
Significant Difference ◽  
Nutritional Benefits

Object Previous studies have shown nutritional benefits of breastfeeding for a child's health, especially for protection against infection. Protective factors in human milk locally and systemically prevent infections in the gastrointestinal as well as upper and lower respiratory tracts. It remains unclear whether breastfeeding protects infants against ventriculoperitoneal (VP) shunt infection. Methods A cohort study was conducted from December 2003 to December 2006 at Children's Hospital Medical Center in Tehran, Iran. A total of 127 infants with hydrocephalus who were treated using a VP shunt in the first 6 months of life were enrolled. Each infant's breastfeeding method was classified as either exclusively breastfed (EBF), combination feedings of breast milk and formula (CFBF), or exclusively formula-fed (EFF). Infants were followed up to determine the occurrence of shunt infection within 6 months after operation. Statistical analysis was performed using survival methods. Results Infants ranged in age from 4 to 170 days at the time of shunt insertion (mean 69.6 days), and 57% were males. Regarding the breastfeeding categories, 57.5% were EBF, 25.2% were CFBF, and 17.3% were EFF. During the follow-up, shunt infection occurred in 16 patients, within 15 to 173 days after shunt surgery (median 49 days). The 6-month risk of shunt infection was 8.5% (95% confidence interval [CI] 4–18%) in the EBF group, 16.5% (95% CI 7–35%) in the CFBF group, and 26.0% (95% CI 12–52%) in the EFF group. There was no statistically significant difference between these 3 groups (p = 0.11). The trend test showed a significant trend between the extent of breastfeeding and the risk of shunt infection (p = 0.035), which persisted even after adjustment for potential confounding variables (hazard ratio = 2.01, 95% CI 1.01–4). Conclusions This study supports the protective effect of breastfeeding against shunt infection during the first 6 months of life and the presence of a dose–response relationship, such that the higher the proportion of an infant's feeding that comes from human milk, the lower the incidence of shunt infection. Encouraging mothers of infants with VP shunts to breastfeed exclusively in the first 6 months of life is recommended.

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

2018 ◽  
Vol 80 (01) ◽  
pp. 026-033 ◽  
Author(s):  
Ahmed Abdullah ◽  
Mohamed Alsawy ◽  
Mohamed Soliman ◽  
Ammar Ghaleb ◽  
Reem Elwy ◽  
...  
Keyword(s):  
Systematic Review ◽  
Shunt Failure ◽  
Medical Subject Headings ◽  
Vp Shunt ◽  
Related Data ◽  
Pediatric Hydrocephalus ◽  
Age Related ◽  
Common Causes ◽  
Evidence Based Guidelines ◽  
Shunt Obstruction

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.

scholarly journals P.096 Iatrogenic pseudoaneurysm of the MCA secondary to VP shunt insertion

2018 ◽  
Vol 45 (s2) ◽  
pp. S41-S41
Author(s):  
A Chalil ◽  
MD Staudt ◽  
SP Lownie
Keyword(s):  
Rare Complication ◽  
Insertion Site ◽  
Vascular Complications ◽  
Careful Consideration ◽  
External Carotid ◽  
Ventricular Catheter ◽  
Shunt Insertion ◽  
Vp Shunt ◽  
Pseudoaneurysm Formation ◽  
Dural Opening

Background: Ventriculoperitoneal (VP) shunting is a common treatment for hydrocephalus. Complications of VP shunt include infection, malfunction, and hemorrhage. Vascular complications such as pseudoaneurysm are rare, and usually involve the choroid plexus or branches of the external carotid artery. We present the case of a fusiform pseudoaneurysm of the middle cerebral artery arising due to VP shunt insertion. Methods: A 36-year-old female presented with a hypertensive cerebellar hemorrhage and hydrocephalus. This was treated with VP shunt placement with limited dural opening. Three weeks afterward there developed a diffuse intraventricular hemorrhage associated with hemorrhage at the cortical insertion site of the ventricular catheter. CT and catheter angiography revealed a fusiform pseudoaneurysm of the M4 segment of the MCA immediately adjacent to the ventricular catheter. Results: The VP shunt was removed, and the aneurysmal segment was coagulated and occluded. Delayed repeat VP shunt insertion was performed through the same entry point and trajectory via a larger dural opening. Conclusions: Pseudoaneurysm formation secondary to catheter insertion is a rare complication. To our knowledge, this is the second reported case of a cortical branch pseudoaneurysm in an adult. Careful consideration should be given to vascular anatomy when planning shunt insertions, and cruciate dural opening for local cortex visualization may help avoid this complication.

Conversion of external ventricular drains to ventriculoperitoneal shunts after aneurysmal subarachnoid hemorrhage: effects of site and protein/red blood cell counts on shunt infection and malfunction

2008 ◽  
Vol 109 (6) ◽  
pp. 1001-1004 ◽  
Author(s):  
Stylianos Rammos ◽  
Jeffrey Klopfenstein ◽  
Lori Augsburger ◽  
Huan Wang ◽  
Anne Wagenbach ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Blood Cell ◽  
Red Blood Cell ◽  
Shunt Infection ◽  
Adult Patients ◽  
Shunt Malfunction ◽  
Shunt Insertion ◽  
Vp Shunt ◽  
The Mean

Object The purpose of this study was to determine the incidence of shunt infection in patients with subarachnoid hemorrhage (SAH) after converting an external ventricular drain (EVD) to a ventriculoperitoneal (VP) shunt using the existing EVD site. The second purpose was to assess the risk of shunt malfunction after converting the EVD to a permanent shunt irrespective of the cerebrospinal fluid (CSF) protein and red blood cell (RBC) counts. Methods Data obtained in 80 consecutive adult patients (18 men and 62 women, mean age 60.8 years, range 33–85 years) who underwent direct conversion of an EVD to a VP shunt for post-SAH hydrocephalus between August 2002 and March 2007 were retrospectively reviewed. In each patient, the existing EVD site was used to pass the proximal shunt catheter. In no patient was VP shunt insertion delayed based on preoperative RBC or protein counts. Results The mean period of external ventricular drainage before VP shunt placement was 14.1 days (range 3–45 days). No patient suffered ventriculitis. The mean perioperative CSF protein level was 124 mg/dl (range 17–516 mg/dl). The mean and median perioperative RBC values in CSF were 14,203 RBCs/mm3 and 4600 RBCs/mm3 (range 119–290,000/mm3), respectively. No patient was lost to follow-up. The mean follow-up duration was 24 months (range 2–53 months). Three patients (3.8%) had shunt malfunction related to obstruction of the shunt system after 15 days, 2 months, and 18 months, respectively. There were no shunt-related infections. No patient suffered a clinically significant hemorrhage from ventricular catheter placement after VP shunt insertion. Conclusions In adult patients with aneurysmal SAH, conversion of an EVD to a VP shunt can be safely done using the same EVD site. In this defined patient population, protein and RBC counts in the CSF do not seem to affect shunt survival adversely. Thus, conversion of an EVD to VP shunt should not be delayed because of an elevated protein or RBC count.

Otogenic tension pneumocephalus complicated by eustachian tube insufflation in a patient with a ventriculoperitoneal shunt

2007 ◽  
Vol 106 (6) ◽  
pp. 1098-1101 ◽  
Author(s):  
Hidemasa Nagai ◽  
Kouzo Moritake
Keyword(s):  
Eustachian Tube ◽  
Valsalva Maneuver ◽  
Csf Shunt ◽  
Tympanic Cavity ◽  
Shunt Surgery ◽  
Shunt Insertion ◽  
Vp Shunt ◽  
Tension Pneumocephalus ◽  
Tegmen Tympani ◽  
Osseous Defects

✓Spontaneous tension pneumocephalus (TPC) related to shunt surgery has sometimes been reported with reference to the Valsalva maneuver and osseous defects of the tegmen tympani. Here, the authors report on a case of TPC complicated by eustachian tube (ET) insufflation and a ventriculoperitoneal (VP) shunt. This 78-year-old man had undergone VP shunt insertion 3 weeks before readmission to the hospital with a diagnosis of TPC, a left temporal porencephalic cyst, and air accumulation and late leakage of cerebrospinal fluid (CSF) into the left tympanic cavity. The TPC was controlled successfully by ligation of the shunt tube. The authors discuss the pathophysiology of this complicated TPC case, which illustrates the risk of ET insufflation in patients undergoing CSF shunt surgery.

Delayed germinal matrix hemorrhage induced by ventriculoperitoneal shunt insertion for congenital hydrocephalus

2013 ◽  
Vol 12 (1) ◽  
pp. 67-70 ◽  
Author(s):  
Mihoko Okazaki ◽  
Toru Fukuhara ◽  
Yoichiro Namba
Keyword(s):  
Late Onset ◽  
Upper Airway ◽  
Male Infant ◽  
Congenital Hydrocephalus ◽  
Preterm Neonates ◽  
Shunt Insertion ◽  
Germinal Matrix ◽  
Vp Shunt ◽  
First Case ◽  
Sudden Decrease

Germinal matrix hemorrhages (GMHs) are typically seen in preterm neonates during the first 4 days of life. The authors encountered 2 children with late-onset GMH subsequent to ventriculoperitoneal (VP) shunt insertion for congenital hydrocephalus. Both children were delivered at full term with normal body weight, although they were compromised with the preceding hypoxic events prior to shunt insertion. The first case involved a female infant with severe craniofacial deformities. Because of aspiration pneumonia related to the comorbid upper airway stenosis, endotracheal intubation with intermittent mechanical ventilation was necessary. The associated congenital hydrocephalus was treated with VP shunt insertion when she was 35 days of age, and GMH was confirmed 1 week after shunt placement. During a period of conservative observation, the hemorrhage resolved without any neurological deterioration. The second case involved a male infant with a large intraparenchymal cyst on the left parietal portion. He was intubated for pneumonia at 1 month of age. He had associated congenital hydrocephalus that was progressive, and he was treated with VP shunting at 69 days of age, after his pneumonia had resolved. Postoperative GMH was confirmed, although hydrocephalus was well controlled by VP shunt insertion. Observed conservatively, he fared well and the GMH resolved. These 2 cases had unique features in common; both had congenital anomalies in the CNS and respiratory problems before shunting. The hypoxic insults on the residual germinal matrix layer and sudden decrease in CSF pressure may relate to the occurrence of these late-onset GMHs.

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