Laparoscopic assisted ventriculoperitoneal shunt revisions as an option for pediatric patients with previous intraabdominal complications

Multiple shunt failure is a challenge in pediatric neurosurgery practice and one of the most feared complications of hydrocephalus. Objective: To demonstrate that laparoscopic procedures for distal ventriculoperitoneal shunt failure may be an effective option for patients who underwent multiple revisions due to repetitive manipulation of the peritoneal cavity, abdominal pseudocyst, peritonitis or other situations leading to a “non reliable” peritoneum. Method: From March 2012 to February 2013, the authors reviewed retrospectively the charts of six patients born and followed up at our institution, which presented with previous intra-peritoneal complications and underwent ventriculoperitoneal shunt revision assisted by video laparoscopy. Results: After a mean follow-up period of nine months, all patients are well and no further shunt failure was identified so far. Conclusion: Laparoscopy assisted shunt revision in children may be, in selected cases, an effective option for patients with multiple peritoneal complications due to ventriculo-peritoneal shunting.

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Ventriculoperitoneal Shunt Surgery Outcome in Adult Transition Patients With Pediatric-Onset Hydrocephalus

Neurosurgery ◽

10.1227/neu.0b013e318231d551 ◽

2011 ◽

Vol 70 (2) ◽

pp. 380-389 ◽

Cited By ~ 30

Author(s):

G. Kesava Reddy ◽

Papireddy Bollam ◽

Gloria Caldito ◽

Bharat Guthikonda ◽

Anil Nanda

Keyword(s):

Ventriculoperitoneal Shunt ◽

Shunt Revision ◽

Shunt Failure ◽

Shunt Surgery ◽

Shunt Placement ◽

Adult Transition ◽

Shunt Survival ◽

Pediatric Onset

Abstract BACKGROUND: Ventriculoperitoneal shunting remains the most widely used neurosurgical procedure for the management of hydrocephalus, albeit with many complications. OBJECTIVE: To review and assess the long-term clinical outcome of ventriculoperitoneal shunt surgery in adult transition patients with pediatric-onset hydrocephalus. METHODS: Patients 17 years or older who underwent ventriculoperitoneal shunt placement for hydrocephalus during their pediatric years (younger than 17 years) were included. Medical charts, operative reports, imaging studies, and clinical follow- up evaluations were reviewed and analyzed retrospectively. RESULTS: A total of 105 adult patients with pediatric-onset hydrocephalus were included. The median age of the patients was 25.9 years. The median age at the time of the initial ventriculoperitoneal shunt placement was 1.0 year. The median follow-up time for all patients was 17.7 years. The incidence of shunt failure at 6 months was 15.2%, and the overall incidence of shunt failure was 82.9%. Single shunt revision occurred in 26.7% of the patients, and 56.2% had multiple shunt revisions. The cause of hydrocephalus was significantly associated with shunt survival for patients who had shunt failure before the age of 17 years. Being pediatric at first shunt revision, infection, proximal shunt complication, and other causes were independently associated with multiple shunt failures. CONCLUSION: The findings of this retrospective study show that the long-term ventriculoperitoneal shunt survival remains low in adult transition patients with pediatric-onset hydrocephalus.

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Late pediatric ventriculoperitoneal shunt failures: a Singapore tertiary institution's experience

Neurosurgical FOCUS ◽

10.3171/2016.8.focus16277 ◽

2016 ◽

Vol 41 (5) ◽

pp. E7 ◽

Cited By ~ 4

Author(s):

Lester Lee ◽

Sharon Low ◽

David Low ◽

Lee Ping Ng ◽

Colum Nolan ◽

...

Keyword(s):

Retrospective Study ◽

Pediatric Patients ◽

Shunt Revision ◽

Shunt Failure ◽

Shunt Insertion ◽

Ventriculoperitoneal Shunts ◽

Effects Of Aging ◽

Age And Sex

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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Readmissions after ventricular shunting in pediatric patients with hydrocephalus: a Nationwide Readmissions Database analysis

Journal of Neurosurgery Pediatrics ◽

10.3171/2021.3.peds20794 ◽

2021 ◽

pp. 1-10

Author(s):

Daniel A. Donoho ◽

Ian A. Buchanan ◽

Shivani D. Rangwala ◽

Arati Patel ◽

Li Ding ◽

...

Keyword(s):

Pediatric Patients ◽

The United States ◽

Population Based ◽

Shunt Revision ◽

Shunt Failure ◽

Hospital Level ◽

Factors Associated ◽

Shunt Placement ◽

Ventricular Shunting

OBJECTIVE Cerebrospinal fluid diversion via ventricular shunting is a common surgical treatment for hydrocephalus in the pediatric population. No longitudinal follow-up data for a multistate population-based cohort of pediatric patients undergoing ventricular shunting in the United States have been published. In the current review of a nationwide population-based data set, the authors aimed to assess rates of shunt failure and hospital readmission in pediatric patients undergoing new ventricular shunt placement. They also review patient- and hospital-level factors associated with shunt failure and readmission. METHODS Included in this study was a population-based sample of pediatric patients with hydrocephalus who, in 2010–2014, had undergone new ventricular shunt placement and had sufficient follow-up, as recorded in the Nationwide Readmissions Database. The authors analyzed the rate of revision within 6 months, readmission rates at 30 and 90 days, and potential factors associated with shunt failure including patient- and hospital-level variables and type of hydrocephalus. RESULTS A total of 3520 pediatric patients had undergone initial ventriculoperitoneal shunt placement for hydrocephalus at an index admission. Twenty percent of these patients underwent shunt revision within 6 months. The median time to revision was 44.5 days. Eighteen percent of the patients were readmitted within 30 days and 31% were readmitted within 90 days. Different-hospital readmissions were rare, occurring in ≤ 6% of readmissions. Increased hospital volume was not protective against readmission or shunt revision. Patients with grade 3 or 4 intraventricular hemorrhage were more likely to have shunt malfunctions. Patients who had private insurance and who were treated at a large hospital were less likely to be readmitted. CONCLUSIONS In a nationwide, population-based database with longitudinal follow-up, shunt failure and readmission were common. Although patient and hospital factors were associated with readmission and shunt failure, system-wide phenomena such as insufficient centralization of care and fragmentation of care were not observed. Efforts to reduce readmissions in pediatric patients undergoing ventricular shunt procedures should focus on coordinating care in patients with complex neurological diseases and on reducing healthcare disparities associated with readmission.

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

10.36106/ijar/9302582 ◽

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.

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Management of Adult Hydrocephalus With Ventriculoperitoneal Shunts: Long-term Single-Institution Experience

Neurosurgery ◽

10.1227/neu.0b013e31821ffa9e ◽

2011 ◽

Vol 69 (4) ◽

pp. 774-781 ◽

Cited By ~ 54

Author(s):

G Kesava Reddy ◽

Papireddy Bollam ◽

Runhua Shi ◽

Bharat Guthikonda ◽

Anil Nanda

Keyword(s):

Median Time ◽

Adult Patients ◽

Shunt Revision ◽

Shunt Failure ◽

Single Institution ◽

Ventriculoperitoneal Shunts ◽

Shunt Placement ◽

Ventriculoperitoneal Shunting

Abstract BACKGROUND: Ventriculoperitoneal shunting is the most widely used neurosurgical procedure for the management of hydrocephalus. OBJECTIVE: To evaluate our long-term single-institution experience in the management of adult hydrocephalus patients with ventriculoperitoneal shunts. METHODS: Adult patients who underwent ventriculoperitoneal shunt placement for hydrocephalus from October 1990 to October 2009 were included. Medical charts, operative reports, imaging studies, and clinical follow-up evaluations were reviewed and analyzed retrospectively for clinical outcome in adult hydrocephalus patients. RESULTS: A total of 683 adult patients were included in the study. The most common etiologies of hydrocephalus include idiopathic (29%), tumors and cysts (20%), postcraniotomy (13%), and subarachnoid hemorrhage (13%). The overall shunt failure rate was 32%, and the majority (74%) of shunt revisions occurred within the first 6 months. The median time to first shunt revision was 9.31 months. Etiology of hydrocephalus showed a significant impact on the incidence of shunt revision/failure and on the median time to shunt revision. Similarly, the type of hydrocephalus had a significant effect on the incidence of shunt failure and the median time to shunt revision. CONCLUSION: A large proportion of patients (32%) experience shunt failure after shunt placement for hydrocephalus. Although the overall incidence of shunt revision was comparable to previously reported studies, the fact that a large proportion of adult populations with shunt placement experience shunt failure is a concern.

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Intraventricular hemorrhage after ventriculoperitoneal shunt revision: a retrospective review

Journal of Neurosurgery Pediatrics ◽

10.3171/2014.11.peds14246 ◽

2015 ◽

Vol 16 (1) ◽

pp. 42-45 ◽

Cited By ~ 9

Author(s):

Mark Calayag ◽

Alexandra R. Paul ◽

Matthew A. Adamo

Keyword(s):

Ventriculoperitoneal Shunt ◽

Retrospective Review ◽

Medical Records ◽

Intraventricular Hemorrhage ◽

Pediatric Patients ◽

Revision Rate ◽

Ct Scans ◽

Shunt Revision ◽

Catheter Position ◽

Vp Shunt

OBJECT The authors review their ventriculoperitoneal (VP) shunt revisions over a 3-year period to determine the rate of intraventricular hemorrhage (IVH) and subsequent need for re-revision. METHODS Review of medical records identified 35 pediatric patients who underwent 52 VP shunt revisions between 2009 and 2012. The presence and amount of IVH as determined by CT and the time to re-revision were documented. The reason for shunting, catheter position, and time between initial VP shunt placement and subsequent revisions were also recorded. RESULTS After 13 (25%) of the 52 revisions, IVH was evident on postoperative CT scans. The majority of patients had a trace amount of IVH, with only 2% having IVH greater than 5 ml. After 2 (15%) of the 13 revisions associated with IVH, re-revision was required within 1 month. In contrast, the re-revision rate in patients without IVH was 18%. All of the patients who developed IVH had occipital catheters. CONCLUSIONS Some degree of IVH can be expected after approximately one-quarter of all VP shunt revision procedures in pediatric patients, but the rate of significant IVH is low. Furthermore, the presence of IVH does not necessitate an early shunt revision.

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Rate of shunt revision as a function of age in patients with shunted hydrocephalus due to myelomeningocele

Neurosurgical FOCUS ◽

10.3171/2016.8.focus16257 ◽

2016 ◽

Vol 41 (5) ◽

pp. E6 ◽

Cited By ~ 18

Author(s):

Esther B. Dupepe ◽

Betsy Hopson ◽

James M. Johnston ◽

Curtis J. Rozzelle ◽

W. Jerry Oakes ◽

...

Keyword(s):

Spina Bifida ◽

Adult Life ◽

Shunt Revision ◽

Csf Shunt ◽

Research Database ◽

Shunt Failure ◽

Number Of Patients ◽

Patients At Risk ◽

Revision Operations

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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Revision rate of pediatric ventriculoperitoneal shunts after 15 years

Journal of Neurosurgery Pediatrics ◽

10.3171/2012.9.peds1298 ◽

2013 ◽

Vol 11 (1) ◽

pp. 15-19 ◽

Cited By ~ 104

Author(s):

Jonathan J. Stone ◽

Corey T. Walker ◽

Maxwell Jacobson ◽

Valerie Phillips ◽

Howard J. Silberstein

Keyword(s):

Transition To Adulthood ◽

Pediatric Patients ◽

Medical Center ◽

High Rate ◽

Shunt Revision ◽

Congenital Defects ◽

Vp Shunt ◽

Shunt Placement ◽

Catheter Occlusion

Object Ventriculoperitoneal (VP) shunt placement remains the mainstay treatment for pediatric hydrocephalus. These devices have a relatively high complication and failure rate, often requiring multiple revisions. The authors present a single institution's experience of pediatric patients treated with VP shunts. With an average follow-up time of 20 years, this study is among the longest reports of VP shunt revision in the literature to date. Hydrocephalus origins, shunt revision rates, and causes of shunt failure are described. Patients who underwent their first shunt revision more than 10 years after initial shunt placement were also explored. Methods A retrospective chart review was performed on all pediatric patients who underwent VP shunt placement from January 1990 through November 1996 at the University of Rochester Medical Center. Only patients who had at least 15 years of follow-up since their initial shunting procedure were included. Results A total of 234 procedures were performed on 64 patients, with a mean follow-up of 19.9 years. Patients ranged from a few days to 17.2 years old when they received their original shunt, with a median age of 4 months; 84.5% of the patients required 1 or more shunt revisions and 4.7% required 10 or more. Congenital defects, Chiari Type II malformations, tumors, and intraventricular hemorrhage were the most common causes of hydrocephalus. Overall, patients averaged 2.66 revisions, with proximal (27%) and distal (15%) catheter occlusion, disconnection (11%), and infection (9%) comprising the most common reasons for shunt malfunction. Notably, 12.5% of patients did not require their first shunt revision until more than 10 years after initial device placement, a previously undescribed finding due to the short follow-up duration in previous studies. Conclusions This long-term retrospective analysis of pediatric VP shunt placement revealed a relatively high rate of complications with need for shunt revision as late as 17 years after initial placement. Catheter occlusion represented a significant percentage of shunt failures. Cerebrospinal fluid shunting has a propensity for mechanical failure and patients with VP shunts should receive follow-up through the transition to adulthood.

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Ventriculoperitoneal Shunt assisted by Neuroendoscopy

JBNC - JORNAL BRASILEIRO DE NEUROCIRURGIA ◽

10.22290/jbnc.v22i3.1013 ◽

2018 ◽

Vol 22 (3) ◽

pp. 100-103

Author(s):

Flávio Ramalho Romero

Keyword(s):

Ventriculoperitoneal Shunt ◽

Intraventricular Hemorrhage ◽

Shunt Revision ◽

Ventricular Catheter ◽

Communicating Hydrocephalus ◽

Common Cause ◽

Vp Shunt ◽

Endoscopic View ◽

Catheter Location

Object. We present our experience in ventriculoperitoneal shunt assisted by neuroendoscopy. Methods. Thirty-six patients with new communicating hydrocephalus were selected to VP shunt placement assisted by neuroendoscopy. Postoperative computerized tomography (CT) was performed in the first day in all patients and ventricular catheter location was analysed. A follow up of 12 months was performed and results showed. Results. Mean patient age at implantation was 57 ± 13.59 years (range, 16-77). There was a slight preponderance of males (22 patients, 61%). The most common cause for shunt surgery was hemorrhage (20 patients, 55%), including subarachnoid hemorrhage (14 patients, 39%), and intracerebral hemorrhage (ICH) or intraventricular hemorrhage (IVH) (5 patients, 16%). Posttraumatic hydrocephalus followed as a secondary cause (11 patients 31.5%). During the period covered by thestudy, 8 valves were revised, thereby meeting the criteria for shunt failure endpoint. The most common cause for shunt revision was underdrainage in 5 patients, followed by infection in 2 patients, and overdrainage in 1 patient. None of them had proximal obstruction and in all cases, the ventricular catheter was well located. Conclusions. Endoscopic view can be used to place the ventricular catheter in a good position inside the ventricular system.

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Factors associated with early shunt revision within 30 days: analyses from the National Surgical Quality Improvement Program

Journal of Neurosurgery Pediatrics ◽

10.3171/2021.7.peds21222 ◽

2021 ◽

pp. 1-10

Author(s):

Mohammed Ali Alvi ◽

Archis R. Bhandarkar ◽

David J. Daniels ◽

Kai J. Miller ◽

Edward S. Ahn

Keyword(s):

Logistic Regression ◽

Quality Improvement ◽

Pediatric Patients ◽

Shunt Infection ◽

Shunt Revision ◽

Shunt Failure ◽

Improvement Program ◽

Surgical Quality ◽

Lower Odds ◽

Factors Associated

OBJECTIVE CSF shunt insertion is the most commonly performed neurosurgical procedure for pediatric patients with hydrocephalus, and complications including infections and catheter obstruction are common. The rate of readmission in the first 30 days after surgery has been used across surgical disciplines to determine healthcare quality. In the current study, the authors sought to assess factors associated with early shunt revision within 30 days using real-world data. METHODS Targeted shunt data set participant user files of the National Surgical Quality Improvement Program (NSQIP) from 2016 to 2019 were queried for patients undergoing a shunt procedure. A multivariable logistic regression model was performed to assess the impact of demographics, etiologies, comorbidities, congenital malformations, and shunt adjuncts on shunt revision within 30 days, as well as shunt revision due to infection within 30 days. RESULTS A total of 3919 primary pediatric shunt insertions were identified in the NSQIP database, with a mean (± SD) patient age of 26.3 ± 51.6 months. There were a total of 285 (7.3%) unplanned shunt revisions within 30 days, with a mean duration of 14.9 ± 8.5 days to first intervention. The most common reason for intervention was mechanical shunt failure (32.6% of revision, 2.4% overall, n = 93), followed by infection (31.2% of all interventions, 2.3% overall, n = 89) and wound disruption or CSF leak (22.1% of all interventions, 1.6% overall, n = 63). Patients younger than 6 months of age had the highest overall unplanned 30-day revision rate (8.5%, 203/2402) as well as the highest 30-day shunt infection rate (3%, 72/2402). Patients who required a revision were also more likely to have a cardiac risk factor (34.7%, n = 99, vs 29.2%, n = 1061; p = 0.048). Multivariable logistic regression revealed that compared to patients 9–18 years old, those aged 2–9 years had significantly lower odds of repeat shunt intervention (p = 0.047), while certain etiologies including congenital hydrocephalus (p = 0.0127), intraventricular hemorrhage (IVH) of prematurity (p = 0.0173), neoplasm (p = 0.0005), infection (p = 0.0004), and syndromic etiology (p = 0.0136), as well as presence of ostomy (p = 0.0095), were associated with higher odds of repeat intervention. For shunt infection, IVH of prematurity was found to be associated with significantly higher odds (p = 0.0427) of shunt infection within 30 days, while use of intraventricular antibiotics was associated with significantly lower odds (p = 0.0085). CONCLUSIONS In this study of outcomes after pediatric shunt placement using a nationally derived cohort, early shunt failure and infection within 30 days were found to remain as considerable risks. The analysis of this national surgical quality registry confirms that, in accordance with other multicenter studies, hydrocephalus etiology, age, and presence of ostomy are important predictors of the need for early shunt revision. IVH of prematurity is associated with early infections while intraventricular antibiotics may be protective. These findings could be used for benchmarking in hospital efforts to improve quality of care for pediatric patients with hydrocephalus.

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