Lumboperitoneal shunt placement using computed tomography and fluoroscopy in conscious patients

2009 ◽  
Vol 111 (3) ◽  
pp. 618-622 ◽  
Author(s):  
Madoka Nakajima ◽  
Kuniaki Bando ◽  
Masakazu Miyajima ◽  
Hajime Arai
Keyword(s):  
Outpatient Surgery ◽  
Guide Wire ◽  
Operating Time ◽  
Normal Pressure ◽  
Shunt Valve ◽  
Shunt Insertion ◽  
Shunt Placement ◽  
Lumboperitoneal Shunt ◽  
Lower Limb Pain ◽  
Programmable Valve

The authors have developed a minimally invasive lumboperitoneal shunt placement procedure conducted after administration of a local anesthetic. The procedure involves placing a guide wire and a peel-away sheath under fluoroscopic and CT guidance. Between June 2004 and August 2006, 40 patients (21 men and 19 women; mean age 72.5 years [range 33–86 years]) underwent surgery. A Codman Hakim programmable valve system (82–3844, Codman & Shurtleff, Inc.) was used for the procedure. The mean operating time was 53 minutes, and 7 patients (17.5%) developed shunt dysfunction complications. These complications comprised an infected shunt valve in 2 patients, postoperative lower-limb pain in 1 patient, and shunt obstruction (caused by debris and hemorrhage) at the ventral and lumbar ends in 2 patients each. This procedure is less invasive than conventional lumboperitoneal shunt insertion and could be performed as an outpatient surgery for treatment of idiopathic normal-pressure hydrocephalus.

Transesophageal Echocardiography-Guided Ventriculoatrial Shunt Insertion

2019 ◽  
Vol 19 (1) ◽  
pp. 25-31
Author(s):  
Albert McAnsah Isaacs ◽  
Danae Krahn ◽  
Andrew M Walker ◽  
Heather Hurdle ◽  
Mark G Hamilton
Keyword(s):  
Transesophageal Echocardiography ◽  
Perioperative Complications ◽  
Superior Vena ◽  
Vena Cava ◽  
Shunt Revision ◽  
Shunt Valve ◽  
Shunt Insertion ◽  
Distal Catheter ◽  
Shunt Placement ◽  
Time Required

Abstract BACKGROUND Determining an optimal location within the right atrium (RA) for placement of the distal ventriculoatrial (VA) shunt catheter offer several operative challenges that place patients at risk for perioperative complications and downstream VA shunt failure. Utilizing transesophageal echocardiography (TEE) guidance to place distal VA shunt catheters may help to circumvent these risks. OBJECTIVE To review our current practice of VA shunt insertion using TEE guidance. METHODS A retrospective review of all consecutive patients who underwent VA shunt procedures between December 19, 2016 and January 22, 2019, during which time intraoperative TEE was used for shunt placement was performed. Data on the time required for shunt placement and total procedure time, baseline echocardiography findings, and short- and long-term complications of shunt placement were assessed. RESULTS A total of 33 patients underwent VA shunt procedures, with a median follow-up time of 250 (88-412) d. The only immediate complication related to shunt placement or TEE use was transient ectopy in 1 patient. The mean time for atrial catheter insertion was 12.6 ± 4.8 min. Right-heart catheters were inserted between the RA-superior vena cava junction and 22 mm within the RA in all but 3 procedures. A total of 7/33 patients (21%) underwent shunt revision. Indications for revisions included distal clots, proximal obstruction, positive blood culture, and shunt valve revision. No other complications of VA shunt insertion were reported. CONCLUSION VA shunt insertion using TEE allows for precise distal catheter placement. Early patient experience confirms this technique has a low complication rate.

TM3-8 Use of adjustable anti-gravity devices in NPH patients with delayed post-shunt deterioration

2019 ◽  
Vol 90 (3) ◽  
pp. e17.1-e17
Author(s):  
JP Funnell ◽  
CL Craven ◽  
L D’Antona ◽  
L Thorne ◽  
LD Watkins ◽  
...  
Keyword(s):  
Neuropsychological Test ◽  
High Volume ◽  
Normal Pressure ◽  
Differential Pressure ◽  
Shunt Valve ◽  
Shunt Insertion ◽  
Vp Shunt ◽  
Temporary Shunt ◽  
Optimum Management

ObjectivesA subset of idiopathic Normal Pressure Hydrocephalus (NPH) patients respond to VP shunt insertion temporarily. Adjustable anti-gravity devices are designed to control position-induced CSF drainage changes; we aim to assess to effect of using these devices to achieve controlled overdrainage in temporary shunt responders.DesignA single-centre retrospective study of patients undergoing VP shunt valve revision from an adjustable differential pressure valve with fixed anti-siphon (ProGAV +Shuntassistant) to a system incorporating an adjustable anti-siphon valve (ProGAV +ProSA) (April 2013-April 2018).Subjects21 patients diagnosed with temporary shunt-responsive NPH who improved on high volume shunt reservoir tap (10M: 11F). Mean age at first VP shunt insertion was 74.5±7.87 years.MethodsMedical records were retrospectively reviewed for demographics, interventions and clinical outcomes.ResultsMean duration until revision with a ProSA valve was 31.5±16.8 months (mean ±SD). Mean follow up was 31.4±15.9 months. Of 20 patients with sufficient follow-up, 12 made objective improvements in walking and/or neuropsychological test outcome. 15 patients made subjective improvements in mobility or cognitive impairment.ConclusionsVP shunting with adjustable differential pressure valves and fixed antigravity devices may not drain sufficient CSF for optimum management of low pressure hydrocephalus. Addition of adjustable anti-gravity devices at lower shunt settings in temporary shunt responders may improve outcome.

Laparoscopic-assisted Peritoneal Shunt Insertion for Ventriculoperitoneal and Lumboperitoneal Shunt Placement

2015 ◽  
Vol 25 (3) ◽  
pp. 235-237 ◽  
Author(s):  
Michael Sosin ◽  
Sujata Sofat ◽  
Daniel R. Felbaum ◽  
Kenneth P. Seastedt ◽  
Kevin M. McGrail ◽  
...  
Keyword(s):  
Shunt Insertion ◽  
Shunt Placement ◽  
Lumboperitoneal Shunt ◽  
Laparoscopic Assisted

Use of the proGAV Shunt Valve in Normal-Pressure Hydrocephalus

2011 ◽  
Vol 68 (suppl_2) ◽  
pp. ons245-ons249 ◽  
Author(s):  
Ahmed K. Toma ◽  
Andrew Tarnaris ◽  
Neil D. Kitchen ◽  
Laurence D. Watkins
Keyword(s):  
Normal Pressure Hydrocephalus ◽  
Normal Pressure ◽  
Shunt Valve ◽  
Shunt Insertion ◽  
Pressure Setting ◽  
Adjustable Valve ◽  
Computed Tomography Scans ◽  
Clinical Records ◽  
The Brain

Abstract Background: Overdrainage is a common complication associated with shunt insertion in normal-pressure hydrocephalus (NPH) patients. Using adjustable valves with antigravity devices has been shown to reduce its incidence. The optimal starting setting of an adjustable shunt valve in NPH is debatable. Objective: To audit our single-center practice of setting adjustable valves. Methods: We performed a retrospective review of clinical records of all NPH patients treated in our unit between 2006 and 2009 by the insertion of shunts with a proGAV valve, recording demographic and clinical data, shunt complications, and revision rates. Radiological reports of postoperative follow-up computed tomography scans of the brain were reviewed for detected subdural hematomas. Results: A proGAV adjustable valve was inserted in 50 probable NPH patients between July 2006 and November 2009. Mean ± SD age was 76 ± 7 years. Mean follow-up was 15 months. The initial shunt setting was 6 ± 3 cm H2O, and the final setting was 4.9 ± 1.9 cm H2O. Nineteen patients required 24 readjustment procedures (readjustment rate, 38%; readjustment number, 0.48 times per patient). One patient (2%) developed delayed bilateral subdural hematoma after readjustment of his shunt valve setting as an outpatient. Conclusion: Starting with a low opening pressure setting on a proGAV adjustable shunt valve does not increase the chances of overdrainage complications and reduces the need for repeated readjustments.

scholarly journals A double-blind randomized trial on the clinical effect of different shunt valve settings in idiopathic normal pressure hydrocephalus

2016 ◽  
Vol 124 (2) ◽  
pp. 359-367 ◽  
Author(s):  
Dan Farahmand ◽  
Terje Sæhle ◽  
Per Kristian Eide ◽  
Magnus Tisell ◽  
Per Hellström ◽  
...  
Keyword(s):  
Clinical Improvement ◽  
Normal Pressure Hydrocephalus ◽  
Normal Pressure ◽  
Idiopathic Normal Pressure Hydrocephalus ◽  
Double Blind ◽  
Shunt Valve ◽  
Shunt Insertion ◽  
Significant Clinical Improvement ◽  
Medium Level ◽  
Double Blinded

OBJECT The study aim was to examine the effect of gradually reducing the opening pressure on symptoms and signs in the shunt treatment of idiopathic normal pressure hydrocephalus (iNPH). METHODS In this prospective double-blinded, randomized, controlled, double-center study on patients with iNPH, a ventriculoperitoneal shunt with an adjustable Codman Medos Valve was implanted in 68 patients randomized into 2 groups. In 1 group (the 20–4 group) the valve setting was initially set to 20 cm H2O and gradually reduced to 4 cm H2O over the course of the 6-month study period. In the other group (the 12 group), the valve was kept at a medium level of 12 cm H2O during the whole study period. All patients were clinically evaluated using 4 tests preoperatively as well as postoperatively at 1, 2, 3, 4, and 6 months. The test scores between the 2 groups (20–4 and 12) were compared for each clinical evaluation. RESULTS Fifty-five patients (81%) were able to complete the study. There were no significant differences between the 2 groups (20–4 and 12) preoperatively or at any time postoperatively. Both groups exhibited significant clinical improvement after shunt insertion at all valve settings compared with the preoperative score, with the greatest improvement observed at the first postoperative evaluation. The clinical improvement was significant within the first 3 months, and thereafter no significant improvement was seen in either group. CONCLUSIONS Gradual reduction of the valve setting from 20 to 4 cm H2O did not improve outcome compared with a fixed valve setting of 12 cm H2O. Improvement after shunt surgery in iNPH patients was evident within 3 months, irrespective of valve setting.

Analysis of hearing loss after shunt placement in patients with normal-pressure hydrocephalus

2001 ◽  
Vol 95 (3) ◽  
pp. 432-434 ◽  
Author(s):  
Marie-Lise C. van Veelen-Vincent ◽  
Ernst J. Delwel ◽  
Rozemarijn Teeuw ◽  
Erkan Kurt ◽  
Dirk A. de Jong ◽  
...  
Keyword(s):  
Hearing Loss ◽  
Normal Pressure Hydrocephalus ◽  
Ventriculoperitoneal Shunt ◽  
Pure Tone ◽  
Pure Tone Audiometry ◽  
Normal Pressure ◽  
Shunt Insertion ◽  
Content Type ◽  
Shunt Placement ◽  
Fine Print

Object. Following shunt placement for treatment of normal-pressure hydrocephalus (NPH), several patients suffered hearing loss. The authors undertook a study to analyze this outcome. Methods. Sixteen patients in whom NPH was diagnosed were treated by placement of a ventriculoperitoneal shunt. Their hearing was assessed pre- and postoperatively by using pure tone audiometry. Two thirds of the ears tested showed a postoperative hearing loss of more than 10 dB. Recovery of the hearing loss occurred 6 to 12 weeks after shunt placement in 75% of the ears examined. Conclusions. Although shunt insertion for treatment of NPH results in a decrease in hearing, most of the loss can be recovered.

Motor cortex disinhibition in normal-pressure hydrocephalus

2012 ◽  
Vol 116 (2) ◽  
pp. 453-459 ◽  
Author(s):  
Andrei V. Chistyakov ◽  
Hava Hafner ◽  
Alon Sinai ◽  
Boris Kaplan ◽  
Menashe Zaaroor
Keyword(s):  
Motor Cortex ◽  
Healthy Volunteers ◽  
Normal Pressure Hydrocephalus ◽  
Close Association ◽  
Motor Evoked Potential ◽  
Normal Pressure ◽  
Corticospinal Excitability ◽  
Conduction Time ◽  
Shunt Placement ◽  
Resting Motor Threshold

Object Previous studies have shown a close association between frontal lobe dysfunction and gait disturbance in idiopathic normal-pressure hydrocephalus (iNPH). A possible mechanism linking these impairments could be a modulation of corticospinal excitability. The aim of this study was 2-fold: 1) to determine whether iNPH affects corticospinal excitability; and 2) to evaluate changes in corticospinal excitability following ventricular shunt placement in relation to clinical outcome. Methods Twenty-three patients with iNPH were examined using single- and paired-pulse transcranial magnetic stimulation of the leg motor area before and 1 month after ventricular shunt surgery. The parameters of corticospinal excitability assessed were the resting motor threshold (rMT), motor evoked potential/M-wave area ratio, central motor conduction time, intracortical facilitation, and short intracortical inhibition (SICI). The results were compared with those obtained in 8 age-matched, healthy volunteers, 19 younger healthy volunteers, and 9 age-matched patients with peripheral neuropathy. Results Significant reduction of the SICI associated with a decrease of the rMT was observed in patients with iNPH at baseline evaluation. Ventricular shunt placement resulted in significant enhancement of the SICI and increase of the rMT in patients who markedly improved, but not in those who failed to improve. Conclusions This study demonstrates that iNPH affects corticospinal excitability, causing disinhibition of the motor cortex. Recovery of corticospinal excitability following ventricular shunt placement is correlated with clinical improvement. These findings support the view that reduced control of motor output, rather than impairment of central motor conduction, is responsible for gait disturbances in patients with iNPH.

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