The necessity of shunt series

2010 ◽  
Vol 6 (5) ◽  
pp. 468-473 ◽  
Author(s):  
Michael Vassilyadi ◽  
Zac L. Tataryn ◽  
Fahad Alkherayf ◽  
Kristin Udjus ◽  
Enrique C. G. Ventureyra
Keyword(s):  
Related Problem ◽  
Shunt Revision ◽  
Csf Shunt ◽  
Csf Shunts ◽  
Shunt Insertion ◽  
Brain Ct ◽  
Ancillary Test ◽  
Ancillary Studies ◽  
Shunt Series

Object This work assessed the value of shunt series in the evaluation of children with CSF shunts, a test that is frequently ordered as part of the assessment of shunt integrity. Methods The medical records of all children who underwent shunt series at Children's Hospital of Eastern Ontario between 1975 and 2007 were reviewed. Ancillary studies that were performed within 2 days of the shunt series (brain CT, MR imaging, ultrasonography, and radionuclide shuntography) were noted, as well as the subsequent requirement for a shunt revision. Shunt series and ancillary studies were categorized as either positive (revealing an observable sign that a shunt-related problem was present, such as shunt discontinuity on the shunt series or enlargement of the ventricles on the brain CT scan) or negative (no clear sign of a shunt-related problem). Shunt series were further grouped into shunt series performed for diagnostic reasons, shunt series performed on a routine basis during follow-up in clinic, and shunt series performed postoperatively. The length of time between shunt insertion and shunt fracture was noted. Statistical analyses were performed, including the derivation of sensitivities and specificities. Results There were 3416 shunt series in 394 patients, of which 3004 were performed with ancillary studies. On average, patients underwent 9 shunt series, with a minimum of 1 and a maximum of 43, during the follow-up period (range 3 weeks to 19 years). A total of 2493 shunt series and ancillary studies (83%) yielded negative results and no surgery was performed. One hundred thirty shunts series were negative with a positive ancillary study (4.3%) and no surgery was required. In 8.7% (261 shunt series negative, ancillary studies positive) shunt revision surgery was necessary. The opposite trend was far less prevalent (17 shunt series positive, ancillary test negative; 0.6%) in which surgery was required. There were 87 patients with 96 shunt fractures (2.8% of shunt series). The average time between shunt insertion and shunt fracture was 7.9 years (range 3 months to 18 years). Shunt series had a sensitivity of 18% and a specificity of 97%. The ancillary studies had a sensitivity of 84% and a specificity of 85%. Conclusions The routine utilization of shunt series in the evaluation of a child with a CSF shunt is not necessary. This study showed that a very small number (0.6%) of shunt series helped in surgical decision making. Shunt series can be performed in selected cases, especially preoperatively in the absence of a baseline study to obtain information necessary for surgical planning.

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.

Nonprogrammable and programmable cerebrospinal fluid shunt valves: a 5-year study

2012 ◽  
Vol 9 (5) ◽  
pp. 462-467 ◽  
Author(s):  
Timothy J. Hatlen ◽  
David B. Shurtleff ◽  
John D. Loeser ◽  
Jeffrey G. Ojemann ◽  
Anthony M. Avellino ◽  
...  
Keyword(s):  
Survival Curve ◽  
Csf Shunt ◽  
Case Control Studies ◽  
Chi Square ◽  
Shunt Insertion ◽  
Term Survival ◽  
Kaplan Meier ◽  
Programmable Valves

Object Programmable valves (PVs) for shunting CSF have increasingly replaced nonprogrammable valves (NPVs). There have been only a few longer-term studies (≥ 5 years) conducted that have compared the effectiveness of NPVs with that of PVs for children with hydrocephalus, and only 1 study has reported NPVs as being favorable over PVs. The objective of this retrospective study was to compare the long-term survival of these 2 types of shunt valves. Methods The authors collected data for all patients who underwent CSF shunt insertion or revision between January 1, 2000, and December 31, 2008. Patients underwent follow-up for a minimum of 2 years postoperatively. Statistical analyses were done using chi-square, Kaplan-Meier survival curve, and multivariate analyses. Results A total of 616 valves were implanted, of which 313 were PVs and 303 were NPVs. Of these, 253 were original shunt implantations and 363 were revisions. The proportion of 5-year survival for NPVs (45.8%) was significantly higher than that for PVs (19.8%) (p = 0.0005, log-rank). The NPVs that survived longer than 6 months also survived through the 5th year better than the PVs (p = 0.0001). Conclusions The authors' data suggest that NPVs survive longer than PVs in children, but there is a need for prospective, case-control studies to confirm these data.

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

2016 ◽  
Vol 41 (5) ◽  
pp. E7 ◽  
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.

Cerebrospinal fluid shunt operations without cranial bandaging

2009 ◽  
Vol 3 (6) ◽  
pp. 511-515 ◽  
Author(s):  
Ken R. Winston ◽  
Elizabeth Trinidad ◽  
C. Corbett Wilkinson ◽  
Lori A. McBride
Keyword(s):  
Cerebrospinal Fluid ◽  
Revision Surgery ◽  
Healthcare Workers ◽  
Age Distribution ◽  
Csf Shunt ◽  
Csf Shunts ◽  
Shunt Insertion ◽  
Shunt Implantation ◽  
Clean Contaminated ◽  
Antibiotic Ointment

Object Cranial bandages are commonly applied over scalp incisions immediately after cerebrospinal fluid (CSF) shunt surgery, putatively to prevent complications, particularly infection. These bandages require resources, consume the time of healthcare workers, and incur non-negligible expenses. It is therefore both reasonable and important to examine the efficacy of cranial bandaging. Methods The combined experience of 3 neurosurgeons over 6.75 years with using no cranial bandaging after operations for implantation or revision of CSF shunts is the basis of this report. These data were prospectively accrued and retrospectively analyzed. Results The infection rate was 4.2% (95% CI 3.1–5.6%) for 1064 operations performed without postoperative cranial bandaging after either shunt insertion or revision surgery through clean or clean-contaminated wounds. The age distribution extended from premature infants through adults 77 years of age. Conclusions The results of this investigation support the position that bandaging scalp wounds after CSF shunt implantation or revision surgery adds no benefit beyond the easier, simpler, faster, and cheaper practice of using antibiotic ointment as a dressing without bandaging.

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

2016 ◽  
Vol 41 (5) ◽  
pp. E6 ◽  
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.

scholarly journals Surgical resource utilization after initial treatment of infant hydrocephalus: comparing ETV, early experience of ETV with choroid plexus cauterization, and shunt insertion in the Hydrocephalus Clinical Research Network

2020 ◽  
Vol 26 (4) ◽  
pp. 337-345
Author(s):  
Jonathan Pindrik ◽  
Jay Riva-Cambrin ◽  
Abhaya V. Kulkarni ◽  
Jessica S. Alvey ◽  
Ron W. Reeder ◽  
...  
Keyword(s):  
Hospital Admission ◽  
Resource Utilization ◽  
Research Network ◽  
Csf Shunt ◽  
Shunt Insertion ◽  
Long Term Follow Up ◽  
Csf Diversion ◽  
Surgical Resource Utilization

OBJECTIVEFew studies have addressed surgical resource utilization—surgical revisions and associated hospital admission days—following shunt insertion or endoscopic third ventriculostomy (ETV) with or without choroid plexus cauterization (CPC) for CSF diversion in hydrocephalus. Study members of the Hydrocephalus Clinical Research Network (HCRN) investigated differences in surgical resource utilization between CSF diversion strategies in hydrocephalus in infants.METHODSPatients up to corrected age 24 months undergoing initial definitive treatment of hydrocephalus were reviewed from the prospectively maintained HCRN Core Data Project (Hydrocephalus Registry). Postoperative courses (at 1, 3, and 5 years) were studied for hydrocephalus-related surgeries (primary outcome) and hospital admission days related to surgical revision (secondary outcome). Data were summarized using descriptive statistics and compared using negative binomial regression, controlling for age, hydrocephalus etiology, and HCRN center. The study population was organized into 3 groups (ETV alone, ETV with CPC, and CSF shunt insertion) during the 1st postoperative year and 2 groups (ETV alone and CSF shunt insertion) during subsequent years due to limited long-term follow-up data.RESULTSAmong 1090 patients, the majority underwent CSF shunt insertion (CSF shunt, 83.5%; ETV with CPC, 10.0%; and ETV alone, 6.5%). Patients undergoing ETV with CPC had a higher mean number of revision surgeries (1.2 ± 1.6) than those undergoing ETV alone (0.6 ± 0.8) or CSF shunt insertion (0.7 ± 1.3) over the 1st year after surgery (p = 0.005). At long-term follow-up, patients undergoing ETV alone experienced a nonsignificant lower mean number of revision surgeries (0.7 ± 0.9 at 3 years and 0.8 ± 1.3 at 5 years) than those undergoing CSF shunt insertion (1.1 ± 1.9 at 3 years and 1.4 ± 2.6 at 5 years) and exhibited a lower mean number of hospital admission days related to revision surgery (3.8 ± 10.3 vs 9.9 ± 27.0, p = 0.042).CONCLUSIONSAmong initial treatment strategies for hydrocephalus, ETV with CPC yielded a higher surgical revision rate within 1 year after surgery. Patients undergoing ETV alone exhibited a nonsignificant lower mean number of surgical revisions than CSF shunt insertion at 3 and 5 years postoperatively. Additionally, the ETV-alone cohort demonstrated significantly fewer hospital admission days related to surgical management of hydrocephalus within 3 years after surgery. These findings suggest a time-dependent benefit of ETV over CSF shunt insertion regarding surgical resource utilization.

Results of surgical treatment of neurocysticercosis in 69 cases

1986 ◽  
Vol 65 (3) ◽  
pp. 309-315 ◽  
Author(s):  
Benedicto Oscar Colli ◽  
Nelson Martelli ◽  
João Alberto Assirati ◽  
Hélio Rubens Machado ◽  
Sylvio de Vergueiro Forjaz
Keyword(s):  
Posterior Fossa ◽  
Complement Fixation Test ◽  
Shunt Infection ◽  
Shunt Revision ◽  
Csf Shunt ◽  
Increased Intracranial Pressure ◽  
Csf Shunts ◽  
Content Type ◽  
Cerebral Parenchyma

✓ The clinical course of 69 patients with neurocysticercosis who underwent surgery to control increased intracranial pressure (ICP) or cyst removal is analyzed. Increased ICP was caused by hydrocephalus in 63 patients, by cerebral edema in four, and by giant cysts in two. Skull x-ray films showed calcifications in 14% and signs of elevated ICP in 46%. Examination of cerebrospinal fluid (CSF) revealed pleocytosis with eosinophils in 52% of cases and a positive complement fixation test for cysticercosis in 66%. Ventriculography allowed localization of the CSF obstruction and ventricular cysts, and generally differentiated between an obstruction due to cysts and an inflammatory process. Computerized tomography showed cysts in the cerebral parenchyma and ventricular dilatation. Ventricular cysts were best seen when intraventricular metrizamide was used. Intracranial shunting and posterior fossa exploration were less effective in the treatment of hydrocephalus than was ventriculoatrial (VA) or ventriculoperitoneal (VP) shunting, although VA or VP shunting was associated with a high percentage of complications. Quality of survival was good in 87% of the cases in the first 3 postoperative months and in 93% of patients who survived 2 years after surgery. Fortyseven patients (68%) were readmitted one or more times for CSF shunt revision; 14 of them for shunt infection (meningitis). The early operative mortality rate was 1.8% for patients with VA or VP shunt placement and 5.3% for those with posterior fossa exploration. The authors conclude that placement of CSF shunts is indicated in the treatment of hydrocephalus, and cyst removal is indicated only when the cyst exhibits tumor-like behavior. Surgical exploration is also indicated when the diagnosis is uncertain.

scholarly journals Reduced ventricular shunt rate in very preterm infants with severe intraventricular hemorrhage: an institutional experience

2012 ◽  
Vol 10 (5) ◽  
pp. 357-364 ◽  
Author(s):  
Nima Alan ◽  
Sunil Manjila ◽  
Nori Minich ◽  
Nancy Bass ◽  
Alan R. Cohen ◽  
...  
Keyword(s):  
Bronchopulmonary Dysplasia ◽  
Gestational Age ◽  
Intraventricular Hemorrhage ◽  
Well Being ◽  
Shunt Revision ◽  
Shunt Insertion ◽  
Vp Shunt ◽  
The Past ◽  
Period 2

Object Although survival for extremely low gestational age newborns (ELGANs) has improved in the past 3 decades, these infants remain prone to complications of prematurity, including intraventricular hemorrhage (IVH). The authors reviewed the outcomes for an entire cohort of ELGANs who suffered severe IVH at their institution during the past 12 years to gain a better understanding of the natural history of IVH and frequency of ventriculoperitoneal (VP) shunt placement in this population. Methods Data from the neonatal ICU (NICU) database, neurosurgery operative log, and medical records were used to identify and follow up all ELGANs who suffered a severe IVH between 1997 and 2008. Trends between Period 1 (1997–2001) and Period 2 (2004–2008) were analyzed using the Pearson chi-square test. Results Between 1997 and 2008, 1335 ELGANs were admitted to the NICU at the authors' institution within 3 days of birth, and 111 (8.3%) of these infants suffered a severe IVH. Survival to 2 years, incidence of severe IVH, neonatal risk factors (gestational age, birth weight, and incidence of necrotizing enterocolitis), ventriculomegaly on cranial ultrasonography, and use of serial lumbar punctures for symptomatic hydrocephalus were all stable. Infants from Period 2 had a significantly lower incidence of bronchopulmonary dysplasia and sepsis than infants from Period 1 (both p < 0.001). All ELGANs with severe IVH and ventriculomegaly underwent long-term follow-up to identify shunt status at late follow-up. Twenty-two ELGANs (20%) with severe IVH required a temporary ventriculosubgaleal (VSG) shunt. Three infants with VSG shunts showed spontaneous hydrocephalus resolution, and 2 infants died of unrelated causes during the neonatal admission. The temporary VSG shunt complication rate was 20% (12% infection and 8% malfunction). Sixteen percent of all ELGANs (18 of 111) with severe IVH eventually required permanent ventricular shunt insertion. Six (35%) of 17 infants with a permanent VP shunt required at least 1 permanent shunt revision during the 1st year. The proportion of ELGANs with severe IVH who required a temporary VSG (35%) or permanent VP shunt (30%) during Period 1 decreased by more than 60% in Period 2 (10% [p = 0.005] and 8.3% [p = 0.009], respectively). Conclusions The authors report for the first time a marked reduction over the past 12 years in the proportion of ELGANs with severe IVH who required surgical intervention for hydrocephalus. Using the NICU database, the authors were able to identify and follow all ELGANs with severe IVH and ventriculomegaly. They speculate that the reduction in ventricular shunt rate results from improved neonatal medical care, including reduced infection, improved bronchopulmonary dysplasia, and postnatal steroid avoidance, which may aid innate repair mechanisms. Multicenter prospective trials and detailed analyses of NICU parameters of neonatal well-being are needed to understand how perinatal factors influence the propensity to require ventricular shunting.

Function of parietal and frontal shunts in childhood hydrocephalus

1988 ◽  
Vol 69 (6) ◽  
pp. 883-886 ◽  
Author(s):  
A. Leland Albright ◽  
Stephen J. Haines ◽  
Floyd H. Taylor
Keyword(s):  
Chi Square ◽  
Catheter Position ◽  
Csf Shunts ◽  
Shunt Insertion ◽  
Content Type ◽  
Frontal Horn ◽  
Recorded Data ◽  
Childhood Hydrocephalus ◽  
Function Time

✓ This study was performed to determine if cerebrospinal fluid (CSF) shunts inserted via the frontal and parietal regions function for similar lengths of time. The medical records of 114 children with CSF shunts were reviewed. In 83 of these cases computerized tomography scans were also available. Ninety percent of the operations were to insert the child's first shunt. The site of insertion, cause of hydrocephalus, patient's age, surgeon, duration of function (time from insertion to malfunction or to latest follow-up evaluation), presence of infection, catheter location within the ventricle, and duration of function of the subsequent shunt were recorded. Data were analyzed by the chi-square, logistic regression, and life-table methods. Shunts had been inserted via the frontal route in 62 children and via the parietal route in 52. The children's ages, causes of hydrocephalus, and infection rates were similar in both groups. Duration of shunt function was predicted by the site of shunt insertion and the catheter position within the ventricles: shunts inserted via the frontal region functioned significantly longer than parietally inserted shunts, both as the initial shunt (Wilcoxon, p = 0.0008) and after a malfunction, and catheters positioned within the ipsilateral frontal horn functioned significantly longer than those in other ventricular locations (Wilcoxon, p = 0.03).

scholarly journals Endoscopic management of intraventricular shunt-related cystic compartment in paediatric patients

2019 ◽  
pp. 191-199
Author(s):  
Ahmed Zaher ◽  
Amr Farid Khalil ◽  
Mohamed State ◽  
Hatem Badr
Keyword(s):  
Fluid Collection ◽  
Shunt Revision ◽  
Csf Leak ◽  
Endoscopic Management ◽  
Third Ventriculostomy ◽  
Shunt Insertion ◽  
Ventriculoperitoneal Shunts ◽  
Endoscopic Procedures ◽  
Surgical Data

Background. Intraventricular uniloculated compartments are relatively seen frequently in children previously treated with ventriculoperitoneal shunts for hydrocephalus. These compartments may present before shunt insertion and even as an end result to the shunt gliosis. Although the availability of different surgical modalities for the management of such loculations but till now there is no consensus about a single therapeutic approach for its management. Objective. The aim of this study is to assess the role of neuroendoscopy in management of uniloculated compartments, in pediatric cases who underwent shunting for hydrocephalus, to avoid multiple shunt insertion and even to eliminate the need for the preexisting shunt system.Patients and Methods. We retrospectively studied 44 consecutive previously shunted patients with isolated intraventricular compartment who underwent 58 endoscopic procedures by a single surgeon during the period between February 2015 and February 2018. These procedures included endoscopic cyst fenestration, intraventricular septum pellucidotomy, foraminoplasty and additionally third ventriculostomy in some cases was added to the previous procedures. Multiloculated hydrocephalus and cysts related to the tumours were excluded. Clinical, radiological and surgical data were assessed.Results. The most common cause of a single loculation in those patients was neuroepithelial cyst (20 cases) followed by post shunt isolated compartment (12 cases), meningitis (8 cases) and four cases of intraventricular haemorrhage. The patient's age varied from two months up to seven years (mean = 3.2 years). The follow-up period was ranged from (2-49 months) with the mean of 12.3 months. The overall success of restoration of communication between the uniloculated compartment and the ventricular system was achieved in 36 patients (81.8%), with 28 (63.6%) patient needed only one shunt and eight (18.2%) patients became independent of their previous shunts. Fourteen repeated endoscopic procedures were considered necessary in ten patients for either reopening of a closed stoma and/or shunt revision and finally, eight patient (18%) required additional shunt insertion during follow up period. The complications encountered were minor and reversible (CSF leak in two cases, infection in two cases, subdural fluid collection in four cases) with no mortality.Conclusion. Minimal invasive endoscopic technique is a useful operative alternative to control uniloculated compartments in patients with previous ventriculoperitoneal shunts. It does not only simplify the existing shunt system by restoration of the communication between the loculated compartment and the draining shunt but it may eliminate the need for external shunt in some cases as well.

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