scholarly journals Intraventricular hemorrhage after ventriculoperitoneal shunt revision: a retrospective review

2015 ◽  
Vol 16 (1) ◽  
pp. 42-45 ◽  
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.

scholarly journals Ventriculoperitoneal Shunt assisted by Neuroendoscopy

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. 

Multiloculated hydrocephalus: craniotomy and fenestration of intraventricular septations

1993 ◽  
Vol 78 (1) ◽  
pp. 70-76 ◽  
Author(s):  
Todd Y. Nida ◽  
Stephen J. Haines
Keyword(s):  
Intraventricular Hemorrhage ◽  
Pediatric Patients ◽  
Revision Rate ◽  
Treatment Options ◽  
Shunt Revision ◽  
Neonatal Meningitis ◽  
Content Type ◽  
Multiloculated Hydrocephalus ◽  
Intraventricular Septations ◽  
Fine Print

✓ Ten pediatric patients with multiloculated hydrocephalus caused by neonatal meningitis, ventriculitis, or intraventricular hemorrhage were surgically treated over a 14-year period (January 1, 1976, to December 31, 1990). Six patients underwent craniotomy and transcallosal fenestration of intraventricular septations followed by placement of a shunt, while the other four were treated by shunting procedures alone. Craniotomy resulted in reduction of the shunt revision rate from a median of 2.75 per year prior to fenestration to 0.25 per year following fenestration, with median observation periods of 44.5 and 27 months, respectively. This was compared to a median revision rate of 0.55 per year for patients treated with shunting procedures alone. There were no deaths in either group. Although no surgical complications were encountered, one patient did require a second fenestration procedure. The important aspects of multiloculated hydrocephalus, including pathophysiology, radiographic correlates, and treatment options, are discussed. The goal of treatment is to eliminate the need for multiple shunt revisions, minimizing the accompanying morbidity and expense. It is concluded that craniotomy and transcallosal fenestration of intraventricular septations is a successful treatment of multiloculated hydrocephalus.

scholarly journals Effect of electromagnetic-navigated shunt placement on failure rates: a prospective multicenter study

2010 ◽  
Vol 113 (6) ◽  
pp. 1273-1278 ◽  
Author(s):  
Caroline Hayhurst ◽  
Tjemme Beems ◽  
Michael D. Jenkinson ◽  
Patricia Byrne ◽  
Simon Clark ◽  
...  
Keyword(s):  
Revision Rate ◽  
Shunt Revision ◽  
Standard Group ◽  
Fisher Exact Test ◽  
Anatomical Landmarks ◽  
Failure Rates ◽  
Shunt Failure ◽  
Catheter Position ◽  
Optimal Position ◽  
Shunt Placement

Object As many as 40% of shunts fail in the first year, mainly due to proximal obstruction. The role of catheter position on failure rates has not been clearly demonstrated. The authors conducted a prospective cohort study of navigated shunt placement compared with standard blind shunt placement at 3 European centers to assess the effect on shunt failure rates. Methods All adult and pediatric patients undergoing de novo ventriculoperitoneal shunt placement were included (patients with slit ventricles were excluded). The first cohort underwent standard shunt placement using anatomical landmarks. All centers subsequently adopted electromagnetic (EM) navigation for routine shunt placements, forming the second cohort. Catheter position was graded on postoperative CT in both groups using a 3-point scale developed for this study: (1) optimal position free-floating in CSF; (2) touching choroid or ventricular wall; or (3) intraparenchymal. Episodes and type of shunt revision were recorded. Early shunt failure was defined as that occurring within 30 days of surgery. Patients with shunts were followed-up for 12 months in the standard group, for a median of 6 months in the EM-navigated group, or until shunt failure. Results A total of 75 patients were included in the study, 41 with standard shunts and 34 with EM-navigated shunts. Seventy-four percent of navigated shunts were Grade 1 compared with 37% of the standard shunts (p = 0.001, chi-square test). There were no Grade 3 placements in the navigated group, but 8 in the standard group, and 75% of these failed. Early shunt failure occurred in 9 patients in the standard group and in 2 in the navigated group, reducing the early revision rate from 22 to 5.9% (p = 0.048, Fisher exact test). Early shunt failures were due to proximal obstruction in 78% of standard shunts (7 of 9) and in 50% of EM-navigated shunts (1 of 2). Conclusions Noninvasive EM image guidance in shunt surgery reduces poor shunt placement, resulting in a significant decrease in the early shunt revision rate.

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

2014 ◽  
Vol 72 (4) ◽  
pp. 307-311 ◽  
Author(s):  
Fernanda O. de Carvalho ◽  
Antonio R. Bellas ◽  
Luciano Guimarães ◽  
José Francisco Salomão
Keyword(s):  
Ventriculoperitoneal Shunt ◽  
Pediatric Patients ◽  
Pediatric Neurosurgery ◽  
Shunt Revision ◽  
Shunt Failure ◽  
Abdominal Pseudocyst ◽  
Effective Option ◽  
Video Laparoscopy ◽  
Laparoscopic Assisted

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.

scholarly journals VP Shunt Complications: Ten Years Experience at UDMNINAS

2019 ◽  
Vol 16 (3) ◽  
pp. 40-42
Author(s):  
Subash Lohani ◽  
Aashish Baniya
Keyword(s):  
Retrospective Review ◽  
Pediatric Population ◽  
Shunt Infection ◽  
Shunt Malfunction ◽  
Shunt Revision ◽  
Shunt Complication ◽  
Vp Shunt ◽  
Shunt Complications ◽  
International Data ◽  
Ventriculo Peritoneal Shunt

Ventriculo-Peritoneal shunt is significantly associated with complications like malfunction and infection. In this study, we aim to review our infection and malfunction rate. This is a retrospective review of charts of patients who underwent ventriculo-peritonealshunt at Upendra Devkota Memorial National Institute of Neurological and Allied Sciences, Bansbari, Nepal between 2008 and 2018. Patients were interviewed via telephone for information regarding shunt complications in the form of malfunction, infection, and the need for revision. A total of 357 patients underwent ventriculoperitonealshunt over a period of 10 years.   of patients was 37.08 years. There were224 males and133 females with M:F::1.7:1.265 patients were available over telephone for interview. 54 of 265 (20.37%) patients needed shunt revision. 32 (12.07%) of them had shunt malfunction. 21 (7.92%) of them had shunt infection. One (0.37%) patient had problems with over drainage. Shunt complications were proportionate in pediatric population as well. Shunt complication at Upendra Devkota Memorial National Institute of Neurological and Allied Sciences is comparable to international data.

Revision rate of pediatric ventriculoperitoneal shunts after 15 years

2013 ◽  
Vol 11 (1) ◽  
pp. 15-19 ◽  
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.

Utility of ventriculogallbladder shunts in complex cases of hydrocephalus related to extreme prematurity

2021 ◽  
pp. 1-7
Author(s):  
Andrew Reisner ◽  
Alexis D. Smith ◽  
David M. Wrubel ◽  
Bryan E. Buster ◽  
Michael S. Sawvel ◽  
...  
Keyword(s):  
Medical Records ◽  
Intraventricular Hemorrhage ◽  
Venous Access ◽  
Shunt Infection ◽  
Definitive Treatment ◽  
Shunt Revision ◽  
Extreme Prematurity ◽  
Shunt Insertion ◽  
Shunt Placement ◽  
The Mean

OBJECTIVEThe management of hydrocephalus resulting from intraventricular hemorrhage related to extreme prematurity remains demanding. Given the complexities of controlling hydrocephalus in this population, less commonly used procedures may be required. The authors examined the utility of ventriculogallbladder (VGB) shunts in a series of such children.METHODSThe authors retrospectively reviewed the medical records of all children who underwent surgery for hydrocephalus in the period from 2011 through 2019 at Children’s Healthcare of Atlanta. Six patients who underwent VGB shunt placement were identified among a larger cohort of 609 patients who had either a new shunt or a newly changed distal terminus site. The authors present an analysis of this series, including a case of laparoscopy-assisted distal VGB shunt revision.RESULTSThe mean age at initial shunt placement was 5.1 months (range 3.0–9.4 months), with patients undergoing a mean of 11.8 shunt procedures (range 5–17) prior to the initial VGB shunt placement at a mean age of 5.3 years (range 7.9 months–12.8 years). All 6 patients with VGB shunt placement had hydrocephalus related to extreme prematurity (gestational age < 28 weeks). At the time of VGB shunt placement, all had complex medical and surgical histories, including poor venous access due to congenital or iatrogenic thrombosis or thrombophlebitis and a peritoneum hostile to distal shunt placement related to severe necrotizing enterocolitis. VGB complications included 1 case of shunt infection, identified at postoperative day 6, and 2 cases of distal shunt failure due to retraction of the distal end of the VGB shunt. In all, there were 3 conversions back to ventriculoperitoneal or ventriculoatrial shunts due to the 2 previously mentioned complications, plus 1 patient who outgrew their initial VGB shunt. Three of 6 patients remain with a VGB shunt, including 1 who underwent laparoscopy-assisted distal shunt revision 110.5 months after initial VGB shunt insertion.CONCLUSIONSPlacement of VGB shunts should be considered in the armamentarium of procedures that may be used in the particularly difficult cohort of children with hydrocephalus related to extreme prematurity. VGB shunts show utility as both a definitive treatment and as a “bridge” procedure until the patient is larger and comorbid abdominal and/or vascular issues have resolved sufficiently to allow conversion back to ventriculoperitoneal or ventriculoatrial shunts, if needed.

Efficacy and duration of propranolol therapy for pediatric parotid hemangiomas

2018 ◽  
pp. 1-5
Keyword(s):  
Electronic Medical Records ◽  
Retrospective Review ◽  
Medical Records ◽  
Pediatric Patients ◽  
Vascular Anomalies ◽  
Children's Hospital ◽  
Children’S Hospital ◽  
Anatomic Locations ◽  
Propranolol Therapy

Objective: To assess the efficacy and duration of propranolol therapy in pediatric patients with parotid hemangiomas, and compare the results with the efficacy and duration of propranolol therapy in patients with infantile hemangiomas in other anatomic locations. Methods: In this retrospective review, we analyzed the electronic medical records of 21 patients with parotid hemangiomas seen at the Children’s Hospital of Orange County’s Vascular Anomalies Clinic between 2009 and 2015. We compared the duration of propranolol therapy and rate of re-growth after completion of therapy with established data for these parameters in the literature for patients with other infantile hemangiomas. Results: In our cohort, 13 of the 21 patients had completed therapy, with a mean duration of 26 months of propranolol therapy. Eighteen patients (85.7%) were treated with the goal dose of propranolol (2 mg/kg/day). Three patients required a higher dose in order to achieve significant improvement in the size of the hemangioma. All patients had some response to propranolol. Eight of the 13 patients (61.5%) who completed propranolol therapy saw regrowth once initial propranolol therapy was either weaned or stopped. Conclusion: Pediatric patients with parotid hemangiomas require longer duration of propranolol therapy than patients with other infantile hemangiomas, and a greater percentage may have regrowth after completion of therapy.

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.

Cerebrospinal fluid shunting protocol for idiopathic intracranial hypertension for an improved revision rate

2021 ◽  
pp. 1-6
Author(s):  
Luke Galloway ◽  
Kishan Karia ◽  
Anwen M. White ◽  
Marian E. Byrne ◽  
Alexandra J. Sinclair ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Intracranial Hypertension ◽  
Idiopathic Intracranial Hypertension ◽  
Revision Rate ◽  
Shunt Revision ◽  
Csf Shunt ◽  
Peritoneal Catheter ◽  
Vp Shunt ◽  
Primary Surgery ◽  
Csf Shunting

OBJECTIVE Cerebrospinal fluid (CSF) shunting in idiopathic intracranial hypertension (IIH) is associated with high complication rates, primarily because of the technical challenges that are related to small ventricles and a large body habitus. In this study, the authors report the benefits of a standardized protocol for CSF shunting in patients with IIH as relates to shunt revisions. METHODS This was a retrospective study of consecutive patients with IIH who had undergone primary insertion of a CSF shunt between January 2014 and December 2020 at the authors’ hospital. In July 2019, they implemented a surgical protocol for shunting in IIH. This protocol recommended IIH shunt insertion by neurosurgeons with expertise in CSF disorders, a frontal ventriculoperitoneal (VP) shunt with an adjustable gravitational valve and integrated intracranial pressure monitoring device, frameless stereotactic insertion of the ventricular catheter, and laparoscopic insertion of the peritoneal catheter. Thirty-day revision rates before and after implementation of the protocol were compared in order to assess the impact of standardizing shunting for IIH on shunt complications. RESULTS The 81 patients included in the study were predominantly female (93%), with a mean age of 31 years at primary surgery and mean body mass index (BMI) of 37 kg/m2. Forty-five patients underwent primary surgery prior to implementation of the protocol and 36 patients after. Overall, 12 (15%) of 81 patients needed CSF shunt revision in the first 30 days, 10 before and 2 after introduction of the protocol. This represented a significant reduction in the early revision rate from 22% to 6% after the protocol (p = 0.036). The most common cause of shunt revision for the whole cohort was migration or misplacement of the peritoneal catheter, occurring in 6 of the 12 patients. Patients with a higher BMI were significantly more likely to have a shunt revision within 30 days (p = 0.022). CONCLUSIONS The Birmingham standardized IIH shunt protocol resulted in a significant reduction in revisions within 30 days of primary shunt surgery in patients with IIH. The authors recommend standardization for shunting in IIH as a method for improving surgical outcomes. They support the notion of subspecialization for IIH shunts, the use of a frontal VP shunt with sophisticated technology, and laparoscopic insertion of the peritoneal end.

Sign in / Sign up

Export Citation Format

Share Document