Choroid plexus coagulation in infants with extreme hydrocephalus or hydranencephaly

2014 ◽  
Vol 14 (1) ◽  
pp. 55-57 ◽  
Author(s):  
Sylvia Shitsama ◽  
Nunthasiri Wittayanakorn ◽  
Humphrey Okechi ◽  
A. Leland Albright
Keyword(s):  
Choroid Plexus ◽  
Medical Records ◽  
Congenital Hydrocephalus ◽  
Shunt Insertion ◽  
Radiographic Images ◽  
Vp Shunt ◽  
Shunt Placement ◽  
Csf Leakage ◽  
Lost To Follow Up ◽  
Severe Hydrocephalus

Object Severe hydrocephalus and hydranencephaly are common congenital conditions in Kenya. In patients with these conditions, ventriculoperitoneal (VP) shunts are associated with appreciable complications and endoscopic third ventriculostomies (ETVs) have limited success. Endoscopic choroid plexus coagulation (CPC) to diminish CSF production is a potential treatment option. The purpose of this study was to evaluate the effect of CPC without ETV in infants with severe hydrocephalus or hydranencephaly. Methods Medical records of infants with severe congenital hydrocephalus or hydranencephaly who underwent CPC in Kijabe Hospital from November 2010 to April 2013 were reviewed retrospectively. Thirty-three patients with complete medical records and preoperative radiographic images were identified. After CPC, the infants were followed in the Kijabe Hospital outpatient department, in mobile clinics, or by telephone. Success of the CPC was defined as resolution of preoperative symptoms, stabilization of head size, and avoidance of VP shunt placement. Results Patients were followed from 30 to 608 days (median of 120 days). Three patients were lost to follow-up. Of the 30 evaluable patients, CPC was considered to be successful in 13 (43.3%), including 8 of 20 patients with severe hydrocephalus and 5 of 10 with hydranencephaly. Failure of CPC was evident from increased head circumference in 14 (82%) of 17 patients and from CSF leakage in 3. Of the 17 failures, 13 occurred within 3 months of surgery. Six patients died: 3 whose CPC procedures were failures, 2 whose CPC was successful, and 1 postoperatively. Of the 17 in whom CPC failed, 10 subsequently underwent VP shunt insertion. Conclusions CPC stabilizes macrocephaly in approximately 40% of infants with severe congenital hydrocephalus and hydranencephaly and can be considered as an alternative to VP shunt placement.

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.

Ventriculoperitoneal shunt insertion for the treatment of refractory perilymphatic fistula

2006 ◽  
Vol 105 (1) ◽  
pp. 1-5 ◽  
Author(s):  
S. Scott Lollis ◽  
Dudley J. Weider ◽  
Joseph M. Phillips ◽  
David W. Roberts
Keyword(s):  
Functional Status ◽  
Fluid Pressure ◽  
Symptomatic Improvement ◽  
Full Time ◽  
Shunt Insertion ◽  
Perilymphatic Fistula ◽  
Vp Shunt ◽  
Shunt Placement ◽  
Time Work ◽  
Clinically Significant

Object The goal of this study was to provide preliminary data regarding clinical and functional outcome, including postoperative morbidity, related to ventriculoperitoneal (VP) shunt insertion for refractory perilymphatic fistula. Methods The authors retrospectively reviewed the records of seven consecutive patients who had undergone VP shunt insertion for medically and surgically refractory perilymphatic fistula between 1996 and 2004. Patients were also contacted by telephone and asked to assess retrospectively their symptomatic improvement, changes in functional status, and changes in work status following shunt placement. Preoperative and postoperative functional statuses were assessed using a standardized instrument. In each patient, preoperative opening pressure was measured via lumbar puncture. Pressures ranged from 160 to 300 mm H2O, with a mean of 241 mm H2O. All patients reported significant improvement in symptom severity following surgery. Two patients reported complete resolution of symptoms. Three patients were able to resume full-time work. Clinically significant improvement in functional status was noted in six of seven patients. All patients would recommend the procedure to others in a similar situation. Conclusions Data in this study suggest that some patients with disabling vertigo, tinnitus, and headache due to perilymphatic fistula, whose conventional medical and surgical therapies have failed to produce a cure, benefit from VP shunt insertion. The authors hypothesize that VP shunt placement blunts intracranial pressure increases, which would cause secondary elevations in perilymphatic fluid pressure. Shunt insertion reduces perilymph leakage into the middle ear and may permit closure of the fistula.

scholarly journals Clinical and Radiological Predictors of Ventriculoperitoneal Shunt Insertion in Myelomeningocele Patients

2021 ◽  
Vol 9 (B) ◽  
pp. 522-532
Author(s):  
Ahmed M. F. El Ghoul ◽  
Ahmed Hamdy Ashry ◽  
Mohamed Hamdy El-Sissy ◽  
Ibrahim Mohamed Ibrahim Lotfy
Keyword(s):  
Cerebrospinal Fluid ◽  
Surgical Repair ◽  
Shunt Insertion ◽  
Vp Shunt ◽  
Shunt Placement ◽  
Group A ◽  
Study Population ◽  
Group B ◽  
Increased Icp

BACKGROUND: Myelomeningocele (MMC) is one of the most common developmental anomalies of the CNS. Many of these patients develop hydrocephalus (HCP). The rate of cerebrospinal fluid diversion in these patients varies significantly in literature, from 52% to 92%. MMC repair conventionally occurs in the post-natal period. With the technological advances in surgical practice and fetal surgeries, intra uterine MMC repair IUMR is adopted in some centers. Cerebrospinal fluid shunting has numerous complications, most notably shunt failure and shunt infection. Studies have suggested that patients with greater numbers of shunt revisions have poorer performance on neuropsychological testing. There is also good evidence to suggest that the IQs of patients with MMC who do not undergo shunt placement are higher than that of their shunt treated counterparts. AIM: In this study, we are trying to identify strong clinical and radiological predictors for the need of ventriculoperitoneal (VP) shunt insertion in patients with MMC who underwent surgical repair and closure of the defect initially. This will decrease the overall rate of shunt placement in this group of patients through applying a strict policy adopting only shunt insertion for the desperately needing patient. METHODS: Prospective clinical study conducted on 96 patients with MMC presented to Aboul Reish Pediatric Specialized Hospital, Cairo University. After confirming the diagnosis through clinical and radiological aids, patients are carefully examined, if HCP is evident clinically and radiologically a shunt is inserted together with MMC repair at the same session after excluding sepsis or cerebrospinal fluid (CSF) infection, (GROUP A). If there are no signs of increased ICP, MMC repair shall be done alone (GROUP B). Those patients shall be monitored carefully postoperatively and after discharge and shall be followed up regularly to early detect and promptly manage latent HCP. Multiple clinical and radiological indices were used throughout the follow-up period and statistical significance of each was measured. RESULTS: Shunt placement was required in 45 (46.88%) of the 96 patients. Eighteen patients (18.75%) needed the shunt as soon as they presented to us (GROUP A), because they were having clinically active HCP. Twenty-seven (28.13%) patients were operated on by MMC repair initially without shunt placement because they did not have signs of increased ICP at the time of presentation. Yet, they developed latent HCP requiring shunt placement during the follow-up period (GROUP B2). Fifty-one patients of the study population (53.13%) underwent surgical repair of the MMC without the need of further VP insertion and they were followed up for 6 months period after the repair without developing latent HCP (GROUP B1). Patients of GROUP B were the study population susceptible for the development of latent HCP. Out of 78 patients in GROUP B, only 27 patients (34.62%) needed a VP shunt. CONCLUSION: In our study, we found that the rate of shunt insertion in patients with MMC is lower than the previously reported rate in the literature. A more thorough evaluation of the patient’s post-operative need for a shunt is mandatory. We suggest that we could accept postoperative (after MMC repair) ventriculomegaly provided it does not mean any deterioration in the patient’s clinical or developmental state. We assume that reduction of shunt insertion rate will eventually reduce what has previously been an enormous burden for a significant proportion of children with MMC.

Ventricular reservoir versus ventriculosubgaleal shunt for posthemorrhagic hydrocephalus in preterm infants: infection risks and ventriculoperitoneal shunt rate

2014 ◽  
Vol 14 (5) ◽  
pp. 447-454 ◽  
Author(s):  
Joanna Y. Wang ◽  
Anubhav G. Amin ◽  
George I. Jallo ◽  
Edward S. Ahn
Keyword(s):  
Preterm Infants ◽  
Time Interval ◽  
Neurodevelopmental Outcomes ◽  
Shunt Insertion ◽  
Posthemorrhagic Hydrocephalus ◽  
Vp Shunt ◽  
Shunt Placement ◽  
Device Infection ◽  
Ventriculosubgaleal Shunt ◽  
Ventricular Reservoir

Object The most common neurosurgical condition observed in preterm infants is intraventricular hemorrhage (IVH), which often results in posthemorrhagic hydrocephalus (PHH). These conditions portend an unfavorable prognosis; therefore, the potential for poor neurodevelopmental outcomes necessitates a better understanding of the comparative effectiveness of 2 temporary devices commonly used before the permanent insertion of a ventriculoperitoneal (VP) shunt: the ventricular reservoir and the ventriculosubgaleal shunt (VSGS). Methods The authors analyzed retrospectively collected information for 90 patients with IVH and PHH who were treated with insertion of a ventricular reservoir (n = 44) or VSGS (n = 46) at their institution over a 14-year period. Results The mean gestational age and weight at device insertion were lower for VSGS patients (30.1 ± 1.9 weeks, 1.12 ± 0.31 kg) than for reservoir patients (31.8 ± 2.9 weeks, 1.33 ± 0.37 kg; p = 0.002 and p = 0.004, respectively). Ventricular reservoir insertion was predictive of more CSF taps prior to VP shunt placement compared with VSGS placement (10 ± 8.7 taps vs 1.6 ± 1.7 taps, p < 0.001). VSGS patients experienced a longer time interval prior to VP shunt placement than reservoir patients (80.8 ± 67.5 days vs 48.8 ± 26.4 days, p = 0.012), which corresponded to VSGS patients gaining more weight by the time of shunt placement than reservoir patients (3.31 ± 2.0 kg vs 2.42 ± 0.63 kg, p = 0.016). Reservoir patients demonstrated a trend toward more positive CSF cultures compared with VSGS patients (n = 9 [20.5%] vs n = 5 [10.9%], p = 0.21). There were no significant differences in the rates of overt device infection requiring removal (reservoir, 6.8%; VSGS, 6.5%), VP shunt insertion (reservoir, 77.3%; VSGS, 76.1%), or early VP shunt infection (reservoir, 11.4%; VSGS, 13.0%) between the 2 cohorts. Conclusions Although the rates of VP shunt requirement and device infection were similar between patients treated with the reservoir versus the VSGS, VSGS patients were significantly older and had achieved greater weights at the time of VP shunt insertion. The authors' results suggest that the VSGS requires less labor-intensive management by ventricular tapping; the VSGS patients also attained higher weights and more optimal surgical candidacy at the time of VP shunt insertion. The potential differences in long-term developmental and neurological outcomes between VSGS and reservoir placement warrant further study.

scholarly journals Neurosurgical transection of the breast: an unexpected extracranial complication of ventriculoperitoneal shunt insertion

2017 ◽  
Vol 20 (6) ◽  
pp. 517-520
Author(s):  
Molly Jakeman ◽  
Ranjeet Jeevan ◽  
Sasha C. Burn ◽  
Sian Falder
Keyword(s):  
Scar Tissue ◽  
Normal Breast ◽  
Breast Development ◽  
Shunt Insertion ◽  
Invasive Approach ◽  
Vp Shunt ◽  
Shunt Placement ◽  
Breast Deformity ◽  
Surgery Department

Ventriculoperitoneal (VP) shunt placement is among the most common surgical procedures undertaken by neurosurgeons. Complications arising from the thoracic portion of the shunt are relatively rare in comparison with those of the intraventricular and peritoneal portions. Disruption of primary breast development following VP shunt placement has not previously been reported. The authors describe the case of a 15-year-old girl referred to the plastic surgery department with a significant right breast deformity and associated asymmetry following VP shunt placement performed during the neonatal period. The calcified shunt was excised and the breast deformity was corrected surgically through multiple scar tissue releases and restoration of the normal breast parenchymal anatomy via a minimally invasive approach, resulting in an excellent aesthetic outcome.This case highlights the potential for injury to occult breast tissue in pediatric patients undergoing VP shunt placement, which can impair subsequent cosmesis and quality of life.

scholarly journals Indications of ventriculoperitoneal shunt: a prospective study

2017 ◽  
Vol 4 (4) ◽  
pp. 1319
Author(s):  
Ritvik D. Jaykar ◽  
Shrikant P. Patil
Keyword(s):  
Ct Scan ◽  
Tuberculous Meningitis ◽  
Surgical Techniques ◽  
Congenital Hydrocephalus ◽  
Clinical Feature ◽  
Communicating Hydrocephalus ◽  
Shunt Surgery ◽  
Shunt Insertion ◽  
Female Ratio ◽  
Vp Shunt

Background: Shunts have been used to drain the Cerebrospinal fluid into practically every body cavity, organ system and tissue spaces. Scraff has critically reviewed the efficacy of various shunts.  These are of historical interest.  Ventriculo peritoneal and ventriculo cardiac shunts continue to remain the chief surgical techniques in the management of hydrocephalus.Methods: This study included sixty cases where VP shunt insertion surgery was indicated. Chhabra’s medium pressure VP shunt was used in all 60 cases.  32 out of 60 cases were below 2 years (53.3%) .70% of the patients were male and 30% were female. Male to female ratio was 2.3:1. Out of 24 cases of congenital hydrocephalus 16 were due to aqueductal stenosis i.e. 66.6 % of cases. Dandy Walker malformation was found in 2 cases. And in 2 more cases, Arnold Chiari malformation was found. In acquired group 22 cases had tuberculous meningitis, 4 cases were of post meningitis aetiology and 10 cases were of communicating hydrocephalus with history of trauma.Results: In congenital group of patients, most common clinical feature was ‘enlargement of head’ bulging of fontanelle.  In acquired group of patients the common clinical features were headache, vomiting, fever and convulsions. USG cranium and CT scan proved to be highly informative investigations and were done wherever necessary. Out of 36 cases of acquired group the percentage of tuberculous meningitis was 61.6% and communicating hydrocephalus with trauma was about 27%. USG cranium was also used in follow up congenital hydrocephalus to assess the position and functioning of shunt.  Even CT scan was used in adult age group to assess the position of shunt and condition of the brain. All patients of with VP shunt surgery were treated with higher antibiotics preoperatively and postoperatively.Conclusions: Common complications included, shunt infections, shunt obstruction, shunt malposition. Rare complications included shunt migration through anus and shunt ascites. Four patients died after VP shunt surgery, two were operated case of encephalocele with associated congenital anomalies with uremia and other two were with dreaded shunt infection with septicaemia. Ten (16.6%) patients required revision of VP shunt surgery in present study.

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.

Infratentorial complications following preresection CSF diversion in children with posterior fossa tumors

2015 ◽  
Vol 15 (1) ◽  
pp. 4-11 ◽  
Author(s):  
Mohamed Ali El-Gaidi ◽  
Ashraf Hesham Abou El-Nasr ◽  
Ehab Mohamed Eissa
Keyword(s):  
Posterior Fossa ◽  
Medical Records ◽  
University Hospital ◽  
Third Ventriculostomy ◽  
Posterior Fossa Tumors ◽  
Vp Shunt ◽  
Computed Tomography Scans ◽  
Csf Diversion ◽  
Tentorial Incisura ◽  
Severe Hydrocephalus

OBJECT This report presents the incidence, causes, and morbidity and mortality of infratentorial complications following CSF diversion before resection in children with posterior fossa tumors. METHODS The medical records of 437 children admitted to Abo El-Reesh Pediatric University Hospital with a diagnosis of posterior fossa tumor between 2005 and 2012 were retrospectively reviewed. Seven children developed neurological deterioration following CSF diversion due to infratentorial complications. Computed tomography scans revealed intratumoral hemorrhage (ITH) in 5 cases, while upward transtentorial herniation (UTH), as evidenced by obliteration of the quadrigeminal and ambient cisterns, was diagnosed in 2 cases. RESULTS Hydrocephalus was noted in 381 patients, and 301 patients underwent CSF diversion before resection. A ventriculoperitoneal (VP) shunt was used in 214 patients, and 6 children (2.8% of shunted cases) deteriorated neurologically (4 due to ITH and 2 due to UTH). Endoscopic third ventriculostomy (ETV) was performed in 87 patients, 1 of whom developed ITH (1.1% of the patients undergoing ETV). Six patients deteriorated within 8 hours (85.7%), whereas 1 patient, the only survivor, deteriorated after 24 hours. The incidence of infratentorial complications between VP shunts and ETVs was not found to be significantly different (p = 0.659). There was a higher risk of such complications in large posterior fossa tumors (diameter ≥ 4 cm) extending close to the tentorial incisura, especially in patients with severe hydrocephalus and significant peritumoral edema. CONCLUSIONS Infratentorial complications (ITH and UTH) in children with posterior fossa tumors are not uncommon (2.3%) after preresection CSF diversion (VP shunt or ETV) and are associated with a very poor prognosis in most cases, even with surgical intervention.

scholarly journals Development of a nonintermediate-incision ventriculoperitoneal shunt procedure using a nasogastric feeding tube for infant patients with hydrocephalus: technical note

2016 ◽  
Vol 17 (5) ◽  
pp. 540-543 ◽  
Author(s):  
Shuji Hamauchi ◽  
Toshitaka Seki ◽  
Toru Sasamori ◽  
Kiyohiro Houkin
Keyword(s):  
Early Period ◽  
Feeding Tube ◽  
Technical Note ◽  
Nasogastric Feeding ◽  
Shunt System ◽  
Shunt Insertion ◽  
Vp Shunt ◽  
Shunt Procedure ◽  
Csf Leakage ◽  
Catheter Tube

Intermediate incisions are considered necessary to pass a catheter tube from the head to the abdomen in ventriculo-peritoneal (VP) shunting via a frontal bur hole. However, an intermediate incision can sometimes become dehiscent, resulting in CSF leakage or infection of the shunt system in the early period after shunt implantation, particularly in infant patients. In this article, the authors describe a novel method of VP shunt insertion that does not require an intermediate incision. This nonintermediate-incision VP shunt procedure was performed in 3 infant patients with hydrocephalus and was not associated with any complications. This method can eliminate the intermediate incision, which is a disadvantage of VP shunt insertion via a frontal bur hole.

scholarly journals Relationship between external ventricular drain clamp trials and ventriculoperitoneal shunt insertion following nontraumatic subarachnoid hemorrhage: a single-center study

2019 ◽  
Vol 130 (3) ◽  
pp. 956-962 ◽  
Author(s):  
Luis C. Ascanio ◽  
Raghav Gupta ◽  
Nimer Adeeb ◽  
Justin M. Moore ◽  
Christoph J. Griessenauer ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
External Ventricular Drain ◽  
Median Number ◽  
Study Patient ◽  
Shunt Insertion ◽  
Female Ratio ◽  
Posthemorrhagic Hydrocephalus ◽  
Vp Shunt ◽  
Shunt Placement ◽  
Lengths Of Stay

OBJECTIVECurrently, there is no established standard regarding the ideal number of external ventricular drain (EVD) clamp trials performed before ventriculoperitoneal (VP) shunt insertion following nontraumatic subarachnoid hemorrhage (SAH). In this study, the authors aimed to evaluate this relationship.METHODSA retrospective review of all patients presenting with SAH between July 2007 and December 2016 was performed. Patients with SAH who had received an EVD within the first 24 hours of hospital admission and had undergone at least 1 clamp trial prior to EVD removal were eligible for inclusion in the study. Patient demographics, clinical presentations, SAH etiologies and grades, clamp trial data, hospital lengths of stay, and functional outcomes were recorded.RESULTSOne hundred fourteen patients with nontraumatic SAH complicated by posthemorrhagic hydrocephalus were included in the study. The median patient age was 57 years (range 28–90 years), with a male/female ratio of 1:1.7. A ruptured aneurysm was the underlying etiology of SAH in 79.8% of patients. A majority of patients (69.4%) had a Hunt and Hess grade III–V on admission. The median number of clamp trials performed was 2 (range 1–6). A VP shunt was required in 40.4% of patients. In those who underwent 2 and 3 clamp trials, 60% and 38.9%, respectively, did not require subsequent VP shunt placement.CONCLUSIONSSurgical placement of a VP shunt is associated with complications. Clamp trials are routinely performed before making the decision to insert a shunt. In the present study, the authors found that a significant percentage of patients passed their second and third clamp trials without requiring subsequent shunt insertion. These data support performing multiple clamp trials prior to shunt placement.

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