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.

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.

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

Neurosurgery ◽  
2011 ◽  
Vol 69 (4) ◽  
pp. 774-781 ◽  
Author(s):  
G Kesava Reddy ◽  
Papireddy Bollam ◽  
Runhua Shi ◽  
Bharat Guthikonda ◽  
Anil Nanda
Keyword(s):  
Median Time ◽  
Adult Patients ◽  
Shunt Revision ◽  
Shunt Failure ◽  
Single Institution ◽  
Ventriculoperitoneal Shunts ◽  
Shunt Placement ◽  
Ventriculoperitoneal Shunting

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

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 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.

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

2021 ◽  
pp. 1-10
Author(s):  
Daniel A. Donoho ◽  
Ian A. Buchanan ◽  
Shivani D. Rangwala ◽  
Arati Patel ◽  
Li Ding ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
The United States ◽  
Population Based ◽  
Shunt Revision ◽  
Shunt Failure ◽  
Hospital Level ◽  
Factors Associated ◽  
Shunt Placement ◽  
Ventricular Shunting

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

Management of Complete Talocrural Luxations by Selective Talocrural Arthrodesis using Hybrid Transarticular External Skeletal Fixation in Dogs

2018 ◽  
Vol 31 (04) ◽  
pp. 291-297
Author(s):  
Taylan Önyay ◽  
Kamil İnal ◽  
Deniz Özbakır ◽  
Ahmet Özak ◽  
Cenk Yardımcı
Keyword(s):  
Retrospective Study ◽  
Clinical Outcomes ◽  
Injured Limb ◽  
Clinical Utilization ◽  
Removal Time ◽  
Hybrid External Fixator ◽  
Early Use ◽  
Clinical Benefits ◽  
Age And Sex

Objective This article presents a novel surgical technique in the management of open complete talocrural luxations and evaluates the results, and clinical benefits with its routine clinical utilization. Study Design Retrospective study. Animals Seventeen medium- or large-breed client-owned dogs of different breed, age and sex with complete talocrural luxations and radiographic follow-up of at least 24 weeks duration. Method Selective talocrural arthrodesis was performed by using a hybrid transarticular external skeletal fixator frame. Clinical and radiographical evaluation was performed regarding the lesion, concomitant injury, duration of the surgery, time to first use of the limb, fixator removal time, complications and clinical outcomes. Results Dogs started to use the injured limb between postoperative days 1 to 11. Pin or wire tract related complications were observed in all dogs. Time to fixator removal ranged from 57 to 90 days with a median of 73 days. All of the operated joints with an exception of one dog resulted in talocrural fusion. Mid-term clinical outcomes score was regarded as excellent in 13/17 dogs, good in 3/17 dogs and poor in 1/17 dogs subject to authors' evaluation. Conclusion A transarticular hybrid external fixator may allow early use of postoperative limb with an excellent patient compliance and is well tolerated as well. The technique showed a promising opportunity of providing favourable limb use.

Occipital Nerve Blocks for Relief of Headaches in Patients With Ventriculoperitoneal Shunts: A Case Series

2019 ◽  
Vol 34 (11) ◽  
pp. 674-678 ◽  
Author(s):  
Eugene Kim ◽  
Giovanni Cucchiaro
Keyword(s):  
Pediatric Patients ◽  
Case Series ◽  
Therapeutic Interventions ◽  
Shunt Revision ◽  
Occipital Neuralgia ◽  
Pulsed Radiofrequency ◽  
Nerve Blocks ◽  
Ventriculoperitoneal Shunts ◽  
Occipital Nerve ◽  
History Of

Pediatric patients with ventriculoperitoneal shunts commonly present with headaches. We report 7 children with ventriculoperitoneal shunts and occipital headaches who received occipital nerve blocks. Eighty-six percent of patients had a history of at least 1 ventriculoperitoneal shunt revision. Headaches improved in every patient after the block. Two patients (29%) were symptom free 11 and 12 months after the block. Four patients (57%) required repeat occipital nerve blocks. Two underwent pulsed radiofrequency ablation. No complications were noted. When patients with ventriculoperitoneal shunts present with headaches, a detailed physical examination is necessary. Persistent occipital headaches with tenderness and radiation in the path of the occipital nerves can be indicative of occipital neuralgia resulting from the shunt having crossed over the path of the greater or lesser occipital nerve. Occipital nerve blocks can help as both diagnostic and therapeutic interventions in these patients.

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

Neurosurgery ◽  
2011 ◽  
Vol 70 (2) ◽  
pp. 380-389 ◽  
Author(s):  
G. Kesava Reddy ◽  
Papireddy Bollam ◽  
Gloria Caldito ◽  
Bharat Guthikonda ◽  
Anil Nanda
Keyword(s):  
Ventriculoperitoneal Shunt ◽  
Shunt Revision ◽  
Shunt Failure ◽  
Shunt Surgery ◽  
Shunt Placement ◽  
Adult Transition ◽  
Shunt Survival ◽  
Pediatric Onset

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

Using a burr hole valve prevents proximal shunt failure in infants and toddlers

2019 ◽  
Vol 24 (3) ◽  
pp. 315-322
Author(s):  
Chiu-Hao Hsu ◽  
Sheng-Che Chou ◽  
Shih-Hung Yang ◽  
Ming-Chieh Shih ◽  
Meng-Fai Kuo
Keyword(s):  
Protective Factor ◽  
Catheter Insertion ◽  
Burr Hole ◽  
Ventricular Catheter ◽  
Shunt Failure ◽  
Shunt Insertion ◽  
Vp Shunt ◽  
Catheter Migration ◽  
The Mean

OBJECTIVEProximal malfunction is the most common cause of ventriculoperitoneal (VP) shunt failure in young children. In this study, the authors sought to determine factors that affect the migration rate of ventricular catheters in hydrocephalic children who undergo shunt implantation in the first 3 years of life.METHODSThe authors reviewed the medical records and imaging studies of newly diagnosed and treated hydrocephalic children who were younger than 3 years. Patients who received VP shunt insertion through the parieto-occipital route were not included. In total, 78 patients were found who underwent VP shunt insertion between December 2006 and April 2017. Eighteen patients were excluded due to mortality, short follow-up period (< 1 year), and lack of imaging follow-up. The age, sex, etiology of hydrocephalus, initial length of ventricular catheter, valve type (burr hole vs non–burr hole), time to ventricular catheter migration, subsequent revision surgery, and follow-up period were analyzed. The diagnosis of a migrated ventricular catheter was made when serial imaging follow-up showed progressive withdrawal of the catheter tip from the ventricle, with the catheter shorter than 4 mm inside the ventricle, or progressive deviation of the ventricular catheter toward the midline or anterior ventricular wall.RESULTSSixty patients were enrolled. The mean age was 5.1 months (range 1–30 months). The mean follow-up period was 50.9 months (range 13–91 months). Eight patients had ventricular catheter migration, and in 7 of these 8 patients a non–burr hole valve was used. In the nonmigration group, a non–burr hole valve was used in only 6 of the 52 patients. Six of the 8 patients with catheter migration needed second surgeries, which included removal of the shunt due to disconnection in 1 patient. The remaining 2 patients with shunt migration were followed for 91 and 46 months, respectively, without clinical and imaging changes. The authors found that patient age at catheter insertion, ventricular catheter length, and the use of a burr hole valve were protective factors against migration. After ventricular catheter length and patient age at catheter insertion were treated as confounding variables and adjusted with multivariable Weibull proportional hazards regression, the use of a burr hole valve shunt remained a protective factor.CONCLUSIONSThe use of burr hole valves is a protective factor against ventricular catheter migration when the shunt is inserted via a frontal route. The authors suggest the use of a burr hole valve along with a frontal entry point in hydrocephalic children younger than 3 years to maintain long-term shunt function.

scholarly journals Reevaluating the weekend effect on patients with hydrocephalus undergoing operative shunt intervention

2016 ◽  
Vol 17 (2) ◽  
pp. 156-162 ◽  
Author(s):  
Frank J. Attenello ◽  
Eisha Christian ◽  
Timothy Wen ◽  
Steven Cen ◽  
Gabriel Zada ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
High Volume ◽  
Adverse Outcomes ◽  
Weekend Effect ◽  
Shunt Revision ◽  
Published Data ◽  
Inpatient Mortality ◽  
Shunt Insertion ◽  
Related Quality ◽  
The Impact

OBJECT Recently published data have suggested an increase in adverse outcomes in pediatric patients after insertion or revision of a ventricular CSF diversion shunt after a same-day weekend procedure. The authors undertook an evaluation of the impact of weekend admission and time to shunting on surgery-related quality outcomes in pediatric patients who underwent ventricular shunt insertion or revision. METHODS Pediatric patients with hydrocephalus who underwent ventriculoperitoneal, ventriculoatrial, or ventriculopleural shunt placement were selected from the 2000–2010 Nationwide Inpatient Sample and Kids’ Inpatient Database. Multivariate regression analyses (adjusted for patient, hospital, case severity, and time to shunting) were used to determine the differences in inpatient mortality and routine discharge rates among patients admitted on a weekday versus those among patients admitted on a weekend. RESULTS There were 99,472 pediatric patients with shunted hydrocephalus, 16% of whom were admitted on a weekend. After adjustment for disease severity, time to procedure, and admission acuity, weekend admission was not associated with an increase in the inpatient mortality rate (p = 0.46) or a change in the percentage of routine discharges (p = 0.98) after ventricular shunt procedures. In addition, associations were unchanged after an evaluation of patients who underwent shunt revision surgery. High-volume centers were incidentally noted in multivariate analysis to have increased rates of routine discharge (OR 1.04 [95% CI 1.01–1.07]; p = 0.02). CONCLUSIONS Contrary to those of previous studies, the authors’ data suggest that weekend admission is not associated with poorer outcomes for ventricular shunt insertion or revision. Increased rates of routine discharge were noted at high-volume centers.

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