A 12-year single-center retrospective analysis of antisiphon devices to prevent proximal ventricular shunt obstruction for hydrocephalus

Koueik, Joyce; Kraemer, Mark Richard; Hsu, David; Rizk, Elias; Zea, Ryan; Haldeman, Clayton; Iskandar, Bermans J.

doi:10.3171/2019.6.peds1951

Cited by 9 publications

(7 citation statements)

References 42 publications

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“…This distinction (more than 10 versus less than 10 revisions) was selected from the beginning of our survey and it is a subjective dividing element. An identical criterion was used in a previous survey [1] and we agree with the estimation of the previously mentioned senior author that if the total amount of lifetime shunt reoperations is equivalent to or exceeds the number of 10, this could be regarded as a criterion that could fair enough differentiate a patient from the average failure rate. The majority of ASDs were inserted in individuals who were proved to be dependent on a well-functioning shunt system, and later on, they were complicated from the existence of sudden onset, or long-standing, CSF overdrainage.…”

supporting

confidence: 83%

“…This is true, although significant innovations in medical and engineering technologies have been reported during the last decades. It is a common concept that CSF diversion via the aid of ventricular shunts constitutes the main management option for all patient populations that are not candidates for endoscopic procedures [1][2][3]. A lot of technical improvements and modifications have been introduced in order to offer a considerable evolution of John Holter's original differential pressure device [4].…”

Section: Introductionmentioning

confidence: 99%

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The Role of Antisiphon Devices in the Prevention of Central Ventricular Catheter Obliteration for Hydrocephalus: A 15-Years Institution’s Experience Retrospective Analysis

Panagopoulos

Strantzalis

Gavra³

et al. 2022

Children

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Shunt over-drainage in patients harboring a ventriculoperitoneal shunt constitutes one of the most devastating, and difficult to manage, side effects associated with this operation. Siphoning is one of the most important contributing factors that predispose to this complication. Based on the fact that the predisposing pathophysiologic mechanism is considerably multiplicated, amelioration of that adverse condition is considerably difficult to achieve. A lot of evidence suggests that the widespread utilization of gravitational valves or antisiphon devices is of utmost importance, in order to minimize or even avoid the occurrence of such complications. The recent literature data highlight that gravity-related, long-lasting shunt over-drainage consists of a momentous factor that could be considered one of the main culprits of central shunt failure. A lot of efforts have been performed, in order to design effective means that are aimed at annihilating siphoning. Our tenet was the investigation of the usefulness of the incorporation of an extra apparatus in the shunt system, capable of eliminating the impact of the siphoning effect, based on the experience that was gained by their long-term use in our institution. A retrospective analysis was performed, based on the data that were derived from our institution’s database, centered on patients to which an ASD was incorporated into their initial shunt device between 2006 and 2021. A combination of clinical, surgical, radiological findings, along with the relevant demographic characteristics of the patients were collected and analyzed. We attempted to compare the rates of shunt dysfunction, attributed to occlusion of the ventricular catheter, in a group of patients, before and after the incorporation of an anti-siphon device to all of them. A total number of 120 patients who have already been shunted due to hydrocephalus of different etiologies, were managed with the insertion of an ASD. These devices were inserted at different anatomical locations, which were located peripherally to the initially inserted valvular mechanism. The data that were collected from a subpopulation of 17 of these patients were subjected to a separate statistical analysis because they underwent a disproportionately large number of operations (i.e., >10-lifetime shunt revisions). These patients were studied separately as their medical records were complicated. The analysis of our records revealed that the secondary implementation of an ASD resulted in a decrease of the 1-year and 5-year central catheter dysfunction rates in all of our patients when compared with the relevant obstruction rates at the same time points prior to ASD insertion. According to our data, and in concordance with a lot of current literature reports, an ASD may offer a significant reduction in the obstruction rates that is related to the ventricular catheter of the shunt. These data could only be considered preliminary and need to be confirmed with prospective studies. Nevertheless, this study could be considered capable of providing supportive evidence that chronic shunt over-drainage is a crucial factor in the pathophysiology of shunt malfunction. Apart from that, it could provide pilot data that could be reviewed in order to organize further clinical and laboratory studies, aiming toward the assessment of optimal shunt valve systems that, along with ASD, resist siphoning.

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supporting

confidence: 83%

Section: Introductionmentioning

confidence: 99%

The Role of Antisiphon Devices in the Prevention of Central Ventricular Catheter Obliteration for Hydrocephalus: A 15-Years Institution’s Experience Retrospective Analysis

Panagopoulos

Strantzalis

Gavra³

et al. 2022

Children

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“…Despite the additional cost and mechanical complexity the use of this shunt adjunct may be justi ed upfront in all IIH, and strong support to this solution can be found in the literature [32][33][34] .…”

Section: Therapeutic Strategies To Reverse Ventricular Collapsementioning

confidence: 99%

A Retrospective Longitudinal Analysis of Risk Factors, Treatment Outcomes and Imaging Parameters of Ventricular Collapse in Idiopathic Intracranial Hypertension

Serra¹,

Mahapatra²,

Huq³

et al. 2020

Preprint

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ObjectiveVentricular collapse is a prevalent yet poorly understood complication of ventriculo-peritoneal shunting (VPS) in patients with idiopathic intracranial hypertension (IIH). By identifying and describing the risk factors of ventricular collapse (VC), this study aims to characterize the clinical progression, etiopathogenesis and treatment of IIH and its complications. The relationships between ventricular size, symptoms and treatments were also assessed longitudinally with ventricular segmentation on MRI/CT imaging, and correlated with other risk factors of IIH and VC. MethodsWe retrospectively reviewed records of 147 patients who underwent VPS for IIH at our Institution, and identified 73 shunt-naïve subjects included in the final analysis. Manual segmentation of CT/MRI scans was performed longitudinally at each clinical stage (baseline, post-shunting, post-collapse and after each intervention). Variables collected included valve type and opening-pressure, shunt revisions, use of anti-siphoning devices (ASD), comorbidities, venous sinus hypoplasia/stenosis and stenting, and general demographics. Linear univariate regression models were used to determine the association between individual risk factors and VC, and to quantitatively assess the effect of treatment. Two multivariate models were also tested, including Pre-Shunting and Post-Shunting variables, to quantify their association with VC. ResultsOf 73 IIH patients with new shunts, 32 experienced collapse (uni- or bilateral, 26.5% of the total). In shunt-naïve patients, collapse was associated with pre-shunting (rho=-0.36; p=0.001) and post-shunting ventricular size (rho=0.62; p=0.0002). Both collapse and ventricular area were correlated with shunt-related symptoms at 6 months (rho=-0.29; p=0.01). Shunt adjustment, addition of ASDs, and valve replacement proved to be the most effective strategies to re-expand the ventricles and reduce symptoms. Nonetheless, a significant fraction of patients remained symptomatic after multiple treatments, suggesting a complex and multifactorial etiology for VC. On univariate analysis, catheter revisions were more common in the VC group, while the multivariate model with Post-Shunting risk factors proved to be significantly associated with VC. ConclusionsIn newly VP-shunted IIH patients, small ventricular size predisposed to collapse and headaches, while higher valve OPs and ASDs may reduce the risk of collapse and promote symptomatic improvement. Within the restraints of a retrospective analysis, this study is the first to analyze the risk factors of VC in IIH patients, longitudinally integrating the clinical progression with ventricular imaging. Further prospective studies are warranted to better understand the etiopathogenesis and clinical progression of collapse.

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“…Nowadays, the insertion of or even the replacement of an ASD or the combination of that device with a programmable valve is considered to be the most widely accepted and scientifically sound treatment option. The insertion (at the time of initial insertion of a shunt or during follow-up) of an ASD has been associated with a significant decrease in the rate of development of SVS, as well as with a lesser incidence of ventricular catheter obstruction [39,40]. A study has mentioned that its use is positively related with the acquisition of better intellectual outcomes [41].…”

Section: Clinical Efficacy Of Asds In Shunt-induced Overdrainage Cond...mentioning

confidence: 99%

Shunt Over-drainage, Slit Ventricle Syndrome, Programmable Valves and Anti-Siphon Devices. A Narrative Review of a Multifactorial and Intractable Problem

Panagopoulos¹,

Stranjalis²,

Gavra³

et al. 2022

J. Integr. Neurosci.

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The current management strategy of hydrocephalus mainly involves the insertion of a ventriculoperitoneal shunt and is inherently related with a complication widely known as shunt over-drainage. Albeit this is a well-recognized complication, the true incidence and severity of this phenomenon remains undefined and most probably underdiagnosed, necessitating a more comprehensive pathophysiologic and therapeutic consideration. The slit ventricle syndrome is intimately related with the entity of shunt over-drainage, although who's the definition of the former is implicated by a lack of universally accepted inclusion criteria. Another point of controversy is related with the absence of widely accepted criteria that would be able to discriminate the existing differentiations between these two entities. This is reflected in the fact that there are many proposed, relevant, treatment protocols. The background for all this data is based on the uncertainty and ambiguity regarding the pathophysiological mechanisms that are implicated. Current efforts are centered on the implementation of precautionary measures, as well as on treatment of both of these entities. Currently, there are enough evidence that support the concept that prevention of siphoning via the use of gravitational valves or antisiphon devices is the most efficacious means contained in our current therapeutic armamentarium. We attempt to present an overview of this complex entity, emphasizing on the hydrodynamics of the cerebrospinal fluid circulation in conditions harboring a ventriculoperitoneal shunt, the effect of the siphoning effect and the role of programmable valves and anti-siphon devices in our effort to eliminate this phenomenon. Based on an extensive literature review and on expert opinion, we concluded that the insertion of an anti-siphon device (gravitational shunt valves) could reliably address the issue of over-drainage, when a patient assumes a vertical position. Besides that, there are ongoing prospective studies centered on the safety and efficacy of adjustable gravitational valves, whose results are of ultimate importance. It is of paramount importance to be recognized that, due to the complexity of the pathophysiology of shunted hydrocephalus, lifelong follow-up of patients with ventriculoperitoneal shunts is necessary.

show abstract

A 12-year single-center retrospective analysis of antisiphon devices to prevent proximal ventricular shunt obstruction for hydrocephalus

Cited by 9 publications

References 42 publications

The Role of Antisiphon Devices in the Prevention of Central Ventricular Catheter Obliteration for Hydrocephalus: A 15-Years Institution’s Experience Retrospective Analysis

The Role of Antisiphon Devices in the Prevention of Central Ventricular Catheter Obliteration for Hydrocephalus: A 15-Years Institution’s Experience Retrospective Analysis

A Retrospective Longitudinal Analysis of Risk Factors, Treatment Outcomes and Imaging Parameters of Ventricular Collapse in Idiopathic Intracranial Hypertension

Shunt Over-drainage, Slit Ventricle Syndrome, Programmable Valves and Anti-Siphon Devices. A Narrative Review of a Multifactorial and Intractable Problem

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