Arne Torkildsen and the ventriculocisternal shunt: the first clinically successful shunt for hydrocephalus

Eide, Per Kristian; Lundar, Tryggve

doi:10.3171/2015.1.jns142659

Cited by 15 publications

(7 citation statements)

References 37 publications

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“…In a historical perspective, management of ncHC was a major challenge, with high mortality rates. 14 CSF diversion by ETV or shunting can be lifesaving.…”

Section: Acute Versus Chronic Nchc and The Classification Of Hcmentioning

confidence: 99%

The pathophysiology of chronic noncommunicating hydrocephalus: lessons from continuous intracranial pressure monitoring and ventricular infusion testing

Eide¹

2018

Journal of Neurosurgery

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OBJECTIVE The pathophysiology of chronic noncommunicating hydrocephalus (ncHC) is poorly understood. This present study explored whether lessons about the pathophysiology of this clinical entity might be retrieved from results of overnight monitoring of pulsatile and static intracranial pressure (ICP) and ventricular infusion testing. METHODS The study cohort included adult patients (> 20 years of age) with chronic ncHC due to aqueductal stenosis in whom symptoms had lasted a minimum of 6 months. A reference cohort consisted of age- and sex-matched patients managed for communicating HC (cHC). Information about symptoms and clinical improvement following surgery was retrieved from a quality register, and results of overnight ICP recordings and ventricular infusion testing were retrieved from the hospital ICP database. RESULTS The cohort with ncHC consisted of 61 patients of whom 6 (10%) were managed conservatively, 34 (56%) by endoscopic third ventriculostomy (ETV), and 21 (34%) using ETV and subsequent shunt surgery. In patients responding to surgery, pulsatile ICP (mean ICP wave amplitude) was significantly increased to a similar magnitude in patients with ncHC and the reference cohort (cHC). Furthermore, intracranial compliance (ICC) was reduced in clinical responders. The results of ventricular infusion testing provided evidence that patients responding to ETV have impaired ventricular CSF absorption, while those requiring shunt placement after ETV present with impaired CSF absorption both in the intraventricular and extraventricular compartments. CONCLUSIONS The study may provide some lessons about the pathophysiology of chronic ncHC. First, increased pulsatile ICP and impaired ICC characterize patients with chronic ncHC who respond clinically to CSF diversion surgery, even though static ICP is not increased. Second, in patients responding clinically to ETV, impaired ventricular CSF absorption may be a key factor. Patients requiring shunt placement for clinical response appear to have both intraventricular and extraventricular CSF absorption failure. A subgroup of patients with ncHC due to aqueductal stenosis has normal ventricular CSF absorption and normal ICC and may not be in need of surgical CSF diversion.

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“…In a historical perspective, management of ncHC was a major challenge, with high mortality rates. 14 CSF diversion by ETV or shunting can be lifesaving.…”

Section: Acute Versus Chronic Nchc and The Classification Of Hcmentioning

confidence: 99%

The pathophysiology of chronic noncommunicating hydrocephalus: lessons from continuous intracranial pressure monitoring and ventricular infusion testing

Eide¹

2018

Journal of Neurosurgery

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“…Arne Torkildsen was a pioneering Norwegian neurosurgeon, the first to perform (on September 9, 1937) a clinically successful procedure, called VCS, for shunting CSF in non-communicating hydrocephalus [ 9 , 31 , 35 ]. The surgical method consisted in a burr hole placed for ventriculography via one of the occipital horns of the lateral ventricle.…”

Section: Discussionmentioning

confidence: 99%

“…A groove was chiseled in the skull underneath the scalp just wide enough to hold the catheter. The procedure was performed under local anesthesia [ 9 , 32 , 37 ]. The technique soon received international acceptance as a standard procedure for treating obstruction of the aqueduct/third ventricle, and it gained widespread use in the 1940s, before extracranial shunts’ introduction [ 9 , 38 ].…”

Section: Discussionmentioning

confidence: 99%

“…Here we describe the skeletal remains of a Slavic soldier who died at the age of 21 years, whose skull shows signs of antemortem neurosurgery procedures morphologically comparable to the Torkildsen’s ventriculocisternostomy (VCS) [ 9 ]. The skeletonized individual (stored in a coffin marked with the number 33 and bearing the years of birth and death “1925–1946”) is part of a skeleton collection of Slavic troops who had been detained and died in the prison camp of Torre Tresca (Bari Italy) during the Second World War, and whose remains were found in the Ossuary of the Monumental Cemetery of Bari [ 10 , 11 ].…”

Section: Introductionmentioning

confidence: 99%

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Torkildsen’s Ventriculocisternostomy First Applications: The Anthropological Evidence of a Young Slavic Soldier Who Died in the Torre Tresca Concentration Camp (Bari, Italy) in 1946

Sablone

Gallieni

Leggio

et al. 2021

Biology

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Human skeletal remains are considered as real biological archives of each subject’s life. Generally, traumas, wounds, surgical interventions, and many human pathologies suffered in life leave identifiable marks on the skeleton, and their correct interpretation is possible only through a meticulous anthropological investigation of skeletal remains. The study here presented concerns the analysis of a young Slavic soldier’s skeleton who died, after his imprisonment, in the concentration camp of Torre Tresca (Bari, Italy), during the Second World War (1946). In particular, the skull exhibited signs of surgical activity on the posterior cranial fossa and the parieto-occipital bones. They could be attributed to surgical procedures performed at different times, showing various degrees of bone edge remodeling. Overall, it was possible to correlate the surgical outcomes highlighted on the skull to the Torkildsen’s ventriculocisternostomy (VCS), the first clinically successful shunt for cerebrospinal fluid (CSF) diversion in hydrocephalus, which gained widespread use in the 1940s. For this reason, the skeleton we examined represents a rare, precious, and historical testimony of an emerging and revolutionary neurosurgical technique, which differed from other operations for treating hydrocephalus before the Second World War and was internationally recognized as an efficient procedure before the introduction of extracranial shunts.

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“…Arne Torkildsen was a pioneering Norwegian neurosurgeon best known for developing ventriculocisternostomy (VCS), the first clinically successful procedure for shunting of CSF. It is widely accepted that Torkildsen developed a procedure that received international recognition and was successfully and safely executed by many neurosurgeons at a period of time when no other safe and effective treatment existed for patients with hydrocephalus [ 5 ]. Indeed, the Torkildsen shunt appears to have been excessively used as a new surgical procedure for treating hydrocephalus in the 1940s and 1950s [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

Torkildsen shunt as a salvage procedure for an infant with post-hemorrhagic hydrocephalus

Panagopoulos¹,

Themistocleous²,

Mitsios³

et al. 2019

International Journal of Surgery Case Reports

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Arne Torkildsen and the ventriculocisternal shunt: the first clinically successful shunt for hydrocephalus

Cited by 15 publications

References 37 publications

The pathophysiology of chronic noncommunicating hydrocephalus: lessons from continuous intracranial pressure monitoring and ventricular infusion testing

The pathophysiology of chronic noncommunicating hydrocephalus: lessons from continuous intracranial pressure monitoring and ventricular infusion testing

Torkildsen’s Ventriculocisternostomy First Applications: The Anthropological Evidence of a Young Slavic Soldier Who Died in the Torre Tresca Concentration Camp (Bari, Italy) in 1946

Torkildsen shunt as a salvage procedure for an infant with post-hemorrhagic hydrocephalus

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