Failure rate of frontal versus parietal approaches for proximal catheter placement in ventriculoperitoneal shunts: revisited

Dickerman, Rob D.; McConathy, Walter J.; Morgan, James; Stevens, Qualls E.; Jolley, J.T.; Schneider, Sanford; Mittler, Mark A.

doi:10.1016/j.jocn.2004.12.005

Cited by 57 publications

(34 citation statements)

References 18 publications

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“…All ventricular catheters were placed frontally, which may reduce the risk of blockage of the holes of the ventricular catheter by choroid plexus or brain parenchyma compared to a parietal trajectory. Studies of shunt survival rate as a function of frontal or parietal trajectory have come to different conclusions on which should be the preferred location [10,11,12]. The only randomized study [11] found a slightly lower revision rate for a parietal catheter location; however, to resolve this issue, a larger randomized study would be needed.…”

Section: Discussionmentioning

confidence: 99%

Long-Term Outcome after Treatment of Hydrocephalus in Children

et al. 2010

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Aims: To provide long-term outcome data after treatment of hydrocephalus in children, and to identify risk factors for ventriculoperitoneal shunt (VPS) failure. Methods: Endoscopic third ventriculostomy (ETV) and VPS procedures in children between 2001 and 2005 were reviewed. Data collected prospectively included age at surgery, sex, aetiology of hydrocephalus, gestational age, emergency/planned surgery, duration of surgery, time of day, surgeon’s experience and other concomitant surgery. The mean follow-up was 4.7 years (min. 2 years). The endpoint was a new surgery due to failure of treatment, and the time to failure was noted. Risk factors for VPS failure were analysed by univariate Cox proportional hazards regression. Results: Ninety-eight patients were included, 76 with a VPS, 22 with an ETV. Fifty-five percent of ETV and 58% of VPS failed. Significant risk factors (p < 0.05) for VPS failure were prematurity (HR: 2.05; 95% CI: 1.12–3.76), concomitant procedure (HR: 2.07; 95% CI: 1.04–4.12) and long duration of surgery (HR: 1.23; 95% CI: 1.06–1.44), while sex, surgeon’s experience, shunt type, at what department the surgery was performed, whether the surgery was acute or elective, and time of day were not. Conclusion: Treatment failure occurred in >50% of patients after ETV and VPS. Prematurity and concomitant surgery were major risk factors for VPS failure.

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Section: Discussionmentioning

confidence: 99%

Long-Term Outcome after Treatment of Hydrocephalus in Children

et al. 2010

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“…Nonetheless, other factors may contribute to this observation: (i) the choroid plexus is relatively smaller in elderly patients; 15 and (ii) the reduction of ventricular size post shunting is significantly less, due to smaller centripetal forces to oppose ventricle dilatation. 30 In comparison, younger patients have relatively smaller ventricular size at shunt insertion and are at increased risk of infection, thus leading to a higher malfunction rate.…”

Section: Predictors Of Optimal Shunt Placementmentioning

confidence: 99%

“…14,15,19,20,31,32 The frontal approach has the shortest intracerebral route 15 with more consistent anatomical landmarks. 15,33,34 However, ventricular catheter shortening and burr hole displacement with growth is more pronounced with this approach. 18,19 In addition, there are aesthetic issues due to the need to shave the scalp in the frontal area.…”

Section: Predictors Of Optimal Shunt Placementmentioning

confidence: 99%

“…22 Accurate placement of the ventricular catheter 11 is one of the most important variables in the longevity of shunt survival. 3,15,16,[23][24][25] We retrospectively analyzed 141 patients who underwent a VP shunt operation at Monash Medical Centre, Melbourne, Australia, from 2005 to 2008. Our objective was to determine possible factors that may affect the quality of the ventricular catheter placement.…”

Section: Introductionmentioning

confidence: 99%

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Factors affecting the accuracy of ventricular catheter placement

Wan

Toy

Wolfe

et al. 2011

Journal of Clinical Neuroscience

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“…4 Another group also concluded that the two approaches were equivalent, but again without verifying the catheter tip position. 5 Because our review of the literature did not support a single optimal target for ventricular shunt catheters, we relied on the historical definition of preferred placement generally accepted in our institution for the past 30 years. The intended target of intraventricular shunt catheters has been the frontal horn of the lateral ventricle, ipsilateral to the point of entry.…”

mentioning

confidence: 99%

Improvement in clinical outcomes following optimal targeting of brain ventricular catheters with intraoperative imaging

Janson

Romanova²,

Rudser

et al. 2014

JNS

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Object The accurate placement of cerebral ventricular shunt catheters in hydrocephalus is an important clinical problem. Malfunction of shunts remains their most common complication and greatest liability, and the influence of catheter position on shunt function remains poorly defined. The objectives of this study were as follows: 1) determine the accuracy of intraventricular catheter placement with respect to a historically favored target, defined as a 1-cm radius sphere at the anterior lip of the ipsilateral foramen of Monro; 2) confirm that this target represents a satisfactory site for frontal and occipital catheter placement by examining whether inaccuracy is associated with more shunt failures; and 3) determine whether catheter trajectory, use of image confirmation, or other factors are associated with either the accuracy or the longevity of shunts. Methods A retrospective cohort analysis was conducted on 236 patients with 426 ventricular shunts placed or revised at the University of Minnesota over a 10-year period. Results Accuracy of shunt placement was optimal in 43.9% of patients and suboptimal or poor in 56.1% of patients. Time to failure was significantly affected by the accuracy of catheter placement with respect to the ipsilateral foramen of Monro, with a 57% higher risk of failure with suboptimal placement (hazard ratio [HR] 1.57, 95% CI 1.26–1.96; p < 0.001) and a 66% higher risk with poor placement (HR 1.66, 95% CI 1.45–1.89; p < 0.001) relative to optimal placement. The odds of highly suboptimal or unacceptable placement were significantly increased by lack of any intraoperative imaging (OR 5.89, 95% CI 2.36–14.65; p < 0.001). Use of a nonfrontal posterior trajectory also showed a trend toward poor placement (OR 1.64, p = 0.138). Conclusions The historical target for catheter tip placement within 1 cm of the foramen of Monro in the ipsilateral lateral ventricle was associated with significantly longer revision-free survival compared with other locations. This effect remained significant after adjusting for age and whether there was a prior history of shunting. The accuracy of catheter placement in both pediatric and adult patients was strongly associated with use of intraoperative fluoroscopic confirmation. In analyses comparing intraoperative fluoroscopy and no imaging, there was a non–statistically significant difference in the 3-year time to failure, but the worst-case scenario of catastrophic short-term failure was almost completely avoided with fluoroscopy. The authors conclude that accuracy of placement is critical for shunt survival, and that use of intraoperative imaging confirmation may optimize outcomes by avoiding the majority of unacceptable placements.

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Failure rate of frontal versus parietal approaches for proximal catheter placement in ventriculoperitoneal shunts: revisited

Cited by 57 publications

References 18 publications

Long-Term Outcome after Treatment of Hydrocephalus in Children

Long-Term Outcome after Treatment of Hydrocephalus in Children

Factors affecting the accuracy of ventricular catheter placement

Improvement in clinical outcomes following optimal targeting of brain ventricular catheters with intraoperative imaging

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