Long-term follow-up of shunting therapy

Abstract

Ventricular CSF shunting surgery has changed the overall outcome figures for hydrocephalic patients over the past three decades. The factors that have improved the outcome are evolution of the shunt systems, improvement of the surgical environment and use of potent antibiotics, technological advances in brain imaging, and refinements in the assessment of cognitive and functional outcomes and of actuarial statistical techniques. But the recent large studies revealed that nearly half of all shunt placements were for revision, and there is a low but real percentage of cases in which death and neurological impairment are related to shunt surgery. The most frequent complication was shunt obstruction, followed by infection, disconnection, hematoma and slit ventricle syndrome. This clearly means that the shunt systems and the techniques in current use involve many problems that have yet to be solved. To solve these problems, new shunt systems should be developed and continuous efforts at reducing shunt infection should be made. The overall complication rate in the authors' series was 31.7%, but we have been able to reduce the complication rate from 37% to 25% by exercising special care focused on the surgical environment and techniques. Careful, long-term follow-up using various parameters and proper statistical analysis is another important factor in improving surgical outcome. Multicenter and international studies will be easier with the development of a network, and it will give us a strong background to treat hydrocephalus.

Beta-2-transferrin to detect cerebrospinal fluid pleural effusion: a case report

“…Despite the wide acceptance of VP shunting, there are important complications associated with this technique. Common problems include obstruction, mechanical shunt failure and infections [1] while CSF ascites and thoracic complications, such as CSF hydrothorax, are less frequently observed sequelae [2]. Most cases of the lattermost complication, CSF hydrothorax, occur secondary to intrathoracic shunt tip migration [3].…”

Complications Associated with Surgical Treatment of Hydrocephalus

“…Surgical techniques for treatment of hydrocephalus are well established, but are associated with a relatively high incidence of complications (Blount et al, 1993, Kang & Lee, 1999. Complications associated with shunt procedures include infection, malfunction (obstruction or disconnection) and silicone allergy, and overdrainage.…”

Laparoscopic revision of the distally obstructed ventriculoperitoneal shunt

“…Ventriculoperitoneal shunt (VPS) is a common neurosurgical procedure and considered the most commonly accepted treatment for hydrocephalus (2,7,14,17,29,30,31,32), however it can be considered one of the most common neurosurgical procedures associated with complications (3,10). Those complications include mechanical failure, infection, and disconnection or fractured segment with or without migration of the shunt tube (3,10,14,29,32).…”

“…Those complications include mechanical failure, infection, and disconnection or fractured segment with or without migration of the shunt tube (3,10,14,29,32).…”