Long-term results after ventriculoatrial and ventriculoperitoneal shunting for infantile hydrocephalus

Keucher, Thomas R.; Mealey, John

doi:10.3171/jns.1979.50.2.0179

Cited by 238 publications

(113 citation statements)

References 30 publications

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“…As a whole, these results are consistent with other pediatric and adult series in the literature that demonstrate no difference in complication rates between VA and VP shunts when those rates are directly compared. [14][15][16]22,29,34 Likewise, the complication and mortality rates were somewhat lower, although largely consistent with previously published findings in series where VA and VP shunt complications were not directly compared. The infection rates in our VP and VA shunt cohorts were lower than those seen in other reports, which range from 2.5% to 18.9% 4,12,20,21,23,31,35 and from 0% to 13%, 3,5,13,19,20,30 respectively.…”

Section: Discussionsupporting

confidence: 78%

“…Studies comparing VA to VP shunting in the pediatric population by Little et al, Olsen and Frykberg, and Keucher and Mealey in the 1970s and 1980s showed that VA shunts required more revisions due to the growth of the child, had similar complications rates, and were associated with a higher mortality rate than VP shunts. 16,22,29 It is important to note that during this period, the sparse evidence of VA shunt inferiority-and the associated reports of cardiopulmonary complications-relied on research collected from the pediatric population.…”

Section: Discussionmentioning

confidence: 99%

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Should ventriculoatrial shunting be the procedure of choice for normal-pressure hydrocephalus?

McGovern¹,

Kelly²,

Chan³

et al. 2014

JNS

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Object. Ventriculoatrial (VA) shunting is rarely used for patients with normal-pressure hydrocephalus (NPH), likely due to surgeon technical preference and case reports indicating cardiopulmonary complications. However, these complications have typically been limited to adults in whom VA shunts had been placed when they were children. Few studies have directly compared VA shunting to ventriculoperitoneal (VP) shunting in cases of NPH.Methods. The authors retrospectively analyzed all NPH patients treated by a single surgeon at their center from January 2002 through December 2011. Thirty patients were treated with VA shunts (14 male) and 157 with VP shunts (86 male). The patients' mean age (± SD) at surgery was 73.7 ± 9.4 years for VA shunting and 76.0 ± 8.2 years for VP shunting; the median durations of follow-up were 42.0 months (IQR 19.2-63.6 months) and 34.2 months (IQR 15.8-67.5), respectively. Statistical analysis was performed using chi-square tests and Wilcoxon rank-sum tests.Results. Perioperative and postoperative complications for VA and VP shunting cohorts, respectively, included distal revision (2.7% vs 6.6%, p = 0.45), proximal revision (2.7% vs 2.5%, p = 0.97), and postoperative seizure (2.7% vs 1.5%, p = 0.62). Shunt drainage-related subdural hematomas/hygromas developed in 8.1%/27.0% of VA shunttreated patients versus 6.6%/26.4% of VP shunt-treated patients (p = 0.76/0.98) and were nearly always successfully managed with programmable-valve adjustment. Symptomatic intracerebral hemorrhage (1.5%) and shunt infection (2.0%) were only observed in those who underwent VP shunting. Of note, no cardiovascular complications were observed in any patient, and there were no cases of distal occlusion of the VA shunt.Conclusions. The authors found no significant differences in complication rates between VA and VP shunting, and VA shunting was not associated with any cardiopulmonary complications. Thus, in the authors' experience, VA shunting is at least as safe as VP shunting for treating NPH. (http://thejns.org/doi/abs/10.3171/2014.1.JNS131808) Key woRDS • normal-pressure hydrocephalus • ventriculoatrial shunt • ventriculoperitoneal shuntAbbreviations used in this paper: NPH = normal-pressure hydrocephalus; VA = ventriculoatrial; VP = ventriculoperitoneal.

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Section: Discussionsupporting

confidence: 78%

Section: Discussionmentioning

confidence: 99%

Should ventriculoatrial shunting be the procedure of choice for normal-pressure hydrocephalus?

McGovern¹,

Kelly²,

Chan³

et al. 2014

JNS

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“…The modern shunting era began in the 1950s when ventriculoatrial (VA) shunts set a new standard in HC treatment. 3,9 The first VA shunt was implanted in Norway in 1961, and VA shunts were the standard treatment procedure until 1979. Beginning in 1980, use of ventriculoperitoneal (VP) shunts became more common because of a few, but fatal, complications from VA shunting.…”

mentioning

confidence: 99%

Pediatric hydrocephalus: 40-year outcomes in 128 hydrocephalic patients treated with shunts during childhood. Assessment of surgical outcome, work participation, and health-related quality of life

Paulsen

Lundar

Lindegaard

2015

PED

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OBJECT Treatment for hydrocephalus has not advanced appreciably since the advent of CSF shunts more than 50 years ago. The outcome for pediatric patients with hydrocephalus has been the object for several studies; however, much uncertainty remains regarding the very long term outcome for these patients. Shunting became the standard treatment for hydrocephalus in Norway during the 1960s, and the first cohorts from this era have now reached middle age. Therefore, the objective of this study was to review surgical outcome, mortality, social outcome, and health-related quality of life in middle-aged patients treated for hydrocephalus during childhood. METHODS Data were collected in all patients, age 14 years or less, who required a CSF shunt during the years 1967–1970. Descriptive statistics were assessed regarding patient characteristics, surgical features, social functioning, and work participation. The time and cause of death, if applicable, were also determined. Kaplan-Meier survival estimates were used to determine the overall survival of patients. Information regarding self-perceived health and functional status was assessed using the 36-Item Short Form Health Survey (SF-36) and the Barthel Index score. RESULTS A total of 128 patients were included in the study, with no patient lost to follow-up. Of the 128 patients in the study, 61 (47.6%) patients died during the 42–45 years of observation. The patients who died belonged to the tumor group (22 patients) and the myelomeningocele group (13 patients). The mortality rate was lowered to 39% if the patients with tumors were excluded. The overall mortality rates at 1, 2, 10, 20, and 40 years from time of initial shunt insertion were 16%, 24%, 31%, 40%, and 48% respectively. The incidence of shunt-related mortality was 8%. The majority of children graduated from a normal school (67%) or from a school specializing in education for physically handicapped children (20%). Self-perceived health was significantly poorer in 6 out of 8 domains assessed by SF-36 as compared with the background population. Functional status among the survivors varied greatly during the follow-up period, but the majority of patients were self-dependent. A total of 56% of the patients were socially independent, and 42% of the patients were employed. CONCLUSIONS Approximately half of the patients are still alive. During the 42–45 year follow-up period, the mortality rate was 48%. Two deaths were due to acute shunt failure, and at least 8% of the deaths were shunt related (probable or late onset). The morbidity in middle-aged individuals treated for pediatric hydrocephalus is considerable. The late mortality rate was low, but not negligible. Twelve patients died during the last 2 decades, 1 of whom died because of acute shunt failure. Although the shunt revision rate was decreasing during the study period, many patients required shunt surgery during adulthood. Forty-one revisions in 21 patients were performed during the last decade. Thus, there is an obvious need for life-long follow-up in these patients.

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“…2 Since the introduction of the VA shunt for hydrocephalus treatment by Nulsen and Spitz in the late 1940s, several complications have been reported. 1,2 Although rare, their presentations are potentially fatal.…”

Section: Discussionmentioning

confidence: 99%

“…1 Various thromboembolic complications have been described with VA shunts. 1,2 We report a case of thrombosis of the internal jugular vein as a rare complication of VA shunt remnants.…”

mentioning

confidence: 99%

Remnants of a 35-year-old ventriculo-atrial shunt presenting as orofacial pain

Nisar

Shetty

et al. 2010

annals

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A 36-year-old man presented to his general dental practitioner with pain in the right jaw and neck. This was initially treated as a dento-alveolar abscess. Three days later, he presented to the oral and maxillofacial unit with neck swelling to the right side. An ultrasound confirmed the swelling was due to thrombosis associated with remnants of a ventriculo-atrial (VA) shunt in the right internal jugular vein. This had been placed during the patient's infancy and apparently removed at the age of 8 years. The patient was treated conservatively with warfarin and Coamoxyclav. The patient made a full recovery and was placed on long-term anticoagulant therapy. The introduction of cerebral spinal fluid shunt procedures for the treatment of hydrocephalus has resulted in a reduction in the mortality rate from 80% to 15-20%. Various thrombo-embolic complications have been described with VA shunts. A thorough medical history is absolutely essential in order to identify uncommon causes of common presentations.

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Long-term results after ventriculoatrial and ventriculoperitoneal shunting for infantile hydrocephalus

Cited by 238 publications

References 30 publications

Should ventriculoatrial shunting be the procedure of choice for normal-pressure hydrocephalus?

Should ventriculoatrial shunting be the procedure of choice for normal-pressure hydrocephalus?

Pediatric hydrocephalus: 40-year outcomes in 128 hydrocephalic patients treated with shunts during childhood. Assessment of surgical outcome, work participation, and health-related quality of life

Remnants of a 35-year-old ventriculo-atrial shunt presenting as orofacial pain

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