Low incidence of delayed intracerebral hemorrhage secondary to ventriculoperitoneal shunt insertion

Savitz, Martin H.; Bobroff, Lewis M.

doi:10.3171/jns.1999.91.1.0032

Cited by 49 publications

(49 citation statements)

References 11 publications

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“…Cerebrospinal fluid shunting requires placement of the catheter in the anterior horn of the lateral ventricle, [1][2][3]6) for maintenance of shunt function and prevention of complications, mainly related to the choroid plexus, a vascular rich and fragile tissue. These complications include intraventricular hemorrhage (IVH) due to direct injury by ventricular catheter insertion, 17) obstruction of the catheter by hypertrophic tissue as a foreign body reaction, 8,19) and IVH 5) or more rarely pseudoaneurysm formation caused by avulsion of the anterior choroidal artery 20) on removal of an obstructed catheter.…”

Section: Introductionmentioning

confidence: 99%

Manual Occipital Ventricular Puncture for Cerebrospinal Fluid Shunt Surgery: Can Aiming Be Standardized?

Shimizu

Tanaka²,

Iida

et al. 2004

Neurol. Med. Chir.(Tokyo)

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The manual occipital ventricular puncture is a standard surgical procedure, but specific targeting has not received sufficient attention despite the experience of anatomical disorientation. This study tried to identify an exact site for the ideal trajectory with this method, especially in the sagittal plane, which avoids contact with the choroid plexus that may be the major source of complications. A total of 44 consecutive adult cases undergoing cerebrospinal fluid shunting through the occipital route for hydrocephalus were retrospectively reviewed for the following: correlations between burr hole site, direction of puncture, and location of the ventricular catheter based on postsurgical radiological studies; calculation of the ideal trajectory to place the catheter tip in the anterior horn of the lateral ventricle without contact with the choroid plexus through the standard occipital burr hole. In addition, the relationships between the location of the ventricular structure, the cranial base line connecting the nasion and inion, and the size of the ventricle were evaluated. Incorrect catheter emplacement was found in five cases, which suggested that this procedure using the standard burr hole site and aim point might result in incorrect catheter placement. The ideal external aim points were widely distributed because of the variable heights of ventricular structures from the cranial baseline. No correlation between the locations of the anatomical points and ventricular size was found. The present study could not define a standard external aim point. Tailored preoperative planning of the trajectory is recommended.

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Section: Introductionmentioning

confidence: 99%

Manual Occipital Ventricular Puncture for Cerebrospinal Fluid Shunt Surgery: Can Aiming Be Standardized?

Shimizu

Tanaka²,

Iida

et al. 2004

Neurol. Med. Chir.(Tokyo)

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“…2 Intracerebral hemorrhage rarely occurs after shunt insertions (4% of cases) and is usually subclinical. 13,16 Around 8%-10% of shunts become infected, requiring lengthy hospitalization for intravenous antibiotics, temporary ventriculostomy placement, and shunt revision. 9,11 In a cohort of patients undergoing VPS placement after SAH, up to 29.6% required a subsequent revision procedure (usually within 6 months).…”

Section: Discussionmentioning

confidence: 99%

Comparison of techniques for ventriculoperitoneal shunting in 523 patients with subarachnoid hemorrhage

Chalouhi

Whiting

Anderson

et al. 2014

JNS

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A cute hydrocephalus occurs in up to two-thirds of patients with subarachnoid hemorrhage (SAH), and its treatment involves the placement of a ventriculostomy catheter. 7,10,12,14 Around 6%-37% of patients ultimately require permanent CSF diversion usually treated through ventriculoperitoneal shunt (VPS) placement because of the development of chronic hydrocephalus. [3][4][5]14 It is common practice to use a new contralateral bur hole for placement of the VPS in SAH patients with an existing ventriculostomy. The classic reasoning behind this practice is that the potential, subclinical contamination of the ventriculostomy site may increase the risk of shunt infection. At Thomas Jefferson University and Jefferson Hospital for Neuroscience, we have primarily used the same ventriculostomy site for placement of the VPS. This technique provides atraumatic insertion of the ventricular catheter without the stylet through an existing track while potentially decreasing the risk of catheter-related hemorrhage or malpositioning and reducing the operative time.Practice in this respect, both in the US and abroad, has largely been driven by operator preference and experience, as little has been published about the optimal shunting technique. We present the results of the first study comparing the safety of the 2 VPS techniques (same site vs contralateral site) in patients with SAH. Object. It is common practice to use a new contralateral bur hole for ventriculoperitoneal shunt (VPS) placement in subarachnoid hemorrhage (SAH) patients with an existing ventriculostomy. At Thomas Jefferson University and Jefferson Hospital for Neuroscience, the authors have primarily used the ventriculostomy site for the VPS. The purpose of this study was to compare the safety of the 2 techniques in patients with SAH.Methods. The rates of VPS-related hemorrhage, infection, and proximal revision were compared between the 2 techniques in 523 patients undergoing VPS placement (same site in 464 and contralateral site in 59 patients).Results. The rate of new VPS-related hemorrhage was significantly higher in the contralateral-site group (1.7%) than in the same-site group (0%; p = 0.006). The rate of VPS infection did not differ between the 2 groups (6.4% for same site vs 5.1% for contralateral site; p = 0.7). In multivariate analysis, higher Hunt and Hess grades (p = 0.05) and open versus endovascular treatment (p = 0.04) predicted shunt infection, but the VPS technique was not a predictive factor (p = 0.9). The rate of proximal shunt revision was 6% in the same-site group versus 8.5% in the contralateralsite group (p = 0.4). In multivariate analysis, open surgery was the only factor predicting proximal VPS revision (p = 0.05).Conclusions. The results of this study suggest that the use of the ventriculostomy site for VPS placement may be feasible and safe and may not add morbidity (infection or need for revision) compared with the use of a fresh contralateral site. This rapid and simple technique also was associated with a lower risk of shunt-related h...

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“…Which of the many factors, such as normal circulation (choroid plexus formation, transependymal absorption, arachnoid villus transport, and elastance) and compliance of the brain, influenced CSF perfusion cannot be determined. 12 Although attempts to cannulate slitlike ventricles may induce intracerebral bleeding, 16 no postoperative shunt placement-related hemorrhages were demonstrated on follow-up CT scans. The shunts were removed after 1 week to avoid formation of a subdural hygroma; tracking of fluid around the tubing may occur with or without obstruction of catheters left in place.…”

Section: Perret and Grafmentioning

confidence: 99%

Subgaleal shunting: A 20-year experience

Savitz¹,

Malis²

2000

FOC

Self Cite

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Object The authors undertook a retropective study to evaluate the effectiveness of diverting intracranial fluid into the subgaleal space for temporary absorption by the membranes of the scalp. Methods Eighty-one patients were treated over a 20-year period. There were 22 cases of hypertensive hydrocephalus, 52 cases of acute head trauma, and seven cases of chronic subdural hematoma. The simple surgical technique is described. Subgaleal shunting provided effective short-term treatment of hydrocephalus and increased intracranial pressure, which was monitored directly in 22 cases of cerebral contusion and edema. Conclusions The closed method for drainage of cerebrospinal fluid avoids the complications of open ventriculostomy or open drainage of the subdural space.

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Low incidence of delayed intracerebral hemorrhage secondary to ventriculoperitoneal shunt insertion

Cited by 49 publications

References 11 publications

Manual Occipital Ventricular Puncture for Cerebrospinal Fluid Shunt Surgery: Can Aiming Be Standardized?

Manual Occipital Ventricular Puncture for Cerebrospinal Fluid Shunt Surgery: Can Aiming Be Standardized?

Comparison of techniques for ventriculoperitoneal shunting in 523 patients with subarachnoid hemorrhage

Subgaleal shunting: A 20-year experience

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