Shunt independence in paediatric hydrocephalus: our 16-year experience and review

Iglesias, Sara; Ros, Bienvenido; Ibáñez, Guillermo; Delgado, Andrea; Ros, Angela; Arráez, Miguel Ángel Escribano

doi:10.1007/s00381-019-04267-0

Cited by 10 publications

(3 citation statements)

References 18 publications

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“…Some authors consider that patients with myelomeningocele should be excluded [26]. Secondary ETV at the time of shunt malfunction may well be successful whereas planned removal of the shunt in overdrainage is an invasive procedure with more likelihood of failure [131]. In cases of increased ICP without ventricular dilatation, the condition behaves as a pseudotumor cerebri ("shunt pseudotumor") with CSF isolation in the subarachnoid space, and LPS implantation has been suggested.…”

Section: Management Strategies In Shunt Overdrainagementioning

confidence: 99%

Shunt Overdrainage: Reappraisal of the Syndrome and Proposal for an Integrative Model

Ros

Iglesias

Linares

et al. 2021

JCM

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Although shunt overdrainage is a well-known complication in hydrocephalus management, the problem has been underestimated. Current literature suggests that the topic requires more examination. An insight into this condition is limited by a lack of universally agreed-upon diagnostic criteria, heterogeneity of published series, the multitude of different management options and misunderstanding of relationships among pathophysiological mechanisms involved. We carried out a review of the literature on clinical, radiological, intracranial pressure (ICP), pathophysiological and treatment concepts to finally propose an integrative model. Active prophylaxis and management are proposed according to this model based on determination of pathophysiological mechanisms and predisposing factors behind each individual case. As pathophysiology is progressively multifactorial, prevention of siphoning with gravitational valves or antisiphon devices is mandatory to avoid or minimize further complications. Shunt optimization or transferal and neuroendoscopy may be recommended when ventricular collapse and cerebrospinal fluid isolation appear. Cranial expansion may be useful in congenital or acquired craniocerebral disproportion and shunting the subarachnoid space in communicating venous hydrocephalus and idiopathic intracranial hypertension.

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Section: Management Strategies In Shunt Overdrainagementioning

confidence: 99%

Shunt Overdrainage: Reappraisal of the Syndrome and Proposal for an Integrative Model

Ros

Iglesias

Linares

et al. 2021

JCM

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“…Several valve technologies such as membrane antisiphoning devices, flow regulated valve systems, and adjustable gravitational valves are available for humans to reduce cerebrospinal fluid (CSF) flow across the valve and therefore, prevent a siphoning effect and overshunting. [16][17][18][19][20] While risk factors for overshunting are well described and the benefit of gravitational valves and the efficacy of treatment options for hemispheric collapse were demonstrated in hydrocephalic humans, [21][22][23][24] such data are scarce in dogs and cats. 25 The aim of this study was therefore first, to document risk factors for overshunting causing subdural hemorrhage and hemispheric collapse, and second to assess the efficacy of a decompressive surgery in shunt overdrainage and collapse.…”

Section: Introductionmentioning

confidence: 99%

Risk factors, treatment, and outcome in dogs and cats with subdural hematoma and hemispheric collapse after ventriculoperitoneal shunting of congenital internal hydrocephalus

Farke,

Siwicka,

Olszewska

et al. 2023

Veterinary Internal Medicne

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BackgroundOvershunting and hemispheric collapse are well‐known complications after ventriculoperitoneal shunt (VPS) implantation. Risk factors that predispose to overshunting, treatment options, and prognosis after therapeutic intervention have not been described.Hypothesis/ObjectivesTo identify preoperative risk factors for overshunting, the effect of surgical decompression, and their outcomes.AnimalsSeventy‐five dogs and 7 cats.MethodsRetrospective case cohort study. Age, breed, sex, body weight, number of dilated ventricles, ventricle brain ratio, intraventricular pressure, and implanted pressure valve systems were evaluated as possible risk factors.ResultsOvershunting had a prevalence of 18% (Cl 95% 9.9‐26.66). An increase of 0.05 in VBR increased the risk of overshunting by OR 2.23 (Cl 95% 1.4‐3.5; P = .001). Biventricular hydrocephalus had the highest risk for overshunting compared to a tri‐ (OR 2.48 with Cl 95% 0.5‐11.1) or tetraventricular hydrocephalus (OR 11.6 with Cl 95% 1.7‐81.1; P = .05). There was no influence regarding the use of gravitational vs differential pressure valves (P > .78). Overshunting resulted in hemispheric collapse, subdural hemorrhage, and peracute deterioration of neurological status in 15 animals. Subdural hematoma was removed in 8 dogs and 2 cats with prompt postoperative improvement of clinical signs.Conclusions and Clinical ImportanceBiventricular hydrocephalus and increased VBR indicate a higher risk for overshunting. The use of differential valves with gravitational units has no influence on occurrence of overshunting related complications and outcomes. Decompressive surgery provides a favorable treatment option for hemispheric collapse and has a good outcome.

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“…1,2 There have been numerous previous studies of ETV in children with a history of a CSF shunt (postshunt ETV), reporting success rates from 50% to 80%. [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] Two review articles also covered this topic, one of which reported ETV success by meta-analysis in 68% of 519 pooled patients. 19,20 However, nearly all of these reports were single-center retrospective reviews, the largest of which included 88 patients.…”

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confidence: 99%

Endoscopic third ventriculostomy in previously shunt-treated patients

Rocque

Jensen²,

Reeder³

et al. 2022

Journal of Neurosurgery: Pediatrics

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OBJECTIVE Endoscopic third ventriculostomy (ETV) is an option for treatment of hydrocephalus, including for patients who have a history of previous treatment with CSF shunt insertion. The purpose of this study was to report the success of postshunt ETV by using data from a multicenter prospective registry. METHODS Prospectively collected data in the Hydrocephalus Clinical Research Network (HCRN) Core Data Project (i.e., HCRN Registry) were reviewed. Children who underwent ETV between 2008 and 2019 and had a history of previous treatment with a CSF shunt were included. A Kaplan-Meier survival curve was created for the primary outcome: time from postshunt ETV to subsequent CSF shunt placement or revision. Univariable Cox proportional hazards models were created to evaluate for an association between clinical and demographic variables and subsequent shunt surgery. Postshunt ETV complications were also identified and categorized. RESULTS A total of 203 children were included: 57% male and 43% female; 74% White, 23% Black, and 4% other race. The most common hydrocephalus etiologies were postintraventricular hemorrhage secondary to prematurity (56, 28%) and aqueductal stenosis (42, 21%). The ETV Success Score ranged from 10 to 80. The median patient age was 4.1 years. The overall success of postshunt ETV at 6 months was 41%. Only the surgeon’s report of a clear view of the basilar artery was associated with a lower likelihood of postshunt ETV failure (HR 0.43, 95% CI 0.23–0.82, p = 0.009). None of the following variables were associated with postshunt ETV success: age at the time of postshunt ETV, etiology of hydrocephalus, sex, race, ventricle size, number of previous shunt operations, ETV performed at time of shunt infection, and use of external ventricular drainage. Overall, complications were reported in 22% of patients, with CSF leak (8.6%) being the most common complication. CONCLUSIONS Postshunt ETV was successful in treating hydrocephalus, without subsequent need for a CSF shunt, in 41% of patients, with a clear view of the basilar artery being the only variable significantly associated with success. Complications occurred in 22% of patients. ETV is an option for treatment of hydrocephalus in children who have previously undergone shunt placement, but with a lower than expected likelihood of success.

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Shunt independence in paediatric hydrocephalus: our 16-year experience and review

Cited by 10 publications

References 18 publications

Shunt Overdrainage: Reappraisal of the Syndrome and Proposal for an Integrative Model

Shunt Overdrainage: Reappraisal of the Syndrome and Proposal for an Integrative Model

Risk factors, treatment, and outcome in dogs and cats with subdural hematoma and hemispheric collapse after ventriculoperitoneal shunting of congenital internal hydrocephalus

Endoscopic third ventriculostomy in previously shunt-treated patients

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