Shunt Revision by Coagulation with Retention of the Ventricular Catheter

Hudgins, Roger J.; Boydston, William

doi:10.1159/000028689

Cited by 14 publications

(4 citation statements)

References 6 publications

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Section: Introductionmentioning

confidence: 99%

“…The ensheathing reaction is believed to be a major contributing factor to decreases in indwelling device performance; however, the precise mechanisms that cause failure are not known [13][14][15][16][17][18][19][20][21][22][23]. For example, catheters implanted for draining excessive cerebrospinal fluid can be blocked by cellular ingrowth and may require frequent surgical revision [22,23]. Increases in microelectrode impedance and loss of neuronal recording has been attributed to the encapsulating brain tissue response [13,20,21], and it has been suggested that glial encapsulation may reduce the permeability of microdialysis membranes and cell encapsulation devices [17][18][19]24].…”

Section: Introductionmentioning

confidence: 99%

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Chronic response of adult rat brain tissue to implants anchored to the skull

et al. 2004

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Chronic response of adult rat brain tissue to implants anchored to the skull

et al. 2004

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“…[1111417] In most centers, the ratio of shunt revision to initial shunt surgery is 2:1. [2] Several studies have examined the surgical technique, [61216] shunt hardware, [315] and postoperative management [7813] of cerebrospinal fluid (CSF) shunting procedures in an attempt to improve shunt survival. However, only a few studies are available, which examine the consequences of replacing the entire shunt system versus a single component for the revision of a failed CSF shunt.…”

Section: Introductionmentioning

confidence: 99%

Comparison of total versus partial revision of primary ventriculoperitoneal shunt failures

Singh

Rohilla²,

Kumawat³

et al. 2013

Surg Neurol Int

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Background:Optimal surgical management of patients presenting with primary shunt failure in the era of neuroendoscopy remains complex. The value of replacing the entire shunt system as opposed to a single shunt component has not been assessed extensively.Methods:In a retrospective study, the records of all patients who underwent their first shunt revision due to mechanical obstruction between September 2007 and December 2011 were reviewed. Shunt revisions were classified as total (entire shunt replaced) or partial (only malfunctioning component replaced). Patients having a minimum follow-up of 1 year after primary shunt revision were included in the study. Kaplan-Meier (shunt survival curves) and log-rank analysis were used to compare failure rates between partially and totally revised shunts.Results:Records of 62 patients in whom cause of primary shunt failure was obstruction (P roximal or distal) were analyzed retrospectively. At the end of follow-up period, 26 out of 28 partial revision group and 22 out of 34 total revision group had shunt failure. The median survival of the shunt in the partial revision and total revision groups was 60 and 270 days, respectively. The method (partial/total revision) related difference in shunt survival duration was statistically significant as shown by log-rank analysis (log-rank test value = 5.94 and P < 0.05).Conclusion:Partial revision of shunt predisposes to accelerated shunt failure as compared with total revision in cases of obstructed ventriculoperitoneal shunt.

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“…Several studies have examined the surgical technique [10, 11, 12], shunt hardware [13, 14]and postoperative management [15, 16, 17]of CSF shunting procedures in an attempt to improve shunt survival. The effect of replacing the entire shunt system versus a single shunt component in the revision of failed CSF shunts has not been assessed.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Total versus Partial Revision of Initial Ventriculoperitoneal Shunt Failures

McGirt¹,

Nimjee²,

Bulsara³

et al. 2002

Pediatr Neurosurg

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Background: Optimal surgical management of patients presenting with shunt failure in the age of neuroendoscopy remains complex. The value of replacing the entire shunt system as opposed to a single shunt component has not been assessed. Methods: We reviewed the records of all pediatric patients who underwent their first shunt revision between January 1992 and December 1998. Patients with primary shunt failure attributed solely to proximal catheter obstruction or distal catheter obstruction were included for analysis. Shunt revisions were classified as total (entire shunt replaced) or partial (only malfunctioning component replaced). Kaplan-Meier (shunt survival curves) and log rank analysis were used to compare failure rates between partially and totally revised shunts according to the underlying diagnosis and failed shunt part. Significant differences in univariate analysis were confirmed with a multivariate proportional hazards regression model. Results: 301 pediatric patients underwent primary shunt revision (183 total, 118 partial revisions). All shunts utilized distal slit peritoneal catheters. In shunt failures attributed to proximal obstruction, reutilization of the distal catheter was associated with a 57% increased risk of subsequent shunt failure (hazard ratio 1.57, 95% confidence interval 1.19–3.49). In shunt failures attributed to distal obstruction, subsequent shunt survival was not affected by reutilization of the proximal catheter (p = 0.581). When stratified according to the etiology of hydrocephalus, only patients with intraventricular hemorrhage (IVH) failed to demonstrate greater survival of totally revised shunts. Conclusions: In this series, in the setting of proximal shunt catheter obstruction, reutilizing the functional distal catheter was associated with an increase in subsequent shunt failure rates compared to revising the entire shunt system. Total revision was not associated with improved shunt survival in patients with IVH.

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Shunt Revision by Coagulation with Retention of the Ventricular Catheter

Cited by 14 publications

References 6 publications

Chronic response of adult rat brain tissue to implants anchored to the skull

Chronic response of adult rat brain tissue to implants anchored to the skull

Comparison of total versus partial revision of primary ventriculoperitoneal shunt failures

Comparison of Total versus Partial Revision of Initial Ventriculoperitoneal Shunt Failures

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