Shunt revision requirements after posthemorrhagic hydrocephalus of prematurity: insight into the time course of shunt dependency

Wang, Joanna Y.; Jackson, Eric M.; Jallo, George I.; Ahn, Edward S.

doi:10.1007/s00381-015-2865-5

Cited by 17 publications

(12 citation statements)

References 34 publications

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“…Given the staggering rate (46-48%) for shunt revision in one's lifetime, novel or unconventional strategies by which these complications could be minimized and/or avoided altogether are worthy of consideration. 4,11 In looking at the current design of shunts, our team noted a common design characteristic being the high-profile nature of the shunt valve, which is placed between the rigid skull and supple scalp. In our opinion, devastating complications such as scalp wounds and implant exposure/infection are foreseeable when using high-profile, extra-anatomical shunt valves, simply because these devices place unsafe pressure on the deep scalp, where its vascular perfusion is most affected (ie, dermal-subdermal plexus).…”

Section: Discussionmentioning

confidence: 99%

First-in-Human Experience With Integration of a Hydrocephalus Shunt Device Within a Customized Cranial Implant

et al. 2019

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BACKGROUNDImplantable shunt devices are critical and life saving for hydrocephalus patients. However, these devices are fraught with high complication rates including scalp dehiscence, exposure, and extrusion. In fact, high shunt valve profiles are correlated with increased complications compared to those with lower profiles. As such, we sought a new method for integrating shunt valves for those challenging patients presenting with scalp-related complications.OBJECTIVETo safely implant and integrate a hydrocephalus shunt valve device within a customized cranial implant, in an effort to limit its high-profile nature as a main contributor to shunt failure and scalp breakdown, and at the same time, improve patient satisfaction by preventing contour deformity.METHODSA 64-yr-old male presented with an extruding hydrocephalus shunt valve and chronic, open scalp wound. The shunt valve was removed and temporary shunt externalization was performed. He received 2 wk of culture-directed antibiotics. Next, a contralateral craniectomy was performed allowing a new shunt valve system to be implanted within a low-profile, customized cranial implant. All efforts were made, at the patient's request, to decrease the high-profile nature of the shunt valve contributing to his most recent complication.RESULTSFirst-in-human implantation was performed without complication. Postoperative shunt identification and programming was uncomplicated. The high-profile nature of the shunt valve was decreased by 87%. At 10 mo, the patient has experienced no complications and is extremely satisfied with his appearance.CONCLUSIONThis first-in-human experience suggests that a high-profile hydrocephalus shunt device may be safely integrated within a customized cranial implant.

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Section: Discussionmentioning

confidence: 99%

First-in-Human Experience With Integration of a Hydrocephalus Shunt Device Within a Customized Cranial Implant

et al. 2019

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“…Ventricular shunt revisions are performed most commonly for shunt obstruction or infection and have been reported to occur most frequently in children during the first 3 years of life, nevertheless, shunt failures can continue to occur throughout the lifetime of an individual. 21,22 There are limitations to this study. Participants included only subjects with VS and BPD who attended a BPD outpatient clinic.…”

Section: Discussionmentioning

confidence: 95%

“…These risk factors were also found in our subjects with VS and BPD. Ventricular shunt revisions are performed most commonly for shunt obstruction or infection and have been reported to occur most frequently in children during the first 3 years of life, nevertheless, shunt failures can continue to occur throughout the lifetime of an individual …”

Section: Discussionmentioning

confidence: 99%

Respiratory outcomes after initial hospital discharge in children with ventricular shunts and bronchopulmonary dysplasia

McGrath‐Morrow¹,

Ahn

Collaco³

2017

Pediatric Pulmonology

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Introduction Children born premature who require ventricular shunt placement for post hemorrhagic hydrocephalus are at increased risk for neurodevelopmental delay. We hypothesized that preterm infants with bronchopulmonary dysplasia (BPD) who require ventricular shunt (VS) placement are at additive risk for long-term respiratory morbidities due to their higher likelihood of neurodevelopmental delay. We also hypothesized that children with BPD and ventricular shunts would require frequent shunt revisions during early childhood following initial shunt placement. Methods All subjects were recruited from the Johns Hopkins Bronchopulmonary Dysplasia Clinic between January 2008 and November 2016. A review of demographic and clinical information was undertaken and a respiratory outcomes questionnaire was completed by the primary caregiver. Results Fifty-five (8.9%) of 623 subjects in the study population had ventricular shunts, with a mean 4.6 ± 2.3 years of follow-up data (range: 0.5–10.1). Subjects with VS were more likely to be born at earlier gestational ages and be discharged on supplemental oxygen compared to BPD subjects alone. Outpatient respiratory symptoms and acute care usage were similar between the two groups. BPD subjects with VS were more likely to have had gastric tubes placed. A total of 270 neurosurgical procedures were performed in subjects with VS with a mean of 4.9 ± 5.4 procedures/subject. Conclusion Children with ventricular shunts and BPD had similar outpatient respiratory outcomes compared to children with BPD alone; however respiratory morbidities may have been mitigated by the greater use of gastric tubes in the VS + BPD group. Multiple neurosurgical procedures were common in children with ventricular shunts.

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“…Nevertheless, the shunt itself carries a high rate of complication even with the best surgical technique, and it is expected that at least 60% of patients must undergo shunt revisions throughout their life. The most common causes of shunt failure are obstruction and mechanical failure, followed by excess drainage, loculations of the ventricular system, infections, and abdominal complications [12][13][14][15].…”

Section: Introductionmentioning

confidence: 99%

Abdominal Complications Related to Ventriculoperitoneal Shunt Placement: A Comprehensive Review of Literature

Furtado¹,

Filho²,

Faleiro³

et al. 2021

Cureus

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Ever since the shunt device became the gold standard treatment for hydrocephalus, complications due to infections and mechanical problems have increased while lives have been saved. In addition, abdominal complications have become an important issue as the peritoneum is now the main place to insert the distal catheter. The most common complications were abdominal pseudocyst, distal catheter migration, inguinal hernia, catheter disconnection, and intestinal obstruction. The pediatric population is more prone to develop most of these complications due to their rapidly growing body, weaker abdominal musculature, and increased intraabdominal pressure. The goal of this review was to study the main aspects associated with abdominal complications after ventriculoperitoneal shunt (VPS) insertion, including the pathophysiology, epidemiological aspects, as well as the rationale for management and prevention according to the current "state-of-the-art." It is paramount to recognize the risk factors associated with various types of complications to manage them properly.

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Shunt revision requirements after posthemorrhagic hydrocephalus of prematurity: insight into the time course of shunt dependency

Cited by 17 publications

References 34 publications

First-in-Human Experience With Integration of a Hydrocephalus Shunt Device Within a Customized Cranial Implant

First-in-Human Experience With Integration of a Hydrocephalus Shunt Device Within a Customized Cranial Implant

Respiratory outcomes after initial hospital discharge in children with ventricular shunts and bronchopulmonary dysplasia

Abdominal Complications Related to Ventriculoperitoneal Shunt Placement: A Comprehensive Review of Literature

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