The incidence of epilepsy after ventricular shunting procedures

Dan, Noel G.; Wade, Megan J.

doi:10.3171/jns.1986.65.1.0019

Cited by 84 publications

(26 citation statements)

References 6 publications

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“…The risk of seizure as a result of shunt placement itself, however, is controversial. 6,48,74 Some work has suggested that frontal rather than parietal bur-hole placement was associated with increased incidence of seizure, 16 though these data have not been corroborated by other studies. 63,79,88 Thus perioperative seizures related to shunt placement are not an independent complication of surgery but warrant discussion given that they are common and can be problematic.…”

Section: Perioperative Epilepsymentioning

confidence: 94%

Patterns in neurosurgical adverse events: cerebrospinal fluid shunt surgery

Wong¹,

Ziewacz

et al. 2012

FOC

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Object As part of a project to devise evidence-based safety interventions for specialty surgery, the authors sought to review current evidence in CSF shunt surgery concerning the frequency of adverse events in practice, their patterns, and the state of knowledge regarding methods for their reduction. This review may also inform future and ongoing efforts for the advancement of neurosurgical quality. Methods The authors performed a PubMed search using search terms “cerebral shunt,” “cerebrospinal fluid shunt,” “CSF shunt,” “ventriculoperitoneal shunt,” “cerebral shunt AND complications,” “cerebrospinal fluid shunt AND complications,” “CSF shunt AND complications,” and “ventriculoperitoneal shunt AND complications.” Only papers that specifically discussed the relevant complication rates were included. Papers were chosen to be included to maximize the range of rates of occurrence for the adverse events reported. Results In this review of the neurosurgery literature, the reported rate of mechanical malfunction ranged from 8% to 64%. The use of programmable valves has increased but remains of unproven benefit even in randomized trials. Infection was the second most common complication, with the rate ranging from 3% to 12% of shunt operations. A meta-analysis that included 17 randomized controlled trials of perioperative antibiotic prophylaxis demonstrated a decrease in shunt infection by half (OR 0.51, 95% CI 0.36–0.73). Similarly, use of detailed protocols including perioperative antibiotics, skin preparation, and limitation of OR personnel and operative time, among other steps, were shown in uncontrolled studies to decrease shunt infection by more than half. Other adverse events included intraabdominal complications, with a reported incidence of 1% to 24%, intracerebral hemorrhage, reported to occur in 4% of cases, and perioperative epilepsy, with a reported association with shunt procedures ranging from 20% to 32%. Potential management strategies are reported but are largely without formal evaluation. Conclusions Surgery for CSF shunt placement or revision is associated with a high complication risk due primarily to mechanical issues and infection. Concerted efforts aimed at large-scale monitoring of neurosurgical complications and consistent quality improvement within these highlighted realms may significantly improve patient outcomes.

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Section: Perioperative Epilepsymentioning

confidence: 94%

Patterns in neurosurgical adverse events: cerebrospinal fluid shunt surgery

Wong¹,

Ziewacz

et al. 2012

FOC

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“…4,8,15) In the present case, irritation of the brain parenchyma associated with previous hemorrhage or insertion of the ventricular catheter, and further worsened by a migrated prechamber, can be considered as an epileptogenic factor, in addition to the possible re-existent elevat-…”

Section: Discussionmentioning

confidence: 99%

Intractable Seizures Associated With Proximal Migration of a Ventriculoperitoneal Shunt-Case Report-

Yamazaki

Shimizu²,

Sagiuchi³

et al. 2005

Neurol. Med. Chir.(Tokyo)

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A 6-year-old girl, who had received a ventriculoperitoneal (VP) shunt using the Codman-Hakim programmable valve system at age 3 months, presented with intractable seizures. Neuroimaging studies showed migration of the proximal part of the system, including the prechamber, into the cranium through the right frontal burr hole. Electroencephalography showed spike-and-wave complexes in the right hemisphere including the site of the migration. The ictus was resolved following revision surgery. The clinical findings suggested the seizures were due to irritation of the brain parenchyma by the migrated system. Proximal migration of a VP shunt may cause both shunt failure and additional focal symptoms.

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“…Ventricular shunting procedures are associated with a widely varying incidence, ranging from 2% to 47%. 6,8,9) Infection of the system was associated with a higher risk. 8,9) Therefore, surgeons should avoid infection of the system to reduce the risk.…”

Section: Postoperative Early Seizuresmentioning

confidence: 99%

Postoperative Seizures: Epidemiology, Pathology, and Prophylaxis

Manaka

Ishijima

Mayanagi

2003

Neurol. Med. Chir.(Tokyo)

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The risk of epileptic seizures after craniotomy is extremely important but the incidence of postoperative epilepsy varies greatly, depending on the patient's conditions such as primary diseases, severity of surgical insult, and pre-existing epilepsy. Animal studies suggest that neurosurgical insults lead to seizures by two different mechanisms: One mechanism is mediated by free radical generation and the other by impaired ion balance across the cell membrane caused by ischemia or hypoxia. Conventional antiepileptic agents such as phenytoin, phenobarbital, carbamazepine, and valproic acid are promising for the prevention of early seizures, but the effect in preventing postoperative epilepsy is still controversial. Studies on the prophylactic effect of newer antiepileptic agents in craniotomized patients were very limited. Zonisamide, an antiepileptic agent with antiepileptogenic, free radical scavenging and neuroprotective actions in experimental animals, showed promising effects against postoperative epilepsy in a randomized double blind controlled trial. Prophylactic treatment for craniotomized patients significantly prevented the development of partial seizures during the follow-up period. Most recent studies have not supported the prophylactic use of antiepileptic agents in craniotomized patients, but further studies are required.

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The incidence of epilepsy after ventricular shunting procedures

Cited by 84 publications

References 6 publications

Patterns in neurosurgical adverse events: cerebrospinal fluid shunt surgery

Patterns in neurosurgical adverse events: cerebrospinal fluid shunt surgery

Intractable Seizures Associated With Proximal Migration of a Ventriculoperitoneal Shunt-Case Report-

Postoperative Seizures: Epidemiology, Pathology, and Prophylaxis

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