LOVA-Hydrozephalus

Abstract

The recently defined term "longstanding overt ventriculomegaly in adults" (LOVA) describes a unique entity of chronic occlusive hydrocephalus. The experiences so far using conventional DP valves were not encouraging because of a high percentage of overdrainage. The objective was to evaluate whether gravitational shunts could be used for this condition with an acceptable overdrainage risk. Twenty-three macrocephalic adults aged 17-72 years suffered from chronic progressive hydrocephalic conditions. They received two different types of gravitational shunt. Follow-up ranged from 6 months to 75 months. Only two patients presented small subdural effusions postoperatively, and only one required additional treatment for that. Eighty-two percent were shunt responders. Ventricular size was only marginally reduced in 22 of the 23 patients. There was no correlation between clinical benefit and the reduction in ventricular size. Gravitational shunts clearly have the potency for safe treatment of LOVA, significantly reducing the risk of overdrainage over conventional valves, and may be considered an equivalent alternative to third ventriculostomy.

Surgical treatment of long-standing overt ventriculomegaly in adults (LOVA)

“…ETV obviates many of the the risks associated with CSF diversion implant procedures, but gravitational shunts may be considered in cases unsuitable for ETV or after recurrence of symptoms after initial ETV [2, 11, 12]. Such recurrence may occur months to years after initial ETV.…”

“…However, the optimal CSF diversion procedure for patients with LOVA has been debated for over a decade [1, 2, 9–12]. This debate has centred on a debate between neuroendoscopic procedures versus CSF shunt diversion.…”

“…After the dramatic complications following PPV insertion in the initial series by Oi et al, focus shifted onto use of gravitational shunts for LOVA patients to minimise the risk of over-drainage [1, 2, 11, 12]. In an important study of shunt procedures for LOVA patients, 23 patients elected gravitational shunt insertion after being offered the choice of ETV or shunt insertion [11, 12].…”

“…Fourteen patients were diagnosed with LOVA at a single neurosurgical unit between 2011 and 2016, by virtue of all the patients meeting the clinical and radiological criteria for LOVA established by Oi et al [2] (Table 1). All patients underwent an ETV utilising the same standardised operative technique, outlined by Al-Jumaily et al [4].…”

“…The mechanism for this phenomenon remains unclear [2]. It is hypothesised that there is a full or partial obstruction of CSF flow through the aqueduct of Sylvius before fusion of cranial sutures (i.e.…”