Management of Adult Hydrocephalus With Ventriculoperitoneal Shunts: Long-term Single-Institution Experience

Reddy, G. Kesava; Bollam, Papireddy; Shi, Runhua; Guthikonda, Bharat; Nanda, Anil

doi:10.1227/neu.0b013e31821ffa9e

Cited by 96 publications

(70 citation statements)

References 22 publications

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“…38 Reddy et al presented a retrospective review of 683 adult patients with shunts and found an overall shunt failure rate of 32%. 34 By this account we recommend and support the attempt of endoscopic CSF restoration in patients with shunt failure and concomitant proof of obstructive hydrocephalus. As mentioned above, there is a risk of sudden ETV failure in the long term.…”

Section: Fig 3 Influence Of Underlying Pathology On Long-term Etv Smentioning

confidence: 73%

Long-term results of endoscopic third ventriculostomy: an outcome analysis

Vulcu

Eickele

Cinalli

et al. 2015

JNS

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T he technique of endoscopic third ventriculostomy (ETV) has been under close evaluation as a treatment option for obstructive hydrocephalus. Although early on the procedure was associated with a very high, unacceptable complication rate, 41 more recent publications have reported success rates of about 70% and low complication rates, including mortality, around 0.5%-1.0%. 9,13,20,31,35 Nowadays, ETV is accepted as the gold standard for treatment of obstructive hydrocephalus. In comparison with ventriculoperitoneal shunting, a significantly lower complication rate and reoperation rate in the long term is expected. 2,10,26 Nevertheless, topics such as the prediction of ETV success, 4,12,26,28,42 period of highest failure rate, 26 and late deterioration after ETV 7,29 are still topics of discussion. However, current data are scarce, and the long-term efficacy of ETV is often under debate, since most studies have reported a rather short follow-up period, e.g., 8 months 13 or a few years. 1,22,23,40 Very few studies exist with a significantly longer follow-up, e.g., 4 years. 35This study investigates very long term success rates, up to 16 years, and the incidence of failures in the early and long-term postoperative periods after ETV. Methods Study DesignThe long-term outcome of ETV was evaluated through a retrospective analysis of all patients who underwent an abbreviatioN ETV = endoscopic third ventriculostomy. SubMitteD February 22, 2014. accepteD November 25, 2014. iNcluDe wheN citiNg Published online July 31, 2015; DOI: 10.3171/2014.11.JNS14414. DiScloSure J. Oertel reports that he is a consultant for Karl Storz Co. The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper. obJect Endoscopic third ventriculostomy (ETV) is the procedure of choice in the treatment of obstructive hydrocephalus. The excellent clinical and radiological success rates are well known. Nevertheless, very few papers have addressed the very long term outcomes of the procedure in very large series. The authors present a large case series of 113 patients who underwent 126 ETVs, and they highlight the initial postoperative outcome after 3 months and long-term follow-up with an average of 7 years. MethoDS All patients who underwent ETV at the Department of Neurosurgery, Mainz University Hospital, between 1993 and 1999 were evaluated. Obstructive hydrocephalus was the causative pathology in all cases. reSultS The initial clinical success rate was 82% and decreased slightly to 78% during long-term follow-up. Longterm success was analyzed using Kaplan-Meier curves. Overall, ETV failed in 31 patients. These patients underwent a second ETV or shunt treatment. A positive impact on long-term success was seen for age older than 6 months, and for obstruction due to cysts or benign aqueductal stenosis. The complication rate was 9% with 5 intraoperative and 5 postoperative events. coNcluSioNS The high clinical success rate in short-term and long-term follow-up confirms ETV's s...

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Section: Fig 3 Influence Of Underlying Pathology On Long-term Etv Smentioning

confidence: 73%

Long-term results of endoscopic third ventriculostomy: an outcome analysis

Vulcu

Eickele

Cinalli

et al. 2015

JNS

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“…Previous data suggest that almost onethird of adult patients undergoing CSF shunt ing will require revision. 8 Optimal catheter placement may help reduce the risk of shunt failure. Ultrasonic and stereotactic guidance significantly improve the accuracy of ventricular catheter placement in comparison with freehand placement using surface anatomical landmarks.…”

Section: Discussionmentioning

confidence: 99%

“…Despite advances in shunt catheter materi als and the valves used, there remains a high rate of shunt failure. In fact, 1 recent study 8 reported shunt failure in 32% of adult patients undergoing VP shunt placement. Mechan ical dysfunction remains the most common cause of this failure.…”

Section: ©Aans 2013mentioning

confidence: 99%

Comparison of the accuracy of ventricular catheter placement using freehand placement, ultrasonic guidance, and stereotactic neuronavigation

Wilson¹,

Stetler²,

Al-Holou³

et al. 2013

JNS

110

104

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Object. The objective of this study was to compare the accuracy of 3 methods of ventricular catheter placement during CSF shunt operations: the freehand technique using surface anatomy, ultrasonic guidance, and stereotactic neuronavigation.Methods. This retrospective cohort study included all patients from a single institution who underwent a ven tricular CSF shunting procedure in which a new ventricular catheter was placed between January 2005 and March 2010. Data abstracted for each patient included age, sex, diagnosis, method of ventricular catheter placement, site and side of ventricular catheter placement, Evans ratio, and bifrontal ventricular span. Postoperative radiographic stud ies were reviewed for accuracy of ventricular catheter placement. Medical records were also reviewed for evidence of shunt failure requiring revision through December 2011. Statistical analysis was then performed comparing the 3 methods of ventricular catheter placement and to determine risk factors for inaccurate placement.Results. There were 249 patients included in the study; 170 ventricular catheters were freehand passed, 51 were placed using stereotactic neuronavigation, and 28 were placed under intraoperative ultrasonic guidance. There was a statistically significant difference between freehand catheters and stereotactic-guided catheters (p < 0.001), as well as between freehand catheters and ultrasound-guided catheters (p < 0.001). The only risk factor for inaccurate place ment identified in this study was use of the freehand technique. The use of stereotactic neuronavigation and ultrasonic guidance reduced proximal shunt failure rates (p < 0.05) in comparison with a freehand technique.Conclusions. Stereotactic-and ultrasound-guided ventricular catheter placements are significantly more accu rate than freehand placement, and the use of these intraoperative guidance techniques reduced proximal shunt failure in this study.

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“…The rate of failure and revision can be as high as 16%-51.9%. 7,10,[18][19][20] The rate of complications and revisions between programmable and nonprogrammable shunts is therefore an important consideration in our study.…”

Section: Shunt Complications and Revisionsmentioning

confidence: 99%

Use of programmable versus nonprogrammable shunts in the management of hydrocephalus secondary to aneurysmal subarachnoid hemorrhage: a retrospective study with cost-benefit analysis

Lee¹,

King²,

Kumar³

et al. 2014

JNS

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Object. The choice of programmable or nonprogrammable shunts for the management of hydrocephalus after aneurysmal subarachnoid hemorrhage (SAH) remains undefined. Variable intracranial pressures make optimal management difficult. Programmable shunts have been shown to reduce problems with drainage, but at 3 times the cost of nonprogrammable shunts.Methods. All patients who underwent insertion of a ventriculoperitoneal shunt for hydrocephalus after aneurysmal SAH between 2006 and 2012 were included. Patients were divided into those in whom nonprogrammable shunts and those in whom programmable shunts were inserted. The rates of shunt revisions, the reasons for adjustments of shunt settings in patients with programmable devices, and the effectiveness of the adjustments were analyzed. A cost-benefit analysis was also conducted to determine if the overall cost for programmable shunts was more than for nonprogrammable shunts.Results. Ninety-four patients underwent insertion of shunts for hydrocephalus secondary to SAH. In 37 of these patients, nonprogrammable shunts were inserted, whereas in 57 programmable shunts were inserted. Four (7%) of 57 patients with programmable devices underwent shunt revision, whereas 8 (21.6%) of 37 patients with nonprogrammable shunts underwent shunt revision (p = 0.0413), and 4 of these patients had programmable shunts inserted during shunt revision. In 33 of 57 patients with programmable shunts, adjustments were made. The adjustments were for a trial of functional improvement (n = 21), overdrainage (n = 5), underdrainage (n = 6), or overly sunken skull defect (n = 1). Of these 33 patients, 24 showed neurological improvements (p = 0.012). Cost-benefit analysis showed $646.60 savings (US dollars) per patient if programmable shunts were used, because the cost of shunt revision is a lot higher than the cost of the shunt.Conclusions. The rate of shunt revision is lower in patients with programmable devices, and these are therefore more cost-effective. In addition, the shunt adjustments made for patients with programmable devices also resulted in better neurological outcomes.

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Management of Adult Hydrocephalus With Ventriculoperitoneal Shunts: Long-term Single-Institution Experience

Cited by 96 publications

References 22 publications

Long-term results of endoscopic third ventriculostomy: an outcome analysis

Long-term results of endoscopic third ventriculostomy: an outcome analysis

Comparison of the accuracy of ventricular catheter placement using freehand placement, ultrasonic guidance, and stereotactic neuronavigation

Use of programmable versus nonprogrammable shunts in the management of hydrocephalus secondary to aneurysmal subarachnoid hemorrhage: a retrospective study with cost-benefit analysis

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