Surgical technique of retrograde ventricle-sinus shunt is an option for the treatment of hydrocephalus in infants after surgical repair of myelomeningocele

Abstract

Introduction Treatment of hydrocephalus is accomplished primarily through a ventricular-peritoneal shunt (VPS). This study aims to describe the application of retrograde ventricle-sinus shunt (RVSS) in patients with hydrocephalus after surgical treatment of myelomeningocele. Method A prospective, randomized and controlled pilot study. We consecutively enrolled 9 patients with hydrocephalus after surgical repair of myelomeningocele from January 2010 to January 2012. These patients underwent elective RVSS or VPS. Five underwent RVSS and 4 underwent VPS. Patients were followed for one year with quarterly evaluations and application of transcranial Doppler. Results RVSS group showed outcomes similar to those of VPS group. Doppler revealed significant improvement when comparing preoperative to postoperative period. RVSS group had significantly higher cephalic perimeter than VPS group. Neuropsychomotor development, complications and subjective outcomes did not differ between groups. Conclusion RVSS shunt is viable; it is an alternative option for the treatment of hydrocephalus.

Revisiting Retrograde Ventriculosinus Shunt as an Alternative for Treating Hydrocephalus in Children

“…Since Toma et al 5 published a full review about VSS in 2010, only 5 manuscripts updated the subject, 1 by El-Shafei et al, and 4 by Oliveira et al and Pinto et al In the present article, we discuss the evolution of the technique and its current results. 6,8,10,22,25,28,[32][33][34]…”

“…27,47,48 The follow-up included evaluations of the cephalic perimeter (CP), bregmatic fontanelle, TCD, computed tomography, neuropsychomotor development, complications and shunt revision, and outcomes focused on patients and caregivers. 22 The cephalic perimeter, the tomography and the fontanelle were characteristic in each group. In the RVSS group, there was no abrupt reduction in head circumference after surgery.…”

“…4). 10,21,22 Another potential option designed by our group, but with limited application until now, is the fragmentation of the catheter in two parts: one catheter for the ventricular puncture, and another for the SSS puncture. Then, the margin of one catheter has a connector to allow the connection of both catheters.…”

“…However, these ideas should be further discussed in experimental and clinical bases. 10,21,22 Experimental Basis for RVSS Secondly, a numerical model of the cortical veins and the SSS was built. No over drainage was found in the antegrade or the retrograde positions of the shunt.…”

“…From neuroendoscopy to shunt valve technologies, we could follow significant changes in the paradigms of the treatment of hydrocephalus. 2,[8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] However, since the 1990s, a few improvements changed the learning curves and the outcome of the hydrocephalus treatment. Currently, ventriculoperitoneal shunt (VPS) is the mainstay for treatment, as well as endoscopic third ventriculostomy (ETV), which is advocated in specific cases.…”