Ventriculoatrial versus ventriculoperitoneal shunt complications in idiopathic normal pressure hydrocephalus

Hung, Alice L.; Vivas-Buitrago, Tito; Adam, Atif; Lu, Jennifer; Robison, Jamie; Elder, Benjamin D.; Goodwin, C. Rory; Jusué-Torres, Ignacio; Rigamonti, Daniele

doi:10.1016/j.clineuro.2017.03.014

Cited by 77 publications

(68 citation statements)

References 41 publications

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“…3 Complication rates for patients treated with VP shunts ranged from 13% to 38%, the majority occurring within the 1st year after surgery. 12,17 It was also estimated that 20%-33% of patients treated with VP shunts required additional surgery, with 15% undergoing shunt revision during a 1-year period (median time to second intervention: 73.5 months). 15,38,42,54 We estimated a lower rate of revision surgeries, especially when considering patients treated in the last 10 years; this difference could potentially be explained as a consequence of improved shunt technology.…”

Section: Discussionmentioning

confidence: 99%

Outcomes and complications of different surgical treatments for idiopathic normal pressure hydrocephalus: a systematic review and meta-analysis

Giordan¹,

Palandri

Lanzino³

et al. 2019

Journal of Neurosurgery

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107

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OBJECTIVEDifferent CSF diversion procedures (ventriculoperitoneal, ventriculoatrial, and lumboperitoneal shunting) have been utilized for the treatment of idiopathic normal pressure hydrocephalus. More recently, endoscopic third ventriculostomy has been suggested as a reasonable alternative in some studies. The purpose of this study was to perform a systematic review and meta-analysis to assess overall rates of favorable outcomes and adverse events for each of these treatments. An additional objective was to determine the outcomes and complication rates in relation to the type of valve utilized (fixed vs programmable).METHODSMultiple databases (PubMed, Ovid MEDLINE In-Process & Other Non-Indexed Citations, Ovid MEDLINE, Ovid Embase, Ovid Cochrane Central Register of Controlled Trials, Ovid Cochrane Database of Systematic Reviews, and Scopus) were searched for studies involving patients with idiopathic ventriculomegaly, no secondary cause of hydrocephalus, opening pressure < 25 mm Hg on high-volume tap or drainage trial, and age > 60 years. Outcomes included the proportion of patients who showed improvement in gait, cognition, and bladder function. Adverse events considered in the analysis included postoperative ischemic/hemorrhagic complications, subdural fluid collections, seizures, need for revision surgery, and infection.RESULTSA total of 33 studies, encompassing 2461 patients, were identified. More than 75% of patients experienced improvement after shunting, without significant differences among the different techniques utilized. Overall, gait improvement was observed in 75% of patients, cognitive function improvement in more than 60%, and improvement of incontinence in 55%. Adjustable valves were associated with a reduction in revisions (12% vs 32%) and subdural collections (9% vs 22%) as compared to fixed valves.CONCLUSIONSOutcomes did not differ significantly among different CSF diversion techniques, and overall improvement was reported in more than 75% of patients. The use of programmable valves decreased the incidence of revision surgery and of subdural collections after surgery, potentially justifying the higher initial cost associated with these valves.

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Section: Discussionmentioning

confidence: 99%

Outcomes and complications of different surgical treatments for idiopathic normal pressure hydrocephalus: a systematic review and meta-analysis

Giordan¹,

Palandri

Lanzino³

et al. 2019

Journal of Neurosurgery

Self Cite

107

View full text Add to dashboard Cite

show abstract

“…Roughly 55% of shunt revisions are unavoidable and typically occur after three months of implantation [5]. Preoperative symptoms such as headache, gait instability, cognitive decline, and urinary incontinence have been described in the literature as predictors of shunt malfunction [6]. Obesity and previous shunt surgery are more specific independent risk factors for catheter migration [7].…”

Section: Discussionmentioning

confidence: 99%

Spontaneous Migration of a Ventriculoperitoneal Shunt into the Venous System: A Multidisciplinary Approach

Nardone

Marotta

Smith

et al. 2020

Cureus

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“…However, in a recent comparative study on long term outcome of VPS, the incidence of complications of VAS is not higher than VPS. 6 7 10) Hung et al 7) reported that VA shunted patients were less likely to experience shunt obstruction and require shunt revision compared to VP shunted patients in the idiopathic normal pressure hydrocephalus group.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, new evaluations of VAS are being made in children and adults. 7 16) In the comparison of VAS and VPS in normal pressure hydrocephalus patients, Hung et al 7) reported that the shunt obstruction and revision rate were lower in VAS, and that severe complications such as cardiopulmonary problem did not occur in VAS. Particularly, in reports of the long term outcome of VPS performed in pediatric patients, the revision rate was over 80% for VPS, with about half of them undergoing multiple revisions.…”

Section: Introductionmentioning

confidence: 99%

Case Series of Ventriculoatrial Shunt placement in Hybrid Room: Reassessment of Ventriculoatrial Shunt

Kim

Lee

Kim

et al. 2020

Korean J Neurotrauma

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Objective Ventriculoatrial shunt (VAS) remains an alternate option for treatment of hydrocephalus in patients with ventriculoperitoneal shunt (VPS) failure. Unfamiliar anatomy for a neurosurgeon has resulted in the VAS falling out of favor as a treatment option. However, there are unsatisfactory reports on the long-term result of VPS, and VAS has been recently re-evaluated. We are to report the simple way to do the VAS using a peel-away sheath in a hybrid operation room. Methods A jugular vein path was drawn by ultrasound, a small incision was made above the clavicle, and a shunt catheter was tunneled into it. The jugular vein was punctured beside the tunneled catheter with a Seldinger needle under ultrasound guidance. A flexible guide wire was introduced into the vein and 6-Fr peel-away sheath was advanced into the vein along the wire. Under fluoroscopic guidance, the catheter was cut to position approximately mid-level in the atrium. After the guide wire was removed, the distal shunt catheter was passed down. After confirming proper position of the distal catheter under the fluoroscope, the catheter-guiding sheath was pulled out as a peeling-away manner. We performed this surgical procedures in 5 cases. Results All the procedures of the VAS using a peel-away sheath were performed in a hybrid operation room Of 5 patients, 3 patients had the distal catheter failures in the peritoneal cavity and 2 patients had shunt A distal catheter was successfully indwelling in all the cases without any difficulties. After the surgery, neither shunt infection nor thromboembolic event happened. Conclusion VAS using fluoroscopy and a peel-away sheath is a good alternative option for hydrocephalus patients with shunt failure related to peritoneal cavity complications.

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Ventriculoatrial versus ventriculoperitoneal shunt complications in idiopathic normal pressure hydrocephalus

Cited by 77 publications

References 41 publications

Outcomes and complications of different surgical treatments for idiopathic normal pressure hydrocephalus: a systematic review and meta-analysis

Outcomes and complications of different surgical treatments for idiopathic normal pressure hydrocephalus: a systematic review and meta-analysis

Spontaneous Migration of a Ventriculoperitoneal Shunt into the Venous System: A Multidisciplinary Approach

Case Series of Ventriculoatrial Shunt placement in Hybrid Room: Reassessment of Ventriculoatrial Shunt

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