Ventriculoperitoneal shunt complications in an adult population: A comparison of various shunt designs to prevent overdrainage

Desai, Virendra R.; Sadrameli, Saeed S.; Jenson, Amanda V.; Asante, Samuel K.; Daniels, Bradley; Trask, Todd; Britz, Gavin W.

doi:10.25259/sni_38_2020

Cited by 22 publications

(21 citation statements)

References 32 publications

(57 reference statements)

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“…In fact, non-programmable GV may not be advisable when the required opening pressure is difficult to estimate before surgery [105]. It should be taken into account that some patients with lower intracranial pressures may benefit from non-siphon control valves [112]. GV may cause under-drainage in bedridden patients [113].…”

Section: Management Strategies In Shunt Overdrainagementioning

confidence: 99%

Shunt Overdrainage: Reappraisal of the Syndrome and Proposal for an Integrative Model

Ros

Iglesias

Linares

et al. 2021

JCM

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Although shunt overdrainage is a well-known complication in hydrocephalus management, the problem has been underestimated. Current literature suggests that the topic requires more examination. An insight into this condition is limited by a lack of universally agreed-upon diagnostic criteria, heterogeneity of published series, the multitude of different management options and misunderstanding of relationships among pathophysiological mechanisms involved. We carried out a review of the literature on clinical, radiological, intracranial pressure (ICP), pathophysiological and treatment concepts to finally propose an integrative model. Active prophylaxis and management are proposed according to this model based on determination of pathophysiological mechanisms and predisposing factors behind each individual case. As pathophysiology is progressively multifactorial, prevention of siphoning with gravitational valves or antisiphon devices is mandatory to avoid or minimize further complications. Shunt optimization or transferal and neuroendoscopy may be recommended when ventricular collapse and cerebrospinal fluid isolation appear. Cranial expansion may be useful in congenital or acquired craniocerebral disproportion and shunting the subarachnoid space in communicating venous hydrocephalus and idiopathic intracranial hypertension.

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Section: Management Strategies In Shunt Overdrainagementioning

confidence: 99%

Shunt Overdrainage: Reappraisal of the Syndrome and Proposal for an Integrative Model

Ros

Iglesias

Linares

et al. 2021

JCM

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“…Desai et al [ 5 ] conducted a retrospective study involving 476 patients with a ventriculoperitoneal shunt in a single institution for five years duration. The study revealed that the overall complication rate of the shunt was 19%.…”

Section: Discussionmentioning

confidence: 99%

Abdominal Pseudocyst: A Rare Complication of Ventriculoperitoneal Shunts

Saqyan¹,

Basunbul²,

Badahdah³

et al. 2021

Cureus

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We present the case of a 69-year-old man patient who was brought with a history of gait disturbances, memory impairment, and urinary incontinence with gradual worsening over the past six months. The patient underwent magnetic resonance imaging of the brain which demonstrated enlarged ventricles, widening of the Sylvian fissure, and narrow sulci at the vertex. Subsequently, the patient underwent a lumbar puncture which revealed a normal opening pressure with normal cerebrospinal fluid analysis. The diagnosis of normal pressure hydrocephalus was established. The patient underwent a ventriculoperitoneal shunt for the management of his symptoms. Three years after the placement of the shunt, the patient was brought to the emergency department with an expanding right-sided subcutaneous abdominal mass. A computed tomography scan of the abdomen showed the subcutaneous mass superficial to the right rectus muscle and was containing the coiled distal end of the shunt. Such findings were consistent with a subcutaneous cerebrospinal fluid pseudocyst. The mass was aspirated and the fluid analysis was in keeping with the cerebrospinal fluid characteristics. The fluid culture revealed no bacterial growth. The ventriculoperitoneal shunt was replaced with a minimally invasive technique.

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“…In recent time, various ventriculoperitoneal shunts were designed to prevent overdrainage. [ 26 ] Further studies are needed to determine which shunt is the most appropriate for LOVA. We believe that patients with LOVA can benefit more from VP shunt surgery.…”

Section: Discussionmentioning

confidence: 99%

Long-standing overt ventriculomegaly in adulthood with primary presentation of psychiatric disturbance

Gao

et al. 2021

Medicine

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Rationale: Hydrocephalus is a common disease in neurosurgery. The typical symptoms of hydrocephalus include urinary incontinence, gait instability, and cognitive decline. Irritability rarely occurs in patients with hydrocephalus. Irritability rarely occurs in patients with hydrocephalus, especially in long-standing overt ventriculomegaly of adulthood (LOVA). Patient concerns: A 30-year-old female was admitted to our hospital because of mental retardation and unstable gait for more than 15 years. She had undergone ventriculoperitoneal shunt 15 years prior due to ventriculomegaly and related symptoms. However, the shunt catheter was removed shortly after surgery because of blockage, with no further postoperative treatment. Diagnosis: The patient was diagnosed with long-standing overt ventriculomegaly according to her head circumference and clinical symptoms, including adult hydrocephalus development, overt triventriculomegaly and absence of a secondary cause for aqueductal stenosis in adulthood. Interventions: After considerable discussion, she underwent ventriculoperitoneal shunt placement and showed dramatic and sustained improvement. Outcomes: The patient has been followed at 3-month intervals for over 2 years since discharge, and both the patient and family have reported a significant change in their daily life. She was able to live independently and control her emotions. Slight epilepsy was noted approximately 5 months after surgery but recovered 2 months later. Lessons: It is difficult to decide whether to treat LOVA when the in patients whose symptoms are not significant. We believe that early diagnosis and positive treatment can help improve outcomes and would recommend ventriculoperitoneal (VP) shunting in patients with LOVA.

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Ventriculoperitoneal shunt complications in an adult population: A comparison of various shunt designs to prevent overdrainage

Cited by 22 publications

References 32 publications

Shunt Overdrainage: Reappraisal of the Syndrome and Proposal for an Integrative Model

Shunt Overdrainage: Reappraisal of the Syndrome and Proposal for an Integrative Model

Abdominal Pseudocyst: A Rare Complication of Ventriculoperitoneal Shunts

Long-standing overt ventriculomegaly in adulthood with primary presentation of psychiatric disturbance

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