Ventriculoperitoneal shunt malfunction caused by fractures and disconnections over 10 years of follow-up

Erol, Fatih Serhat; Öztürk, Sait; Akgun, Bekir; Kaplan, Metin

doi:10.1007/s00381-017-3342-0

Cited by 26 publications

(17 citation statements)

References 23 publications

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“…Other authors have reported that a disconnected portion of fractured shunt may be working and that it is not safe to state that the shunt is no longer needed. 11,28 In this way, we believe that the concept of arrested hydrocephalus should be treated with great care and that patients with catheter fractures, disconnections, or migrations should be carefully followed up with routine control examinations, and also that the ability of the family to access the hospital should be considered in the decision between surgical or conservative treatment.…”

Section: Discussionmentioning

confidence: 99%

Reviewing the prognostic factors in myelomeningocele

Protzenko¹,

Bellas²,

Pousa³

et al. 2019

Neurosurgical Focus

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OBJECTIVEThe goal of this study was to analyze the factors that have an impact on morbidity and mortality in patients with myelomeningocele (MMC).METHODSA retrospective cohort study was conducted to analyze factors associated with MMC that influence the morbidity and mortality of the disease. Data were collected from medical records of children who underwent the primary repair of MMC at the Fernandes Figueira Institute–Oswaldo Cruz Foundation (IFF-Fiocruz) between January 1995 and January 2015, with a minimum follow-up of 1 year. The following variables were analyzed: demographic characteristics (gestational age, sex, and birth weight); clinical features (head circumference at birth, anatomical and functional levels of MMC, hydrocephalus, symptomatic Chiari malformation type II, neurogenic bladder, and urinary tract infection [UTI]); and surgical details such as timing of repair of MMC, age at first shunt placement, shunt surgery modality (elective or emergency), concurrent surgery (correction of MMC and shunt insertion in the same surgical procedure), incidence and cause of shunt dysfunction, use of external ventricular drain, transfontanelle puncture, surgical wound complications prior to shunting, and endoscopic treatment of hydrocephalus.RESULTSA total of 231 patients with MMC were included in the analysis. Patients were followed for periods ranging from 1 to 20 years, with a mean of 6.9 years. The frequency of shunt placement was observed mainly among patients with MMC at the highest spinal levels (p < 0.01). The main causes of morbidity and mortality in patients with MMC were shunt failures, diagnosed in 91 of 193 cases (47.2%) of hydrocephalus, and repeated UTIs, in 129 of 231 cases (55.8%) of MMC; these were the main causes of hospitalization and death. Head circumference ≥ 38 cm at birth was found to be a significant risk factor for shunt revision (p < 0.001; 95% CI 1.092–1.354). Also, the lumbar functional level of MMC was associated with less revision than upper levels (p < 0.014; 95% CI 0.143–0.805). There was a significant association between recurrent UTI and thoracic functional level.CONCLUSIONSMacrocephaly at birth and higher levels of the defect have an impact on worse outcome and, therefore, are a challenge to the daily practice of pediatric neurosurgery.

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Section: Discussionmentioning

confidence: 99%

Reviewing the prognostic factors in myelomeningocele

Protzenko¹,

Bellas²,

Pousa³

et al. 2019

Neurosurgical Focus

View full text Add to dashboard Cite

show abstract

“…Shunt disconnection is the cause of malfunction in approximately 10% of cases. 1 Diagnosing shunt disconnection with shunt series X-rays may prove difficult as the disconnection may be subtle, as in our case, and the shunt may still be partially functional which can manifest as inconsistent and intermittent symptoms. 2,3 The negative predictive value of shunt series X-rays is only 22%.…”

mentioning

confidence: 80%

Three-Dimensional Computed Tomography Reconstruction Unmasks Shunt Disconnection in a Child

Tailor

Coulter

Dewan

et al. 2020

Can. J. Neurol. Sci.

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“…First, all observed patients were symptom‐free. In patients who suffered from cHC (eg, after meningitis or subarachnoid hemorrhage) years after the implantation of the shunt, the possibility of shunt independency should be acknowledged 28‐32 . The issue of NPH is even more complex.…”

Section: Discussionmentioning

confidence: 99%

Phase‐Contrast MRI Detection of Ventricular Shunt CSF Flow: Proof of Principle

König

Stucht

Baecke

et al. 2020

Journal of Neuroimaging

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The evaluation of a suspected malfunction of a ventricular shunt is a common procedure in neurosurgery. The evaluation relies on either the interpretation of the ventricular width using cranial imaging or invasive techniques. Several attempts have been made to measure the flow velocity of cerebrospinal fluid (CSF) utilizing different phasecontrast magnet resonance imaging (PC MRI) techniques. In the present study, we evaluated 3 T (Tesla) MRI scanners for their effectiveness in determining of flow in the parenchymal portion of ventricular shunt systems with adjustable valves containing magnets. METHODS: At first, an MRI phantom was used to measure the phase-contrasts at different constant low flow rates. The next step was to measure the CSF flow in patients treated with ventricular shunts without suspected malfunction of the shunt under observation. RESULTS: The measurements of the phantom showed a linear correlation between the CSF flow and corresponding phase values. Despite many artifacts resulting from the magnetic valves, the ventricular catheter within the parenchymal portion of shunt was not superimposed by artifacts at each PC MRI plane and clearly distinguishable in 9 of 12 patients. Three patients suffering from obstructive hydrocephalus showed a clear flow signal. CONCLUSION: CSF flow detected within the parenchymal portion of the shunt by PC MRI may reliably provide information about the functional status of a ventricular shunt. Even in patients whose hydrocephalus was treated with magnetic adjustable valves, the CSF flow was detectable using PC MRI sequences at 3 T field strength.

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Ventriculoperitoneal shunt malfunction caused by fractures and disconnections over 10 years of follow-up

Abstract: Disconnection and fracture are two significant mechanical VP shunt dysfunctions and must be adequately researched and understood even during routine follow-ups. A disconnected or fractured shunt may be working and it is not safe to state that the shunt is no longer needed.

Cited by 26 publications

References 23 publications

Reviewing the prognostic factors in myelomeningocele

Reviewing the prognostic factors in myelomeningocele

Three-Dimensional Computed Tomography Reconstruction Unmasks Shunt Disconnection in a Child

Phase‐Contrast MRI Detection of Ventricular Shunt CSF Flow: Proof of Principle

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