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Farke D, Siwicka AK, Olszewska A, Czerwik A, Büttner K, Schmidt MJ. Risk factors, treatment, and outcome in dogs and cats with subdural hematoma and hemispheric collapse after ventriculoperitoneal shunting of congenital internal hydrocephalus. J Vet Intern Med 2023; 37:2269-2277. [PMID: 37675951 PMCID: PMC10658535 DOI: 10.1111/jvim.16861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 08/24/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND Overshunting and hemispheric collapse are well-known complications after ventriculoperitoneal shunt (VPS) implantation. Risk factors that predispose to overshunting, treatment options, and prognosis after therapeutic intervention have not been described. HYPOTHESIS/OBJECTIVES To identify preoperative risk factors for overshunting, the effect of surgical decompression, and their outcomes. ANIMALS Seventy-five dogs and 7 cats. METHODS Retrospective case cohort study. Age, breed, sex, body weight, number of dilated ventricles, ventricle brain ratio, intraventricular pressure, and implanted pressure valve systems were evaluated as possible risk factors. RESULTS Overshunting had a prevalence of 18% (Cl 95% 9.9-26.66). An increase of 0.05 in VBR increased the risk of overshunting by OR 2.23 (Cl 95% 1.4-3.5; P = .001). Biventricular hydrocephalus had the highest risk for overshunting compared to a tri- (OR 2.48 with Cl 95% 0.5-11.1) or tetraventricular hydrocephalus (OR 11.6 with Cl 95% 1.7-81.1; P = .05). There was no influence regarding the use of gravitational vs differential pressure valves (P > .78). Overshunting resulted in hemispheric collapse, subdural hemorrhage, and peracute deterioration of neurological status in 15 animals. Subdural hematoma was removed in 8 dogs and 2 cats with prompt postoperative improvement of clinical signs. CONCLUSIONS AND CLINICAL IMPORTANCE Biventricular hydrocephalus and increased VBR indicate a higher risk for overshunting. The use of differential valves with gravitational units has no influence on occurrence of overshunting related complications and outcomes. Decompressive surgery provides a favorable treatment option for hemispheric collapse and has a good outcome.
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Affiliation(s)
- Daniela Farke
- Department of Veterinary Clinical Sciences, Small Animal ClinicJustus‐Liebig‐University, Frankfurter Strasse 11435392 GiessenGermany
| | - Anna K. Siwicka
- Department of Veterinary Clinical Sciences, Small Animal ClinicJustus‐Liebig‐University, Frankfurter Strasse 11435392 GiessenGermany
| | - Agnieszka Olszewska
- Department of Veterinary Clinical Sciences, Small Animal ClinicJustus‐Liebig‐University, Frankfurter Strasse 11435392 GiessenGermany
| | - Adriana Czerwik
- Department of Veterinary Clinical Sciences, Small Animal ClinicJustus‐Liebig‐University, Frankfurter Strasse 11435392 GiessenGermany
| | - Kathrin Büttner
- Unit for Biomathematics and Data Processing, Faculty of Veterinary MedicineJustus Liebig‐University‐GiessenGiessenGermany
| | - Martin J. Schmidt
- Department of Veterinary Clinical Sciences, Small Animal ClinicJustus‐Liebig‐University, Frankfurter Strasse 11435392 GiessenGermany
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Reis RC, Yamashita RHG, Solla DJF, Ramin LF, Teixeira MJ, Pinto FCG. Treatment of Idiopathic Normal Pressure Hydrocephalus with a Novel Programmable Valve: Prospective Evaluation of Costs, Efficacy, and Safety. Asian J Neurosurg 2023; 18:548-556. [PMID: 38152509 PMCID: PMC10749867 DOI: 10.1055/s-0043-1771370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2023] Open
Abstract
Objective Programmable valves provide an equal or superior neurological outcome when compared with fixed pressure ones, with fewer complications, in treating idiopathic normal pressure hydrocephalus (iNPH) patients. Long-term costs of these treatments have not been properly compared in literature. We sought to compare costs, efficacy, and safety of 1-year treatment of iNPH patients with programmable valve Sphera Pro and a fixed pressure valve. Materials and Methods A prospective cohort of iNPH patients treated with programmable valve was compared with a historical cohort of iNPH patients treated with fixed pressure valve. Our primary outcome was mean direct cost of treating iNPH up to 1 year. Efficacy in treating iNPH and safety were assessed as secondary outcomes. Statistical Analysis Proportions were compared using chi-square or Fisher's exact tests. Normally distributed variables were compared using the Student's t -test or the Mann-Whitney's U test. Differences in the evolution of the variables over time were assessed using generalized estimating equations. All tests were two-sided, with an α of 0.05. Results A total of 19 patients were analyzed in each group (mean age 75 years, the majority male). Comorbidities and clinical presentation were similar between groups. Both fixed pressure and programmable valve patients had neurological improvement over time ( p < 0.001), but no difference was seen between groups ( p = 0.104). The fixed pressure valve group had more complications than the programmable valve group (52.6% vs. 10.5%, respectively, p = 0.013). Annual treatment cost per patient was US$ 3,820 ± 2,231 in the fixed pressure valve group and US$ 3,108 ± 553 in the programmable valve group. Mean difference was US$712 (95% confidence interval, 393-1,805) in favor of the programmable valve group. Conclusion The Sphera Pro valve with gravitational unit had 1 year treatment cost not higher than that of fixed pressure valve, and resulted in similar efficacy and fewer complications.
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Affiliation(s)
- Rodolfo Casimiro Reis
- Department of Neurosurgery, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
| | | | | | - Laís Fajardo Ramin
- Neuroradiology Section, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
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de Oliveira MF, Sorte AAB, Emerenciano DL, Rotta JM, Mendes GAS, Pinto FCG. Long term follow-up of shunted idiopathic normal pressure hydrocephalus patients: a single center experience. Acta Neurol Belg 2021; 121:1799-1806. [PMID: 33136273 DOI: 10.1007/s13760-020-01538-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 10/21/2020] [Indexed: 10/23/2022]
Abstract
Idiopathic normal pressure hydrocephalus (iNPH) is a condition characterized by gait disturbance, dementia and/or urinary incontinence and enlarged ventricular system due to disturbance of cerebrospinal fluid (CSF). This study aims to describe the long-term experience with patients with iNPH submitted to ventriculoperitoneal shunt (VPS) with the programmable valve STRATA® (Medtronic). We prospectively selected a cohort of patients with a diagnosis of iNPH from January 2010 to April 2013 in a Brazilian tertiary hospital. All patients underwent clinical evaluation, which consists of the Mini-Mental State Examination and Time Up and Go tests and the application of Japanese Scale for Idiopathic Normal Pressure Hydrocephalus in three stages: prior to the TT, 3 h after the TT and 72 h after the TT. Fifty patients were submitted to VPS and followed. There were 32 men and 18 women. Mean age was 77.1 with standard deviation of 10.9. Follow-up time ranged from 96 to 120 months, with mean of 106 months. After 1 year of follow-up, 42 (83%) patients presented with clinical improvement, decreasing to 62% of patients at mid-term follow-up and 38% of patients at late follow-up. Complications occurred in 18% of subjects, needing reoperation in 16%. Our results show relevant clinical impact of shunting in iNPH patients, decreasing over time. Complications should not be underestimated, reaching up to 18% and demanding reoperation in 16% of cases. Thus, although much has been improved with current shunt technology, it is still important to consider the drawbacks of treatment.
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Panagopoulos D, Karydakis P, Themistocleous M. Slit ventricle syndrome: Historical considerations, diagnosis, pathophysiology, and treatment review. Brain Circ 2021; 7:167-177. [PMID: 34667900 PMCID: PMC8459697 DOI: 10.4103/bc.bc_29_21] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 05/08/2021] [Accepted: 05/21/2021] [Indexed: 11/06/2022] Open
Abstract
After the introduction of shunt treatment for the management of childhood hydrocephalus, a wide variety of complications related to this treatment modality have been recognized. The entity of slit ventricle syndrome (alternatively, symptomatic ventricular coaptation) is one of them, is frequently encountered in the pediatric population and its symptom complex resembles that of shunt failure. We conducted research on PubMed®, MEDLINE®, and Web of Science®, using the keywords: “slit ventricles,” “slit ventricle syndrome,” “SVS” and “ventricular coaptation.” The aim of our review was to trace the advances made through the past decades, concerning our knowledge about the clinical characteristics, pathophysiology, and treatment options of this entity. The discrepancy among researchers about the offending etiology and the optimum treatment algorithm of this entity, as well as the necessity of an updated concept regarding shunt over drainage is analyzed. The multiple treatment modalities proposed and pathophysiologic mechanisms implicated for the treatment of slit ventricle syndrome illustrate the complexity of this entity. Consequently, the issue requires more detailed evaluation. In this review, we comment on all the main facets related to shunt over drainage and the resultant slit ventricle syndrome.
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Affiliation(s)
- Dimitrios Panagopoulos
- Department of Neurosurgery, Pediatric Hospital of Athens, "Agia Sophia,", Athens, Greece
| | | | - Marios Themistocleous
- Department of Neurosurgery, Pediatric Hospital of Athens, "Agia Sophia,", Athens, Greece
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Ros B, Iglesias S, Linares J, Cerro L, Casado J, Arráez MA. Shunt Overdrainage: Reappraisal of the Syndrome and Proposal for an Integrative Model. J Clin Med 2021; 10:jcm10163620. [PMID: 34441916 PMCID: PMC8396927 DOI: 10.3390/jcm10163620] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 08/05/2021] [Accepted: 08/12/2021] [Indexed: 11/16/2022] Open
Abstract
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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Affiliation(s)
- Bienvenido Ros
- Pediatric Neurosurgery Division, Department of Neurosurgery, Regional University Hospital, Avda. Carlos Haya s/n, 29010 Malaga, Spain;
- Correspondence:
| | - Sara Iglesias
- Pediatric Neurosurgery Division, Department of Neurosurgery, Regional University Hospital, Avda. Carlos Haya s/n, 29010 Malaga, Spain;
| | - Jorge Linares
- Department of Neurosurgery, Regional University Hospital, Avda. Carlos Haya s/n, 29010 Malaga, Spain; (J.L.); (L.C.); (J.C.); (M.A.A.)
| | - Laura Cerro
- Department of Neurosurgery, Regional University Hospital, Avda. Carlos Haya s/n, 29010 Malaga, Spain; (J.L.); (L.C.); (J.C.); (M.A.A.)
| | - Julia Casado
- Department of Neurosurgery, Regional University Hospital, Avda. Carlos Haya s/n, 29010 Malaga, Spain; (J.L.); (L.C.); (J.C.); (M.A.A.)
| | - Miguel Angel Arráez
- Department of Neurosurgery, Regional University Hospital, Avda. Carlos Haya s/n, 29010 Malaga, Spain; (J.L.); (L.C.); (J.C.); (M.A.A.)
- Department of Surgery, Malaga University, 29010 Malaga, Spain
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Desai VR, Sadrameli SS, Jenson AV, Asante SK, Daniels B, Trask TW, Britz G. Ventriculoperitoneal shunt complications in an adult population: A comparison of various shunt designs to prevent overdrainage. Surg Neurol Int 2020; 11:269. [PMID: 33033631 PMCID: PMC7538957 DOI: 10.25259/sni_38_2020] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 06/09/2020] [Indexed: 11/10/2022] Open
Abstract
Background: Overdrainage after cerebrospinal fluid diversion remains a significant morbidity. The hydrostatic, gravitational force in the upright position can aggravate this. Siphon control (SC) mechanisms, as well as programmable and flow regulating devices, were developed to counteract this. However, limited studies have evaluated their safety and efficacy. In this study, direct comparisons of the complication rates between siphon control (SC) and non-SC (NSC), fixed versus programmable, and flow- versus pressure regulating valves are undertaken. Methods: A retrospective chart review was performed over all shunt implantations from January 2011 to December 2016 within the Houston Methodist Hospital system. Complication rates within 6 months of the operative date, including infection, subdural hematoma, malfunction, and any other shunt-related complication, were analyzed via Fisher’s exact test, with P < 0.05 regarded as significant. Subgroup analyses based on diagnoses – normal pressure hydrocephalus (HCP), pseudotumor cerebri, or other HCP – were also performed. Results: The overall shunt-related complication rate in this study was 19%. Overall rates of infection, shunt failure, and readmission within 180 days were 3%, 11%, and 34%, respectively. No difference was seen between SC and NSC groups in any complication rate overall or on subgroup analyses. When comparing fixed versus programmable and flow- versus pressure-regulating valves, the latter in each analysis had significantly lower malfunction and total complication rates. Conclusions: Programmable and pressure regulating devices may lead to lower shunt malfunction and total complication rates. Proper patient selection should guide valve choice. Future prospective studies may further elucidate the difference in complication rates between these various shunt designs.
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Affiliation(s)
- Virendra Rajendrakumar Desai
- Department of Neurosurgery, Houston Methodist Neurological Institute, Houston Methodist Hospital, Houston, Texas, United States
| | - Saeed Sam Sadrameli
- Department of Neurosurgery, Houston Methodist Neurological Institute, Houston Methodist Hospital, Houston, Texas, United States
| | - Amanda V Jenson
- Department of Neurosurgery, Houston Methodist Neurological Institute, Houston Methodist Hospital, Houston, Texas, United States
| | - Samuel K Asante
- Department of Neurosurgery, Houston Methodist Neurological Institute, Houston Methodist Hospital, Houston, Texas, United States
| | - Bradley Daniels
- Department of Neurosurgery, Houston Methodist Neurological Institute, Houston Methodist Hospital, Houston, Texas, United States
| | - Todd W Trask
- Department of Neurosurgery, Houston Methodist Neurological Institute, Houston Methodist Hospital, Houston, Texas, United States
| | - Gavin Britz
- Department of Neurosurgery, Houston Methodist Neurological Institute, Houston Methodist Hospital, Houston, Texas, United States
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Pinto FCG, Oliveira MFD, Castro JPSD, Morais JVR, Pinto FMG, Teixeira MJ. Clinical performance of fixed-pressure Sphera Duo® hydrocephalus shunt. ARQUIVOS DE NEURO-PSIQUIATRIA 2020; 78:9-12. [PMID: 32074184 DOI: 10.1590/0004-282x20190135] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 08/28/2019] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Cerebral hydrodynamics complications in shunted patients are due to the malfunction of the system. The objective of this retrospective, single-center, single-arm cohort study is to confirm the safety and performance of Sphera® Duo when used in adult patients suffering from hydrocephalus, pseudotumor cerebri or arachnoid cysts. METHODS Data were generated by reviewing 112 adult patient's charts, who were submitted to a ventriculoperitoneal shunt surgery and followed for one year after surgery. RESULTS The results show us that 76% of patients had their neurological symptoms improved and that the reoperation rate was 15% in the first year following surgery. DISCUSSION Sphera Duo® shunt system is an applicable shunt option in routine neurosurgical management of hydrocephalus by several causes. It has presented good results while mitigating effects of overdrainage. Overdrainage is especially important in adults with non-hypertensive hydrocephalus and can cause functional shunt failure, which causes subnormal ICP (particularly in the upright position) and is associated with characteristic neurological symptoms, such as postural headache and nausea. CONCLUSION Sphera Duo® shunt system is safe when used in adult patients suffering from hydrocephalus, pseudotumor cerebri or arachnoid cyst.
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Affiliation(s)
- Fernando Campos Gomes Pinto
- Universidade de São Paulo, Hospital das Clínicas, Instituto de Psiquiatria, Divisão de Neurocirurgia Funcional, Grupo de Hidrodinâmica Cerebral, São Paulo SP, Brazil
| | - Matheus Fernandes de Oliveira
- Universidade de São Paulo, Hospital das Clínicas, Instituto de Psiquiatria, Divisão de Neurocirurgia Funcional, Grupo de Hidrodinâmica Cerebral, São Paulo SP, Brazil
| | - João Paulo Souza de Castro
- Universidade de São Paulo, Hospital das Clínicas, Instituto de Psiquiatria, Divisão de Neurocirurgia Funcional, Grupo de Hidrodinâmica Cerebral, São Paulo SP, Brazil
| | - João Vitor Rocha Morais
- Universidade de São Paulo, Hospital das Clínicas, Instituto de Psiquiatria, Divisão de Neurocirurgia Funcional, Grupo de Hidrodinâmica Cerebral, São Paulo SP, Brazil
| | - Flávia Morais Gomes Pinto
- Universidade de São Paulo, Hospital das Clínicas, Instituto de Psiquiatria, Divisão de Neurocirurgia Funcional, Grupo de Hidrodinâmica Cerebral, São Paulo SP, Brazil
| | - Manoel Jacobsen Teixeira
- Universidade de São Paulo, Hospital das Clínicas, Instituto de Psiquiatria, Divisão de Neurocirurgia Funcional, Grupo de Hidrodinâmica Cerebral, São Paulo SP, Brazil
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Ros B, Iglesias S, Martín Á, Carrasco A, Ibáñez G, Arráez MA. Shunt overdrainage syndrome: review of the literature. Neurosurg Rev 2017; 41:969-981. [DOI: 10.1007/s10143-017-0849-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 12/03/2016] [Accepted: 03/22/2017] [Indexed: 10/19/2022]
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Oliveira MFD, Teixeira MJ, Norremose KA, Matushita H, Oliveira MDL, Shu EBS, Pinto FCG. Surgical technique of retrograde ventricle-sinus shunt is an option for the treatment of hydrocephalus in infants after surgical repair of myelomeningocele. ARQUIVOS DE NEURO-PSIQUIATRIA 2015; 73:1019-25. [DOI: 10.1590/0004-282x20150169] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 08/24/2015] [Indexed: 11/21/2022]
Abstract
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.
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Pereira RM, Suguimoto MT, Oliveira MF, Tornai JB, Amaral RA, Teixeira MJ, Pinto FCG. Performance of the fixed pressure valve with antisiphon device SPHERA® in the treatment of normal pressure hydrocephalus and prevention of overdrainage. ARQUIVOS DE NEURO-PSIQUIATRIA 2015; 74:55-61. [PMID: 26602193 DOI: 10.1590/0004-282x20150190] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 10/05/2015] [Indexed: 05/28/2023]
Abstract
Normal pressure hydrocephalus (NPH) is characterized by the triad of gait apraxia, dementia and urinary incontinence associated with ventriculomegaly and normal pressure of cerebrospinal fluid. Treatment is accomplished through the implantation of a ventricular shunt (VPS), however some complications are still frequent, like overdrainage due to siphon effect. This study analyses the performance of a valve with anti-siphon device (SPHERA®) in the treatment of patients with NPH and compares it with another group of patients with NPH who underwent the same procedure without anti-siphon mechanism (PS Medical® valve). 30 patients were consecutively enrolled in two groups with 15 patients each and followed clinically and radiologically for 1 year. Patients submitted to VPS with SPHERA® valve had the same clinical improvement as patients submitted to VPS with PS Medical®. However, complications and symptomatology due to overdrainage were significantly lower in SPHERA® group, suggesting it as a safe tool to treat NPH.
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Affiliation(s)
| | | | - Matheus F Oliveira
- Departamento de Neurocirurgia, Hospital do Servidor Público Estadual de São Paulo, São Paulo, SP, Brazil
| | - Juliana B Tornai
- Instituto de Psiquiatria, Hospital das Clínicas, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Ricardo A Amaral
- Instituto de Psiquiatria, Hospital das Clínicas, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Manoel Jacobsen Teixeira
- Instituto de Psiquiatria, Hospital das Clínicas, Universidade de São Paulo, São Paulo, SP, Brazil
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