Download PDF
CC BY-NC-ND 4.0 · Arq Neuropsiquiatr 2020; 78(01): 9-12
DOI: 10.1590/0004-282X20190135
Article

Clinical performance of fixed-pressure Sphera Duo® hydrocephalus shunt

Performance clínica da válvula de pressão fixa Sphera Duo®
Fernando Campos Gomes PINTO 
1   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 
1   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
1   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
1   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
1   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 
1   Universidade de São Paulo, Hospital das Clínicas, Instituto de Psiquiatria, Divisão de Neurocirurgia Funcional, Grupo de Hidrodinâmica Cerebral, São Paulo SP, Brazil.
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

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.

Resumo

Introdução: As complicações da hidrodinâmica cerebral em pacientes com derivação ventriculoperitoneal são frequentemente relacionadas ao malfuncionamento do sistema. O objetivo deste estudo retrospectivo de coorte de centro único é avaliar a segurança e performance clínica do Sistema Sphera® Duo quando utilizado em adultos com hidrocefalia, pseudotumor cerebral ou cistos aracnoides. Métodos: Avaliamos os prontuários de 112 pacientes adultos submetidos a cirurgia de derivação ventriculoperitoneal e acompanhados por 1 ano após a cirurgia. Resultados: O resultado mostra que 76% dos pacientes melhoraram dos sintomas neurológicos e a taxa de reoperação foi de 15% no primeiro ano após a cirurgia. Discussão: O sistema de derivação Sphera Duo® é uma opção de shunt adequada a ser usada no tratamento neurocirúrgico da hidrocefalia por causas diversas. Ele demonstrou bons resultados clínicos enquanto reduziu riscos de hiperdrenagem. A hiperdrenagem é especialmente preocupante e mórbida em pacientes adultos com hidrocefalia não hipertensiva e pode levar a prejuízo clínico e disfunção da válvula, com sintomas de hipotensão craniana, como cefaléia ortostática e náuseas. Conclusão: O sistema de derivação Sphera Duo® é seguro para tratamento da hidrocefalia, pseudotumor cerebri ou cistos aracnóides em adultos.

Keywords:

ventriculoperitoneal shunt - complications - reoperation - outcome

Palavras-chave:

derivação ventriculoperitoneal - complicações - reoperação - desfecho


Publication History

Received: 14 May 2019

Accepted: 18 August 2019

Article published online:
13 June 2023

© 2020. Academia Brasileira de Neurologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil

 

  • References

  • 1 De Oliveira MF, Pinto FC, Nishikuni K, Botelho RV, Lima AM, Rotta JM. Revisiting hydrocephalus as a model to study brain resilience. Front Hum Neurosci. 2012 Jan;5:181. https://doi.org/10.3389/fnhum.2011.00181
  • 2 Pinto FC, Oliveira MF, Nespoli VS, Castro JPS, Morais JVR, Pinto FMG. Clinical Follow-Up Study for Sphera Duo® Hydrocephalus Shunt. Austin J Surg. 2018;5(4):1134.
  • 3 Pinto FC, Saad F, Oliveira MF, Pereira RM, Miranda FL, Tomai JB, et al. Role of endoscopic third ventriculostomy and ventriculoperitoneal shunt in idiopathic normal pressure hydrocephalus: preliminary results of a randomized clinical trial. Neurosurgery. 2013 May;72(5):845-53. https://doi.org/10.1227/NEU.0b013e318285b37c
  • 4 O’Kane MC, Richards H, Winfield P, Pickard JD. The United Kingdom Shunt Registry. Eur J Pediatr Surg. 1997;7 Suppl. 1:S56.
  • 5 Choux M, Genitori L, Lang D, Lena G. Shunt implantation: reducing the incidence of shunt infection. J Neurosurg 1992;77(6):875-80. https://doi.org/10.3171/jns.1992.77.6.0875
  • 6 Camacho EF, Boszczowski I, Freire MP, Pinto FC, Guimaraes T, Teixeira MJ, et al. Impact of an educational intervention implanted in a neurological intensive care unit on rates of infection related to external ventricular drains. PLoS One. 2013 Feb;8(2):e50708. https://doi.org/10.1371/journal.pone.0050708
  • 7 Pinto FC, Pereira RM, Saad F, Teixeira MJ. Performance of fixed-pressure valve with antisiphon device SPHERA(®) in hydrocephalus treatment and overdrainage prevention. Arq Neuropsiquiatr. 2012 Sep;70(9):704-9. http://dx.doi.org/10.1590/S0004-282X2012000900011
  • 8 Oliveira MF, Saad F, Reis RC, Rotta JM, Pinto FC. Programmable valve represents an effcient and safe tool in the treatment of idiopathic normal-pressure hydrocephalus patients. Arq Neuropsiquiatr. 2013 Apr;71(4):229-36. https://doi.org/10.1590/0004-282x20130007
  • 9 Pereira RM, Suguimoto MT, Oliveira MF, Tornai JB, Amaral RA, Teixeira MJ, Pinto FC. Performance of the fixed pressure valve with antisiphon device SPHERA® in the treatment of normal pressure hydrocephalus and prevention of overdrainage. Arq Neuropsiquiatr. 2016 Jan;74(1):55-61. http://dx.doi.org/10.1590/S0004-282X2012000900011
  • 10 Haridas AT, Tomita M, Patterson MC, Armsby C. Hydrocephalus in children: Management and prognosis; 2017. Available from: https://www.uptodate.com/contents/hydrocephalus-in-children-management-and-prognosis
  • 11 Graff-Radford NR, DeKosky ST, Wilterdink JL. Normal pressure hydrocephalus; 2016. Available from: https://www.uptodate.com/contents/normal-pressure-hydrocephalus
  • 12 Pinto FC, de Oliveira MF. Laparoscopy for ventriculoperitoneal shunt implantation and revision surgery. World J Gastrointest Endosc. 2014 Sep;6(9):415-8. https://doi.org/10.4253/wjge.v6.i9.415
  • 13 Espay AJ, Da Prat GA, Dwivedi AK, Rodriguez-Porcel F, Vaughan JE, Rosso M, et al. Deconstructing normal pressure hydrocephalus: Ventriculomegaly as early sign of neurodegeneration. Ann Neurol. 2017 Oct;82(4):503-13. https://doi.org/10.1002/ana.25046
  • 14 Junkkari A, Häyrinen A, Rauramaa T, Sintonen H, Nerg O, Koivisto AM, et al. Health-related quality-of-life outcome in patients with idiopathic normal-pressure hydrocephalus - a 1-year follow-up study. Eur J Neurol. 2017 Jan;24(1):58-66. https://doi.org/10.1111/ene.13130
  • 15 McDowell MM, Chiang MC, Agarwal N, Friedlander RM, Wecht DA. Exclusive use of fixed pressure valves for cerebrospinal fluid diversion in a modern adult cohort. Heliyon. 2018 Dec 29;4(12):e01099. https://doi.org/10.1016/j.heliyon.2018.e01099
  • 16 Feletti A, d'Avella D, Wikkelsø C, Klinge P, Hellström P, Tans J, et al. Ventriculoperitoneal Shunt Complications in the European Idiopathic Normal Pressure Hydrocephalus Multicenter Study. Operative Neurosurgey. 2019 Jul 1;17(1):97-102. https://doi.org/10.1093/ons/opy232.
  • 17 Benveniste RJ, Sur S. Delayed symptom progression after ventriculoperitoneal shunt placement for normal pressure hydrocephalus. J Neurol Sci. 2018 Oct 15;393:105-9. https://doi.org/10.1016/j.jns.2018.08.002
  • 18 Grahnke K, Jusue-Torres I, Szujewski C, et al. The Quest for Predicting sustained shunt response in normal-pressure hydrocephalus: an analysis of the callosal angle's utility. World Neurosurg. 2018 Jul;115:e717-22. https://doi.org/10.1016/j.wneu.2018.04.150
  • 19 Agarwal N, Kashkoush A, McDowell MM, Lariviere WR, Ismail N, Friedlander RM. Comparative durability and costs analysis of ventricular shunts. J Neurosurg. 2019 Apr;130(4):1039-408. https://doi.org/10.3171/2017.11.JNS172212