Neuroendoscopic Procedures in Achievement of Shunt Independence: Outcome Analysis of 28 Patients with Shunt Malfunction

Abstract

Objective: The authors review their experience of the TV-controlled endoscopic technique in the treatment of shunt malfunction in 28 patients suffering from hydrocephalus.

Material and Methods: We treated 28 patients (6.6±1.2 years) with shunt malfunctions by a neuroendoscopic procedure. The number of reimplantations of the shunt systems prior to the neuroendoscopic procedure varied from 1 to 13. Duration of the shunt dependency has averaged to 42.7±8.1 months (range: 5-180 months). All procedures were performed with the Gaab I neuroendoscope and Gaab II miniature neuroendoscope. All patients presented with neurological signs and deficits. The follow-up period has averaged to 32.3±6.2 months (4-114 months).

Conclusion: Endoscopic surgery offers an effective technique in the surgical treatment of shunt malfunction. On the basis of our experience, the use of a neuroendoscopic procedure for shunt malfunction allows us to achieve shunt independence in 82.1% and shunt removal in 50.0%. The introduction of these methods is recommended in neurosurgical centers that are traditionally widely engaged in the treatment of hydrocephalus.

Key words

neuroendoscopy - hydrocephalus - shunt malfunction - endoscopic third ventriculostomy - shunt independence

References

• 1 Drake JM, Kestle JR, Milner R. et al . Randomized trial of cerebrospinal fluid shunt valve design in pediatric hydrocephalus.  Neurosurgery. 1998;  43 294-305
• 2 Hoppe-Hirsch E, Laroussinie F, Brunet L. et al . Late outcome of the surgical treatment of hydrocephalus.  Childs Nerv Syst. 1998;  14 97-99
• 3 Kestle J, Drake J, Milner R. et al . Long-term follow-up data from the Shunt Design Trial.  Pediatr Neurosurg. 2000;  33 230-236
• 4 Keucher TR, Mealey Jr J. Long-term results after ventriculoatrial and ventriculoperitoneal shunting for infantile hydrocephalus.  J Neurosurg. 1979;  50 179-186
• 5 Sainte-Rose C. Third ventriculostomy. In: Manwaring KH, Crone KR (eds): Neuroendoscopy. Mary Ann Liebert, New York 1992
• 6 Sato O, Yamguchi T, Kittaka M. et al . Hydrocephalus and epilepsy.  Childs Nerv Syst. 2001;  17 76-86
• 7 Sufianov AA, Komarevsky AV, Belik AA. et al . Shunting operations in the hypertensive hydrocephalic syndrome in children with developmental defects of the central nervous system [in Russian].  Zh Vopr Neirokhir Im N N Burdenko. 1999;  1 7-11
• 8 Di Rocco C, Marchese F, Velardi F. A survey of the first complication of newly implanted CSF shunt devices for the treatment of nontumoral hydrocephalus.  Childs Nerv Syst. 1994;  10 321-327
• 9 Drake JM, Kestle JR, Tuli S. CSF shunts 50 years on - past, present and future.  Childs Nerv Syst. 2000;  16 800-804
• 10 Sainte-Rose C, Piatt JH, Renier D. et al . Mechanical complications in shunts.  Pediatr Neurosurg. 1991;  17 2-9
• 11 Cinalli G, Salazar C, Mallucci C. et al . The role of endoscopic third ventriculostomy in the management of shunt malfunction.  Neurosurgery. 1998;  43 1323-1329
• 12 O’Brien DF, Javadpour M, Collins DR. et al . Endoscopic third ventriculostomy: an outcome analysis of primary cases and procedures performed after ventriculoperitoneal shunt malfunction.  J Neurosurg. 2005;  103 ((5 Suppl Pediatrics)) 393-400
• 13 Guzelbag E, Ersahin Y, Mutluer S. Cerebrospinal fluid shunt complications.  Turk J Pediatr. 1997;  39 363-371
• 14 Punt J, Vloeberghs M. Endoscopy in neurosurgery.  Minim Invas Ther Allied Technol. 1998;  7 159-170
• 15 Perlman BB. Percutaneous third ventriculostomy in the treatment of a hydrocephalus infant with aqueduct stenosis.  Int Surg. 1968;  49 443
• 16 Sayers MP, Kosnik EJ. Percutaneous third ventriculostomy: experience and technique.  Childs Brain. 1976;  2 24-30
• 17 Jones RF, Stening WA, Brydon M. Endoscopic third ventriculostomy.  Neurosurgery. 1990;  26 86-92
• 18 Hellwig D, Heinemann A, Riegel T. Endoscopic third ventriculostomy in treatment of obstructive hydrocephalus caused by primary aqueductal stenosis. In: Hellwig D, Bauer BL (eds), Minimally Invasive Techniques for Neurosurgery. Springer, Berlin 1998: 65-72
• 19 Jones RF, Stening WA, Kwok BC. et al . Third ventriculostomy for shunt infections in children.  Neurosurgery. 1993;  32 855-860
• 20 Punt J. Third ventriculostomy in shunt malfunction. In: Cinalli G, Maixner WJ, Sainte-Rose C (eds) Pediatric hydrocephalus. Springer-Verlag, Milano 2004: 389-396
• 21 Schroeder HWS, Gaab MR. Intracranial endoscopy.  Neurosurg Focus. 1999;  6 1-11
• 22 Baskin JJ, Manwaring KH, Rekate HL. Ventricular shunt removal: the ultimate treatment of the slit ventricle syndrome.  J Neurosurg. 1998;  88 478-484
• 23 Cinalli G. Alternatives to shunting.  Childs Nerv Syst. 1999;  15 718-731
• 24 Kehler U, Gliemroth J, Knopp U. et al .The role of third ventriculostomy in previously shunted hydrocephalus. In: Hellwig D, Bauer BL (eds), Minimally Invasive Techniques for Neurosurgery. Springer, Berlin 1998: 77-80
• 25 Yamamoto M, Oka K, Ikeda K. et al . Percutaneous flexible neuroendoscopic ventriculostomy in patients with shunt malfunction as an alternative procedure to shunt revision.  Surg Neurol. 1994;  42 218-223
• 26 Mallucci CL, Buxton N, Vloeberghs M. et al . Neuroendoscopic third ventriculostomy: the first line of treatment for blocked ventriculoperitoneal shunts?.  Eur J Pediatr Surg. 1997;  67 ((Suppl 1)) , Abstract
• 27 Brockmeyer D, Abtin K, Carey L. et al . Endoscopic third ventriculostomy: an outcome analysis.  Pediatr Neurosurg. 1998;  28 236-240
• 28 Hopf NJ, Grunert P, Fries G. et al . Endoscopic third ventriculostomy: outcome analysis of 100 consecutive procedures.  Neurosurgery. 1999;  44 795-804
• 29 Jones RF, Kwok BC, Stening WA. et al . The current status of endoscopic third ventriculostomy in the management of noncommunicating hydrocephalus.  Minim Invas Neurosurg. 1994;  37 28-36
• 30 Lewis AI, Keiper G, Crone KR. Endoscopic treatment of loculated ventricles.  J Neurosurg. 1995;  82 780-785
• 31 Macarthur DC, Buxton N, Punt J. The role of neuroendoscopy in the management of brain tumor.  Childs Nerv Syst. 2001;  17 589-594
• 32 Veto F, Horvath Z, Doczi T. Biportal endoscopic management of third ventricle tumors in patients with occlusive hydrocephalus: technical note.  Neurosurgery. 1997;  40 871-877
• 33 Boschert J, Hellwig D, Krauss JK. Endoscopic third ventriculostomy for shunt dysfunction in occlusive hydrocephalus: long-term follow up and review.  J Neurosurg. 2003;  98 1032-1039
• 34 Drake JM. Ventriculostomy for treatment of hydrocephalus.  Neurosurg Clin N Am. 1993;  4 657-666
• 35 Handler MH, Abbott R, Lee M. A near-fatal complication of endo-scopic third ventriculostomy: case report.  Neurosurgery. 1994;  35 525-528
• 36 Saxena S, Ambesh SP, Saxena HN. et al . Pneumatocephalus and convulsion after ventriculoscopy: a potentially catastrophic complication.  J Neurosurg Anesthesiol. 1999;  11 200-202
• 37 Schroeder HW, Niendorf WR, Gaab MR. Complications of endoscopic third ventriculostomy.  J Neurosurg. 2002;  96 1032-1040
• 38 Teo C, Rahman S, Boop FA. et al . Complications of endoscopic neurosurgery.  Childs Nerv Syst. 1996;  12 248-253

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