Subscribe to RSS
DOI: 10.1055/s-2008-1046760
© Georg Thieme Verlag KG Stuttgart · New York
Neuroendoscopic Procedures in Achievement of Shunt Independence: Outcome Analysis of 28 Patients with Shunt Malfunction
Publication History
Publication Date:
02 June 2008 (online)
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
Correspondence
A. SufianovMD, PhD
Russian Academy of Medical Sciences
East-Siberian Minimally Invasive Neurosurgical Centre
16 Timiriazeva Street
664003 Irkutsk
Russia
(or Postbox 64, 664047 Irkutsk, Russia)
Phone: +7/3952/206 311
Fax: +7/3952/206 311
Email: sufianov@bk.ru