Shunted Hydrocephalus: Who Has More Chances to Get Rid of the Shunt?
Adolescent
Adult
Age Factors
Cerebrospinal Fluid Shunts
Child
Child, Preschool
Device Removal
/ methods
Equipment Failure
/ statistics & numerical data
Female
Follow-Up Studies
Humans
Hydrocephalus
/ surgery
Infant
Magnetic Resonance Imaging
Male
Reoperation
/ methods
Retrospective Studies
Treatment Outcome
Ventriculostomy
/ methods
Young Adult
Hydrocephalus
Secondary endoscopic third ventriculostomy
Shunt malfunction
Journal
World neurosurgery
ISSN: 1878-8769
Titre abrégé: World Neurosurg
Pays: United States
ID NLM: 101528275
Informations de publication
Date de publication:
05 2019
05 2019
Historique:
received:
14
08
2018
revised:
03
01
2019
accepted:
05
01
2019
pubmed:
27
1
2019
medline:
18
12
2019
entrez:
27
1
2019
Statut:
ppublish
Résumé
The natural history and the outlook of patients with hydrocephalus are dramatically affected using cerebrospinal fluid shunts. The several issues related with a long-standing shunt should suffice to justify all the possible attempts to free the patient from it. This study focused on the role of secondary endoscopic third ventriculostomy (ETV) in the achievement of shunt removal in cases of shunt malfunction, and to identify patients who could benefit most from the procedure. In the period of 2006-2015, ETV was attempted in 47 patients >6 months old with ventriculoperitoneal shunt malfunction who presented with increased ventricle size compared with the previous neuroradiological examinations; simultaneously the shunt was removed or ligated. The overall success rate of secondary ETV was 74% (shunt-free patients with normalized intracranial pressure and absence of symptoms attributable to hydrocephalus) in patients with a long shunt duration (up to 30 years). The number of previous shunt revision procedures (P = 0.026) and lower age (P = 0.017) correlate with the likelihood of secondary ETV failure, a score of 80 as ETV success score (calculated for both pediatric and adult patients, even if the score was meant for the pediatric population) correlates with secondary ETV success (P = 0.014). Many patients with shunt malfunction can benefit from secondary ETV even after decades of shunting. Age at secondary ETV, the number of previous shunt revisions, and the ETV success score can help to better identify the best candidates for the procedure.
Sections du résumé
OBJECTIVE/BACKGROUND
The natural history and the outlook of patients with hydrocephalus are dramatically affected using cerebrospinal fluid shunts. The several issues related with a long-standing shunt should suffice to justify all the possible attempts to free the patient from it. This study focused on the role of secondary endoscopic third ventriculostomy (ETV) in the achievement of shunt removal in cases of shunt malfunction, and to identify patients who could benefit most from the procedure.
METHODS
In the period of 2006-2015, ETV was attempted in 47 patients >6 months old with ventriculoperitoneal shunt malfunction who presented with increased ventricle size compared with the previous neuroradiological examinations; simultaneously the shunt was removed or ligated.
RESULTS
The overall success rate of secondary ETV was 74% (shunt-free patients with normalized intracranial pressure and absence of symptoms attributable to hydrocephalus) in patients with a long shunt duration (up to 30 years). The number of previous shunt revision procedures (P = 0.026) and lower age (P = 0.017) correlate with the likelihood of secondary ETV failure, a score of 80 as ETV success score (calculated for both pediatric and adult patients, even if the score was meant for the pediatric population) correlates with secondary ETV success (P = 0.014).
CONCLUSIONS
Many patients with shunt malfunction can benefit from secondary ETV even after decades of shunting. Age at secondary ETV, the number of previous shunt revisions, and the ETV success score can help to better identify the best candidates for the procedure.
Identifiants
pubmed: 30684709
pii: S1878-8750(19)30149-4
doi: 10.1016/j.wneu.2019.01.052
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e229-e235Informations de copyright
Copyright © 2019 Elsevier Inc. All rights reserved.