Long-term outcomes of Ventriculoperitoneal Shunt Surgery in Patients with Hydrocephalus

Ventriculoperitoneal Shunt Surgery in Hydrocephalus Patients

Authors

  • Naeem Ul Haq Neurosurgery Unit, MMC Bacha Khan Medical Collage Mardan KPK Pakistan
  • Inayat Shah Neurosurgery unit, MTI Mardan Medical Complex KPK Pakistan
  • Musawer Khan Department of Neurosurgery, Mardan Medical Complex KPK Pakistan

DOI:

https://doi.org/10.54393/pbmj.v5i6.509

Keywords:

VP Shunt, Cerebrospinal Fluid, Hydrocephalus, Peritoneum, Shunt Replacement

Abstract

For the treatment of hydrocephalus, VP shunt surgery is considered the most appropriate method of treatment, but this treatment has a number of complications, it needs to be replaced after the failure of the previous shunt.  Objective: To evaluate the different regulatory factors involved in the failure of Shunt surgery, the initiation points of shunt failure, and the number of shunt surgeries required after first shunt treatment. The time duration required for shunt failure was also considered to evaluate the lifelong experience with this VP shunt surgery. Methods: It is a retrospective study with a statistical approach. This study was conducted in Neurosurgery unit, Mardan medical complex / Bacha khan medical college, Mardan for the Duration of One year August 2020 to July 2021. Patients suffering from hydrocephalus undergoing shunt surgery visited the neurosurgery unit of Mardan Medical complex, Bacha Khan Medical College were included in the study. Complete information related to the etiology, imaging results, demographic distribution, surgery reports, and medical follow-ups were analyzed thoroughly. Results: About 25 patients having VP shunt surgery were selected; their average age was above 60 years. The median mean of the follow-ups was 6 and 9 respectively. Patients with having age of more than 18 years are considered adult patients and constituted of the 70 % of the total. The rate of shunt failure was estimated, it was about 46.2 %. The pediatric patients are more prone to shunt failure than the adult ones. Different factors are involved in shunt replacement but age and sex have a major role. Shunt replacement time is quite low in young patients. While in case of age, male patients have a greater number of shunt replacements within their lifespan. Conclusion: The results inferred that age has a particular role in the triggering of shunt failure, many other factors are also associated independently to increase the rate of shunt failure. There is a need for controlled studies to understand the link between risk factors and shunt failure rate.

References

Paff M, Alexandru-Abrams D, Muhonen M, Loudon W. Ventriculoperitoneal shunt complications: a review. Interdisciplinary Neurosurgery. 2018 Sep; 13:66-70. doi.org/10.1016/j.inat.2018.04.004.

Broggi M, Zattra CM, Schiariti M, Acerbi F, Tringali G, Falco J et al. Diagnosis of Ventriculoperitoneal Shunt Malfunction: A Practical Algorithm. World Neurosurgery. 2020 May; 137:e479-e486. doi: 10.1016/j.wneu.2020.02.003.

Anderson IA, Saukila LF, Robins JMW, Akhunbay-Fudge CY, Goodden JR, Tyagi AK et al. Factors associated with 30-day ventriculoperitoneal shunt failure in pediatric and adult patients. Journal of Neurosurgery. 2018 Mar; 130(1):145-153. doi: 10.3171/2017.8.JNS17399.

Liptak GS, McDonald JV. Ventriculoperitoneal shunts in children: factors affecting shunt survival. Pediatr Neurosci. 1985;12(6):289-93. doi: 10.1159/000120268.

Mallucci CL, Jenkinson MD, Conroy EJ, Hartley JC, Brown M, Dalton J et al. Antibiotic or silver versus standard ventriculoperitoneal shunts (BASICS): a multicentre, single-blinded, randomised trial and economic evaluation. Lancet. 2019 Oct; 394(10208):1530-1539. doi: 10.1016/S0140-6736(19)31603-4.

Azad TD, Zhang Y, Varshneya K, Veeravagu A, Ratliff JK, Li G. Lumboperitoneal and Ventriculoperitoneal Shunting for Idiopathic Intracranial Hypertension Demonstrate Comparable Failure and Complication Rates. Neurosurgery. 2020 Feb; 86(2):272-280. doi: 10.1093/neuros/nyz080.

Lund-Johansen M, Svendsen F, Wester K. Shunt failures and complications in adults as related to shunt type, diagnosis, and the experience of the surgeon. Neurosurgery. 1994 Nov; 35(5):839-44; discussion 844. doi: 10.1227/00006123-199411000-00006.

McGirt MJ, Leveque JC, Wellons JC, Villavicencio AT, Hopkins JS, Fuchs HE et al. Cerebrospinal fluid shunt survival and etiology of failures: a seven-year institutional experience. Pediatric Neurosurgery. 2002 May; 36(5):248-55. doi: 10.1159/000058428.

Mohanty A, Biswas A, Satish S, Vollmer DG. Efficacy of endoscopic third ventriculostomy in fourth ventricular outlet obstruction. Neurosurgery. 2008 Nov; 63(5):905-13; discussion 913-4. doi: 10.1227/01.NEU.0000333262.38548.E1.

Patwardhan RV, Nanda A. Implanted ventricular shunts in the United States: the billion-dollar-a-year cost of hydrocephalus treatment. Neurosurgery. 2005 Jan; 56(1):139-44; discussion 144-5. doi: 10.1227/01.neu.0000146206.40375.41.

Piatt JH Jr, Carlson CV. A search for determinants of cerebrospinal fluid shunt survival: retrospective analysis of a 14-year institutional experience. Pediatric Neurosurgery. 1993 Sep-Oct; 19(5):233-41; discussion 242. doi: 10.1159/000120738.

Piatt JH Jr, Garton HJ. Clinical diagnosis of ventriculoperitoneal shunt failure among children with hydrocephalus. Pediatric Emergency Care. 2008 Apr; 24(4):201-10. doi: 10.1097/PEC.0b013e31816a8d43.

Prusseit J, Simon M, von der Brelie C, Heep A, Molitor E, Volz S et al. Epidemiology, prevention and management of ventriculoperitoneal shunt infections in children. Pediatric Neurosurgery. 2009;45(5):325-36. doi: 10.1159/000257520.

Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR. Guideline for Prevention of Surgical Site Infection, 1999. Centers for Disease Control and Prevention (CDC) Hospital Infection Control Practices Advisory Committee. Infection Control & Hospital Epidemiology. 1999 Apr; 27(2):97-132.

Puca A, Anile C, Maira G, Rossi G. Cerebrospinal fluid shunting for hydrocephalus in the adult: factors related to shunt revision. Neurosurgery. 1991 Dec; 29(6):822-6. doi: 10.1097/00006123-199112000-00003.

Reddy GK, Bollam P, Caldito G. Ventriculoperitoneal shunt surgery and the risk of shunt infection in patients with hydrocephalus: long-term single institution experience. World Neurosurgery. 2012 Jul; 78(1-2):155-63. doi: 10.1016/j.wneu.2011.10.034.

Reddy GK, Bollam P, Caldito G, Willis B, Guthikonda B, Nanda A. Ventriculoperitoneal shunt complications in hydrocephalus patients with intracranial tumors: an analysis of relevant risk factors. Journal of neuro-oncology. 2011 Jun; 103(2):333-42. doi: 10.1007/s11060-010-0393-4.

Berry JG, Hall MA, Sharma V, Goumnerova L, Slonim AD, Shah SS. A multi-institutional, 5-year analysis of initial and multiple ventricular shunt revisions in children. Neurosurgery. 2008 Feb; 62(2):445-53; discussion 453-4. doi: 10.1227/01.neu.0000316012.20797.04.

Bhasin RR, Chen MK, Pincus DW. Salvaging the “lost peritoneum” after ventriculoatrial shunt failures. Child's Nervous System. 2007 May; 23(5):483-6. doi.org/10.1007/s00381-006-0292-3.

Reddy GK, Bollam P, Caldito G. Long-term outcomes of ventriculoperitoneal shunt surgery in patients with hydrocephalus. World Neurosurgery. 2014 Feb; 81(2):404-10. doi: 10.1016/j.wneu.2013.01.096.

Dobran M, Nasi D, Mancini F, Gladi M, Polonara G, Marini A et al. Relationship between the location of the ventricular catheter tip and the ventriculoperitoneal shunt malfunction. Clinical neurology and neurosurgery. 2018 Dec; 175:50-53. doi: 10.1016/j.clineuro.2018.10.006.

Paudel P, Bista P, Pahari DP, Sharma GR. Ventriculoperitoneal Shunt Complication in Pediatric Hydrocephalus: Risk Factor Analysis from a Single Institution in Nepal. Asian Journal of Neurosurgery. 2020 Feb; 15(1):83-87. doi: 10.4103/ajns.AJNS_216_19.

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Published

2022-06-30
CITATION
DOI: 10.54393/pbmj.v5i6.509
Published: 2022-06-30

How to Cite

Haq, N. U. ., Shah, I. ., & Khan, M. . (2022). Long-term outcomes of Ventriculoperitoneal Shunt Surgery in Patients with Hydrocephalus: Ventriculoperitoneal Shunt Surgery in Hydrocephalus Patients . Pakistan BioMedical Journal, 5(6), 97–101. https://doi.org/10.54393/pbmj.v5i6.509

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