Ventriculoperitoneal shunt with endoscopic assistance
Keywords:
hydrocephalus, neuroendoscopy, ventriculoperitoneal shunt.Abstract
Introduction: The ventriculoperitoneal shunt in neurosurgery is one of the most used procedures for the treatment of hydrocephalus. Scientific evidence reports multiple methods of intraoperative guidance for catheter placement at the cranial portion. However, there is a high rate of dysfunction of the derivative system. Endoscopic assistance in ventriculoperitoneal shunt represents a tool with excellent results.Objective: To describe the surgical results of endoscopically assisted ventriculoperitoneal shunting.
Method: A descriptive, longitudinal and retrospective study was carried out, which included 70 patients at the "Hermanos Ameijeiras" Hospital operated on for hydrocephalus who underwent ventricle-peritoneal shunting with endoscopic assistance with its different variables: Sociodemographic, clinical, post-surgical and related complications. with the procedure. For data analysis, absolute and relative frequencies were used as summary measures.
Results: The average intracranial catheter distance was 10.5 cm. There was 97.1 % optimal positioning of the intracranial catheter. Presence of improvement in neurological status in 97.1 % of patients. In the 95.7 % postoperative Evans index was < 0.30. The main complications related to the procedure were: Three patients with intracranial hematoma, dysfunction and system revision (2.9 %), respectively.
Conclusions: Ventriculoperitoneal shunting with endoscopic assistance for hydrocephalus is a safe and effective method with a significant reduction in postoperative complications, especially shunt system dysfunction.
Downloads
Download data is not yet available.
References
1. Thomale UW. Integrated understanding of hydrocephalus a practical approach for a complex disease. Childs Nerv Syst. 2021; 37(11):3313-24. DOI: 10.1007/s00381-021-05243-3
2. Yamada S. Cerebrospinal fluid dynamics. Croat Med J. 2021; 62(4):399-410. DOI: 10.3325/cmj.2021.62.399
3. Kestle JRW, Riva-Cambrin J. Prospective multicenter studies in pediatric hydrocephalus. J Neurosurg Pediatr. 2019; 23(2):135-41. DOI: 10.3171/2018.10
4. Hamilton MG, Israelsson H, Palandri G, Elder BD, Williams MA. Introduction. Adult hydrocephalus: advancements in diagnosis, treatment, and patient outcomes. Neurosurg Focus. 2023; (4):E1. DOI: 10.3171/2023.1. FOCUS22641
5. Hochstetler A, Raskin J, Blazer-Yost BL. Hydrocephalus: historical analysis and considerations for treatment. Eur J Med Res. 2022; 27(1):168. DOI: 10.1186/s40001-022-00798-6
6. Rekate HL. Hydrocephalus in infants: the unique biomechanics and why they matter. Childs Nerv Syst. 2020; 36(8):1713-28. DOI: 10.1007/s00381-020-04683-7
7. Rekate HL. Classifications of hydrocephalus based on Walter Dandy and his paradigm. Childs Nerv Syst. 2023; 39(10):2701-2708. DOI: 10.1007/s00381-023-06131-8
8. Chung DY, Olson DM, John S, Mohamed W, Kumar MA, Thompson BB, et al. Evidence-Based Management of External Ventricular Drains. Curr Neurol Neurosci Rep. 2019; 19(12):94. DOI: 10.1007/s11910-019-1009-9
9. Holwerda JC, van Lindert EJ, Buis DR, Hoving EW. Dutch Pediatric Neurosurgery Study Group. Surgical intervention for hydrocephalus in infancy; etiology, age and treatment data in a Dutch cohort. Childs Nerv Syst. 2020; 36(3):577-82. DOI: 10.1007/s00381-019-04333-7
10. Balasubramaniam C. Shunt Complications - Staying Out of Trouble. Neurol India. 2021; 69(Supplement):S495-S501. DOI: 10.4103/0028-3886.332256
11. Yim B, Reid Gooch M, Dalfino JC, Adamo MA, Kenning TJ. Optimizing ventriculoperitoneal shunt placement in the treatment of idiopathic intracranial hypertension: an analysis of neuroendoscopy, frameless stereotaxy, and intraoperative CT. Neurosurg Focus. 2016; 40(3):E12. DOI: 10.3171/2015.12.FOCUS15583
12. Isaacs AM, Ball CG, Hamilton MG. Neuronavigation and laparoscopy guide ventriculoperitoneal shunt insertion for the treatment of hydrocephalus. J Vis Exp. 2022;(188). DOI: 10.3791/62678
13. Housley SB, Hoffman A, Siddiqui AH. Ventriculoperitoneal shunt placement with ultrasound guidance and laparoscopic assistance: 2-dimensional instructional video. Surg Neurol Int. 2020; 11:82. DOI: 10.25259/SNI_8_2020
14. López-Arbolar O, Ortiz- Machín M, Cruz-Pérez P, Caballero García J, Nolasco Guzmán J. Colocación endoscópica por vía occipital de catéteres ventriculares permanentes. Nota técnica. Revista Chilena de Neurocirugía. 2016 [acceso: 14/05/2023]; 42(2):102-6. Disponible en: https://revistachilenadeneurocirugia.com/index.php/revchilneurocirugia/article-/view/106/93
15. Merkler AE, Ch'ang J, Parker WE, Murthy SB, Kamel H. The Rate of Complications after Ventriculoperitoneal Shunt Surgery. World Neurosurg. 2017; 98:654-8. DOI: 10.1016/j.wneu.2016.10.136
16. Kulkarni AV, Drake JM, Lamberti-Pasculli M. Cerebrospinal fluid shunt infection: a prospective study of risk factors. J Neurosurg. 2001; 94(2):195-201. DOI: 10.3171/jns.2001.94.2.0195
17. Evans WA, Jr An encephalographic ratio for estimating ventricular enlargement and cerebral atrophy. Arch Neurol Psychiatry. 1942 [acceso: 14/05/2023]; 47(6):931-7. Disponible en: https://jamanetwork.com/journals/archneurpsyc/article-abstract/649255
18. Hosainey SAM, Hald JK, Meling TR. Risk of early failure of VP shunts implanted for hydrocephalus after craniotomies for brain tumors in adults. Neurosurg Rev. 2022; 45(1):479-90. DOI: 10.1007/s10143-021-01549-7
19. Schneider C, Ramaswamy V, Kulkarni AV, Rutka JT, Remke M, Tabori U, et al. Clinical implications of medulloblastoma subgroups: incidence of CSF diversion surgery. J Neurosurg Pediatr. 2015; 15(3):236-42. DOI: 10.3171/2014.9.PEDS14280
20. Muthukumar N. Hydrocephalus Associated with Posterior Fossa Tumors: How to Manage Effectively? Neurol India. 2021; 69(Supplement):S342-S349. DOI: 10.4103/0028-3886.332260
21. Braksick SA, Himes BT, Snyder K, Van Gompel JJ, Fugate JE, Rabinstein AA. Ventriculostomy and Risk of Upward Herniation in Patients with Obstructive Hydrocephalus from Posterior Fossa Mass Lesions. Neurocrit Care. 2018; 28(3):338-43. DOI: 10.1007/s12028-017-0487-3
22. Hayhurst C, Beems T, Jenkinson MD, Byrne P, Clark S, Kandasamy J, et al. Effect of electromagnetic-navigated shunt placement on failure rates: a prospective multicenter study. J Neurosurg. 2010; 113(6):1273-8. DOI: 10.3171/2010.3.JNS091237
23. Peng A, Yang M, Zhao H, Wu Y, Zhao Y, Zhou L. Compared with conventional procedures, an intraoperative navigation system for ventriculoperitoneal shunting via the occipital horn improves outcomes in patients with hydrocephalus. Br J Neurosurg. 2021; 35(3):292-300. DOI: 10.1080/02688697.2020.1789555
24. Dickerman RD, McConathy WJ, Morgan J, Stevens QE, Jolley JT, Schneider S, et al. Failure rate of frontal versus parietal approaches for proximal catheter placement in ventriculoperitoneal shunts: revisited. J Clin Neurosci. 2005; 12(7):781-3. DOI: 10.1016/j.jocn.2004.12.005
25. Kullmann M, Khachatryan M, Schuhmann MU. Ultrasound-guided placement of ventricular catheters in first-time pediatric VP shunt surgery. Childs Nerv Syst. 2018; 34(3):465-71. DOI: 10.1007/s00381-017-3660-2
26. Janson CG, Romanova LG, Rudser KD, Haines SJ. Improvement in clinical outcomes following optimal targeting of brain ventricular catheters with intraoperative imaging. J Neurosurg. 2014; 120(3):684-96. DOI: 10.3171/2013.8.JNS13250
27. Nesvick CL, Khan NR, Mehta GU, Klimo P Jr. Image Guidance in Ventricular Cerebrospinal Fluid Shunt Catheter Placement: A Systematic Review and Meta-Analysis. Neurosurgery. 2015; 77(3):321-31; DOI: 10.1227/NEU.0000000000000849
28. Pillai SV. Techniques and Nuances in Ventriculoperitoneal Shunt Surgery. Neurol India. 2021: 69(Supplement):S471-S475. DOI: 10.4103/0028-3886.332261
29. Song Z, Chen X, Sun Z, Li F, Xue Z, Liang Y, et al. The utility of combined neuroendoscopic- and laparoscopic-assisted ventriculo- peritoneal shunt as a treatment for patients with communicating hydrocephalus. Technol Health Care. 2021;29(S1):3-10. DOI: 10.3233/THC-218001
30. Villavicencio AT, Leveque J-C, McGirt MJ, Hopkins JS, Fuchs HE, George TM. Comparison of revision rates following endoscopically versus nonendoscopically placed ventricular shunt catheters. Surg Neurol. 2003;59(5):375-9. DOI: 10.1016/s0090-3019(03)00070-3
31. Bota DP, Lefranc F, Vilallobos HR, Brimioulle S, Vincent J-L. Ventriculostomy related infections in critically ill patients: a 6-year experience. J Neurosurg. 2005; 103:468-72. DOI: 10.3171/jns.2005.103.3.0468
32. Javeed F, Mohan A, Wara UU, Rehman L, Khan M. Ventriculoperitoneal Shunt Surgery for Hydrocephalus: One of the Common Neurosurgical Procedures and Its Related Problems. Cureus. 2023; 15(2): e35002. DOI: 10.7759/cureus.35002
2. Yamada S. Cerebrospinal fluid dynamics. Croat Med J. 2021; 62(4):399-410. DOI: 10.3325/cmj.2021.62.399
3. Kestle JRW, Riva-Cambrin J. Prospective multicenter studies in pediatric hydrocephalus. J Neurosurg Pediatr. 2019; 23(2):135-41. DOI: 10.3171/2018.10
4. Hamilton MG, Israelsson H, Palandri G, Elder BD, Williams MA. Introduction. Adult hydrocephalus: advancements in diagnosis, treatment, and patient outcomes. Neurosurg Focus. 2023; (4):E1. DOI: 10.3171/2023.1. FOCUS22641
5. Hochstetler A, Raskin J, Blazer-Yost BL. Hydrocephalus: historical analysis and considerations for treatment. Eur J Med Res. 2022; 27(1):168. DOI: 10.1186/s40001-022-00798-6
6. Rekate HL. Hydrocephalus in infants: the unique biomechanics and why they matter. Childs Nerv Syst. 2020; 36(8):1713-28. DOI: 10.1007/s00381-020-04683-7
7. Rekate HL. Classifications of hydrocephalus based on Walter Dandy and his paradigm. Childs Nerv Syst. 2023; 39(10):2701-2708. DOI: 10.1007/s00381-023-06131-8
8. Chung DY, Olson DM, John S, Mohamed W, Kumar MA, Thompson BB, et al. Evidence-Based Management of External Ventricular Drains. Curr Neurol Neurosci Rep. 2019; 19(12):94. DOI: 10.1007/s11910-019-1009-9
9. Holwerda JC, van Lindert EJ, Buis DR, Hoving EW. Dutch Pediatric Neurosurgery Study Group. Surgical intervention for hydrocephalus in infancy; etiology, age and treatment data in a Dutch cohort. Childs Nerv Syst. 2020; 36(3):577-82. DOI: 10.1007/s00381-019-04333-7
10. Balasubramaniam C. Shunt Complications - Staying Out of Trouble. Neurol India. 2021; 69(Supplement):S495-S501. DOI: 10.4103/0028-3886.332256
11. Yim B, Reid Gooch M, Dalfino JC, Adamo MA, Kenning TJ. Optimizing ventriculoperitoneal shunt placement in the treatment of idiopathic intracranial hypertension: an analysis of neuroendoscopy, frameless stereotaxy, and intraoperative CT. Neurosurg Focus. 2016; 40(3):E12. DOI: 10.3171/2015.12.FOCUS15583
12. Isaacs AM, Ball CG, Hamilton MG. Neuronavigation and laparoscopy guide ventriculoperitoneal shunt insertion for the treatment of hydrocephalus. J Vis Exp. 2022;(188). DOI: 10.3791/62678
13. Housley SB, Hoffman A, Siddiqui AH. Ventriculoperitoneal shunt placement with ultrasound guidance and laparoscopic assistance: 2-dimensional instructional video. Surg Neurol Int. 2020; 11:82. DOI: 10.25259/SNI_8_2020
14. López-Arbolar O, Ortiz- Machín M, Cruz-Pérez P, Caballero García J, Nolasco Guzmán J. Colocación endoscópica por vía occipital de catéteres ventriculares permanentes. Nota técnica. Revista Chilena de Neurocirugía. 2016 [acceso: 14/05/2023]; 42(2):102-6. Disponible en: https://revistachilenadeneurocirugia.com/index.php/revchilneurocirugia/article-/view/106/93
15. Merkler AE, Ch'ang J, Parker WE, Murthy SB, Kamel H. The Rate of Complications after Ventriculoperitoneal Shunt Surgery. World Neurosurg. 2017; 98:654-8. DOI: 10.1016/j.wneu.2016.10.136
16. Kulkarni AV, Drake JM, Lamberti-Pasculli M. Cerebrospinal fluid shunt infection: a prospective study of risk factors. J Neurosurg. 2001; 94(2):195-201. DOI: 10.3171/jns.2001.94.2.0195
17. Evans WA, Jr An encephalographic ratio for estimating ventricular enlargement and cerebral atrophy. Arch Neurol Psychiatry. 1942 [acceso: 14/05/2023]; 47(6):931-7. Disponible en: https://jamanetwork.com/journals/archneurpsyc/article-abstract/649255
18. Hosainey SAM, Hald JK, Meling TR. Risk of early failure of VP shunts implanted for hydrocephalus after craniotomies for brain tumors in adults. Neurosurg Rev. 2022; 45(1):479-90. DOI: 10.1007/s10143-021-01549-7
19. Schneider C, Ramaswamy V, Kulkarni AV, Rutka JT, Remke M, Tabori U, et al. Clinical implications of medulloblastoma subgroups: incidence of CSF diversion surgery. J Neurosurg Pediatr. 2015; 15(3):236-42. DOI: 10.3171/2014.9.PEDS14280
20. Muthukumar N. Hydrocephalus Associated with Posterior Fossa Tumors: How to Manage Effectively? Neurol India. 2021; 69(Supplement):S342-S349. DOI: 10.4103/0028-3886.332260
21. Braksick SA, Himes BT, Snyder K, Van Gompel JJ, Fugate JE, Rabinstein AA. Ventriculostomy and Risk of Upward Herniation in Patients with Obstructive Hydrocephalus from Posterior Fossa Mass Lesions. Neurocrit Care. 2018; 28(3):338-43. DOI: 10.1007/s12028-017-0487-3
22. Hayhurst C, Beems T, Jenkinson MD, Byrne P, Clark S, Kandasamy J, et al. Effect of electromagnetic-navigated shunt placement on failure rates: a prospective multicenter study. J Neurosurg. 2010; 113(6):1273-8. DOI: 10.3171/2010.3.JNS091237
23. Peng A, Yang M, Zhao H, Wu Y, Zhao Y, Zhou L. Compared with conventional procedures, an intraoperative navigation system for ventriculoperitoneal shunting via the occipital horn improves outcomes in patients with hydrocephalus. Br J Neurosurg. 2021; 35(3):292-300. DOI: 10.1080/02688697.2020.1789555
24. Dickerman RD, McConathy WJ, Morgan J, Stevens QE, Jolley JT, Schneider S, et al. Failure rate of frontal versus parietal approaches for proximal catheter placement in ventriculoperitoneal shunts: revisited. J Clin Neurosci. 2005; 12(7):781-3. DOI: 10.1016/j.jocn.2004.12.005
25. Kullmann M, Khachatryan M, Schuhmann MU. Ultrasound-guided placement of ventricular catheters in first-time pediatric VP shunt surgery. Childs Nerv Syst. 2018; 34(3):465-71. DOI: 10.1007/s00381-017-3660-2
26. Janson CG, Romanova LG, Rudser KD, Haines SJ. Improvement in clinical outcomes following optimal targeting of brain ventricular catheters with intraoperative imaging. J Neurosurg. 2014; 120(3):684-96. DOI: 10.3171/2013.8.JNS13250
27. Nesvick CL, Khan NR, Mehta GU, Klimo P Jr. Image Guidance in Ventricular Cerebrospinal Fluid Shunt Catheter Placement: A Systematic Review and Meta-Analysis. Neurosurgery. 2015; 77(3):321-31; DOI: 10.1227/NEU.0000000000000849
28. Pillai SV. Techniques and Nuances in Ventriculoperitoneal Shunt Surgery. Neurol India. 2021: 69(Supplement):S471-S475. DOI: 10.4103/0028-3886.332261
29. Song Z, Chen X, Sun Z, Li F, Xue Z, Liang Y, et al. The utility of combined neuroendoscopic- and laparoscopic-assisted ventriculo- peritoneal shunt as a treatment for patients with communicating hydrocephalus. Technol Health Care. 2021;29(S1):3-10. DOI: 10.3233/THC-218001
30. Villavicencio AT, Leveque J-C, McGirt MJ, Hopkins JS, Fuchs HE, George TM. Comparison of revision rates following endoscopically versus nonendoscopically placed ventricular shunt catheters. Surg Neurol. 2003;59(5):375-9. DOI: 10.1016/s0090-3019(03)00070-3
31. Bota DP, Lefranc F, Vilallobos HR, Brimioulle S, Vincent J-L. Ventriculostomy related infections in critically ill patients: a 6-year experience. J Neurosurg. 2005; 103:468-72. DOI: 10.3171/jns.2005.103.3.0468
32. Javeed F, Mohan A, Wara UU, Rehman L, Khan M. Ventriculoperitoneal Shunt Surgery for Hydrocephalus: One of the Common Neurosurgical Procedures and Its Related Problems. Cureus. 2023; 15(2): e35002. DOI: 10.7759/cureus.35002
Published
2024-04-25
How to Cite
1.
Mapolon Roman E, Lopez Arbolay O, Ortiz Machin MMM, Vargas Galvez CR. Ventriculoperitoneal shunt with endoscopic assistance. Rev Cubana Med Milit [Internet]. 2024 Apr. 25 [cited 2025 Apr. 3];53(2):e024025805. Available from: https://revmedmilitar.sld.cu/index.php/mil/article/view/25805
Issue
Section
Clinical Practice Article
License
Authors who have publications with this Journal accept the following terms:
- The authors will retain their copyright and guarantee the Journal the right of first publication of their work, which will simultaneously be subject to the Creative Commons Attribution License. The content presented here can be shared, copied and redistributed in any medium or format; Can be adapted, remixed, transformed or created from the material, using the following terms: Attribution (giving appropriate credit to the work, providing a link to the license, and indicating if changes have been made); non-commercial (you cannot use the material for commercial purposes) and share-alike (if you remix, transform or create new material from this work, you can distribute your contribution as long as you use the same license as the original work).
- The authors may adopt other non-exclusive license agreements for the distribution of the published version of the work (for example: depositing it in an institutional electronic archive or publishing it in a monographic volume) as long as the initial publication in this Journal is indicated.
- Authors are allowed and recommended to disseminate their work through the Internet (e.g., in institutional electronic archives or on their website) before and during the submission process, which can produce interesting exchanges and increase citations. of the published work.
