Matthias Gmeiner1, Helga Wagner2, Willem J R van Ouwerkerk3, Gracija Sardi4, Wolfgang Thomae4, Wolfgang Senker4, Kurt Holl4, Andreas Gruber5. 1. Kepler University Hospital, Neuromed Campus, Department of Neurosurger, Linz, Austria; Johannes Kepler University Linz, Linz, Austria. Electronic address: matthias.gmeiner@kepleruniklinikum.at. 2. Department of Applied Statistics, Johannes Kepler University Linz, Linz, Austria. 3. Vrije Universitet University Medical Centre Amsterdam, Department of Neurosurgery, Amsterdam, and Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands. 4. Kepler University Hospital, Neuromed Campus, Department of Neurosurger, Linz, Austria. 5. Kepler University Hospital, Neuromed Campus, Department of Neurosurger, Linz, Austria; Johannes Kepler University Linz, Linz, Austria.
Abstract
OBJECTIVE: Long-term outcomes are rarely reported for patients with pediatric hydrocephalus. Ventriculoperitoneal shunting is the surgical standard; nevertheless, in selected patients, a ventriculoatrial shunt (VAS) remains an important alternative. This study aimed to analyze the causes of VAS revisions and complications. METHODS: Pediatric patients who underwent their first shunt operation between 1982 and 1992 were included. The timing, cause, and modality of VAS revisions were retrospectively determined. RESULTS: Overall, 138 patients were treated for hydrocephalus and 61 patients received a VAS during the follow-up period. A primary VAS was the first shunt type in 42 (68.85%) patients. In 19 (31.15%) patients, conversions to second-line VAS were carried out. The rates of VAS revisions performed for dysfunction or elective lengthening of a short atrial catheter were 52.2% and 22.9%, respectively. There was no difference in the number of VAS revisions between patients with primary VASs and second-line VASs. Age at VAS and etiology of hydrocephalus had no effect on the number of revisions. Specific VAS complications were observed in 2 patients. Deep positioning of the distal catheter led to asymptomatic tricuspid regurgitation that was reversible after shortening of the atrial catheter. Another patient presented with shunt nephritis and completely recovered after the atrial catheter was replaced with a peritoneal catheter. CONCLUSIONS: VAS remains an appropriate second-line alternative in selected patients. Specific VAS complications were rarely observed and completely reversible after treatment. However, regular and specific follow-up examinations are strongly recommended to avoid cardiopulmonary or renal complications.
OBJECTIVE: Long-term outcomes are rarely reported for patients with pediatric hydrocephalus. Ventriculoperitoneal shunting is the surgical standard; nevertheless, in selected patients, a ventriculoatrial shunt (VAS) remains an important alternative. This study aimed to analyze the causes of VAS revisions and complications. METHODS: Pediatric patients who underwent their first shunt operation between 1982 and 1992 were included. The timing, cause, and modality of VAS revisions were retrospectively determined. RESULTS: Overall, 138 patients were treated for hydrocephalus and 61 patients received a VAS during the follow-up period. A primary VAS was the first shunt type in 42 (68.85%) patients. In 19 (31.15%) patients, conversions to second-line VAS were carried out. The rates of VAS revisions performed for dysfunction or elective lengthening of a short atrial catheter were 52.2% and 22.9%, respectively. There was no difference in the number of VAS revisions between patients with primary VASs and second-line VASs. Age at VAS and etiology of hydrocephalus had no effect on the number of revisions. Specific VAS complications were observed in 2 patients. Deep positioning of the distal catheter led to asymptomatic tricuspid regurgitation that was reversible after shortening of the atrial catheter. Another patient presented with shunt nephritis and completely recovered after the atrial catheter was replaced with a peritoneal catheter. CONCLUSIONS: VAS remains an appropriate second-line alternative in selected patients. Specific VAS complications were rarely observed and completely reversible after treatment. However, regular and specific follow-up examinations are strongly recommended to avoid cardiopulmonary or renal complications.
Authors: Young Ha Kim; Sang Weon Lee; Dong Hyun Kim; Chi Hyung Lee; Chang Hyeun Kim; Soon Ki Sung; Dong Wuk Son; Geun Sung Song Journal: Korean J Neurotrauma Date: 2020-10-28
Authors: Andrés Segura-Hernández; Fernando Hakim; Juan F Ramón; Enrique Jiménez-Hakim; Juan A Mejía-Cordovez; Diego Quintero-Rueda; Yessid Araque-Puello; Camila Pedraza-Ciro; Juan P Leal-Isaza; Juliana Mendoza-Mantilla; Vanesa Robles; Martina Gonzalez; Daniel Jaramillo-Velásquez; Diego F Gómez Journal: Surg Neurol Int Date: 2021-10-19