Shunted Hydrocephalus: Who Has More Chances to Get Rid of the Shunt?

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish
Pages (from-to)e229-e235
JournalWorld Neurosurgery
Volume125
DOIs
Publication statusPublished - May 1 2019

Fingerprint

Ventriculostomy
Hydrocephalus
Cerebrospinal Fluid Shunts
Pediatrics
Ventriculoperitoneal Shunt
Intracranial Pressure
Natural History

Keywords

  • Hydrocephalus
  • Secondary endoscopic third ventriculostomy
  • Shunt malfunction

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

@article{3fae0763e18340a981b447c9bdaad11b,
title = "Shunted Hydrocephalus: Who Has More Chances to Get Rid of the Shunt?",
abstract = "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.",
keywords = "Hydrocephalus, Secondary endoscopic third ventriculostomy, Shunt malfunction",
author = "Mino Zucchelli and Francesca Nicolini and Francesco Toni and Monica Maffei and Giorgio Palandri and Ercole Galassi",
year = "2019",
month = "5",
day = "1",
doi = "10.1016/j.wneu.2019.01.052",
language = "English",
volume = "125",
pages = "e229--e235",
journal = "World Neurosurgery",
issn = "1878-8750",
publisher = "Elsevier Inc.",

}

TY - JOUR

T1 - Shunted Hydrocephalus

T2 - Who Has More Chances to Get Rid of the Shunt?

AU - Zucchelli, Mino

AU - Nicolini, Francesca

AU - Toni, Francesco

AU - Maffei, Monica

AU - Palandri, Giorgio

AU - Galassi, Ercole

PY - 2019/5/1

Y1 - 2019/5/1

N2 - 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.

AB - 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.

KW - Hydrocephalus

KW - Secondary endoscopic third ventriculostomy

KW - Shunt malfunction

UR - http://www.scopus.com/inward/record.url?scp=85061716366&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85061716366&partnerID=8YFLogxK

U2 - 10.1016/j.wneu.2019.01.052

DO - 10.1016/j.wneu.2019.01.052

M3 - Article

C2 - 30684709

AN - SCOPUS:85061716366

VL - 125

SP - e229-e235

JO - World Neurosurgery

JF - World Neurosurgery

SN - 1878-8750

ER -