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Comparison of revision rates following endoscopically versus nonendoscopically placed ventricular shunt catheters
Alan T Villavicencio1, Jean-Christophe Leveque, Matthew J McGirt
1Pediatric Neurosurgery Service, Division of Neurosurgery, Duke University Medical Center, Durham, North Carolina 27710, USA.
Insights
Endoscopic placement of ventriculoperitoneal (VP) shunts in children did not improve overall survival but reduced proximal obstruction. Further research is needed to confirm long-term benefits in hydrocephalus treatment.
Area of Science:
- Neurosurgery
- Pediatric Surgery
- Medical Technology
Background:
- Ventriculoperitoneal (VP) shunt placement is common for pediatric hydrocephalus.
- High revision rates necessitate improved surgical techniques.
- Endoscopic-assisted catheter placement is a newer approach to minimize revisions.
Purpose of the Study:
- To compare revision rates of endoscopic versus non-endoscopic VP shunt catheter placement in pediatric patients.
- To analyze the impact of neuroendoscopy on shunt survival and causes of failure.
Main Methods:
- Retrospective review of 447 pediatric patients undergoing 965 shunt procedures (April 1992 - February 1998).
- Comparison between shunts placed endoscopically (n=605) and non-endoscopically (n=360).
- Multivariate proportional hazards and logistic regression models analyzed shunt failure risk and etiology.
Main Results:
- Neuroendoscopy did not significantly affect overall shunt failure risk (HR 1.08).
- Endoscopic placement reduced proximal obstruction odds (OR 0.56) but increased distal malfunction odds (OR 1.52).
- No significant association was found between endoscopic placement and infection (OR 1.42).
Conclusions:
- Endoscopic-assisted ventricular catheter placement in pediatric hydrocephalus reduces proximal obstruction.
- This technique did not demonstrate an improvement in overall shunt survival within the 6-year study period.
- The findings suggest a trade-off between different types of shunt failure.
Background:
Endoscopic placement of ventriculoperitoneal (VP) shunt catheters in pediatric patients has been increasingly used in an attempt to minimize the unacceptably high rates of revision. Although this procedure carries an increased expense, there is currently no evidence to support an improved long-term outcome. This paper compares the rates of revision following ventricular catheter placement for shunted hydrocephalus with and without the use of endoscopy.
Methods:
We retrospectively reviewed the records of all pediatric patients who had undergone shunt placement for hydrocephalus between April 1992 and February 1998. All shunts placed before March 1995 were performed without the endoscope; all subsequent shunts were placed endoscopically. The independent effect of endoscopic versus nonendoscopic shunt placement on subsequent shunt failure was analyzed via multivariate proportional hazards regression model. Multiple logistic regression analyses were used to determine the independent effect of endoscopic placement on subsequent etiology of failure (infection, proximal obstruction, distal malfunction) in the 511 failing shunts.
Results:
There were 447 pediatric patients who underwent a total of 965 shunt placements or revisions. Six hundred and five (63%) catheters were placed with the use of the endoscope. Three hundred and sixty (37.3%) were placed without the use of the endoscope. Neuroendoscopy did not independently affect the risk of subsequent shunt failure [Hazard Ratio (95% Confidence Interval) = 1.08 (0.84-1.41)]. Endoscopic placement independently decreased the odds [Odds Ratio (95% Confidence Interval) = 0.56 (0.32-0.93)] of proximal obstruction, increased the odds of distal malfunction [1.52 (1.02-2.72)], and was not associated with infection [1.42 (0.78-2.61)].
Conclusions:
Endoscopic assisted ventricular catheter placement decreased the odds of proximal obstruction but failed to improve overall shunt survival in this 6 year experience.