Related Experiment Video
Updated: Jun 23, 2026
Neuronavigation and Laparoscopy Guided Ventriculoperitoneal Shunt Insertion for the Treatment of Hydrocephalus
Published on: October 14, 2022
Keeping CSF valve function with urokinase in children with intra-ventricular haemorrhage and CSF shunts
Juan F Martínez-Lage1, María-José Almagro, Antonio Ruíz-Espejo
1Regional Service of Neurosurgery and Unit of Paediatric Neurosurgery, Virgen de la Arrixaca University Hospital, El Palmar E-30120, Murcia, Spain. juanf.martinezlage@cablemurcia.com
Insights
Intraventricular hemorrhage (IVH) in patients with cerebrospinal fluid (CSF) shunts can be safely treated with intraventricular urokinase. This method avoids shunt removal and effectively clears blood from the CSF.
Area of Science:
- Neurosurgery
- Pediatric Neurosurgery
- Neurology
Background:
- Intraventricular hemorrhage (IVH) is a potential complication during cerebrospinal fluid (CSF) shunt surgery.
- IVH can occur spontaneously or during revision of existing CSF shunts.
Purpose of the Study:
- To evaluate the safety and efficacy of a novel method for treating IVH during CSF shunt valve revision.
- To maintain the function of previously implanted CSF shunts in patients experiencing IVH.
Main Methods:
- Retrospective review of six patients with IVH and ventriculoperitoneal (VP) shunts.
- External ventricular drainage insertion without removing the original shunt.
- Intraventricular urokinase administration via the drain until CSF blood clearance, monitored by CT scans.
Main Results:
- The treatment was safe and effective in all six patients.
- Existing VP shunts remained functional post-treatment.
- No shunt replacements were necessary due to treatment failure.
Conclusions:
- Intraventricular urokinase is a safe and effective treatment for IVH in patients with VP shunts, avoiding shunt removal.
- The technique utilizes the external ventricular drain for acute IVH management.
- Shunt replacement remains an option if this urokinase treatment fails.
Background:
Intra-ventricular haemorrhage (IVH) can occur spontaneously or during the surgical revision of ventricular cerebrospinal fluid (CSF) shunts.
Aim:
The aim of the study was to report the safety and efficacy of an original method for treatment of IVH that may occur at the time of valve revision aimed at maintaining the function of previously implanted CSF shunts.
Patients And Methods:
We reviewed the medical records of six patients who experienced an IVH in the presence of a previously placed ventriculoperitoneal (VP) shunt. Five of the haemorrhages occurred during ventricular catheter replacement and the remaining one in a child given a VP shunt who sustained a spontaneous intra-cerebral haemorrhage. We inserted an external ventricular drainage without removing the original shunt. Urokinase was administered via the ventricular drain during several days until blood clearance in the CSF. Disappearance of the ventricular clots was checked by a cranial computerised tomography scan, while CSF shunt function was verified by the children's evolution and/or by a reservoir tap.
Results:
Follow-up evaluation of the six patients demonstrated that the existing VP shunts were functioning appropriately and that the treatment was safe.
Conclusions:
Patients with IVH complicating ventricular catheter replacement and patients with spontaneous bleeding who harbour a VP shunt can be treated by intra-ventricular urokinase to avoid the removal of the initial shunt. The technique has proven to be safe and utilises the ventricular drain placed for the acute management of the IVH. Shunt replacement will always be possible in case of failure of the technique we are reporting.
