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Neuronavigation and Laparoscopy Guided Ventriculoperitoneal Shunt Insertion for the Treatment of Hydrocephalus
14:59

Neuronavigation and Laparoscopy Guided Ventriculoperitoneal Shunt Insertion for the Treatment of Hydrocephalus

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Initial proximal obstruction of ventriculoperitoneal shunt in patients with preterm-related posthaemorrhagic

P Miranda1, J A Simal, F Menor

  • 1Pediatric Division, Department of Neurosurgery, Hospital La Fe, Valencia, Spain. mirandalloret@gmail.com

Pediatric Neurosurgery
|September 29, 2011
PubMed

Insights

Shunt obstruction in preterm hydrocephalus remains high. Preventing infection and using appropriate valves can reduce obstruction rates and complications like slit ventricle syndrome.

Area of Science:

  • Neuroscience
  • Pediatric Surgery
  • Biomedical Engineering

Background:

  • Ventriculoperitoneal shunts are crucial for managing hydrocephalus, but obstruction remains a significant complication, particularly in preterm infants with posthaemorrhagic hydrocephalus.
  • Despite advancements, shunt obstruction rates exceed 40%, necessitating further investigation into risk factors and prevention strategies.
  • Preterm-related posthaemorrhagic hydrocephalus presents unique challenges due to the high risk of shunt malfunction.

Purpose of the Study:

  • To analyze the incidence of first ventricular shunt obstruction in preterm infants with posthaemorrhagic hydrocephalus.
  • To identify clinical and radiological factors associated with shunt obstruction in this vulnerable patient population.
  • To evaluate the impact of valve type and patient weight on shunt obstruction rates.

Main Methods:

  • Retrospective review of 103 cases of preterm-related posthaemorrhagic hydrocephalus treated between 1982 and 2010.
  • Descriptive analysis, bivariate correlations (raw and adjusted), and survival analysis were employed to assess obstruction risk.
  • Data collection focused on patient characteristics, surgical details, and outcomes related to shunt function.

Main Results:

  • 42% of patients experienced at least one shunt obstruction requiring proximal revision.
  • Medium-opening pressure valves showed a higher obstruction rate than low-opening pressure valves, significantly in infants over 2,000g (OR 6.75).
  • Previous infection (OR 3.35) and late slit ventricle syndrome (OR 4.27) were significantly associated with ventricular catheter obstruction.

Conclusions:

  • Shunt obstruction rates in preterm-related posthaemorrhagic hydrocephalus are high but comparable to other pediatric hydrocephalus groups.
  • Preventing infections and selecting appropriate valve designs are key strategies to reduce proximal shunt obstruction.
  • Decreasing shunt obstruction incidence can mitigate the occurrence of symptomatic slit ventricle syndromes.
Abstract

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