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[Chronic subdural hematoma as a complication of ventriculoperitoneal shunts]
J F Salomão1, R D Leibinger, Y M Lima
1Serviço de Neurocirurgia Hospital dos Servidores do Estado (HSE), Rio de Janeiro, Brasil.
Insights
Chronic subdural hematoma can occur after ventriculo-peritoneal shunt insertion, particularly in patients with hydrocephalus. Management strategies vary, including shunting or surgical intervention, with one case resulting in mortality.
Area of Science:
- Neurosurgery
- Neurology
- Medical Devices
Context:
- Ventriculo-peritoneal shunts are commonly used to treat hydrocephalus.
- Chronic subdural hematoma is a potential complication following neurosurgical procedures.
- Specific patient populations, including children and adults with aqueductal stenosis or normal pressure hydrocephalus, are at risk.
Purpose:
- To describe nine cases of chronic subdural hematoma (CSDH) post-ventriculo-peritoneal (VP) shunt insertion.
- To analyze the characteristics of affected patients and the management strategies employed.
- To evaluate the outcomes of different treatment approaches for CSDH in shunt-dependent patients.
Summary:
- Nine patients developed CSDH after VP shunt placement, including children and adults with specific hydrocephalus types.
- Initial management involved burr holes and transient catheter occlusion to aid brain reexpansion.
- Subsequent treatments included subdural-peritoneal shunts, higher-pressure shunts, and craniotomy with membranectomy; one patient died from infectious complications.
Impact:
- Highlights the risk of CSDH as a complication of VP shunting, necessitating vigilant monitoring.
- Demonstrates the efficacy of alternative shunting procedures (subdural-peritoneal) in selected cases.
- Underscores the need for tailored management strategies based on patient-specific factors and CSDH characteristics.
Abstract:
Nine cases of chronic subdural hematoma occurring after the insertion of ventriculo-peritoneal shunts are described. Three patients were children, two were adults with stenosis of the Sylvian aqueduct, and the last four had normal pressure hydrocephalus. Patients with chronic hydrocephalus were initially treated with burr holes associated to transient occlusion of the distal catheter of the diversion in order to promote reexpansion of the compressed hemisphere. Two shunt-dependent patients were successfully treated with a concurrent subdural-peritoneal shunt. In two cases a higher pressure shunt was inserted, and in another craniotomy with membranectomy was required to treat persistent subdural fluid accumulation. One patient died due to infectious complications of multiple procedures.