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Neuronavigation and Laparoscopy Guided Ventriculoperitoneal Shunt Insertion for the Treatment of Hydrocephalus
Published on: October 14, 2022
Treatment of abdominal pseudocysts and associated ventricuoperitoneal shunt failure
Emily Dzongowski1, Kamary Coriolano2, Sandrine de Ribaupierre3
1Division of Paediatric Surgery, Department of Surgery, Western University, London, ON, Canada.
Insights
Drainage and revision of abdominal pseudocysts associated with ventriculoperitoneal (VP) shunts are ineffective for long-term resolution. A high rate of secondary shunt failure was observed, indicating limited success with this treatment approach.
Area of Science:
- Neurosurgery
- Pediatric Surgery
- Medical Device Technology
Background:
- Abdominal pseudocysts can complicate ventriculoperitoneal (VP) shunts, leading to shunt failure.
- Effective management of these pseudocysts is crucial for successful hydrocephalus treatment in children.
Purpose of the Study:
- To evaluate the efficacy of pseudocyst drainage and VP shunt revision in treating abdominal pseudocyst-associated shunt failure.
- To determine the overall rate of secondary shunt failure after these interventions.
Main Methods:
- Retrospective review of pediatric patients with hydrocephalus and abdominal pseudocysts treated between 2000 and 2016.
- Inclusion criteria: VP shunt, pseudocyst development (ages 2-18), pseudocyst drainage (IR or surgical), and VP shunt revision.
- Data collected on demographics, pseudocyst treatment, and subsequent shunt failures.
Main Results:
- Twelve patients met the inclusion criteria.
- A high secondary shunt failure rate of 91% was observed after drainage and revision.
- Common reasons for failure included pseudocyst recurrence (3), distal obstruction (1), and unresolved infection (6).
Conclusions:
- Drainage and revision of abdominal pseudocysts are ineffective for long-term resolution of VP shunt problems.
- This approach has a limited success rate in preventing recurrent shunt failure.
Purpose:
The purpose of this study was to determine whether drainage and revision are an effective treatment for abdominal pseudocyst associated ventriculoperitoneal (VP) shunt failure by estimating the total rate of secondary shunt failure.
Methods:
We performed a retrospective review of children with hydrocephalus diagnosed with and treated for an abdominal pseudocyst at the Children's Hospital, London Health Sciences Centre (LHSC) between January 1, 2000 and May 31, 2016 (ethics approval # 108136). Patients with a VP shunt were included if (i) the development of an abdominal pseudocyst at age 2 to 18 years was identified, (ii) treatment of the pseudocyst by either interventional radiology (IR) or surgical drainage, and (iii) revision of the VP shunt. Demographic data and details of pseudocyst formation/ treatment as well as subsequent failures were identified.
Results:
Twelve patients who had a VP shunt developed abdominal pseudocyst and met inclusion criteria. A 91% shunt failure rate after drainage and shunt revision was identified. Three patients had the pseudocyst drained in interventional radiology and then externalized due to shunt infection. Nine patients were treated by surgical revision. Ten patients experienced recurrent shunt failure following initial drainage of the pseudocyst: pseudocyst reoccurrence (n = 3), distal obstruction from adhesions (n = 1), and uncleared infection (n = 6).
Conclusion:
The results suggest that pseudocyst drainage and shunt revision is ineffective in providing long-term resolution of shunt problems.
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