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Neuronavigation and Laparoscopy Guided Ventriculoperitoneal Shunt Insertion for the Treatment of Hydrocephalus
Published on: October 14, 2022
The Conundrum of Ventricular Dilatations Following Decompressive Craniectomy: Is Ventriculoperitoneal Shunt, The Only
Raja K Kutty1, Sunilkumar Balakrishnan Sreemathyamma1, Jyothish Sivanandapanicker1
1Department of Neurosurgery, Government Medical College, Thiruvananthapuram, Kerala, India.
Insights
Ventriculomegaly after decompressive craniectomy (DC) can be managed with aspiration and cranioplasty in asymptomatic patients. This approach offers a viable alternative to permanent cerebrospinal fluid (CSF) diversion in selected cases.
Area of Science:
- Neurosurgery
- Neurology
- Critical Care Medicine
Background:
- Ventriculomegaly and hydrocephalus (HCP) are potential complications following decompressive craniectomy (DC).
- Current diagnostic criteria for HCP often rely on radiological findings, potentially overlooking clinical patient status.
- This can lead to the widespread use of permanent cerebrospinal fluid (CSF) diversion procedures.
Purpose of the Study:
- To evaluate the efficacy of aspiration with cranioplasty for managing asymptomatic ventriculomegaly post-DC.
- To compare outcomes between patients with symptomatic HCP and those with asymptomatic ventriculomegaly after DC.
Main Methods:
- Patients undergoing cranioplasty post-DC with radiological evidence of HCP were included.
- Group 1: Symptomatic HCP patients received ventriculoperitoneal shunt followed by cranioplasty.
- Group 2: Asymptomatic ventriculomegaly patients underwent simultaneous cranioplasty and temporary lateral ventricle aspiration.
Main Results:
- Twenty-one patients developed post-DC ventriculomegaly (10 in Group 1, 11 in Group 2).
- Group 1 experienced shunt over-drainage requiring revision in two patients.
- Group 2 had only one patient requiring permanent CSF diversion.
Conclusions:
- Cranioplasty combined with aspiration is a safe and effective strategy for selected patients with asymptomatic ventriculomegaly post-DC.
- This minimally invasive approach can potentially avoid the need for permanent CSF shunts in specific patient populations.
Introduction:
Ventriculomegaly and hydrocephalus (HCP) are sometimes a bewildering sequela of decompressive craniectomy (DC). The distinguishing criteria between both are less well defined. Majority of the studies quoted in the literature have defined HCP radiologically, rather than considering the clinical status of the patient. Accordingly, these patients have been treated with permanent cerebrospinal fluid (CSF) diversion procedures. We hypothesize that asymptomatic ventriculomegaly following DC should undergo aspiration with cranioplasty and be followed up regularly.
Materials And Methods:
All patients with post-DC who were scheduled for cranioplasty and satisfied the radiological criteria for HCP were included. These patients were categorized into two groups. Group 1 included ventriculomegaly with clinical signs attributable to HCP and Group 2 constituted ventriculomegaly but no clinical signs attributable to HCP. All patients in Group 1 underwent ventriculoperitoneal shunt followed by cranioplasty, whereas all patients in Group 2 underwent cranioplasty along with simultaneous ventriculostomy and temporary aspiration of the lateral ventricle. All patients were regularly followed as the outpatient basis.
Results:
There were 21 patients who developed ventriculomegaly following DC. There were 10 patients in Group 1 and 11 patients in Group 2. The average duration of follow-up was from 6 months to 2 years. Two patients in the shunt group - (group 1) had over drainage and required revision. One patient in aspiration group - (group 2) required permanent CSF diversion.
Conclusions:
Cranioplasty with aspiration is a viable option in selected group of patients in whom there is ventriculomegaly but no signs or symptoms attributable to HCP.
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