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[Valveless shunting in occlusive hydrocephalus in children]
Insights
One-stage ventriculocisternostomy (VC) with lumboperitoneal anastomosis offers reliable hydrocephalus treatment in children, reducing complications. Separate procedures are only advised for critically ill infants.
Area of Science:
- Neurosurgery
- Pediatric Surgery
Context:
- Hydrocephalus, particularly the occlusive form with impaired cerebrospinal fluid resorption, affects infants and young children.
- Surgical interventions are crucial for managing this condition in pediatric patients.
Purpose:
- To evaluate the efficacy and safety of one-stage ventriculocisternostomy (VC) combined with lumboperitoneal anastomosis using avalvular shunts for treating occlusive hydrocephalus in children.
- To compare the outcomes of combined one-stage procedures versus separate interventions or VC alone.
Summary:
- Thirty-two children with hydrocephalus underwent surgical treatment. Twenty-seven received a combined one-stage or staged ventriculocisternostomy (VC) and lumboperitoneal anastomosis, while five had VC alone.
- The combined one-stage intervention demonstrated higher success rates (85.7%) in stabilizing hydrocephalus compared to VC alone (20%).
- One-stage procedures with avalvular drains are presented as simple, reliable, and associated with fewer complications, making them suitable for widespread neurosurgical practice.
Impact:
- The study highlights the superior outcomes of one-stage combined ventriculocisternostomy and lumboperitoneal anastomosis in pediatric hydrocephalus management.
- This technique offers a more reliable and safer approach, potentially reducing the risks associated with staged procedures or VC alone in infants and young children.
- The findings support the recommendation of this one-stage technique for broader adoption in neurosurgical practice.
Abstract:
Operations were carried out on 32 children for the occlusive form of hydrocephalus with impaired resorption of the cerebrospinal fluid. Thirty children were under the age of 12 months, two were up to 2 years of age. Twenty-seven patients underwent two interventions either in one stage or at an interval of up to 4 months: ventriculocisternostomy (VC) and lumboperitoneal anastomosis by means of an avalvular shunt; five children were subjected only to VC. Hydrocephalus was stabilized in 18 children (85.7%) by the combined intervention and in 1 (20%) by means of VC alone. One-stage performance of Torkildsen's operation with lumboperitoneal anastomosis produces results, which are more reliable and fewer complications. These two operations can be conducted separately at some interval only if the child is very weak in the preoperative period and vital disorders occur during the surgical intervention. The performance of VC without subsequent lumboperitoneal anastomosis is a great risk for infants and young children. The developed techniques of one-stage VC with lumboperitoneal anastomosis and the use of avalvular drains is simple and reliable, which allows it to be recommended for wide use in neurosurgical practice.