Gravitational shunt management of long-standing overt ventriculomegaly in adult (LOVA) hydrocephalus

Abstract

Recently a new subtype of chronic hydrocephalus was described: long-standing overt ventriculomegaly in adults (LOVA). Experience to date has indicated that shunt therapy was contraindicated, due to over-drainage. Therefore we investigated whether this problem could be overcome using gravitational shunts. Thirty macrocephalic adults (17-72 years of age), suffering from progressive hydrocephalus were managed with two different gravitational shunts. The post-operative observation period was 5-87 months. Only two patients developed hygromas, and only one of these required surgical shunt revision. Eighty-seven percent of patients had a long-lasting clinical improvement. Ventricular size was only slightly reduced in 29 patients. There was no correlation between reduction in ventricular size and clinical improvement. Contrary to clinical guidelines issued to date, we demonstrate that LOVA can be treated reliably with gravitational shunts, making them a genuine alternative to endoscopic third ventriculostomy (ETV).