Torkildsen shunt: re-evaluation of the historical procedure

Abstract

The Torkildsen shunt, which bypasses the cerebrospinal fluid (CSF) flow from the lateral ventricle to the cisterna magna, has been regarded as a historical procedure. We re-evaluated the clinical usefulness of the Torkildsen shunt as a treatment for hydrocephalus in the era of modern neurosurgery. Two hundred seventeen hydrocephalic patients were treated with 494 surgical procedures between April 2002 and April 2009. Among them, five patients (aged 9 months old to 14 years old, followed for 2 months to 4 years) had a Torkildsen shunt. The surgical procedure consists of a parieto-occipital burr hole opening and, if required, C1 partial laminectomy. A ventricular catheter passed subcutaneously bridges the lateral ventricle and the cervical subarachnoid space at the foramen magnum or C1 level. All five patients presented with non-communicating hydrocephalus with a lesion in and around the third ventricle, which precluded endoscopic third ventriculostomy or other endoscopic procedures. The Torkildsen shunt was the first choice treatment in two patients, while three patients had several previous failed CSF diversion surgeries. No complications relating to the surgical procedure occurred. The Torkildsen shunt has been functioning in all but one patient in whom temporary ventricular drainage was added later. The Torkildsen shunt can be effective in selected patients with hydrocephalus even in the era of computed tomography, magnetic resonance imaging, and neuroendoscopy. Although the surgical procedure is technically more demanding, the procedure enables one to avoid a standard ventriculoperitoneal shunt.