Ventriculoperitoneal Shunt Group Research Articles

Shunt options for normal pressure hydrocephalus: a comparison of complications, overdrainage rates and neurological outcomes between integra low flow regulated and Codman Hakim programmable shunts

Aims: Shunt surgery is the most commonly performed treatment for idiopathic normal pressure hydrocephalus, and shunt systems with different operating principles are employed. This study aimed to retrospectively compare programmable ventriculoperitoneal shunts and flow-regulated shunts in terms of complications, overdrainage rates, and neurological outcomes. Methods: Between January 2020 and May 2022, 44 patients who underwent shunt operation with a diagnosis of idiopathic normal pressure hydrocephalus at our clinic were retrospectively analyzed. Patients were categorized into two groups: the programmable ventriculoperitoneal shunt and the flow-regulated shunt group. Demographic characteristics, complications, rates of insufficient drainage/overdrainage, and surgical outcomes were compared. Results: There were 26 patients in the programmable ventriculoperitoneal shunt group and 18 patients in the flow-regulated shunt group. In the programmable ventriculoperitoneal shunt group, 14 patients (53.8%) required 27 shunt setting adjustments owing to excessive or inadequate drainage. Subdural effusion was observed in five patients (19.2%), and shunt revision was performed in one patient (3.8%). Subdural effusion was observed in two (11.1%) patients in the flow-regulated shunt group. One of these patients (5.5%) underwent shunt revision. There was no significant difference between the groups in terms of the development of subdural effusion and need for shunt revision (p>0.05). The rate of improvement in at least one of the symptoms was 53.8% in the programmable ventriculoperitoneal shunt group at the 1st-month postoperative outpatient follow-up. In the flow-regulated shunt group, this rate was 72.2% and there was no statistically significant difference. Both groups showed similar clinical improvement at the 1-year follow-up. Conclusion: There was no difference between the groups in terms of neurological outcomes and the need for shunt revision. However, the use of flow-regulated shunts has demonstrated earlier rates of clinical improvement without the need for reprogramming.

Lumboperitoneal shunt and ventriculoperitoneal shunt for chronic hydrocephalus after aneurysmal subarachnoid hemorrhage: a comparison.

Chronic hydrocephalus after aneurysmal subarachnoid hemorrhage (aSAH) results in poor neurological outcomes and cognitive deficits. Currently, the main treatments for chronic hydrocephalus include ventriculoperitoneal shunt (VPS) and lumboperitoneal shunt (LPS); however, the optimal treatment for chronic hydrocephalus after aSAH remains controversial. The records of 82 patients were retrospectively analyzed, and the patients were divided into VPS and LPS groups based on surgical methods. The efficacy, shunt successful rate and complications were compared. The assessments of treatment efficacy included the Evans index score (EIS), Keifer's hydrocephalus score (KHS), Mini-Mental State Examination (MMSE) score and functional independence measure (FIM). Patients were followed up for three months to observe the postoperative curative effects and complications. The rate of shunt obstruction was significantly higher in the LPS group than that in the VPS group (p < 0.05), and the shunt successful rate was significantly higher in the VPS group than that in the LPS group (p < 0.05). The total rate of complications was 24.4% for LPS and 39% for VPS. The improvements in EIS, KHS, MMSE, and FIM within each group after the shunt were significantly different compared to those before shunt (p < 0.05). Compared to those in the LPS group, the improvements in EIS, KHS, MMSE, and FIM were significantly different in the VPS group after shunt (p < 0.05). Compared with LPS, VPS in the treatment for chronic hydrocephalus after aSAH had greater therapeutic efficacy, as indicated by improved radiological outcomes, improved shunt successful rate, improved clinical outcomes, and improved quality of life. Therefore, we believe that VPS is the preferred treatment option for chronic hydrocephalus after aSAH, while LPS should only be used as an alternative to VPS.

Endoscopic Third Ventriculostomy versus Ventriculo-Peritoneal Shunt for Infant Hydrocephalus

Objective: To compare the outcome of ventriculo-peritoneal shunt (VP shunt) versus endoscopic third ventriculostomy (ETV) as surgical intervention in management of Infant hydrocephalus. Methodology: A prospective, randomized controlled trial was conducted at the department of Neurosurgery Nishtar University Hospital between June 2023 and November 2023. Study was conducted on 62 pediatric patients with hydrocephalus, all fewer than two years of age, who underwent cerebrospinal fluid (CSF) diversion through either endoscopic third ventriculostomy (ETV) or ventriculoperitoneal (VP) shunt placement. Patients were randomly assigned to one of two treatment groups: ETV or VP shunt. Randomization was done using a computer-generated sequence to ensure unbiased allocation. The ETV group underwent endoscopic surgery to create an opening in the third ventricle to allow CSF to bypass the obstruction. The VP shunt group received a surgically implanted device to divert CSF from the ventricles to the peritoneal cavity. Results: Infection was higher in Group VP than Group ETV as 5 (16.1%) and 1 (3.2%), respectively, (p=0.086). Similarly, obstruction was higher in Group VP than Group ETV as 11 (35.5%) and 9 (29.0%), respectively, (p=0.587). Whereas, surgery was revised 16 (51.6%) in Group VP and 13 (41.9%) in Group Erate TV, (p=0.445). Conclusion: This suggests that ETV presents as a favorable alternative to VP shunt placement due to its reduced risk of postoperative complications and quicker operative duration, while still maintaining comparable efficacy in terms of preventing obstruction, and the necessity for revision surgeries.

A scoring system categorizing risk factors to evaluate the need for ventriculoperitoneal shunt in pediatric patients after brain tumor resection.

To develop a scoring system based on independent predictors of the need for ventriculoperitoneal (VP) shunt after brain tumor resection in pediatric patients. A total of 416 pediatric patients (≤ 14 years old) with brain tumors who underwent surgery were randomly assigned to the training (n = 333) and validation cohorts (n = 83). Based on the implementation of VP shunt, the training cohort was divided into the VP shunt group (n = 35) and the non-VP shunt group (n = 298). Univariate and multivariate logistic analyses were performed. A scoring system was developed based on clinical characteristics and operative data, and scores and corresponding risks were calculated. Age < 3 (p = 0.010, odds ratio [OR] = 3.162), blood loss (BL) (p = 0.005, OR = 1.300), midline tumor location (p < 0.001, OR = 5.750), preoperative hydrocephalus (p = 0.001, OR = 7.044), and total resection (p = 0.025, OR = 0.284) were identified as independent predictors. The area under the curve (AUC) of the scoring system was higher than those of age < 3, BL, midline tumor location, preoperative hydrocephalus, and total resection (0.859 vs. 0.598, 0.717, 0.725, 0.705, and 0.555, respectively; p < 0.001). Furthermore, the scoring system showed good performance in the validation cohort (AUC = 0.971). The cutoff value for predictive scores was 5.5 points, which categorized patients into low risk (0-5 points) and high risk (6-14 points) groups. Our scoring system, integrating age < 3, BL, midline tumor location, preoperative hydrocephalus, and total resection, provides a practical evaluation. Scores ranging from 6 to 14 points indicate high risk.

Blood Loss in Operation Is Independently Predictive of Postoperative Ventriculoperitoneal Shunt in Pediatric Patients With Posterior Fossa Tumors

BackgroundTo identify the risk factors for postoperative hydrocephalus and the need for ventriculoperitoneal (VP) shunt after posterior fossa tumor (PFT) resection in pediatric patients and establish a predictive model. MethodsA total of 217 pediatric patients (≤14 years old) with PFTs who underwent tumor resection from November 2010 to December 2020 were divided into a VP shunt group (n = 29) and non-VP shunt group (n = 188). Univariate and multivariate logistic regression were performed. A predictive model was established based on the independent predictors. Receiver operating characteristic curves were generated to determine the cutoff values and areas under the curve (AUCs). The Delong test was performed to compare the AUCs. ResultsAge less than three years (P = 0.015, odds ratio [OR] = 3.760), blood loss (BL) (P = 0.002, OR = 1.601), and locations at fourth ventricle (P < 0.001, OR = 7.697) were the independent predictors. The predictive model was as follows: total score = age (<3; yes = 2, no = 0) + BL + tumor locations (fourth ventricle; yes = 5, no = 0). The AUC of our model was higher than those of age less than three years, BL, locations at the fourth ventricle, and compound factors (age <3 + locations) (0.842 vs 0.609, 0.734, 0.732, and 0.788, respectively). The cutoff values of the model and BL were 7.5 points and 2.75 U, respectively. ConclusionsBL, age less than three years, and tumors at the fourth ventricle were independent predictors. Model scores over 7.5 points predict a high risk.

Introduction and comparision of three different fixation methods in the suprahepatic space in laparoscopy-assisted ventriculoperitoneal shunt for hydrocephalus

Ventriculoperitoneal shunt (VPS) placement is the standard procedure in the management of hydrocephalus. The introduction of laparoscopy allows better visualization during the operation and a more reliable placement of the peritoneal terminal of the catheter, which significantly decreases postoperative obstruction and malposition rates. However, the fixation methods of the peritoneal terminal of the catheter have not been previously discussed. The indications, techniques, and complications were compared between conventional VPS and laparoscopy-guided VPS. Furthermore, same analyses were performed within the laparoscopy-guided VPS group subdivided by three different techniques of the fixation of the peritoneal terminal of catheter, including suture and ligature, titanium clip fixation, and subcutaneous fixation. A total of 137 patients with hydrocephalus who received VPS treatment was retrospectively studied, 85 of which were laparoscopy-guided, and 52 were not. The distal ends of the catheters were all placed in the suprahepatic space. At least one year (mean 28.6 months) follow-up was given postoperatively. The average duration of the whole operation was 45 min for suture and ligature, 40 min for titanium clip fixation, and 30 min for the subcutaneous fixation, respectively. Six patients (4.4%) had obstructive of the ventricular catheter in total. The success rates for the laparoscopy-assisted VPS procedure and the conventional VPS procedure were 87.1% (74/85) and 80.8% (42/52), respectively. Within subgroups of the laparoscopy-assisted VPS divided by fixation methods, the procedures were successful in 85.2% (23/27) of suture and ligation, 82.1% (23/28) of titanium clip fixation, and 93.3% (28/30) of subcutaneous fixation, respectively. Two patients had dislocated shunt tube in peritoneal end in laparoscopy group, all in the titanium clip fixation subgroups. The laparoscopy-assisted VPS insertion is an ideal shunt method for its effectiveness and lesser complication rate after operation. The subcutaneous fixation method of the peritoneal terminal of catheter might be the optimal fixation technique.

Obstructive Hydrocephalus Due to Posterior Fossa Tumors in Adults: A Comparative Analysis of 3 Surgical Techniques

The main treatments for hydrocephalus due to posterior fossa tumors are tumor resection with or without an external ventricular drain, ventriculoperitoneal shunt (VPS), and endoscopic third ventriculostomy. Although preoperative cerebrospinal fluid diversion by any of these techniques improves clinical outcomes, evidence comparing the efficacy of these techniques is scarce. Therefore, we aimed to retrospectively evaluate each treatment modality. This single-center study analyzed 55 patients. Treatments were classified as successful (hydrocephalus resolution with a single surgical event) or failed and compared with a χ2 test. Kaplan-Meier curves and log-rank tests were employed. A Cox proportional hazard model was used to determine relevant covariates predicting outcomes. Mean patient age was 36.3 years, 43.4% of patients were men, and 50.9% of patients presented with uncompensated intracranial hypertension. Mean tumor volume was 33.4 cm3, and extent of resection was 90.85%. Tumor resection with or without an external ventricular drain was successful in 58.82% of cases, VPS was successful in 100%, and endoscopic third ventriculostomy was successful in 76.19% (P= 0.014). Mean follow-up time was 15.12 months. Log-rank test found statistically significant differences between survival curves of treatments (P= 0.016) favoring the VPS group. Postoperative surgical site hematoma was a significant covariate in the Cox model (hazard ratio= 17; 95% confidence ratio, 2.301-81.872; P= 0.004). This study favored VPS as the most reliable treatment of hydrocephalus due to posterior fossa tumors in adult patient; however, several factors influence clinical outcomes. We proposed an algorithm based on our findings and other authors' findings to facilitate the decision-making process.

Short-term and long-term outcomes in patients with cryptococcal meningitis after ventriculoperitoneal shunt placement.

The purpose of this study was to assess the short-term and long-term outcomes of ventriculoperitoneal shunt (VPS) placement in patients with cryptococcal meningitis (CM). We performed a retrospective analysis of all patients with CM admitted to the Peking Union Medical College Hospital from September 1990 to January 2021. We collected related clinical features to analyze the short- and long-term outcomes of VPS at 1 month and 1 year at least the following therapy, respectively. Overall survival (OS) was compared with all patients and a subgroup of critically ill cases by the Kaplan-Meier method with the log-rank test. Univariable and multivariable analyses were also performed using the Cox proportional hazard model to identify statistically significant prognostic factors. We enrolled 98 patients, fifteen of whom underwent VPS. Those who received VPS had a lower cerebrospinal fluid (CSF) Cryptococcus burden (1:1 vs. 1:16; p = 0.046), lower opening pressures (173.3 mmH2 O vs. 224 mmH2O; p = 0.009) at lumbar punctures, and a lower incidence of critical cases (6.7 vs. 31.3%; p = 0.049). According to our long-term follow-up, no significant difference was shown in the Barthel Index (BI) between the two groups. Two patients in the VPS group suffered postoperative complications and had to go through another revision surgery. According to survival analysis, overall survival (OS) between the VPS and non-VPS groups was not significantly different. However, the Kaplan-Meier plots showed that critical patients with VPS had better survival in OS (p < 0.009). Multivariable analyses for critical patients showed VPS was an independent prognostic factor. A VPS could reduce the intracranial pressure (ICP), decrease the counts of Cryptococcus neoformans by a faster rate and reduce the number of critical cases. The VPS used in critical patients with CM has a significant impact on survival, but it showed no improvement in the long-term Barthel Index (BI) vs. the conservative treatment and could lead to postoperative complications.

The utility of congenital cardiac status to predict endoscopic third ventriculostomy and ventriculoperitoneal shunt failure in hydrocephalic infants.

The effect of congenital cardiac status on endoscopic third ventriculostomy (ETV) and ventriculoperitoneal shunt (VPS) failure in hydrocephalic infants is unknown. Because cardiac status in infants can impact central venous pressure (CVP), it is possible that congenital heart disease (CHD) and congenital cardiac anomalies may render these cerebrospinal fluid diversion interventions more susceptible to failure. Correspondingly, the aim of this study was to determine how CHD and congenital cardiac anomalies may impact the failure of these initial interventions. A retrospective review of the Nationwide Inpatient Sample (NIS) database was conducted. Infants (aged < 1 year) with known congenital cardiac status managed with either ETV or VPS were included. Quantitative data were compared using either parametric or nonparametric methods, and failure rates were modeled using univariable and multivariable regression analyses. A total of 18,763 infants treated with ETV or VPS for hydrocephalus were identified in our search, with ETV used to treat 7657 (41%) patients and VPS used to treat 11,106 (59%). There were 6722 (36%) patients who presented with CHD at admission, and a total of 25 unique congenital cardiac anomalies were detected across the cohort. Overall, the most common anomaly was patent ductus arteriosus (PDA) in 4990 (27%) patients, followed by atrial septal defect (ASD) in 2437 (13%) patients and pulmonary hypertension in 810 (4%) patients. With respect to initial intervention failure, 3869 (21%) patients required repeat surgical intervention during admission. This was significantly more common in the ETV group than the VPS group (36% vs 10%, p < 0.01). In both the ETV and VPS groups, CHD (p < 0.01), including all congenital cardiac anomalies, was an independent and significant predictor of failure. ASD (p < 0.01) and PDA (p < 0.01) both significantly predicted ETV failure, and PDA (p < 0.01) and pulmonary hypertension (p = 0.02) both significantly predicted VPS failure. These results indicate that congenital cardiac status predicts ETV and VPS failure in patients with infantile hydrocephalus. The authors hypothesized that this finding was primarily due to changes in CVP; however, this may not be completely universal across both interventions and all congenital cardiac anomalies. Future studies about optimization of congenital cardiac status with ETV and VPS are required to understand the practical significance of these findings.

Effects of ETV and VPS on cognitive impairment in infants with congenital hydrocephalus: A retrospective study

This study aims to investigate the postoperative cognitive function changes of infants who underwent endoscopic third ventriculostomy (ETV) or ventriculoperitoneal shunt (VPS) for the treatment of congenital hydrocephalus. Data of 70 hydrocephalus infants and children were retrospectively analyzed. Among these patients, 20 patients underwent ETV, 27 patients underwent VPS, and 23 patients did not undergo any operation (controls). All patients were routinely cared after discharge. The Gecell Developmental Diagnostic Scale was filled for all patients at 2 weeks, 2 months, and 6 months after diagnosis. A total of 20 patients in the ETV group were followed up for 6 months. Among these patients, the clinical symptoms of 18 patients significantly improved. Results determined at 6 months after surgery in the ETV group was statistically significant, compared with the control group ( P &lt; 0.05). Results determined at 2 and 6 months after surgery in the VPS group were statistically significant, compared with the control group ( P &lt; 0.05). Developmental quotient (DQ) values in these two operation groups increased after the operation ( P &lt; 0.01), and the differences were statistically significant. ETV and VPS can improve the cognitive function of infants with hydrocephalus. Improvement of cognitive function by VPS is more significant for infants.

Triple therapy combined with ventriculoperitoneal shunts can improve neurological function and shorten hospitalization time in non-HIV cryptococcal meningitis patients with increased intracranial pressure

BackgroundRaised intracranial pressure (ICP) and insufficient antifungal regimens are the two main factors result to unsatisfactory outcomes in non-HIV cryptococcal meningitis (CM) patients. In this study, we try to discuss that whether triple therapy of amphotericin B (AmB), fluconazole, 5-flucytosine (5-FC) plus ventriculoperitoneal shunts (VPS) is superior to AmB, 5-FC, fluconazole plus intermittent lumbar puncture in induction therapy in non-HIV CM patients with increased ICP.MethodsWe reviewed 66 clinical records from non-HIV CM patients with increased ICP. The demographic and clinical characteristics, BMRC staging, cerebrospinal fluid profiles (CSF), brain magnetic resonance imaging, treatment, and outcomes of these individuals were retrospectively analyzed. All non-HIV CM patients with increased ICP (≥ 25 cmH2O) were divided into two groups, including 27 patients treated with triple antifungal agents and 39 patients treated with the same triple therapy plus VPS.ResultsTriple therapy plus VPS group had more satisfactory outcomes, more CSF sterilization at 10 weeks follow-up, lower CSF opening pressure, lower BMRC staging scores one week after VPS, less CSF C. neoformans counts and CSF culture positive. Besides, these patients had shorter hospital stay than triple therapy group.ConclusionsTriple antifungal agents combined with VPS could effectively reduce ICP, had faster rate of clearance of C. neoformans counts, more improved neurological function, shorten hospitalization time and better outcomes in non-HIV CM patients with increased ICP. Our study indicated that triple therapy plus early VPS may be an optimal treatment for non-HIV CM patients with increased ICP.

Complications After Dual Placement of a Baclofen Pump and Ventricular Shunt in Individuals With Severe Brain Injury

ObjectiveTo assess the complications of dual placement of an intrathecal baclofen (ITB) pump and a ventriculoperitoneal shunt (VPS) in people with severe brain injury. DesignCase series. SettingReferral center, ambulatory, and hospitalized care. ParticipantsReferred sample (N=9) composed of 5 men and 4 women with severe brain injuries (5 traumatic brain injuries, 3 subarachnoid hemorrhages, 1 intracerebral hemorrhage) and a mean disease duration of 6±4.5 years (range, 0.5-11.4y). InterventionBoth systems (ie, an ITB device and a VPS system) were implanted in all participants. Main Outcome MeasuresWe assessed the number and type of complications that occurred after implantation of the second system, as well as subsequent interventions. ResultsThe ITB delivery system was implanted after the VPS system in 5 patients (ITB group), and the VPS system was the second implanted system in 4 groups (VPS group). Seven complications occurred in 7 patients after implantation of the second system, 4 in the ITB group and 3 in the VPS group. Three of the complications were drug-related, 2 were procedure-related, and 2 were device-related. The complication occurred within 4 days after implantation of the second system in 6 patients. ConclusionsComplications are frequent in patients who undergo implantation of both an ITB delivery device and a VPS system. Drug-related complications were more common. Complications occurred more often when an ITB device was implanted as the second system. The critical period is the first 4 days.

Our Experience with the Treatment of Hydrocephalus in infants: Endoscopic Third Ventriculostomy versus Ventriculo-Peritoneal Shunt: A retrospective comparative study

Background: Hydrocephalus is the commonest pediatric neurological disorder and usually treated by cerebrospinal fluid (CSF) diversion. This diversion accomplished by third ventriculostomy or ventriculo-peritoneal shunt. However, the optimal management is still controversial. Aim of the work: To compare the endoscopic third ventriculostomy (ETV) to ventriculo-peritoneal (VP) shunt in management of Infantile hydrocephalus. Patients and Methods:We conducted a retrospective analysis for 40 infants with hydrocephalus. The treatment used was CSF diversion by ETV or VP shunt. Results: oth treatment groups were comparable regarding age, gender, cause of hydrocephalus, incidence of postoperative re-obstruction, OFC change, hematoma, revision surgery, mortality or success rate. However, the operative time was significantly reduced among ETV when compared to VP shunt group (48.80±9.13 vs 66.75±7.65 minutes, respectively). The rate of postoperative infection was significantly decreased in ETV when compared to VP shunt groups (15.0% vs 45.0% respectively). Finally, the overall mortality during postoperative one year follow up duration was 42.5% with no significant difference between ETV and VP shunt groups (35.0% vs 50.0% respectively). In addition, the overall failure rate was 50.0%, which was lower among ETV when compared to V shunt groups (35.0% vs 65.0% respectively) with no significant difference. Conclusion: Endoscopic third ventriculostomy is effective and safe intervention for treatment of infantile hydrocephalus (for infants between 6 and 3 years of age). It is superior to VP shunt as it is associated with lower postoperative infection and shorter operation time, when compared to shunt.

Hydranencephaly treatments: retrospective case series and review of the literature.

The objective of this study was to review treatment options for infants with hydranencephaly and to consider the pros and cons of each treatment modality. This paper is a review of hydranencephaly as well as a retrospective analysis evaluating the outcomes of 52 infants with hydranencephaly who were treated at the Kijabe Hospital, Kijabe, Kenya, in one of four ways: ventriculoperitoneal shunt (VPS) insertion, endoscopic choroid plexus coagulation (CPC), open choroid plexectomy (CPlx), and palliative care. The primary outcome measure was control of head size, with the aim of improving patient care. One-year mortality was a secondary outcome. Of the 52 patients analyzed, 11 underwent VPS insertion, 17 CPC, 14 CPlx, and 10 were treated palliatively. Head size was controlled at the 3-month evaluation interval in 5 of 7 infants treated with VPS, 10 of 16 of those treated with CPC, 6 of 9 of those treated with CPlx, and 1 of 4 treated palliatively. The number of infants in each category with complete follow-up data that were needed to analyze change in head size was lower than the total number of patients included in each category. Mortality at 1 year of age was 9 of 11 in the VPS group, 14 of 17 in the CPC group, 6 of 14 in the CPlx group, and 7 of 10 in the palliative group. Head size decreased by 1 cm or more in similar proportions (62%-71%) of infants with hydranencephaly who were treated by VPS insertion, CPC, and CPlx, and progressed in those who received palliative care. Mortality at 1 year of age was similar in infants treated by a VPS, CPC, and palliative care (70%-82%), but lower (43%) in those treated with CPlx.

Is Endoscopic Third Ventriculostomy a Feasible Option or Ventriculoperitoneal Shunt a Safer Bet for the Treatment of Posttraumatic Hydrocephalus? A Gap Time Model-based Algorithm.

Posttraumatic hydrocephalus (PTH) adds to the morbidity and mortality of traumatic brain injury (TBI) and there are insufficient clinical data to suggest usefulness of ventriculoperitoneal shunt (VPS) over endoscopic third ventriculostomy (ETV) in PTH or vice versa. To evaluate the usefulness of VPS and ETV in the treatment of PTH and to establish the indications for their usage. This was an ambispective study of 141 patients who developed PTH out of 2500 cases of TBI treated during the study duration (2012-2016). These patients were segregated into two groups depending on the primary procedure for PTH-ETV group and VPS group. The two groups were compared to analyze the differences in radiological and clinical outcome. 141 patients were included in the study and 175 procedures were performed in these patients. ETV group had 30 procedures and VPS had 145 procedures. In the ETV group, 37% of cases showed improvement v/s 73% cases in the VPS group. A statistically significant number of patients had improvement in presenting symptoms in the VPS group, as compared with the ETV group (P = 0.001). There was no significant difference in Glasgow coma scale (GCS) at discharge (P = 0.15) and Glasgow outcome score at 6 months of follow-up (P = 0.22) between the two groups. Poor GCS, previous cerebrospinal fluid infection, and postoperative meningitis were found to have significant effect on the failure-free period of the procedure. On comparing the probabilities of failure-free period of ETV v/s VPS, the chances of VPS failure are 61% lesser than ETV. VPS is an effective modality for the management of PTH and has a much lower failure rate as compared to ETV. However, ETV can be considered as a salvage procedure in difficult situations of recurrent shunt malfunction or infection.

Comparative Study of the Effectiveness of Lumboperitoneal and Ventriculoperitoneal Shunting with Neuronavigation in the Treatment of Idiopathic Intracranial Hypertension.

Idiopathic intracranial hypertension is an uncommon intracranial disorder in which intracranial pressure is increased without radiological evidence of lesions. Surgery is indicated when severe optic neuropathy is present or medical treatment fails. To assess the comparative effectiveness of lumboperitoneal (LPS) and ventriculoperitoneal shunt (VPS) with neuronavigation. A retrospective study was performed based on our database. We analyzed demographics, pre and postoperative parameters, and follow-up data on patients who had undergone either LPS or VPS between January 2007 and December 2017. Group I consisted of 17 VPS patients, of which 16 were female, and group II consisted of 29 LPS patients, of which 26 were female. The number of surgeries performed in the LPS group was higher (due to recurrence) than that in the VPS group. Moreover, the rate of complications was higher in the LPS group. VPS is safer and has a lower rate of complications and reinterventions compared to LPS.

Prior endoscopic third ventriculostomy does not increase ventriculoperitoneal shunt failure rate.

To determine whether prior endoscopic third ventriculostomy (ETV) influences the failure rate of subsequently placed ventriculoperitoneal (VP) shunts. Our institution's operative database and patient records were reviewed retrospectively to identify all paediatric patients who had undergone a first VP shunt or ETV at our institution between January 2012 and December 2015. Data was analysed using the Microsoft Excel, GraphPad Prism v7 and SPSS statistics. The literature on this topic to date was also reviewed. Eighty-six children were included in the study: 61 patients had a primary VP shunt inserted during the study period and 25 had a VP shunt inserted following failed ETV. There was no significant difference in the underlying aetiology or age of the patients in each group. In the primary VP shunt group, 47.5% (29 patients) required shunt removal at an average of 274days post-insertion (range 7days to 3.4years). The 1-year revision rate was 34.4%. In the shunt post-ETV group, 48% (12 patients) required shunt removal at an average of 207days post-insertion (range 2days to 2.7years). The 1-year revision rate was 36%. The most common reason for revision in both groups was blockage. We found no significant difference in failure rate or pattern between primarily inserted VP shunts and those inserted following an endoscopic third ventriculostomy. On the basis of this study and the small number of previously reported studies, we would advocate a trial of ETV where feasible to allow a chance at shunt independence.

Initial Results of Using Blood Beta 2 Transferrin as a Marker of the Functional Status of a Shunt

Ventriculoperitoneal shunt is the most common cerebrospinal fluid diversion procedure to treat hydrocephalus. With the change of physiologic cerebrospinal fluid absorption site from arachnoid granulations to the peritoneum, beta 2 transferrin enters the systemic circulation. Therefore, the detection of beta 2 transferrin in the blood can possibly be used as a noninvasive method to assess the functional status of the shunt. The objective of this study was to study the presence of beta 2 transferrin in patients with functional shunts and in shunts suspected of being malfunctional. Blood samples were obtained from a group of 20 patients with functional ventriculoperitoneal shunts, from a control group of 10 age-matched healthy volunteers, and from 8 patients with suspected shunt malfunction (6ventriculoperitoneal, 2 lumboperitoneal). Blood serum beta 2 transferrin levels were measured by enzyme-linked immunosorbent assay with specific anti-beta 2 transferrin antibodies. The mean age in the ventriculoperitoneal shunt group was 36.5 years (range, 24-50 years). The mean age in the control group was 39.5 years (range, 32-48). There was no statistical difference in age between the groups. Beta 2 transferrin levels were 1.99 ± 1.02 ng/mL in the ventriculoperitoneal shunt group and 0.05 ± 0.02 ng/mL in the control group; the statistical difference was strongly significant (P < 0.001). Patients presenting with suspected shunt malfunction had preoperative low beta 2 transferrin levels (0.10 ± 0.12). Postoperatively, their beta 2 transferrin levels increased to 1.75 ± 0.46 ng/mL, and the difference was statistically significant (P= 0.012). Blood beta 2 transferrin can be used as a noninvasive test to assess the functional status of a shunt.

Complications in Staged Late Titanium Cranioplasty and Ventriculoperitoneal Shunting for Patients with Traumatic Brain Injury

Hydrocephalus is a common complication following decompressive craniectomy. Ventriculoperitoneal shunt (VPS) is required for some patients before receiving a cranioplasty (CP). The presence of a VPS is regarded as a risk factor for overall CP complications. A retrospective survey was conducted on 176 patients with traumatic brain injury who underwent late (>3 months) titanium CP (Ti-CP) in our hospital from April 2014 to July 2018. Thirteen patients (7.4%) had preoperative VPS. Propensity score matching was performed for these 13 patients with a ratio of 1:5. A total of 78 patients were selected. Preoperative clinical parameters and postoperative complications were analyzed. The period of postoperative follow-up ranged from 3 to 63 months (mean 21.3 ± 17.0 months). The overall complication rate was greater in the VPS group (P= 0.010). These patients were more likely to develop a sunken skin flap (P < 0.001). The rate of postoperative cerebral hemorrhage was greater in the VPS group. Logistic analysis showed that preoperative VPS was an independent risk factor for postoperative extradural collection (odds ratio 17.714, P < 0.001). VPS was not related to postoperative infection and seizure. Postoperative drainage duration longer than 2.5 days significantly increased the risk of postoperative infection (odds ratio 7.715, P= 0.023). The presence of a VPS significantly increased the risk of extradural collection in patients with traumatic brain injury who underwent late Ti-CP. It also was related to postoperative hemorrhage. The sunken skin flap in patients with VPS increased surgical difficulty and the likelihood of extradural accumulation. Preoperative VPS was not related to postoperative infection and seizure in Ti-CP.

Lumboperitoneal and Ventriculoperitoneal Shunt Surgery for Posthemorrhagic Communicating Hydrocephalus: A Comparison

This study aimed to compare the efficacy and complications of lumboperitoneal (LP) and ventriculoperitoneal (VP) shunt surgeries in patients with posthemorrhagic communicating hydrocephalus. Retrospective analysis of the records of patients who were admitted to the Shanghai Tenth People's Hospital Affiliated to Tongji University between February 2012 and January 2018 was performed. The efficacy of the LP and VP shunt surgeries and their associated complications were compared. The evaluation of the efficacy of these surgeries involved both clinical and radiologic aspects. The evaluated complications included hemorrhage, infection, excessive drainage, seizure disorder, shunt obstruction, and migration. Revision and mortality were regarded as the consequence of complications and were collected. One-hundred and fifty-eight (115 males and 43 females) patients were treated with VP or LP shunt (102 vs. 56, respectively) for posthemorrhagic communicating hydrocephalus. The percentage of patients with a Glasgow Coma Scale (GCS) score between 3.00 and 12.00 was 79.11%. There was no significant difference in the observed clinical (P= 0.097) or radiologic (P= 0.360) improvements between the LP and VP shunt groups. The total rate of complications (P= 0.009) and hemorrhage (P= 0.03) were lower in the LP shunt group than in the VP shunt group. In the treatment of moderate and severe coma patients with posthemorrhagic communicating hydrocephalus, LP shunt surgery is equally as effective as the VP shunt surgery and is associated with fewer complications.