Shunting for hydrocephalus: analysis of techniques and failure patterns

• Published in: The Journal of surgical research Vol. 191; no. 1; pp. 140 - 147
• Main Authors: Nigim, Fares, MD, Critchlow, Jonathan F., MD, Schneider, Benjamin E., MD, Chen, Clark, MD, PhD, Kasper, Ekkehard M., MD, PhD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-09-2014
• Subjects: Adult; Aged; Aged, 80 and over; Cerebrospinal fluid (CSF); Equipment Failure; Equipment Failure Analysis; Female; Humans; Hydrocephalus, Normal Pressure - surgery; Ileus - etiology; Laparoscopic technique (Lap technique); Laparoscopy - adverse effects; Laparoscopy - methods; Length of Stay; Longitudinal Studies; Male; Middle Aged; Normal pressure hydrocephalus (NPH); Operative Time; Retrospective Studies; Surgery; Treatment Outcome; Ventriculoperitoneal shunt (VPS); Ventriculoperitoneal Shunt - adverse effects; Young Adult; Normal pressure hydrocephalus (NPH); Cerebrospinal fluid (CSF); Ventriculoperitoneal shunt (VPS); Laparoscopic technique (Lap technique)
• ISSN: 0022-4804; 1095-8673
• DOI: 10.1016/j.jss.2014.03.075

Abstract Background Hydrocephalus is characterized by ventricular dilatation because of progressive accumulation of cerebrospinal fluid. Normal pressure hydrocephalus (NPH) affects a subset of patients representing a reversible clinical triad of gait disturbance, urinary incontinence, and dementia with normal cerebrospinal fluid pressure and composition. Various shunting procedures have been used for treatment, but techniques and outcomes remain under debate. The objective of this study was to evaluate the clinical outcomes of 232 patients with and without NPH after the first-time Ventriculoperitoneal shunt placement and assessed patterns of failure between December 2004 and December 2012. Results Mean age was 54.7 y in non-NPH and 71.9 y in NPH patients. We used open technique in 34.3% and laparoscopic technique in 65.7% of NPH patients and 32.7% and 67.3% of the non-NPH patients, respectively. A total of 36 of 232 patients displayed shunt failure, 16.4% in NPH and 15.2% in non-NPH patients. Twenty-three of 155 patients failed after laparoscopic and 13 of 77 failed after open placement. Proximal shunt failure was more frequent in the non-NPH cohort. Distal failures accounted for 13 of 232 cases, and the difference between laparoscopic (six of 155) and open failures (seven of 77) was profound, but not between NPH- and non-NPH patients. Conclusions Shunt failures are related to the placement method. Non-NPH patients showed more proximal failures. NPH patients showed fewer proximal failures. Less distal failures were observed after laparoscopic ventriculoperitoneal shunt placement without significant differences between NPH and non-NPH patients. Beyond this, laparoscopic surgery carries distinct advantages such as shorter operating room times and hospital stays, which should translate into less use of pain medications, earlier mobilization, and a lower incidence of ileus.