Artikel
Prognostic factors and standardized procedures of testing shunt dependence after long-term shunt implantation in hydrocephalus
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Autoren
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Alexandra Huthmann
- Sektion Pädiatrische Neurochirurgie, Neurochirurgische Klinik und Poliklinik, Universitätsmedizin der Johannes Gutenberg-Universität Mainz
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Wolfgang Wagner
- Sektion Pädiatrische Neurochirurgie, Neurochirurgische Klinik und Poliklinik, Universitätsmedizin der Johannes Gutenberg-Universität Mainz
| Veröffentlicht: | 13. Mai 2014 |
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Gliederung
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Objective: The principle “once a shunt – always a shunt” was generally accepted for a long time. In recent years, some criticism pointed at the possible development of shunt independence in the context of problems of long-term shunt implantation. The question arose whether there are predictive factors for assessing the chance of shunt independence in patients in whom a shunt revision was necessary because of catheter fracture, disconnection or dislocation together with the absence of clinical signs of elevated ICP.
Method: From 2001-2012, tentative shunt ligature was performed in 45 patients. These belonged to a group of more than 1400 shunted hydrocephalic patients, followed in our outpatient clinic over many years. They were all without any clinical signs of elevated ICP and fulfilled one or more of the following aspects: broken/dislocated/disconnected peritoneal or ventricular catheters, mechanical defects of the valve, no ultrasonographic evidence of free fluid in the peritoneal cavity, normal CT/MR images. A disconnected was found most often r, valve dysfunction or lacking fluid in abdominal ultrasonograms. All patients were treated and observed for several days during a hospital stay.
Results: 36 out of these 45 patients turned out to be shunt independent; 5 of these showed slight headaches for a few days that resolved spontaneously. The 9 shunt-dependent patients underwent revision (reopening or reinsertion of the shunt) 1-10 days after shunt ligature. The median follow-up was 5 years. Follow-up MRI scans showed no enlargement of the ventricular size even years after shunt ligature. No single criterion or combination of criteria was found to reliably predicted shunt independence. The relative incidence of shunt independence was highest in posthemorrhagic hydrocephalus, compared with postmeningitic or MMC-associated hydrocephalus.
Conclusions: The results are in accordance with data published in the literature. It can be concluded that in selected cases of mechanical shunt dysfunction without clinical signs of elevated ICP, the testing of shunt dependence during a hospital stay may be warranted and promising.
