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66th Annual Meeting of the German Society of Neurosurgery (DGNC)
Friendship Meeting with the Italian Society of Neurosurgery (SINch)

German Society of Neurosurgery (DGNC)

7 - 10 June 2015, Karlsruhe

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Comparison of long-term revision-rates in ventriculoatrial, ventriculoperitoneal and lumboperitoneal shunt therapy in patients with pseudotumor cerebri

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  • Chuh-Hyoun Na - Klinik für Neurochirurgie, Universitätsklinikum der RWTH Aachen, Aachen
  • Hans Clusmann - Klinik für Neurochirurgie, Universitätsklinikum der RWTH Aachen, Aachen

Deutsche Gesellschaft für Neurochirurgie. 66. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC). Karlsruhe, 07.-10.06.2015. Düsseldorf: German Medical Science GMS Publishing House; 2015. DocDI.13.07

doi: 10.3205/15dgnc166, urn:nbn:de:0183-15dgnc1666

Published: June 2, 2015

© 2015 Na et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objective: The optimal type of shunt therapy in pseudotumor cerebri (idiopathic intracranial hypertension) is still a matter of debate. Traditionally, lumboperitoneal shunt systems have been favored in these patients owing to the fact that they lack ventricular enlargement. Data on experience with ventricular shunt systems in these patients are sparse. We compared long-term revision-rates of lumboperitoneal (LP), ventriculoperitoneal (VP) and ventriculoatrial (VA) shunt therapy in patients treated for pseudotumor cerebri.

Method: A retrospective chart review was conducted on 36 patients treated for pseudotumor cerebri between 1990 and 2014. Epidemiologic and clinical data as well as shunt revision-rates were evaluated with respect to different shunt systems.

Results: 36 patients [3 male, mean 38.1 years (SD ± 13.4), BMI mean 35.4 (SD ± 8.4); mean follow-up 58.6 months (range 8 d-294 months)] underwent shunt placement for the first time. 7/36 received a lumboperitoneal (LP), 11/36 a ventriculoatrial (VA) and 18/36 a ventriculo- peritoneal (VP) shunt initially. In 20 patients (3/7 LP, 8/11 VA, 9/18 VP), revision was required, totaling 50 revisions in the long-term. With placement of 8 LP, 13 VA and 23 VP shunts in total, revision-rates (per shunt placement) in LP and VA shunts were similiar (mean 1.25 and 1.23, respectively) while revision-rate in VP shunts was lower (mean 1.04). The most common reason for revision in LP was dislocation/deviation of the intraspinal catheter (4/10), in VA dislocation/malplacement of the atrial catheter (7/16). In VP, revision of the distal shunt catheter (peritoneal catheter) occured less often (6/24). However, revision of the ventricular catheter was frequently (12/40) required in the ventricular shunt systems (VA, VP). Severe complications occurred in 4/13 of VA patients (1 endocarditis, 1 meningitis, 1 sepsis, 1 subdural hematoma) and in 2/23 of VP patients (1 intracranial abscess, 1 intracerebral hemorrhage).

Conclusions: VA shunt seemed to be the least favorable treatment option considering the high revision rate and an increased risk for severe (especially infectious) complications. Although revision-rate seemed to be slightly higher in LP than in VP shunt therapy, the potential risk of severe intracerebral complications in ventricular shunt placement has to be taken into account. Prospective data is needed to assess efficacy and safety of different treatment options.