Article
Internal shunting of brain tumour patients via vascular polyester stents: a technical note
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Authors
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Mario Mühmer
- Neurochirurgische Klinik, Heinrich-Heine-Universität, Düsseldorf, Germany
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Jan Vesper
- Neurochirurgische Klinik, Heinrich-Heine-Universität, Düsseldorf, Germany
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Hans-Jakob Steiger
- Neurochirurgische Klinik, Heinrich-Heine-Universität, Düsseldorf, Germany
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Michael Sabel
- Neurochirurgische Klinik, Heinrich-Heine-Universität, Düsseldorf, Germany
| Published: | June 8, 2016 |
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Outline
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Objective: Patients with malignant brain tumours sometimes show clinical deterioration due to development of a compartment hydrocephalus because of liquor cysts or trapped ventricles. Opening of the cysts or ventriculostomy are often not a permanent solution to obtain free liquor flow. Classical drainage via a ventriculo- or cysto-peritoneal shunt is prone to mechanical complications of the valve system or different pressure characteristics within the cysts. Here, we report a experimental method of draining the cysts or ventricle by navigated implantation of polyester grafts, usually used in vascular stenting.
Method: We report on two patients with recurrent glioma of the brain. The first one was stereotactically shunted with two stents to establish a connection of the compartments with the ventricle system as previously described by Berlis, Vesper and Ostertag in 2006. The other patient was stented between the left and right cella media using neuronavigation and opening of the cyst. Both patients were stented internally via polyester grafts (double-knitted velours with gelatine impregnation; Uni-Graft®; B. Braun).
Results: Of the two cases, one presented with clinical deterioration and reduction of consciousness due to a cyst and a trapped left temporal horn of the left ventricle, while the other patient showed progressive hemiparesis due to a right frontal cyst and trapping of the right ventricle with consecutive midline shift. Right after operation, each of them showed clinical improvement of their symptoms afterwards. After a follow-up of over 5 years, the trapped ventricle of patient 1 was still drained, while the cyst re-developed, so a drainage via an Ommaya reservoir was facilitated. Patient 2 still had a fully functioning internal drain after 1 year of follow-up.
Conclusions: Compartment hydrocephalus due to cyst formation and trapping of the ventricle is occasionally seen, when resecting recurrent glioma with ventricle opening. Since cystostomy or ventriculostomy is prone to re-occlusion, a classical shunt system is implanted sometimes with known complications. Internally stenting with vascular grafts seems to be a safe and cheap method to re-establish liquor circulation.
