gms | German Medical Science

Objective: Ventriculoperitoneal (VP) shunting is an established treatment for medical refractory pseudotumor cerebri syndrome (PTCS). Nevertheless, rates of shunt failure in PTCS patients appear to be higher than in other disorders, mostly attributable to obstruction of the shunt system. The aim of this study was to assess the patterns of shunt failure and the reasons for shunt-related operations in PTCS treated with VP shunts.

Methods: We retrospectively reviewed all patients who were diagnosed with PTCS and treated with a VP shunt in our department from 2005 to 2021. We excluded patients with PTCS initially diagnosed and operated elsewhere but treated for shunt failure in our department. Patterns of “shunt failure” were categorized according to their etiology (infection, obstruction, malfunction, migration, disconnection) and the corresponding site of the VP system if applicable. Operations performed for shunt patency unrelated causes were analysed as well.

Results: Fifty-two patients (43 women and 9 men) underwent VP shunt placement. The median age was 32 years (range 18-67 years) and the median body mass index was 34 kg/cm² (range 19-50). Insertion of the ventricular catheter was aided in 48/52 procedures by electromagnetic navigation. A programmable valve was implanted in all patients at a median opening pressure of 6cmH2O (range 6-15 cmH2O), in 49/52 with an integrated gravitation unit. In all cases, accurate positioning of the shunt system was confirmed on early postoperative CT-scan and in radiographic shunt series. Eleven patients had a total of 20 shunt-related operations during a median follow-up of 37 months (range 3-202 months). Cases of shunt failure were attributable to infection (4), preperitoneal migration of the distal catheter (2), malfunction of the shunt valve (1), disconnection of the proximal catheter (1) and disruption of the abdominal catheter (1). Additional causes for revision surgery included shortening of the abdominal catheter because of intrabdominal pain (4); wound revision (1) and abdominal hernia repair (1). In 5/52 patients replacement of the integrated gravitation unit by an adjustable device was performed for treatment of low pressure headaches.

Conclusion: Our findings demonstrate a high shunt patency rate without shunt obstruction, probably attributable to the optimal initial placement of the ventricular catheter. Nevertheless, VP-shunting in PTCS is associated with a relatively high rate of non-obstructive revision surgery.