Letter to the Editor. Entry site for ventriculoperitoneal shunt insertion and de novo post-shunt seizures

Ali A. Asadi-Pooya Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
Jefferson Comprehensive Epilepsy Center, Thomas Jefferson University, Philadelphia, PA

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TO THE EDITOR: I read with interest the article by Whitehead et al.1 (Whitehead WE, Riva-Cambrin J, Wellons JC III, et al. Anterior versus posterior entry site for ventriculoperitoneal shunt insertion: a randomized controlled trial by the Hydrocephalus Clinical Research Network. J Neurosurg Pediatr. Published online November 19, 2021. doi:10.3171/2021.9.PEDS21391). Dr. Whitehead and colleagues concluded that anterior and posterior entry site shunt surgeries have similar outcomes and similar complication rates.1 They reported that there were no significant differences between entry sites for intraoperative complications, shunt infections, postoperative seizures, new-onset epilepsy, or intracranial hemorrhages. In a recent study, we specifically investigated whether shunt location is a risk factor for the development of de novo post-shunt seizures.2 Among 114 studied patients, 68 (60%) had a frontal location for shunt insertion and 46 (40%) had a parietal entry site. Twenty-four patients (21%) reported experiencing de novo post-shunt seizures; 15 of them had a frontal entry location and 9 had a parietal entry location (p = 0.824).2 These two studies strongly suggest that shunt location is not a significant risk factor for the development of de novo post-shunt seizures in patients with hydrocephalus. One study suggested that shunt location was important in the development of de novo post-shunt seizures in patients with hydrocephalus,3 but this observation was not reproduced in two other studies.4,5

On the basis of these studies, we can conclude that de novo post-shunt seizures are relatively common occurrences; however, shunt entry location is not a significant risk factor for the development of de novo post-shunt seizures.

Disclosures

Dr. Asadi-Pooya receives honoraria from Cobel Darou, Sanofi, and Raymand Rad and royalties from Oxford University Press.

References

  • 1

    Whitehead WE, Riva-Cambrin J, Wellons JC III, et al. Anterior versus posterior entry site for ventriculoperitoneal shunt insertion: a randomized controlled trial by the Hydrocephalus Clinical Research Network. J Neurosurg Pediatr. Published online November 19, 2021.doi:10.3171/2021.9.PEDS21391

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  • 2

    Bazrafshan H, Masoudi M, Bazrafshan M, Asadi-Pooya A. Is shunt location a risk factor for the development of de novo post-shunt seizures?. Iran J Med Sci. Published online September 14, 2021.doi:doi:10.30476/ijms.2021.88641.1934

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  • 3

    Dan NG, Wade MJ. The incidence of epilepsy after ventricular shunting procedures. J Neurosurg. 1986;65(1):1921.

  • 4

    Klepper J, Büsse M, Strassburg HM, Sörensen N. Epilepsy in shunt-treated hydrocephalus. Dev Med Child Neurol. 1998;40(11):731736.

  • 5

    Bhargav AG, Rinaldo L, Lanzino G, Elder BD. Comparison of complication and revision rates after frontal versus parietal approach for ventricular shunt placement in idiopathic normal pressure hydrocephalus. World Neurosurg. 2019;126:e1017e1022.

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William E. Whitehead Baylor College of Medicine, Houston, TX

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Response

We thank Dr. Asadi-Pooya for his interest in our study and for calling attention to an important finding. When one reviews the body of evidence, as Dr. Asadi-Pooya has done and referenced, one can be reasonably confident that the shunt entry site does not affect the risk of de novo post-shunt seizures and new-onset epilepsy.

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Illustration from Pettersson et al. (pp 467–475).
  • 1

    Whitehead WE, Riva-Cambrin J, Wellons JC III, et al. Anterior versus posterior entry site for ventriculoperitoneal shunt insertion: a randomized controlled trial by the Hydrocephalus Clinical Research Network. J Neurosurg Pediatr. Published online November 19, 2021.doi:10.3171/2021.9.PEDS21391

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2

    Bazrafshan H, Masoudi M, Bazrafshan M, Asadi-Pooya A. Is shunt location a risk factor for the development of de novo post-shunt seizures?. Iran J Med Sci. Published online September 14, 2021.doi:doi:10.30476/ijms.2021.88641.1934

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3

    Dan NG, Wade MJ. The incidence of epilepsy after ventricular shunting procedures. J Neurosurg. 1986;65(1):1921.

  • 4

    Klepper J, Büsse M, Strassburg HM, Sörensen N. Epilepsy in shunt-treated hydrocephalus. Dev Med Child Neurol. 1998;40(11):731736.

  • 5

    Bhargav AG, Rinaldo L, Lanzino G, Elder BD. Comparison of complication and revision rates after frontal versus parietal approach for ventricular shunt placement in idiopathic normal pressure hydrocephalus. World Neurosurg. 2019;126:e1017e1022.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation

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