Continuous-flow shunt for treatment of hydrocephalus due to lesions of the posterior fossa

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  • 1 Research and Neurosurgical Divisions, National Institute of Neurology and Neurosurgery of Mexico, Mexico City, Mexico
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Object. Management of hydrocephalus caused by expansive lesions of the posterior fossa is complicated by two main drawbacks of shunt devices: sudden decompression and overdrainage. The ventriculoperitoneal (VP) continuous-flow (CF) shunt is characterized by a peritoneal catheter with an internal diameter of 0.51 mm that promotes continuous drainage of cerebrospinal fluid (CSF) at its production rate. The authors have previously demonstrated in adult patients with hydrocephalus that sudden decompression and overdrainage are absent when this shunt is used; here they report the findings of a prospective study in which the goal was to test the performance of this shunt in patients with severe hydrocephalus due to lesions of the posterior fossa.

Methods. During a 5-year period, 103 patients with severe hydrocephalus caused by lesions of the posterior fossa were treated by placement of a VP shunt. In 53 of these patients (control group) a shunt and valve system was surgically implanted and in 50 patients a CF shunt was implanted. All patients were followed up for a minimum of 2 years after surgery.

Shunt revision or change was necessary in 21 patients (40%) with conventional shunts and in four patients (8%) with the CF shunt (p < 0.003). Signs of overdrainage were observed in 18 patients (34%) in the control group, four of whom had ascending transtentorial herniation; this complication was not seen in patients with the CF shunt.

Conclusions. The CF shunt had a low rate of dysfunction and an absence of complications caused by overdrainage, which were frequently associated with the control shunts. The hydrodynamic properties of the CF shunt make it effective, even in severe cases of hydrocephalus caused by lesions of the posterior fossa.

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Contributor Notes

Address reprint requests to: Julio Sotelo, M.D., Instituto Nacional de Neurología y Neurocirugía, Insurgentes Sur 3877, 14269 Mexico City, Mexico. email: jsotelo@servidor.unam.mx.
  • 1.

    Arriada N, & Sotelo J: Treatment of hydrocephalus in adults. Surg Neurol 58:377384, 2002 Arriada N, Sotelo J: Treatment of hydrocephalus in adults. Surg Neurol 58:377–384, 2002

    • Search Google Scholar
    • Export Citation
  • 2.

    Bergsneider M, , Peacock WJ, & Mazziotta JC, et al: Beneficial effect of siphoning in treatment of adult hydrocephalus. Arch Neurol 56:12241229, 1999 Bergsneider M, Peacock WJ, Mazziotta JC, et al: Beneficial effect of siphoning in treatment of adult hydrocephalus. Arch Neurol 56:1224–1229, 1999

    • Search Google Scholar
    • Export Citation
  • 3.

    Blount JP, , Campbell JA, & Haines SJ: Complications in ventricular cerebrospinal fluid shunting. Neurosurg Clin N Am 4:633656, 1993 Blount JP, Campbell JA, Haines SJ: Complications in ventricular cerebrospinal fluid shunting. Neurosurg Clin N Am 4:633–656, 1993

    • Search Google Scholar
    • Export Citation
  • 4.

    Bogdahn U, , Lau W, & Hassel W, et al: Continous-pressure controlled external ventricular draining for treatment of acute hydrocephalus—evaluation of risk factors. Neurosurgery 31:898904, 1992 Bogdahn U, Lau W, Hassel W, et al: Continous-pressure controlled external ventricular draining for treatment of acute hydrocephalus—evaluation of risk factors. Neurosurgery 31:898–904, 1992

    • Search Google Scholar
    • Export Citation
  • 5.

    Briggs RJ, , Shelton C, & Kwartler JA, et al: Management of hydrocephalus resulting from acoustic neuromas. Otolaryngol Head Neck Surg 109:10201024, 1993 Briggs RJ, Shelton C, Kwartler JA, et al: Management of hydrocephalus resulting from acoustic neuromas. Otolaryngol Head Neck Surg 109:1020–1024, 1993

    • Search Google Scholar
    • Export Citation
  • 6.

    Culley DJ, , Berger MS, & Shaw D, et al: An analysis of factors determining the need for ventriculoperitoneal shunts after posterior fossa tumor surgery in children. Neurosurgery 34:402408, 1994 Culley DJ, Berger MS, Shaw D, et al: An analysis of factors determining the need for ventriculoperitoneal shunts after posterior fossa tumor surgery in children. Neurosurgery 34:402–408, 1994

    • Search Google Scholar
    • Export Citation
  • 7.

    Decq P, , Yepes C, & Anno Y, et al: L'endoscopies neurochirurgicale. Indications diagnostiques et terapeutiques. Neurochirurgie 40:313321, 1994 Decq P, Yepes C, Anno Y, et al: L'endoscopies neurochirurgicale. Indications diagnostiques et terapeutiques. Neurochirurgie 40:313–321, 1994

    • Search Google Scholar
    • Export Citation
  • 8.

    Foltz EL: Hydrocephalus: slit ventricles, shunt obstructions, and third ventricle shunts: a clinical study. Surg Neurol 40:119124, 1993 Foltz EL: Hydrocephalus: slit ventricles, shunt obstructions, and third ventricle shunts: a clinical study. Surg Neurol 40:119–124, 1993

    • Search Google Scholar
    • Export Citation
  • 9.

    Foltz EL, & Blanks JP: Symptomatic low intracranial pressure in shunted hydrocephalus. J Neurosurg 68:401408, 1988 Foltz EL, Blanks JP: Symptomatic low intracranial pressure in shunted hydrocephalus. J Neurosurg 68:401–408, 1988

    • Search Google Scholar
    • Export Citation
  • 10.

    Grant JA, & McLone DG: Third ventriculostomy: a review. Surg Neurol 47:210212, 1997 Grant JA, McLone DG: Third ventriculostomy: a review. Surg Neurol 47:210–212, 1997

    • Search Google Scholar
    • Export Citation
  • 11.

    Hopf NJ, , Grunert P, & Fries G, et al: Endoscopic third ventriculostomy: outcome analysis of 100 consecutive procedures. Neurosurgery 44:795806, 1999 Hopf NJ, Grunert P, Fries G, et al: Endoscopic third ventriculostomy: outcome analysis of 100 consecutive procedures. Neurosurgery 44:795–806, 1999

    • Search Google Scholar
    • Export Citation
  • 12.

    Hoppe-Hirsch E, , Sainte Rose C, & Renier D: Pericerebral collections after shunting. Child Nerv Syst 3:97102, 1987 Hoppe-Hirsch E, Sainte Rose C, Renier D: Pericerebral collections after shunting. Child Nerv Syst 3:97–102, 1987

    • Search Google Scholar
    • Export Citation
  • 13.

    Jamjoom AB, , Jamjoom ZAB, & Ur Rahman N, et al: Low rate of shunt revision in tumoural obstructive hydrocephalus. Acta Neurochir 140:595597, 1998 Jamjoom AB, Jamjoom ZAB, Ur Rahman N, et al: Low rate of shunt revision in tumoural obstructive hydrocephalus. Acta Neurochir 140:595–597, 1998

    • Search Google Scholar
    • Export Citation
  • 14.

    Jones RF, , Kwok BC, & Stening WA, et al: The current status of endoscopic third ventriculostomy in the management of non-communicating hydrocephalus. Minim Invasive Neurosurg 37:2836, 1994 Jones RF, Kwok BC, Stening WA, et al: The current status of endoscopic third ventriculostomy in the management of non-communicating hydrocephalus. Minim Invasive Neurosurg 37:28–36, 1994

    • Search Google Scholar
    • Export Citation
  • 15.

    Jones RF, , Kwok BC, & Stening WA, et al: Neuroendoscopic third ventriculostomy. A practical alternative to extracranial shunts in non-communicating hydrocephalus. Acta Neurochir Suppl 61:7983, 1994 Jones RF, Kwok BC, Stening WA, et al: Neuroendoscopic third ventriculostomy. A practical alternative to extracranial shunts in non-communicating hydrocephalus. Acta Neurochir Suppl 61:79–83, 1994

    • Search Google Scholar
    • Export Citation
  • 16.

    Kelley R, , Duong DH, & Locke GE: Characteristics of ventricular shunt malfunctions among patients with neurocysticercosis. Neurosurgery 50:757762, 2002 Kelley R, Duong DH, Locke GE: Characteristics of ventricular shunt malfunctions among patients with neurocysticercosis. Neurosurgery 50:757–762, 2002

    • Search Google Scholar
    • Export Citation
  • 17.

    Lund-Johansen M, , Svendsen F, & Wester K: Shunt failures and complications in adults as related to shunt type, diagnosis, and the experience of the surgeon. Neurosurgery 35:839844, 1994 Lund-Johansen M, Svendsen F, Wester K: Shunt failures and complications in adults as related to shunt type, diagnosis, and the experience of the surgeon. Neurosurgery 35:839–844, 1994

    • Search Google Scholar
    • Export Citation
  • 18.

    Pirouzmand F, , Tator CH, & Rutka J: Management of hydrocephalus associated with vestibular schwannoma and other cerebellopontine angle tumors. Neurosurgery 48:12461254, 2001 Pirouzmand F, Tator CH, Rutka J: Management of hydrocephalus associated with vestibular schwannoma and other cerebellopontine angle tumors. Neurosurgery 48:1246–1254, 2001

    • Search Google Scholar
    • Export Citation
  • 19.

    Pudenz RH, & Foltz EL: Hydrocephalus: overdrainage by ventricular shunts. A review and recommendations. Surg Neurol 35:200212, 1991 Pudenz RH, Foltz EL: Hydrocephalus: overdrainage by ventricular shunts. A review and recommendations. Surg Neurol 35:200–212, 1991

    • Search Google Scholar
    • Export Citation
  • 20.

    Raimondi AJ, & Tomita T: Hydrocephalus and infratentorial tumors. Incidence, clinical picture, and treatment. J Neurosurg 55:174182, 1981 Raimondi AJ, Tomita T: Hydrocephalus and infratentorial tumors. Incidence, clinical picture, and treatment. J Neurosurg 55:174–182, 1981

    • Search Google Scholar
    • Export Citation
  • 21.

    Rappaport ZH, & Shalit MN: Perioperative external ventricular drainage in obstructive hydrocephalus secondary to infratentorial brain tumours. Acta Neurochir 96:118121, 1989 Rappaport ZH, Shalit MN: Perioperative external ventricular drainage in obstructive hydrocephalus secondary to infratentorial brain tumours. Acta Neurochir 96:118–121, 1989

    • Search Google Scholar
    • Export Citation
  • 22.

    Sainte-Rose C, , Cinalli G, & Roux FE, et al: Management of hydrocephalus in pediatric patients with posterior fossa tumors: the role of endoscopic third ventriculostomy. J Neurosurg 95:791797, 2001 Sainte-Rose C, Cinalli G, Roux FE, et al: Management of hydrocephalus in pediatric patients with posterior fossa tumors: the role of endoscopic third ventriculostomy. J Neurosurg 95:791–797, 2001

    • Search Google Scholar
    • Export Citation
  • 23.

    Samii M, & Matthies C: Management of 1000 vestibular schwannomas (acoustic neuromas): surgical management and results with an emphasis on complications and how to avoid them. Neurosurgery 40:1123, 1997 Samii M, Matthies C: Management of 1000 vestibular schwannomas (acoustic neuromas): surgical management and results with an emphasis on complications and how to avoid them. Neurosurgery 40:11–23, 1997

    • Search Google Scholar
    • Export Citation
  • 24.

    Schroeder HWS, , Niendorf W, & Gaab MR: Complications of endoscopic third ventriculostomy. J Neurosurg 96:10321040, 2002 Schroeder HWS, Niendorf W, Gaab MR: Complications of endoscopic third ventriculostomy. J Neurosurg 96:1032–1040, 2002

    • Search Google Scholar
    • Export Citation
  • 25.

    Sotelo J, , Arriada N, & López MA: Ventriculoperitoneal shunt of continuous flow vs valvular shunt for treatment of hydrocephalus in adults. Surg Neurol (In press) Sotelo J, Arriada N, López MA: Ventriculoperitoneal shunt of continuous flow vs valvular shunt for treatment of hydrocephalus in adults. Surg Neurol (In press)

    • Search Google Scholar
    • Export Citation
  • 26.

    Sotelo J, , Izurieta M, & Arriada N: Treatment of hydrocephalus in adults by an open ventricular shunt. J Neurosurg 94:873879, 2001 Sotelo J, Izurieta M, Arriada N: Treatment of hydrocephalus in adults by an open ventricular shunt. J Neurosurg 94:873–879, 2001

    • Search Google Scholar
    • Export Citation
  • 27.

    Sotelo J, , Rubalcava MA, & Gomez-Llata S: A new shunt for hydrocephalus that relies on CSF production rather than on ventricular pressure: initial clinical experiences. Surg Neurol 43:324332, 1995 Sotelo J, Rubalcava MA, Gomez-Llata S: A new shunt for hydrocephalus that relies on CSF production rather than on ventricular pressure: initial clinical experiences. Surg Neurol 43:324–332, 1995

    • Search Google Scholar
    • Export Citation
  • 28.

    Zemack G, & Romner B: Seven years of clinical experience with the programmable Codman Hakim valve: a retrospective study of 583 patients. J Neurosurg 92:941948, 2000 Zemack G, Romner B: Seven years of clinical experience with the programmable Codman Hakim valve: a retrospective study of 583 patients. J Neurosurg 92:941–948, 2000

    • Search Google Scholar
    • Export Citation

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