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World Neurosurg. 2016 Aug;92:445-453. doi: 10.1016/j.wneu.2016.05.038. Epub 2016 May 27.

Failed Ventriculoperitoneal Shunt: Is Retrograde Ventriculosinus Shunt a Reliable Option?

Author information

1
Group of Cerebral Hydrodynamics, Division of Functional Neurosurgery of the Institute of Psychiatry, Hospital das Clinicas, University of Sao Paulo School of Medicine, Sao Paulo, Brazil. Electronic address: mafernoliv@yahoo.com.br.
2
Group of Cerebral Hydrodynamics, Division of Functional Neurosurgery of the Institute of Psychiatry, Hospital das Clinicas, University of Sao Paulo School of Medicine, Sao Paulo, Brazil; Division of Neurological Surgery, Hospital das Clinicas, University of Sao Paulo School of Medicine, Sao Paulo, Brazil.
3
Group of Cerebral Hydrodynamics, Division of Functional Neurosurgery of the Institute of Psychiatry, Hospital das Clinicas, University of Sao Paulo School of Medicine, Sao Paulo, Brazil.

Abstract

BACKGROUND:

Currently, the treatment of hydrocephalus is mainly carried out through a ventriculoperitoneal shunt (VPS) insertion. However, in some cases, there may be surgical revisions and requirement of an alternative distal site for shunting. There are several described distal sites, and secondary options after VPS include ventriculopleural and ventriculoatrial shunt, which have technical difficulties and harmful complications.

OBJECTIVES:

In this preliminary report we describe our initial experience with retrograde ventriculosinus shunt (RVSS) after failed VPS.

RESULTS:

In 3 consecutive cases we applied RVSS to treat hydrocephalus in shunt-dependent patients who had previously undergone VPS revision and in which peritoneal space was full of adhesions and fibrosis. RVSS was performed as described by Shafei et al., with some modifications to each case. All 3 patients kept the same clinical profile after RVSS, with no perioperative or postoperative complications. However, revision surgery was performed in the first operative day in 1 out of 3 patients, in which the catheter was not positioned in the superior sagittal sinus.

CONCLUSIONS:

We propose that in cases where VPS is not feasible, RVSS may be a safe and applicable second option. Nevertheless, the long-term follow-up of patients and further learning curve must bring stronger evidence.

KEYWORDS:

Failed ventriculoperitoneal shunt; Hydrocephalus; Neurosurgery; Retrograde ventriculosinus shunt

PMID:
27237416
DOI:
10.1016/j.wneu.2016.05.038
[Indexed for MEDLINE]

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