Valved or valveless ventriculoperitoneal shunting in the treatment of post-haemorrhagic hydrocephalus: a population-based consecutive cohort study

TY - JOUR

T1 - Valved or valveless ventriculoperitoneal shunting in the treatment of post-haemorrhagic hydrocephalus

T2 - a population-based consecutive cohort study

AU - Andreasen, Trine Hjorslev

AU - Holst, Anders Vedel

AU - Lilja, Alexander

AU - Andresen, Morten

AU - Bartek, Jiri

AU - Eskesen, Vagn

AU - Juhler, Marianne

PY - 2016/2/1

Y1 - 2016/2/1

N2 - BACKGROUND: Implant infection and obstruction are major complications for ventriculoperitoneal shunts in patients with post-haemorrhagic hydrocephalus. In an effort to (1) reduce the incidence of these complications, (2) reduce the rate of shunt failure and (3) shorten the duration of neurosurgical hospitalisation, we have implemented valveless ventriculoperitoneal shunts at our department for adult patients with post-haemorrhagic hydrocephalus and haemorrhagic cerebrospinal fluid at the time of shunt insertion.METHODS: All adult patients (>18 years old) treated for post-haemorrhagic hydrocephalus with ventriculoperitoneal shunting at our institution from 1 January 2008 to 31 December 2014 were included in this retrospective population-based consecutive cohort study. Data were collected by retrospectively reviewing medical records. We compared two different shunt modalities (valveless vs valve-regulated), analysing frequencies of complications, shunt survival and duration of neurosurgical hospitalisation.RESULTS: A total of 214 patients aged 22-86 (mean age, 60.5 ± 11.5 years) were included, comprising 137 valveless and 77 valve-regulated shunts. We found no difference in the rate of surgical shunt revision (p = 0.65) or differences in time interval from insertion to first surgical revision (p = 0.31) between the two shunt modalities. The duration of neurosurgical hospitalisation was shorter for patients receiving a valveless shunt (p = 0.004). Patients with valveless shunts had a lower rate of shunt infection (5.1 % vs 14.3 %, p = 0.02), but a higher rate of overdrainage (10.3 % vs 2.6 %, p = 0.04).CONCLUSION: The use of a valveless shunting for patients with post-haemorrhagic hydrocephalus results in shorter duration of neurosurgical hospitalisation and lower rate of shunt infection, although these advantages should be held up against the risk of overdrainage. We propose valveless shunting to be used as first-line shunting strategy in this patient category, with careful follow-up ensuring that these are substituted by a valve-bearing system if necessary.

AB - BACKGROUND: Implant infection and obstruction are major complications for ventriculoperitoneal shunts in patients with post-haemorrhagic hydrocephalus. In an effort to (1) reduce the incidence of these complications, (2) reduce the rate of shunt failure and (3) shorten the duration of neurosurgical hospitalisation, we have implemented valveless ventriculoperitoneal shunts at our department for adult patients with post-haemorrhagic hydrocephalus and haemorrhagic cerebrospinal fluid at the time of shunt insertion.METHODS: All adult patients (>18 years old) treated for post-haemorrhagic hydrocephalus with ventriculoperitoneal shunting at our institution from 1 January 2008 to 31 December 2014 were included in this retrospective population-based consecutive cohort study. Data were collected by retrospectively reviewing medical records. We compared two different shunt modalities (valveless vs valve-regulated), analysing frequencies of complications, shunt survival and duration of neurosurgical hospitalisation.RESULTS: A total of 214 patients aged 22-86 (mean age, 60.5 ± 11.5 years) were included, comprising 137 valveless and 77 valve-regulated shunts. We found no difference in the rate of surgical shunt revision (p = 0.65) or differences in time interval from insertion to first surgical revision (p = 0.31) between the two shunt modalities. The duration of neurosurgical hospitalisation was shorter for patients receiving a valveless shunt (p = 0.004). Patients with valveless shunts had a lower rate of shunt infection (5.1 % vs 14.3 %, p = 0.02), but a higher rate of overdrainage (10.3 % vs 2.6 %, p = 0.04).CONCLUSION: The use of a valveless shunting for patients with post-haemorrhagic hydrocephalus results in shorter duration of neurosurgical hospitalisation and lower rate of shunt infection, although these advantages should be held up against the risk of overdrainage. We propose valveless shunting to be used as first-line shunting strategy in this patient category, with careful follow-up ensuring that these are substituted by a valve-bearing system if necessary.

KW - Journal Article

KW - Research Support, Non-U.S. Gov't

U2 - 10.1007/s00701-015-2659-2

DO - 10.1007/s00701-015-2659-2

M3 - Journal article

C2 - 26668079

SN - 0001-6268

VL - 158

SP - 261

EP - 270

JO - Acta Neurochirurgica

JF - Acta Neurochirurgica

IS - 2

ER -