A Technique for Treatment of Overdrainage in Ventriculoperitoneal Shunt

Kpélao *, Essossinam; Anthony Békéti, Katanga; Moumouni, Abdel Kader; Hobli-Ahanogbé, Kodjo Mensah; Doléagbenou, Agbéko Komlan; Egu, Komi; Alihonou, Thierry; Bakondé, Essosolim Hodabalo; Egbohou, Pilakimwé; Dossim, Assang

doi:10.29252/irjns.3.2.58

Volume 3, Issue 2 (9-2017) Iran J Neurosurg 2017, 3(2): 58-62 | Back to browse issues page

‎ 10.29252/irjns.3.2.58

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Kpélao * E, Anthony Békéti K, Moumouni A K, Hobli-Ahanogbé K M, Doléagbenou A K, Egu K, et al . A Technique for Treatment of Overdrainage in Ventriculoperitoneal Shunt . Iran J Neurosurg 2017; 3 (2) :58-62
URL: http://irjns.org/article-1-108-en.html

A Technique for Treatment of Overdrainage in Ventriculoperitoneal Shunt

Essossinam Kpélao * ^*

¹, Katanga Anthony Békéti²

, Abdel Kader Moumouni²

, Kodjo Mensah Hobli-Ahanogbé²

, Agbéko Komlan Doléagbenou²

, Komi Egu²

, Thierry Alihonou³

, Essosolim Hodabalo Bakondé²

, Pilakimwé Egbohou⁴

, Assang Dossim²

1- Department of Neurosurgery, Sylvanus Olympio University Hospital, Lomé, Togo , kpelas77@yahoo.fr
2- Department of Neurosurgery, Sylvanus Olympio University Hospital, Lomé, Togo
3- Department of Surgery University Hospital Center of Ouémé and Plateau, Benin
4- Intensive Care Unit, Sylvanus Olympio University Hospital, Lomé, Togo

Abstract: (5331 Views)

Background and Importance: Overdrainage is a complication of ventriculoperitoneal shunt but adjustable valves and anti-siphon devices can prevent it. These very expensive valves are most often inaccessible, so that the majority of the valves available in Togo are fixed differential pressure valves. Although overdrainage is a widely-known issue, we aimed to introduce a new risk factor and the way we manage this complication.

Case Presentation: This case series study included all patients who had overdrainage or a high potential risk of overdrainage (hydranencephaly). Our technique consisted of partial ligation of the peritoneal catheter at the level of the thorax by non-resorbable wire while controlling the drainage rate at the slots. The goal was to transform this fixed differential pressure valve into a pressure-controlled and flow-regulated one. Patients were followed for 1, 3 and 6 months, postoperatively.

Conclusion: Hydranencephaly predisposes patients to overdrainage. The partial ligature of the catheter is an effective technique for treating or preventing overdrainage.

Keywords: Overdrainage, Ligation, Catheter

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Type of Study: Clinical Trial | Subject: Neurotrauma

References

1. Faulhauer K, Schmitz P. Overdrainage phenomena in shunt treated hydrocephalus. Acta Neurochir. 1978; 45 :89–101. [DOI:10.1007/BF01774384]

2. Pudenz RH, Foltz EL. Hydrocephalus: overdrainage by ventricular shunts. A review and recommendations. Surg Neurol. 1991; 35(3): 200–212. [DOI:10.1016/0090-3019(91)90072-H]

3. Epstein F, Lapras C, Wisoff JH. 'Slit-ventricle syndrome': etiology and treatment. Pediatr Neurosurg. 1988; 14 :5–10. [DOI:10.1159/000120354]

4. Tschan CA, Antes S, Huthmann A, Vulcu S, Oertel J, Wagner W. Overcoming CSF overdrainage with the adjustable gravitational valve proSA. Acta Neurochir (Wien). 2014; 156 :767–776. [DOI:10.1007/s00701-013-1934-3]

5. Aschoff A, Kremer P, Benesch C, Fruh K, Klank A, Kunze S. Overdrainage and shunt technology. Childs Nerv Sys. 1995 ;11 :193–202. [DOI:10.1007/BF00277653]

6. Drake JM, Kestle JR, Milner R, Cinalli G, Boop F, Piatt J Jr, et al. Randomized trial of cerebrospinal fluid shunt valve design in pediatric hydrocephalus. Neurosurg. 1998; 43 :294–303. https://doi.org/10.1097/00006123-199811000-00158 [DOI:10.1097/00006123-199808000-00068]

7. Portnoy HD, Schulte RR, Fox JL, Croissant PD, Tripp L. Antisiphon and reversible occlusion valves for shunting in hydrocephalus and preventing post-shunt subdural hematomas. J Neurosurg. 1973; 38(6):729–738. [DOI:10.3171/jns.1973.38.6.0729]

8. Reinprecht A, Dietrich W, Bertalanffy A, Czech T. The Medos Hakim programmable valve in the treatment of pediatric hydrocephalus. Childs Nerv Sys. 1997; 13(11–12) :588–593. [DOI:10.1007/s003810050145]

9. Piatt JH, Carlson CV. A search for determinants of cerebrospinal fluid shunt survival: Retrospective analysis of a 14 years institutional experience. Pediatr. Neurosurg. 1993; 19 (5): 233-241. [DOI:10.1159/000120738]

10. Sainte-Rose C, Piatt JH, Renier D, Pierre-Kahn A, Hirsch JF, Hoffman HJ, et al. Mechanical complications in shunts. Pediatr. Neurosurg. 1991-1992; 17 (1): 2-9. [DOI:10.1159/000120557]

11. Freimann FB, Sprung C. Shunting with gravitational valves-can adjustments end the era of revisions for overdrainage-related events? J Neurosurg. 2012; 117 :1197–1204. [DOI:10.3171/2012.8.JNS1233]

12. Boon AJ, Tans JT, Delwel EJ, Egeler-Peerdeman SM, Hanlo PW,Wurzer HA, et al. Dutch Normal-Pressure-Hydrocephalus Study. Randomized comparison of low- and medium-pressure shunts. J Neurosurg. 1998; 88(3) :490–495. [DOI:10.3171/jns.1998.88.3.0490]

13. Gruber RW, Roehrig B. Prevention of ventricular catheter obstruction and slit ventricle syndrome by the prophylactic use of the Integra antisiphon device in shunt therapy for pediatric hypertensive hydrocephalus: a 25-year follow-up study. J Neurosurg Pediatr. 2010; 5(1):4–16. [DOI:10.3171/2008.7.17690]

14. Kestle J, Drake J, Milner R, Sainte-Rose C, Cinalli G, Boop F, et al. Longterm follow-up data from the Shunt Design Trial. Pediatr Neurosurg. 2000; 33(5) :230–236. [DOI:10.1159/000055960]

15. Freimann FB, Kimura T, Stockhammer F, Schulz M, Rohde V, Thomale UW. In vitro performance and principles of antisiphoning devices. Acta Neurochir (Wien). 2014; 156 :2191–2199. [DOI:10.1007/s00701-014-2201-y]

16. Drake JM, Tenti G, Sivalsganathan S. Computer modeling of siphoning for CSF shunt design evaluation. Pediatr Neurosurg. 1994; 21 :6–15. [DOI:10.1159/000120808]

17. Cheok S, Chen J, Lazareff J. The truth and coherence behind the concept of overdrainage of cerebrospinal fluid in hydrocephalic patients. Childs Nerv Syst. 2014; 30(4) :599– 606. [DOI:10.1007/s00381-013-2327-x]

18. Fox JL, McCullough DC, Green RC. Effect of cerebrospinal fluid shunts on intracranial pressure and on cerebrospinal fluid dynamics 2. A new technique of pressure measurements: results and concepts 3. A concept of hydrocephalus. J Neurol Neurosurg Psychiatry. 1973; 36 :302–312. [DOI:10.1136/jnnp.36.2.302]

19. Meier U, Stengel D, Müller C, Fritsch MJ, Kehler U, Langer N, et al. Predictors of subsequent overdrainage and clinical outcomes after ventriculoperitoneal shunting for idiopathic normal pressure hydrocephalus. Neurosurgery. 2013; 73 :1054-1060. [DOI:10.1227/NEU.0000000000000155]

20. Diesner N, Freimann F, Clajus C, Kallenberg K, Rohde V, Stockhammer F. Female gender predisposes for cerebrospinal fluid overdrainage in ventriculoperitoneal shunting. Acta Neurochir. 2016; 158 (7) :1273–8. [DOI:10.1007/s00701-016-2827-z]

21. Enzi G, Gasparo M, Biondetti PR, Fiore D, Semisa M, Zurlo F. Subcutaneous and visceral fat distribution according to sex, age, and overweight, evaluated by computed tomography. Am J Clin Nutr.1986; 44 :739–746. [DOI:10.1093/ajcn/44.6.739] [PMID]

22. Yamada H, Tajima M, Nagaya M. Effect of respiratory movement on cerebrospinal fluid dynamics in hydrocephalic infants with shunts. J Neurosurg. 1975; 42(2) :194–200. [DOI:10.3171/jns.1975.42.2.0194] [PMID]

23. Andersson H. Craniosynostosis as a complication after operation for hydrocephalus. Acta Paediatr. 1966; 55 :192–196. [DOI:10.1111/j.1651-2227.1966.tb15225.x]

24. Czosnyka M, Czosnyka Z, Pickard JD. Programmable shunt assistant tested in Cambridge shunt evaluation laboratory. Acta Neurochir (Wein). 2012; 113 :71–76. [DOI:10.1007/978-3-7091-0923-6_15] [PMID]

25. Kehler U, Kiefer M, Eymann R, Wagner W, Tschan CA, Langer N, et al. PROSAIKA: a prospective multicenter registry with the first programmable gravitational device for hydrocephalus shunting. Clin Neurol Neurosurg. 2015; 137: 132–136. [DOI:10.1016/j.clineuro.2015.07.002] [PMID]

26. Kay AD, Fisher AJ, O'Kane C, Richards HK, Pickard JD. A clinical audit of the Hakim programmable valve in patients with complex hydrocephalus. Br J Neurosurg. 2000; 14(6) :535–543. [DOI:10.1080/02688690020005545]

27. Kiefer M. Treatment of hydrocephalus. Radiologe. 2012; 52(9) :833–839. [DOI:10.1007/s00117-012-2328-x]

28. Kremer P, Aschoff A, Kunze S. Risks of using siphonreducing devices. Childs Nerv Syst. 1994; 10(4) :231–235. [DOI:10.1007/BF00301159]

29. Covington C, Taylor H, Gill C, Padaliya B, Newman W, Smart JR 3rd, et al. Prolonged survival in hydranencephaly: a case report. Tenn Med. 2003; 96(9) :423-4.

30. Cecchetto G, Milanese L, Giordano R, Viero A, Suma V, Manara R. Looking at the missing brain: hydranencephaly case series and literature review. Pediatr Neurol. 2013; 48(2) :152-8. [DOI:10.1016/j.pediatrneurol.2012.10.009]

31. Sutton LN, Bruce DA, Schut L. Hydranencephaly versus maximal hydrocephalus: an important clinical distinction. Neurosurgery. 1980; 6(1) :34-8. https://doi.org/10.1097/00006123-198001000-00004 [DOI:10.1227/00006123-198001000-00004]

32. Adeloye A. Hydranencephaly in Malawian children. East Afr Med J. 2000; 77(6): 316-8. [PMID]

33. Malheiros JA, Trivelato FP, Oliveira MM, Gusmão S, Cochrane DD, Steinbok P. Endoscopic choroid plexus cauterization versus ventriculoperitoneal shunt for hydranencephaly and near hydranencephaly: a prospective study. Neurosurgery. 2010; 66(3): 459-64. [DOI:10.1227/01.NEU.0000365264.99133.CA] [PMID]

34. Hode L, Gandaho HJP, Yekpe FP, Alihonou T, Houessou GF, Hadonou AA, et al. Hydranencephalie a cotonou (benin) a propos de 3 cas cliniques. African Journal of Neurological Sciences. 2013; 32 (2): 65-71

35. Hyde-Rowan MD, Rekate HL, Nulsen FE. Reexpansion of previously collapsed ventricles: the slit ventricle syndrome. J Neurosurg. 1982; 56 :536-9. [DOI:10.3171/jns.1982.56.4.0536] [PMID]

36. Thomas PF, Azan JL. Calcul des forces pressantes sur les parois planes. In : Thomas PF, Azan JL (eds) Précis de physique-chimie. Bréal, Nanterre: Levallois-Perret. 2006; 171-173.

37. Ziebell M, Wetterslev J, Tisell M, Gluud C, Juhler M. Flow-regulated versus differential pressure-regulated shunt valves for adult patients with normal pressure hydrocephalus. Cochrane Database Syst Rev. 2013; 31 (5):CD009706. doi: 10.1002/14651858.CD009706.pub2. [DOI:10.1002/14651858.CD009706.pub2]

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