Radyolojik anormalliklerin yokluğunda ventriküloperitoneal şant obstrüksiyonları: pediatrik bir kohortun retrospektif analizi
Abstract
Öz
Amaç: Ventriküloperitoneal şant uygulanması pediatrik hidrosefali hastaları için halen temel tedavi yöntemidir. Yüksek komplikasyon ve başarısızlık oranına sahiptirler ve çoklu revizyon gerektirirler. Bu çalışmada radyolojik bulgu olmaksızın şant replasmanı gerektiren hastaların araştırılması amaçlanmıştır.
Gereç ve yöntem: Bursa Uludağ Üniversitesi Tıp Fakültesi Nöroşirürji Kliniği’nde Aralık 2015-Aralık 2020 tarihleri arasında şant revizyonu yapılan 18 yaş altı hastaların dosyaları retrospektif olarak incelendi. Hastaların tüm radyolojik çalışmaları, laboratuvar sonuçları ve klinik durumları incelendi.
Bulgular: Mekanik obstrüksiyon şüphesi nedeniyle ventriküloperitoneal şant revizyonu gerektiren 127 hasta tespit edildi. 6 hastada (%5) artmış intrakraniyal basınç semptomlar vardı, ancak progresif ventrikül dilatasyonuna ait radyografik bulgu görülmedi.
Sonuç: Ventriküloperitoneal şantın disfonksiyonu her zaman ilişkili radyolojik değişikliklere yol açmaz. İntrakraniyal hipertansiyon bulguları olan bir hastada, radyolojik çalışmalarda ilerleyici ventriküler dilatasyon olmasa bile sistemin revizyonu düşünülmelidir.
References
- 1. Sivaganesan A, Krishnamurthy R, Sahni D, Viswanathan C. Neuroimaging of ventriculoperitoneal shunt complications in children. Pediatr Radiol 2012;42:1029-1046. https://doi.org/10.1007/s00247-012-2410-6
- 2. Iskandar BJ, McLaughlin C, Mapstone TB, Grabb PA, Oakes WJ. Pitfalls in the diagnosis of ventricular shunt dysfunction: radiology reports and ventricular size. Pediatrics 1998;101:1031-1036. https://doi.org/10.1542/peds.101.6.1031
- 3. Mcnatt SA, Kim A, Hohuan D, Krieger M, Mccomb JG. Pediatric shunt malfunction without ventricular dilatation. Pediatr Neurosurg 2008;44:128-132. https://doi.org/10.1159/000113115
- 4. Engel M, Carmel PW, Chutorian AM. Increased intraventricular pressure without ventriculomegaly in children with shunts: "normal volume" hydrocephalus. Neurosurgery 1979;5:549-552. https://doi.org/10.1227/00006123-197911000-00001
- 5. Dahlerup B, Gjerris F, Harmsen A, Sorensen PS. Severe headache as the only symptom of long-standing shunt dysfunction in hydrocephalic children with normal or slit ventricles revealed by computed tomography. Child's Nerv Syst 1985;1:49-52. https://doi.org/10.1007/BF00706731
- 6. Barnes NP, Jones SJ, Hayward RD, Harkness WJ, Thompson D. Ventriculoperitoneal shunt block: what are the best predictive clinical indicators? Arch Dis Child 2002;87:198-201. https://doi.org/10.1136/adc.87.3.198
- 7. Watkins L, Hayward R, Andar U, Harkness W. The diagnosis of blocked cerebrospinal fluid shunts: a prospective study of referral to a paediatric neurosurgical unit. Child’s Nerv Syst 1994;10:87-90. https://doi.org/10.1007/BF00302769
Ventriculoperitoneal shunt obstructions in the absence of radiological abnormalities: retrospective analysis of a pediatric cohort
Abstract
Purpose: Ventriculoperitoneal shunts are still the mainstay treatment for pediatric hydrocephalus. They have a high complication and failure rate, requiring multiple revisions. In this study, we aim to investigate patients who required shunt replacement without any radiological findings.
Material and method: The files of patients under the age of 18, who underwent shunt revision between December 2015 and December 2020 in Bursa Uludag University Medical Faculty Neurosurgery Clinic were reviewed retrospectively. All the radiological studies, laboratory results and clinical conditions of the patients were examined.
Results: We identified 127 patients who required a revision of ventriculoperitoneal shunt for suspected mechanical obstruction. 6 patients (5%) had symptoms of raised intracranial pressure, but showed no radiographic evidence of progressive ventricular dilatation.
Conclusion: Dysfunction of a ventriculoperitoneal shunt does not always lead to associated radiological alterations. In a patient with signs of intracranial hypertension, revision of the system should be considered even in the absence of progressive ventricular dilatation in radiological studies.
References
- 1. Sivaganesan A, Krishnamurthy R, Sahni D, Viswanathan C. Neuroimaging of ventriculoperitoneal shunt complications in children. Pediatr Radiol 2012;42:1029-1046. https://doi.org/10.1007/s00247-012-2410-6
- 2. Iskandar BJ, McLaughlin C, Mapstone TB, Grabb PA, Oakes WJ. Pitfalls in the diagnosis of ventricular shunt dysfunction: radiology reports and ventricular size. Pediatrics 1998;101:1031-1036. https://doi.org/10.1542/peds.101.6.1031
- 3. Mcnatt SA, Kim A, Hohuan D, Krieger M, Mccomb JG. Pediatric shunt malfunction without ventricular dilatation. Pediatr Neurosurg 2008;44:128-132. https://doi.org/10.1159/000113115
- 4. Engel M, Carmel PW, Chutorian AM. Increased intraventricular pressure without ventriculomegaly in children with shunts: "normal volume" hydrocephalus. Neurosurgery 1979;5:549-552. https://doi.org/10.1227/00006123-197911000-00001
- 5. Dahlerup B, Gjerris F, Harmsen A, Sorensen PS. Severe headache as the only symptom of long-standing shunt dysfunction in hydrocephalic children with normal or slit ventricles revealed by computed tomography. Child's Nerv Syst 1985;1:49-52. https://doi.org/10.1007/BF00706731
- 6. Barnes NP, Jones SJ, Hayward RD, Harkness WJ, Thompson D. Ventriculoperitoneal shunt block: what are the best predictive clinical indicators? Arch Dis Child 2002;87:198-201. https://doi.org/10.1136/adc.87.3.198
- 7. Watkins L, Hayward R, Andar U, Harkness W. The diagnosis of blocked cerebrospinal fluid shunts: a prospective study of referral to a paediatric neurosurgical unit. Child’s Nerv Syst 1994;10:87-90. https://doi.org/10.1007/BF00302769
Details
| Primary Language | English |
|---|---|
| Subjects | Surgery |
| Journal Section | Research Article |
| Authors | |
| Early Pub Date | June 23, 2023 |
| Publication Date | July 1, 2023 |
| Submission Date | February 13, 2023 |
| Acceptance Date | April 10, 2023 |
| Published in Issue | Year 2023 Volume: 16 Issue: 3 |
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