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

2010 ◽  
Vol 5 (1) ◽  
pp. 4-16 ◽  
Author(s):  
Rolf W. Gruber ◽  
Bernd Roehrig
Keyword(s):  
High Rate ◽  
Ventricular Catheter ◽  
Shunt System ◽  
Distal Catheter ◽  
Slit Ventricle Syndrome ◽  
Follow Up Study ◽  
Catheter Obstruction ◽  
Slit Ventricle ◽  
Antisiphon Device

Object This 25-year follow-up study was performed on 120 children with hypertensive hydrocephalus to evaluate the influence of the early prophylactic implantation of the Integra antisiphon device (ASD, Integra Neurosciences Ltd.) on the rate of proximal shunt obstructions and the frequency of symptomatic slit ventricle syndrome (SVS). The adaptability of the ASD to growth, proper positioning of the ASD as a necessity for its successful performance, and the 3 phases of SVS development are discussed. Method Since 1978, the ASD has consistently been implanted either at the time of primary shunt insertion (66 neonates, mean follow-up 11 years) or during revisions of preexisting shunts (54 children, mean follow-up 11.8 years). The complication rate among the 54 children before ASD implantation (mean follow-up 8.3 years) was compared with that among all 120 patients once an ASD had been inserted. Shunt complications were documented as ventricular catheter, distal catheter, and infectious complications. Results The study revealed a significant long-term reduction in ventricular catheter obstructions and hospitalizations due to intermittent intracranial hypertension symptoms (symptomatic SVS) after both primary and secondary ASD implantation. Data in the study suggest that the high rate of ventricular catheter obstruction in pediatric shunt therapy is caused by hydrostatic suction induced by differential-pressure valve shunts during mobilization of the patient and that the development of a SVS can be traced back to this constant suction, which causes chronic CSF overdrainage and ventricular noncompliance. Recurrent ventricular catheter obstruction and SVS can be prevented by prophylactic supplementation of every shunt system with an ASD. Conclusions To inhibit chronic hydrostatic suction, to prevent overdrainage and proximal shunt obstruction, and to avoid SVS and thus improve the patient's quality of life, the prophylactic implantation of an ASD in every pediatric hydrocephalus shunt is recommended.

Experiences with the anti-siphon device (ASD) in shunt therapy of pediatric hydrocephalus

1984 ◽  
Vol 61 (1) ◽  
pp. 156-162 ◽  
Author(s):  
Rolf Gruber ◽  
Peter Jenny ◽  
Bruno Herzog
Keyword(s):  
Clinical Course ◽  
Fluid Pressure ◽  
Shunt System ◽  
Slit Ventricle Syndrome ◽  
Content Type ◽  
Pediatric Hydrocephalus ◽  
Before And After ◽  
History Of ◽  
Slit Ventricle

✓ A follow-up study was performed on 41 hydrocephalic children with primary (10 patients) or secondary (31 patients) placement of an anti-siphon device (ASD) connected to their shunt. The clinical course before and after ASD implantation was compared in these two groups, including studies of the head circumference, the radiological ventricular size, cerebrospinal fluid pressure studies on the supine and upright patient, and the history of shunt-induced complaints and complications leading to hospitalization. The authors discuss the pathophysiological concept of the “chronic overdrainage” or slit-ventricle syndrome based on ventricular collapse due to chronic suction-induced overdrainage by the vertical shunt system in the upright patient. The use of an ASD in connection with the regular shunt system of children with hydrocephalus is proposed. This ASD-shunt combination successfully reduced the number of complaints and shunt dysfunctions over a period of more than 6 years.

Ventricular catheter exchange using a peel-away outer catheter

2011 ◽  
Vol 115 (3) ◽  
pp. 633-635 ◽  
Author(s):  
David A. Omahen ◽  
Stephen J. Hentschel ◽  
G. Stuart Cameron
Keyword(s):  
Simple Technique ◽  
Senior Author ◽  
Ventricular Catheter ◽  
Benign Intracranial Hypertension ◽  
Initial Experience ◽  
Slit Ventricle Syndrome ◽  
Catheter Exchange ◽  
Catheter Obstruction ◽  
Slit Ventricle ◽  
Catheter Replacement

Ventricular catheter replacement can be challenging, especially in patients with small ventricles. Shunt malfunction due to ventricular catheter obstruction can occur without ventricular enlargement, such as in the setting of slit-ventricle syndrome or benign intracranial hypertension. The authors describe a simple technique for ventricular catheter exchange using a peel-away catheter. In the limited initial experience of the senior author (G.S.C.), this technique appears to be safe and effective. To the authors' knowledge, this method has not been described in the neurosurgical literature before.

The use of noninvasive electromagnetic neuronavigation for slit ventricle syndrome and complex hydrocephalus in a pediatric population

2008 ◽  
Vol 2 (6) ◽  
pp. 430-434 ◽  
Author(s):  
Simon Clark ◽  
Meharpal Sangra ◽  
Caroline Hayhurst ◽  
Jothi Kandasamy ◽  
Michael Jenkinson ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
Pediatric Population ◽  
Prospective Data ◽  
Distal Catheter ◽  
Slit Ventricle Syndrome ◽  
First Pass ◽  
Ventricular Catheters ◽  
Electromagnetic Neuronavigation ◽  
Slit Ventricle

Object The aim of this study was to prospectively evaluate the use of noninvasive electromagnetic neuronavigation in children, in particular its use in complex hydrocephalus and slit ventricle syndrome. Methods Prospective data was collected from all pediatric patients undergoing insertion of ventriculoperitoneal shunts using electromagnetic frameless neuronavigation from January 2006 to November 2007. Results Twenty-three patients fulfilled the study criteria. All ventricles were cannulated on the first pass. There were no immediate or early postprocedural complications. All but 1 patient had resolution of symptoms (mainly chronic headache) on follow-up (median 7 months, range 1–17 months). The proximal revision rate was 9% (2 of 23 patients). One patient required distal catheter revision. Infection occurred in 1 patient. Conclusions Electromagnetic neuronavigation using a frameless and pinless system is especially suited for pediatric patients. The authors hypothesize that successful placement of ventricular catheters will reduce morbidity and improve shunt longevity.

Slit Ventricle Syndrome Presenting with Paroxysmal Hypersomnia in an Adult: Case Report

Neurosurgery ◽  
1988 ◽  
Vol 22 (3) ◽  
pp. 594-595 ◽  
Author(s):  
Ender Korfali ◽  
Kaya Aksoy ◽  
Imran Safi
Keyword(s):  
Case Report ◽  
Intracranial Pressure ◽  
Shunt Malfunction ◽  
Ventricular Catheter ◽  
Ventricular Enlargement ◽  
Adult Case ◽  
Slit Ventricle Syndrome ◽  
Computed Tomographic ◽  
Lateral Ventricles ◽  
Slit Ventricle

Abstract The slit ventricle syndrome (SVS), defined as intermittent shunt malfunction without substantial ventricular enlargement, is usually observed in shunted children with small, slitlike ventricles. This syndrome has been attributed to recurrent obstruction of the ventricular catheter, which then causes an increase of intracranial pressure. Only rarely has the SVS been reported in adults. We describe a 29-year-old woman whose shunt malfunction presented with longlasting paroxysmal hypersomnia and was diagnosed with computed tomographic evidence of small lateral ventricles. This episodic hypersomnia presented every 2 to 3 weeks and each episode lasted 1 to 2 weeks. After revision of the ventricular catheter, her symptoms stopped and she remained well. (Neurosurgery 22:594-595, 1988)

Ventricular shunt removal: the ultimate treatment of the slit ventricle syndrome

1998 ◽  
Vol 88 (3) ◽  
pp. 478-484 ◽  
Author(s):  
Jonathan J. Baskin ◽  
Kim H. Manwaring ◽  
Harold L. Rekate
Keyword(s):  
Third Ventriculostomy ◽  
Slit Ventricle Syndrome ◽  
Content Type ◽  
Number Of Patients ◽  
Csf Diversion ◽  
Shunt Removal ◽  
Slit Ventricle ◽  
Fine Print

Object. The aim of this study was to assess the effectiveness of an algorithm used to evaluate and prescribe treatment for patients having slit ventricle syndrome (SVS). Methods. All patients included in this protocol underwent fiberoptic intracranial pressure monitoring after removal or externalization of their ventricular shunt systems. A significant number of patients did not need extracranial cerebrospinal fluid (CSF) diversion and tolerated removal of their shunt systems without requiring further intervention. Patients who demonstrated a need for CSF drainage underwent an endoscopic third ventriculostomy, regardless of the putative cause of their hydrocephalus. Sixteen (72.7%) of 22 patients experienced resolution of or significant improvement in their SVS complaints after their inclusion in the protocol. Concomitantly, 14 (64%) of 22 patients were no longer shunt dependent after a mean follow-up period of 21.4 months. Conclusions. A significant number of patients debilitated by SVS may experience improvement in their symptoms and undergo shunt removal according to this protocol, improving their quality of life and simplifying their medical follow up.

Bioabsorbable poly-L/D-lactide (96/4) scaffold arthroplasty (RegJoint™) for trapeziometacarpal osteoarthritis: a 3-year follow-up study

2017 ◽  
Vol 43 (4) ◽  
pp. 413-419 ◽  
Author(s):  
Simo Mattila ◽  
Mari Ainola ◽  
Eero Waris
Keyword(s):  
Degradation Process ◽  
High Rate ◽  
Subjective Improvement ◽  
Level Of Evidence ◽  
Revision Procedure ◽  
Follow Up Study ◽  
Trapeziometacarpal Osteoarthritis ◽  
High Incidence ◽  
Tissue Reactions

The poly-L/D-lactide joint scaffold (RegJoint™) has recently been associated with adverse tissue reactions and osteolysis after partial trapeziectomy for trapeziometacarpal osteoarthritis. Twenty-two of 23 patients previously operated on with this scaffold were re-examined at a mean follow-up of 3.3 years (range 36–53 months). Overall, the results showed an unacceptably high rate of adverse tissue reactions related to the degradation process of the implant, resulting in a revision procedure in three patients. At final follow-up, at which point the implant had completely degraded, there were no signs of ongoing adverse tissue reactions. There was a significant decrease in pain, increase in strength and subjective improvement in function at final follow-up compared with the pre-operative results in patients who had not undergone revision surgery. However, owing to the high incidence of adverse tissue reactions, the use of the implant has been discontinued in the treatment of trapeziometacarpal osteoarthritis. Level of evidence: IV

A 12-year single-center retrospective analysis of antisiphon devices to prevent proximal ventricular shunt obstruction for hydrocephalus

2019 ◽  
Vol 24 (6) ◽  
pp. 642-651
Author(s):  
Joyce Koueik ◽  
Mark R. Kraemer ◽  
David Hsu ◽  
Elias Rizk ◽  
Ryan Zea ◽  
...  
Keyword(s):  
Shunt Revision ◽  
Ventricular Catheter ◽  
Shunt Failure ◽  
Shunt System ◽  
Shunt Valve ◽  
Catheter Obstruction ◽  
Before And After ◽  
Observational Cohort ◽  
Shunt Obstruction

OBJECTIVERecent evidence points to gravity-dependent chronic shunt overdrainage as a significant, if not leading, cause of proximal shunt failure. Yet, shunt overdrainage or siphoning persists despite innovations in valve technology. The authors examined the effectiveness of adding resistance to flow in shunt systems via antisiphon devices (ASDs) in preventing proximal shunt obstruction.METHODSA retrospective observational cohort study was completed on patients who had an ASD (or additional valve) added to their shunt system between 2004 and 2016. Detailed clinical, radiographic, and surgical findings were examined. Shunt failure rates were compared before and after ASD addition.RESULTSSeventy-eight patients with shunted hydrocephalus were treated with placement of an ASD several centimeters distal to the primary valve. The records of 12 of these patients were analyzed separately due to a complex shunt revision history (i.e., > 10 lifetime shunt revisions). The authors found that adding an ASD decreased the 1-year ventricular catheter obstruction rates in the “simple” and “complex” groups by 67.3% and 75.8%, respectively, and the 5-year rates by 43.3% and 65.6%, respectively. The main long-term ASD complication was ASD removal for presumed valve pressure intolerance in 5 patients.CONCLUSIONSUsing an ASD may result in significant reductions in ventricular catheter shunt obstruction rates. If confirmed with prospective studies, this observation would lend further evidence that chronic shunt overdrainage is a central cause of shunt malfunction, and provide pilot data to establish clinical and laboratory studies that assess optimal ASD type, number, and position, and eventually develop shunt valve systems that are altogether resistant to siphoning.

scholarly journals Performance of fixed-pressure valve with antisiphon device SPHERA® in hydrocephalus treatment and overdrainage prevention

2012 ◽  
Vol 70 (9) ◽  
pp. 704-709 ◽  
Author(s):  
Fernando Campos Gomes Pinto ◽  
Renan Muralho Pereira ◽  
Felippe Saad ◽  
Manoel Jacobsen Teixeira
Keyword(s):  
Risk Factors ◽  
Subdural Hematoma ◽  
Chronic Subdural Hematoma ◽  
Normal Pressure ◽  
Pseudotumor Cerebri ◽  
Adult Patients ◽  
Slit Ventricle Syndrome ◽  
Evans Index ◽  
Slit Ventricle ◽  
Antisiphon Device

Patients with hydrocephalus and risk factors for overdrainage may be submitted to ventricular shunt (VS) implant with antisiphon device. The objective of this study was to prospectively evaluate for two years the clinical and tomographic results of the implant of fixed-pressure valves with antisiphon device SPHERA® in 35 adult patients, with hydrocephalus and risk factors for overdrainage. Of these, 3 had congenital hydrocephalus in adult patients with very dilated ventricles (Evans index >50%), 3 had symptomatic overdrainage after previous VS implant (subdural hematoma, hygroma or slit ventricle syndrome), 1 had previous chronic subdural hematoma, 15 had normal pressure hydrocephalus with final lumbar pressure <5 cm H2O after tap test (40 mL), 6 had pseudotumor cerebri, and 7 had hydrocephalus due to other causes. Clinical improvement was observed and sustained in 94.3% of the patients during the two-year period with no computed tomography (CT) evidence of hypo or overdrainage, and no immediate early or late significant complications.

Antimigraine Treatment for Slit Ventricle Syndrome

Neurosurgery ◽  
1990 ◽  
Vol 27 (5) ◽  
pp. 760-763 ◽  
Author(s):  
William G. Obana ◽  
Neil H. Raskin ◽  
Philip H. Cogen ◽  
Joyce A. Szymanski ◽  
Michael S.B. Edwards
Keyword(s):  
Intracranial Pressure ◽  
Intracranial Hypotension ◽  
Ventricular Volume ◽  
Shunt Revision ◽  
Elevated Intracranial Pressure ◽  
Increased Intracranial Pressure ◽  
Slit Ventricle Syndrome ◽  
Shunt Treatment ◽  
Slit Ventricle

Abstract Slit ventricle syndrome is characterized by chronic or recurring headaches associated with subnormal ventricular volume in patients who have undergone shunt treatment for hydrocephalus. There appear to be at least three pathophysiological mechanisms that cause this syndrome: 1) intermittent shunt malfunction: 2) intracranial hypotension: and 3) paroxysms of increased intracranial pressure in the presence of normal shunt function. To treat seven patients with slit ventricle syndrome caused by paroxysms of elevated intracranial pressure, we successfully used antimigraine therapy rather than standard calvarial expansion procedures. None of these patients has required shunt revision or calvarial expansion during a mean follow-up period of 2 years. The symptoms of slit ventricle syndrome may be a form of “acquired” migraine in shunt patients. We suggest that, in clinically stable patients with normal shunt function, treatment against migraine may stabilize symptoms resulting from paroxysms of increased intracranial pressure. Such treatment may prevent unnecessary shunt revisions and/or calvarial expansion procedures.

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