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Kaplan–Meier curves demonstrating 5-year shunt longevity. Red continuous and blue dotted lines represent patients with and without pre-craniotomy hydrocephalus, respectively
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Long-term risks and survival times of ventriculoperitoneal (VP) shunts implanted due to hydrocephalus (HC) after crani-otomy for brain tumors are largely unknown. The aim of this study was to establish the overall VP shunt survival rates during a decade after shunt insertion and to determine risks of shunt failure after brain tumor surgery in the l...
Citations
... However including our observations such patients have a harder time tolerating surgery, require careful postoperative monitoring and deterioration of their condition may require urgent VPS. There is also no data on the quality of life of such patients in the long-term follow-up period [21,22]. In our experience tumor removal with this approach is much more difficult due to the swollen cerebellum, reduced surgical access and increased bleeding of both tumor and cerebellar structures. ...
Objective to develop an algorithm for the management of patients with VS in combination with HC (occlusive, open with increased pressure, normal pressure).Materials and methods. 76 patients with VS in combination with HC were treated at the subtentorial neurooncology department in 2017‒2023. All patients were examined by an ophthalmologist before surgery, in the early postoperative period and at repeated examinations after 3, 6 and 12 months. Standard preoperative procedures included CT scan, MRI brain examination with contrast, CT scan on the first day after surgery, MRI with contrast in the early postoperative period – before discharge, and MRI with contrast in 3, 6 and 12 months. All patients were distributed in subgroups depending on the severity of symptoms of both hydrocephalus and VS, general somatic condition according to the ASA scale and age, and the most reasonable treatment tactics aimed at preserving the quality of life was used.Results. Depending on the type of HC and treatment algorithm patients were divided into 6 groups: I included 37 patients with VS and occlusive or open HC with increased pressure (OOHCIP) and papilledema. In these patients the 1st stage consisted of ventriculoperitoneal shunting (VPS), 2nd – VS removal; II – 6 patients with OOHCIP: 1st – VS removal, 2nd – VPS in whom HC not regressed; III – 13: 6 of whom OOHCIP and 7 with normotensive HC (NHC) – all VPS and observation in dynamics; IV – 9 with VS and NHC underwent VS removal and given the regression of HC VPS was not performed; V – 7 with VS and NHC in whom there was no HC regression after VS removal therefore the 2nd – VPS was carried out; VI – 4 with VS and vicarious HC underwent removal of VS and dynamic observation. Karnofsky scale increased more then 20 % was in groups I, III (OOHCIP), IV and V.Conclusions. For patients with OOHCIP and papilledema, the optimal tactic is 1st – VPS, 2nd –removal of VS. For elderly patients with VS in combination with normotensive or connective HC with increased pressure and concomitant pathology and predominance of HC symptoms it is recommended to conduct first step or only VPS under the follow up and VS removal in case of tumor/clinical signs progression.
... As for the other etiologies, such as brain neoplasm, ischemic stroke, central nervous system (CNS) infection, no difference in the initial revision rate, total revision rate, and revision-free survival between PV and NPV groups was observed. Tumor-related hydrocephalus patients with ventricular CSF shunts were reported to have a shunt failure rate around 33% [15,32], which is in accordance with our results. Sex, age, tumor location, previous EVD placement, previous craniotomy, post-craniotomy hemorrhage, and post-craniotomy meningitis were found as non-significant risk factors for revision in adult brain tumor patients [15]. ...
... Tumor-related hydrocephalus patients with ventricular CSF shunts were reported to have a shunt failure rate around 33% [15,32], which is in accordance with our results. Sex, age, tumor location, previous EVD placement, previous craniotomy, post-craniotomy hemorrhage, and post-craniotomy meningitis were found as non-significant risk factors for revision in adult brain tumor patients [15]. Further studies are needed to clarify the underlying cause of relatively high shunt failure rate in adult brain tumor patients with either PVs or NPVs. ...
Background:
Programmable valve (PV) has been shown as a solution to the high revision rate in pediatric hydrocephalus patients, but it remains controversial among adults. This study is to compare the overall revision rate, revision cause, and revision-free survival between PV and non-programmable valve (NPV) in adult patients with different hydrocephalus etiologies.
Method:
We reviewed the chart of all patients with hydrocephalus receiving index ventricular cerebrospinal fluid (CSF) shunt operations conducted at a single institution from January 2017 to December 2017. Patients included in the study were followed up for at least 5 years. Statistical tests including independent t-test, chi-square test, and Fisher's exact test were used for comparative analysis, and Kaplan-Meier curve using log-rank test was performed to compare the revision-free survival between the PV and NPV groups.
Results:
A total of 325 patients were included in the study, of which 181 patients were receiving PVs and 144 patients receiving NPV. There were 23 patients (12.8%) with PV and 22 patients (15.3%) with NPV receiving initial revision. No significant statistical difference in the initial revision rate was observed between the two groups (p = 0.52). No survival difference was found between the PV and NPV groups. However, better revision-free survival was noted in the PV group among idiopathic normal pressure hydrocephalus (iNPH) (p = 0.0274) and post-traumatic hydrocephalus (p = 0.017).
Conclusions:
The combination of the different etiologies of hydrocephalus and the features of PV and NPV results in different outcomes-revision rate and revision-free survival. PV use might be superior to NPV in iNPH and post-traumatic hydrocephalus patients. Further studies are needed to clarify the indications of PV use in adult hydrocephalus patients.
... The rates of intracranial infection, postresection hydrocephalus, and PFS were 9.2%, 18.3%, and 16.7%, respectively. Unexpectedly, we found that the risk of each associated complication differed from that reported in the literature; thus, our results did not support that an EVD increased the risk of intracranial infection [20,21] or postresection hydrocephalus [22]. We also found that the presence of EVD did not correlate with PFS or its severity [9]. ...
An external ventricular drain (EVD) is used to facilitate cerebrospinal fluid (CSF) removal in medulloblastoma patients suffering from hydrocephalus. It is essential to recognize that EVD management plays a crucial role in influencing the incidence of drain-related complications. However, the ideal method for EVD management remains undetermined. Our research sought to examine the safety of EVD placement and the impact of EVD on the incidences of intracranial infections, postresection hydrocephalus, and posterior fossa syndrome (PFS). We conducted a single-center observational study involving a cohort of 120 pediatric medulloblastoma patients who were treated from 2017 to 2020. The rates of intracranial infection, postresection hydrocephalus, and PFS were 9.2%, 18.3%, and 16.7%, respectively. EVD did not influence the occurrence of intracranial infection (p = 0.466), postresection hydrocephalus (p = 0.298), or PFS (p = 0.212). A gradual EVD weaning protocol correlated with an elevated incidence of postresection hydrocephalus (p = 0.033), whereas a rapid weaning approach resulted in 4.09 ± 0.44 fewer drainage days (p < 0.001) than the gradual weaning strategy. EVD placement (p = 0.010) and intracranial infection (p = 0.002) were linked to delayed speech return, whereas a longer duration of drainage was conducive to the recovery of language function (p = 0.010). EVD insertion was not correlated with the incidence of intracranial infection, postoperative hydrocephalus, or PFS. The optimal EVD management method should encompass a rapid EVD weaning strategy, followed by prompt drain closure. We have presented additional evidence to improve the safety of EVD insertion and management in neurosurgical patients to ultimately facilitate the establishment of standardized institutional/national implementation and management protocols.
This study proposes a Dimensionality Reduction Electric Field Source Seeking (EFSS) method for real-time, high-precision navigation in intracranial puncture surgeries. The method integrates internal localization electrodes and external potential measurement electrodes to minimize surgical trauma while ensuring the accurate localization and guidance of surgical instruments. To optimize the electrode arrangement, two evaluation metrics—Mean Response Coefficient (MRC) and MRC-mean—were introduced. The simulation results demonstrated the effectiveness of these metrics, with the optimal arrangement achieving an average localization error below 2 mm and a 56% reduction in error after optimization. Experimental validation was conducted using a brain model with conductivity properties similar to those of human tissue. Localization experiments confirmed the robustness and accuracy of the EFSS method, with all results showing consistent repeatability and monotonic trends in performance across different electrode configurations. This study highlights the potential of the dimensionality reduction EFSS method as a novel and effective approach for navigation in minimally invasive intracranial surgeries.
OBJECTIVE
Reported rates of failures varies greatly from below 5% up to over 50% and, no meta-analysis to assess the overall prevalence has ever been performed. Herein, the authors estimated the failure rate after internal CSF shunt (ICSFS) insertion and searched for associated factors.
METHODS
Six databases were searched from January 1990 to February 2022. Only original articles reporting the rate of adult shunt failure were included. Random-effects meta-analysis with generalised linear mixed model method and logit transformation was used to compute the overall failure prevalence. Subgroup analysis and meta-regression were implemented to search for associated factors.
RESULTS
Of 1,763 identified articles, 46 were selected, 70,859 ICSFS implantations and for 13,603 shunt failure, suggesting an accumulated incidence of 19.2%. However, the calculated pooled prevalence value and its 95% confidence interval (CI) were 22.7% 95%CI[19.8-5.8]. The CI of the different estimates did not overlap, indicating a strong heterogeneity confirmed by a high I² of 97.5%, 95%CI[97.1-97.8], p<0.001 with a τ²=0.3. Ninety-five percent prediction interval of shunt failure prevalence ranged from 8.75% up to 47.36%. A meta-regression of prevalence by year of publication found a barely significant decreasing failure rate of about two percent per year (-2.11, 95%CI[-4.02- -0.2], p-value=0.031).
CONCLUSION
Despite being a quite simple neurosurgical procedure, ICSFS insertion has one of the highest risk of complications with failure prevalence involving more than 1 patient out of 5. Nonetheless, all the efforts to lower these frustrating high level of shunt failure seem to be effective.
Trial registration: This meta-analysis is registered in https://www.crd.york.ac.uk/PROSPERO/, PROSPERO ID: CRD42022339954.
