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Erschienen in: Surgical Endoscopy 8/2008

01.08.2008

Laparoscopic management of distal ventriculoperitoneal shunt complications

verfasst von: V. Nfonsam, B. Chand, S. Rosenblatt, R. Turner, M. Luciano

Erschienen in: Surgical Endoscopy | Ausgabe 8/2008

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Abstract

Background

The traditional management of hydrocephalus still is the placement of ventriculoperitoneal (VP) shunts. However, the majority of patients require one or more revisions over their lifetime. Revisions may be required for infections, proximal site malfunction, or distal catheter complications. The authors present their experience with distal catheter complications managed laparoscopically.

Methods

Patients with recurrent symptoms of increased intracranial pressure or abdominal complaints were evaluated for shunt malfunction. Similar radiographic imaging was performed for all the patients, including computed tomography (CT) of the head and abdomen, shunt series, and/or ultrasound of the distal catheter.

Results

From April 2003 to July 2005, 13 patients with distal VP shunt complications were managed laparoscopically. On the basis of preoperative cerebrospinal fluid (CSF) cultures, all the patients were determined not to have an infection. Radiographic imaging showed the patients to have distal catheter problems. Preoperatively, five abdominal CT scans, six shunt series, and four abdominal ultrasounds were obtained. All studies singly and positively identified the appropriate abdominal catheter defect except in three patients who required multiple sequential radiographic studies for final determination of the diagnosis. In four patients (30.8%), the distal catheter was found to be in the extraperitoneal space. Another four patients (30.8%) had intraabdominal CSF pseudocysts. Five patients (38.4%) had issues with the position of the intraabdominal catheter: four of them subdiaphragmatic and one on the dome of the bladder. Laparoscopic repositioning was successful for all 13 patients.

Conclusion

Regardless of the patient’s presenting symptoms, appropriate imaging studies should be obtained preoperatively in a sequential manner. Distal VP shunt complications can be safely and effectively managed laparoscopically. This approach allows the intraabdominal portion of the catheter to be assessed and problems to be managed, thereby salvaging the existing shunt and avoiding the potential morbidity associated with additional VP shunt placement.
Literatur
1.
Zurück zum Zitat Rizvi R, Anjum Q (2005) Hydrocephalus in children. J Pak Med Assoc 55:502–507PubMed Rizvi R, Anjum Q (2005) Hydrocephalus in children. J Pak Med Assoc 55:502–507PubMed
2.
Zurück zum Zitat Vinchon M, Fichten A, Delestret I, Dhellemmes P (2003) Shunt revision for asymptomatic failure: Surgical and clinical results. Neurosurgery 52:347–353 discussion 353–356PubMedCrossRef Vinchon M, Fichten A, Delestret I, Dhellemmes P (2003) Shunt revision for asymptomatic failure: Surgical and clinical results. Neurosurgery 52:347–353 discussion 353–356PubMedCrossRef
3.
Zurück zum Zitat Caldarelli M, Di Rocco C, La Marca F (1996) Shunt complications in the first postoperative year in children with meningomyelocele. Childs Nerv Syst 12:748–754PubMed Caldarelli M, Di Rocco C, La Marca F (1996) Shunt complications in the first postoperative year in children with meningomyelocele. Childs Nerv Syst 12:748–754PubMed
4.
Zurück zum Zitat Blount JP, Campbell JA, Haines SJ (1993) Complications in ventricular cerebrospinal fluid shunting. Neurosurg Clin North Am 4:633–656 Blount JP, Campbell JA, Haines SJ (1993) Complications in ventricular cerebrospinal fluid shunting. Neurosurg Clin North Am 4:633–656
5.
Zurück zum Zitat Cochrane DD, Kestle JR (2003) The influence of surgical operative experience on the duration of first ventriculoperitoneal shunt function and infection. Pediatr Neurosurg 38:295–301PubMedCrossRef Cochrane DD, Kestle JR (2003) The influence of surgical operative experience on the duration of first ventriculoperitoneal shunt function and infection. Pediatr Neurosurg 38:295–301PubMedCrossRef
6.
Zurück zum Zitat Kestle J, Drake J, Milner R, Sainle-Rose, Cinalli G, Boop F, Piatt J, Haines S, Schiff S, Cochrane D, Steinbok P, MacNeil N (2000) Long-term follow-up data from the Shunt Design Trial. Pediatr Neurosurg 33:230–236PubMedCrossRef Kestle J, Drake J, Milner R, Sainle-Rose, Cinalli G, Boop F, Piatt J, Haines S, Schiff S, Cochrane D, Steinbok P, MacNeil N (2000) Long-term follow-up data from the Shunt Design Trial. Pediatr Neurosurg 33:230–236PubMedCrossRef
7.
Zurück zum Zitat Esposito C, Porreca A, Gangemi M, et al. (1998) The use of laparoscopy in the diagnosis and treatment of abdominal complications of ventriculoperitoneal shunts in children. Pediatr Surg Int 13:352–354PubMedCrossRef Esposito C, Porreca A, Gangemi M, et al. (1998) The use of laparoscopy in the diagnosis and treatment of abdominal complications of ventriculoperitoneal shunts in children. Pediatr Surg Int 13:352–354PubMedCrossRef
8.
Zurück zum Zitat Lortat-Jacob S, Pierre-Kahn A, Renier D, et al. (1984) Abdominal complications of ventriculoperitoneal shunts in children: 65 cases. Chir Pediatr 25:17–21PubMed Lortat-Jacob S, Pierre-Kahn A, Renier D, et al. (1984) Abdominal complications of ventriculoperitoneal shunts in children: 65 cases. Chir Pediatr 25:17–21PubMed
9.
Zurück zum Zitat Acharya R, Ramachandran CS, Singh S (2001) Laparoscopic management of abdominal complications in ventriculoperitoneal shunt surgery. J Laparoendosc Adv Surg Tech A 11:167–170PubMedCrossRef Acharya R, Ramachandran CS, Singh S (2001) Laparoscopic management of abdominal complications in ventriculoperitoneal shunt surgery. J Laparoendosc Adv Surg Tech A 11:167–170PubMedCrossRef
10.
Zurück zum Zitat Pernas JC, Catala J (2004) Case 72: Pseudocyst around ventriculoperitoneal shunt. Radiology 232:239–243PubMedCrossRef Pernas JC, Catala J (2004) Case 72: Pseudocyst around ventriculoperitoneal shunt. Radiology 232:239–243PubMedCrossRef
11.
Zurück zum Zitat Deinsberger W, Langhans M, Winking M, Boker DK (1995) Retrieval of a disconnected ventriculoperitoneal shunt catheter by laparoscopy in a newborn child: Case report. Minim Invasive Neurosurg 38:123–124PubMedCrossRef Deinsberger W, Langhans M, Winking M, Boker DK (1995) Retrieval of a disconnected ventriculoperitoneal shunt catheter by laparoscopy in a newborn child: Case report. Minim Invasive Neurosurg 38:123–124PubMedCrossRef
12.
Zurück zum Zitat Samdani AF, Storm PB, Kuchner EB, et al. (2005) Ventriculoperitoneal shunt malfunction presenting with pleuritic chest pain. Pediatr Emerg Care 21:261–263PubMedCrossRef Samdani AF, Storm PB, Kuchner EB, et al. (2005) Ventriculoperitoneal shunt malfunction presenting with pleuritic chest pain. Pediatr Emerg Care 21:261–263PubMedCrossRef
13.
Zurück zum Zitat Naradzay JF, Browne BJ, Rolnick MA, Doherty RJ (1999) Cerebral ventricular shunts. J Emerg Med 17:311–322PubMedCrossRef Naradzay JF, Browne BJ, Rolnick MA, Doherty RJ (1999) Cerebral ventricular shunts. J Emerg Med 17:311–322PubMedCrossRef
14.
Zurück zum Zitat Paddon AJ, Horton D (2000) Knotting of distal ventriculoperitoneal shunt tubing. Clin Radiol 55:1–3PubMedCrossRef Paddon AJ, Horton D (2000) Knotting of distal ventriculoperitoneal shunt tubing. Clin Radiol 55:1–3PubMedCrossRef
15.
Zurück zum Zitat Kusano T, Miyazato H, Shimoji H, et al. (1998) Revision of ventriculoperitoneal shunt under laparoscopic guidance in patients with hydrocephalus. Surg Laparosc Endosc 8:474–476PubMedCrossRef Kusano T, Miyazato H, Shimoji H, et al. (1998) Revision of ventriculoperitoneal shunt under laparoscopic guidance in patients with hydrocephalus. Surg Laparosc Endosc 8:474–476PubMedCrossRef
16.
Zurück zum Zitat Turner R, Chahlavi A, Rasmussen P, Brody F (2004) Laparoscopic revision of a ventriculoperitoneal shunt. J Laparoendosc Adv Surg Tech A 14:310–312PubMedCrossRef Turner R, Chahlavi A, Rasmussen P, Brody F (2004) Laparoscopic revision of a ventriculoperitoneal shunt. J Laparoendosc Adv Surg Tech A 14:310–312PubMedCrossRef
17.
Zurück zum Zitat Oh A, Wildbrett P, Golub R, et al. (2001) Laparoscopic repositioning of a ventriculoperitoneal catheter tip for a sterile abdominal cerebrospinal fluid (CSF) pseudocyst. Surg Endosc 15:518PubMedCrossRef Oh A, Wildbrett P, Golub R, et al. (2001) Laparoscopic repositioning of a ventriculoperitoneal catheter tip for a sterile abdominal cerebrospinal fluid (CSF) pseudocyst. Surg Endosc 15:518PubMedCrossRef
18.
Zurück zum Zitat Goeser CD, McLeary MS, Young LW (1998) Diagnostic imaging of ventriculoperitoneal shunt malfunctions and complications. Radiographics 18:635–651PubMed Goeser CD, McLeary MS, Young LW (1998) Diagnostic imaging of ventriculoperitoneal shunt malfunctions and complications. Radiographics 18:635–651PubMed
19.
Zurück zum Zitat Bartynski WS, Valliappan S, Uselman JH, Spearman MP (2000) The adult radiographic shuntogram. AJNR Am J Neuroradiol 21:721–726PubMed Bartynski WS, Valliappan S, Uselman JH, Spearman MP (2000) The adult radiographic shuntogram. AJNR Am J Neuroradiol 21:721–726PubMed
20.
Zurück zum Zitat Drake JM, Martin AJ, Henkleman RM (1991) Determination of cerebrospinal fluid shunt obstruction with magnetic resonance phase imaging. J Neurosurg 75:535–540PubMed Drake JM, Martin AJ, Henkleman RM (1991) Determination of cerebrospinal fluid shunt obstruction with magnetic resonance phase imaging. J Neurosurg 75:535–540PubMed
21.
Zurück zum Zitat Seppanen U, Serlo W, Saukkonen AL (1987) Valvography in the assessment of hydrocephalus shunt function in children. Neuroradiology 29:53–57PubMedCrossRef Seppanen U, Serlo W, Saukkonen AL (1987) Valvography in the assessment of hydrocephalus shunt function in children. Neuroradiology 29:53–57PubMedCrossRef
22.
Zurück zum Zitat Salomao JF, Leibinger RD (1999) Abdominal pseudocysts complicating CSF shunting in infants and children: Report of 18 cases. Pediatr Neurosurg 31:274–278PubMedCrossRef Salomao JF, Leibinger RD (1999) Abdominal pseudocysts complicating CSF shunting in infants and children: Report of 18 cases. Pediatr Neurosurg 31:274–278PubMedCrossRef
23.
Zurück zum Zitat Khaitan L, Brennan EJ Jr (1999) A laparoscopic approach to ventriculoperitoneal shunt placement in adults. Surg Endosc 13:1007–1009PubMedCrossRef Khaitan L, Brennan EJ Jr (1999) A laparoscopic approach to ventriculoperitoneal shunt placement in adults. Surg Endosc 13:1007–1009PubMedCrossRef
24.
Zurück zum Zitat Khosrovi H, Kaufman HH, Hrabovsky E, et al. (1998) Laparoscopic-assisted distal ventriculoperitoneal shunt placement. Surg Neurol 49:127–34 discussion 134–135PubMedCrossRef Khosrovi H, Kaufman HH, Hrabovsky E, et al. (1998) Laparoscopic-assisted distal ventriculoperitoneal shunt placement. Surg Neurol 49:127–34 discussion 134–135PubMedCrossRef
25.
Zurück zum Zitat Chopra I, Gnanalingham K, Pal D, Peterson D (2004) A knot in the catheter: An unusual cause of ventriculoperitoneal shunt blockage. Acta Neurochir (Wien) 146:1055–1056 discussion 1056–1057CrossRef Chopra I, Gnanalingham K, Pal D, Peterson D (2004) A knot in the catheter: An unusual cause of ventriculoperitoneal shunt blockage. Acta Neurochir (Wien) 146:1055–1056 discussion 1056–1057CrossRef
26.
Zurück zum Zitat Naim Ur R, Jamjoom A, Jamjoom ZA (1996) Intestinal obstruction caused by extraperitoneal cerebrospinal fluid collection. Pediatr Neurosurg 25:160–162 discussion 163CrossRef Naim Ur R, Jamjoom A, Jamjoom ZA (1996) Intestinal obstruction caused by extraperitoneal cerebrospinal fluid collection. Pediatr Neurosurg 25:160–162 discussion 163CrossRef
27.
Zurück zum Zitat Fewel ME, Garton HJ (2004) Migration of distal ventriculoperitoneal shunt catheter into the heart: Case report and review of the literature. J Neurosurg 100(2 Suppl Pediatrics):206–211PubMed Fewel ME, Garton HJ (2004) Migration of distal ventriculoperitoneal shunt catheter into the heart: Case report and review of the literature. J Neurosurg 100(2 Suppl Pediatrics):206–211PubMed
28.
Zurück zum Zitat Hirano Y, Sasajima H, Mineura K, et al. (1997) Laparoscopic retrieval of a dislocated ventriculoperitoneal shunt catheter: Report of three cases and a review of the literature. No Shinkei Geka 25:629–633PubMed Hirano Y, Sasajima H, Mineura K, et al. (1997) Laparoscopic retrieval of a dislocated ventriculoperitoneal shunt catheter: Report of three cases and a review of the literature. No Shinkei Geka 25:629–633PubMed
Metadaten
Titel
Laparoscopic management of distal ventriculoperitoneal shunt complications
verfasst von
V. Nfonsam
B. Chand
S. Rosenblatt
R. Turner
M. Luciano
Publikationsdatum
01.08.2008
Verlag
Springer-Verlag
Erschienen in
Surgical Endoscopy / Ausgabe 8/2008
Print ISSN: 0930-2794
Elektronische ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-007-9728-4

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