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Our initial experience with ventriculo-epiplooic shunt in treatment of hydrocephalus in two centers
Affiliations- University of Medicine and Pharmacy “Carol Davila”, Department of General Surgery, Emergency Clinical Hospital Bagdasar-Arseni, Bucharest, Romania
- Fourth Department of Neurosurgery, Emergency Clinical Hospital Bagdasar-Arseni, Bucharest, Romania
- University Pitesti, Department of Neurosurgery, Emergency County Hospital Arges, Pitesti, Romania
- University of Medicine and Pharmacy “Iuliu Hatieganu”, Cluj-Napoca, Romania
- University of Medicine and Pharmacy “Grigore T. Popa”, Emergency County Hospital St. Spiridon, Iasi, Romania
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Abstract
Hydrocephalus represents impairment in cerebrospinal fluid (CSF) dynamics. If the treatment of hydrocephalus is considered difficult, the repeated revisions of ventriculo-peritoneal (VP) shunts are even more challenging.
ObjectiveThe aim of this article is to evaluate the efficiency of ventriculo-epiplooic (VEp) shunt as a feasible alternative in hydrocephalic patients.
Material and methodsA technical modification regarding the insertion of peritoneal catheter was imagined: midline laparotomy 8–10cm long was performed in order to open the peritoneal cavity; the great omentum was dissected between its two layers; we placed the distal end of the catheter between the two epiplooic layers; a fenestration of 4cm in diameter into the visceral layer was also performed.
A retrospective study of medical records of 15 consecutive patients with hydrocephalus treated with VEp shunt is also presented.
ResultsBetween 2008 and 2014 we performed VEp shunt in 15 patients: 5 with congenital hydrocephalus, 8 with secondary hydrocephalus and 2 with normal pressure hydrocephalus. There were 7 men and 8 women. VEp shunt was performed in 13 patients with multiple distal shunt failures and in 2 patients, with history of abdominal surgery, as de novo extracranial drainage procedure. The outcome was favorable in all cases, with no significant postoperative complications.
ConclusionsVEp shunt is a new, safe and efficient surgical technique for the treatment of hydrocephalus. VEp shunt is indicated in patients with history of recurrent distal shunt failures, and in patients with history of open abdominal surgery and high risk for developing abdominal complications.
Abstract
Hydrocephalus represents impairment in cerebrospinal fluid (CSF) dynamics. If the treatment of hydrocephalus is considered difficult, the repeated revisions of ventriculo-peritoneal (VP) shunts are even more challenging.
ObjectiveThe aim of this article is to evaluate the efficiency of ventriculo-epiplooic (VEp) shunt as a feasible alternative in hydrocephalic patients.
Material and methodsA technical modification regarding the insertion of peritoneal catheter was imagined: midline laparotomy 8–10cm long was performed in order to open the peritoneal cavity; the great omentum was dissected between its two layers; we placed the distal end of the catheter between the two epiplooic layers; a fenestration of 4cm in diameter into the visceral layer was also performed.
A retrospective study of medical records of 15 consecutive patients with hydrocephalus treated with VEp shunt is also presented.
ResultsBetween 2008 and 2014 we performed VEp shunt in 15 patients: 5 with congenital hydrocephalus, 8 with secondary hydrocephalus and 2 with normal pressure hydrocephalus. There were 7 men and 8 women. VEp shunt was performed in 13 patients with multiple distal shunt failures and in 2 patients, with history of abdominal surgery, as de novo extracranial drainage procedure. The outcome was favorable in all cases, with no significant postoperative complications.
ConclusionsVEp shunt is a new, safe and efficient surgical technique for the treatment of hydrocephalus. VEp shunt is indicated in patients with history of recurrent distal shunt failures, and in patients with history of open abdominal surgery and high risk for developing abdominal complications.
Keywords
Epiploon, Greater omentum, Hydrocephalus, Ventriculo-epiplooic shunt, Ventriculo-peritoneal shunt failure
About this articleTitle
Our initial experience with ventriculo-epiplooic shunt in treatment of hydrocephalus in two centers
Journal
Neurologia i Neurochirurgia Polska
Issue
Pages
290-298
Page views
309
Article views/downloads
792
DOI
10.1016/j.pjnns.2017.04.007
Bibliographic record
Neurol Neurochir Pol 2017;51(4):290-298.
Keywords
Epiploon
Greater omentum
Hydrocephalus
Ventriculo-epiplooic shunt
Ventriculo-peritoneal shunt failure
Authors
Valentin Titus Grigorean
Aurelia Mihaela Sandu
Mihai Popescu
Ioan Stefan Florian
Cristian Dumitru Lupascu
Corina Lupascu Ursulescu
