Ventriculoperitoneal Shunt Complications in the European Idiopathic Normal Pressure Hydrocephalus Multicenter Study

Alberto Feletti; Domenico d'Avella; Carsten Wikkelsø; Petra Klinge; Per Hellström; Jos Tans; Michael Kiefer; Ulrich Meier; Johannes Lemcke; Vincenzo Paternò; Lennart Stieglitz; Martin Sames; Karel Saur; Mariann Kordás; Dusan Vitanovic; Andreu Gabarrós; Feixa Llarga; Michael Triffaux; Alain Tyberghien; Marianne Juhler; Steen  Hasselbalch; Kristina Cesarini; Katarina Laurell

doi:10.1093/ons/opy232

Ventriculoperitoneal Shunt Complications in the European Idiopathic Normal Pressure Hydrocephalus Multicenter Study

Alberto Feletti, Domenico d'Avella, Carsten Wikkelsø, Petra Klinge, Per Hellström, Jos Tans, Michael Kiefer, Ulrich Meier, Johannes Lemcke, Vincenzo Paternò, Lennart Stieglitz, Martin Sames, Karel Saur, Mariann Kordás, Dusan Vitanovic, Andreu Gabarrós, Feixa Llarga, Michael Triffaux, Alain Tyberghien, Marianne JuhlerSteen Hasselbalch, Kristina Cesarini, Katarina Laurell

48 Citationer (Scopus)

Abstract

BACKGROUND: Ventriculoperitoneal shunt (VP-shunt) is the standard of treatment for idiopathic normal pressure hydrocephalus (iNPH). However, a thorough investigation of VP-shunt complications in this population is lacking.

OBJECTIVE: To present the analysis and the rates of complications progressively occurring during the first year after shunt surgery in the patients with iNPH included in the European multicenter (EU-iNPH) study.

METHODS: Patients (n = 142) were prospectively included in the EU-iNPH study by 13 institutions. All patients received a programmable VP-shunt. One hundred fifteen patients completed the 12-mo follow-up. Reexaminations were performed 1, 3, and 12 mo after surgery. Data regarding symptomatic over- or underdrainage, infections, malposition, subdural collections, and shunt surgery were collected and analyzed.

RESULTS: Thirty patients (26%) experienced symptoms due to shunt underdrainage. Symptomatic overdrainage was reported in 10 (9%). Shunt adjustments were made in 43 (37%). Shunt malposition was recognized as the primary cause of shunt malfunction in 8 (7%), while only 1 infection (0.9%) occurred. Subdural hematoma was diagnosed in 7 (6%) and was treated by increasing the opening pressure of the valve in 5 patients. Hygroma was diagnosed in 10 (9%), requiring surgery in 1 patient. Overall, 17 patients (15%) underwent 19 shunt surgeries.

CONCLUSION: The advances in valve technology, a careful opening pressure setting, and rigorous follow-up allow a significant reduction of complications, which can be usually managed nonsurgically within the first 3 to 6 mo.

Originalsprog	Engelsk
Artikelnummer	opy232
Tidsskrift	Operative neurosurgery
Vol/bind	17
Udgave nummer	1
Sider (fra-til)	97-102
Antal sider	6
ISSN	2332-4252
DOI	https://doi.org/10.1093/ons/opy232
Status	Udgivet - 1 jul. 2019

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10.1093/ons/opy232

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Feletti, A., d'Avella, D., Wikkelsø, C., Klinge, P., Hellström, P., Tans, J., Kiefer, M., Meier, U., Lemcke, J., Paternò, V., Stieglitz, L., Sames, M., Saur, K., Kordás, M., Vitanovic, D., Gabarrós, A., Llarga, F., Triffaux, M., Tyberghien, A., ... Laurell, K. (2019). Ventriculoperitoneal Shunt Complications in the European Idiopathic Normal Pressure Hydrocephalus Multicenter Study. Operative neurosurgery, 17(1), 97-102. Artikel opy232. https://doi.org/10.1093/ons/opy232

Feletti, A, d'Avella, D, Wikkelsø, C, Klinge, P, Hellström, P, Tans, J, Kiefer, M, Meier, U, Lemcke, J, Paternò, V, Stieglitz, L, Sames, M, Saur, K, Kordás, M, Vitanovic, D, Gabarrós, A, Llarga, F, Triffaux, M, Tyberghien, A, Juhler, M , Hasselbalch, S, Cesarini, K & Laurell, K 2019, 'Ventriculoperitoneal Shunt Complications in the European Idiopathic Normal Pressure Hydrocephalus Multicenter Study', Operative neurosurgery, bind 17, nr. 1, opy232, s. 97-102. https://doi.org/10.1093/ons/opy232

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title = "Ventriculoperitoneal Shunt Complications in the European Idiopathic Normal Pressure Hydrocephalus Multicenter Study",

abstract = "BACKGROUND: Ventriculoperitoneal shunt (VP-shunt) is the standard of treatment for idiopathic normal pressure hydrocephalus (iNPH). However, a thorough investigation of VP-shunt complications in this population is lacking.OBJECTIVE: To present the analysis and the rates of complications progressively occurring during the first year after shunt surgery in the patients with iNPH included in the European multicenter (EU-iNPH) study.METHODS: Patients (n = 142) were prospectively included in the EU-iNPH study by 13 institutions. All patients received a programmable VP-shunt. One hundred fifteen patients completed the 12-mo follow-up. Reexaminations were performed 1, 3, and 12 mo after surgery. Data regarding symptomatic over- or underdrainage, infections, malposition, subdural collections, and shunt surgery were collected and analyzed.RESULTS: Thirty patients (26%) experienced symptoms due to shunt underdrainage. Symptomatic overdrainage was reported in 10 (9%). Shunt adjustments were made in 43 (37%). Shunt malposition was recognized as the primary cause of shunt malfunction in 8 (7%), while only 1 infection (0.9%) occurred. Subdural hematoma was diagnosed in 7 (6%) and was treated by increasing the opening pressure of the valve in 5 patients. Hygroma was diagnosed in 10 (9%), requiring surgery in 1 patient. Overall, 17 patients (15%) underwent 19 shunt surgeries.CONCLUSION: The advances in valve technology, a careful opening pressure setting, and rigorous follow-up allow a significant reduction of complications, which can be usually managed nonsurgically within the first 3 to 6 mo.",

keywords = "Complication, Idiopathic normal pressure hydrocephalus, Multicenter study, Symptoms and signs, Ventriculoperitoneal shunt",

author = "Alberto Feletti and Domenico d'Avella and Carsten Wikkels{\o} and Petra Klinge and Per Hellstr{\"o}m and Jos Tans and Michael Kiefer and Ulrich Meier and Johannes Lemcke and Vincenzo Patern{\`o} and Lennart Stieglitz and Martin Sames and Karel Saur and Mariann Kord{\'a}s and Dusan Vitanovic and Andreu Gabarr{\'o}s and Feixa Llarga and Michael Triffaux and Alain Tyberghien and Marianne Juhler and Steen Hasselbalch and Kristina Cesarini and Katarina Laurell",

note = "Copyright {\textcopyright} 2018 by the Congress of Neurological Surgeons.",

year = "2019",

month = jul,

day = "1",

doi = "10.1093/ons/opy232",

language = "English",

volume = "17",

pages = "97--102",

journal = "Operative neurosurgery",

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TY - JOUR

T1 - Ventriculoperitoneal Shunt Complications in the European Idiopathic Normal Pressure Hydrocephalus Multicenter Study

AU - Feletti, Alberto

AU - d'Avella, Domenico

AU - Wikkelsø, Carsten

AU - Klinge, Petra

AU - Hellström, Per

AU - Tans, Jos

AU - Kiefer, Michael

AU - Meier, Ulrich

AU - Lemcke, Johannes

AU - Paternò, Vincenzo

AU - Stieglitz, Lennart

AU - Sames, Martin

AU - Saur, Karel

AU - Kordás, Mariann

AU - Vitanovic, Dusan

AU - Gabarrós, Andreu

AU - Llarga, Feixa

AU - Triffaux, Michael

AU - Tyberghien, Alain

AU - Juhler, Marianne

AU - Hasselbalch, Steen

AU - Cesarini, Kristina

AU - Laurell, Katarina

PY - 2019/7/1

Y1 - 2019/7/1

N2 - BACKGROUND: Ventriculoperitoneal shunt (VP-shunt) is the standard of treatment for idiopathic normal pressure hydrocephalus (iNPH). However, a thorough investigation of VP-shunt complications in this population is lacking.OBJECTIVE: To present the analysis and the rates of complications progressively occurring during the first year after shunt surgery in the patients with iNPH included in the European multicenter (EU-iNPH) study.METHODS: Patients (n = 142) were prospectively included in the EU-iNPH study by 13 institutions. All patients received a programmable VP-shunt. One hundred fifteen patients completed the 12-mo follow-up. Reexaminations were performed 1, 3, and 12 mo after surgery. Data regarding symptomatic over- or underdrainage, infections, malposition, subdural collections, and shunt surgery were collected and analyzed.RESULTS: Thirty patients (26%) experienced symptoms due to shunt underdrainage. Symptomatic overdrainage was reported in 10 (9%). Shunt adjustments were made in 43 (37%). Shunt malposition was recognized as the primary cause of shunt malfunction in 8 (7%), while only 1 infection (0.9%) occurred. Subdural hematoma was diagnosed in 7 (6%) and was treated by increasing the opening pressure of the valve in 5 patients. Hygroma was diagnosed in 10 (9%), requiring surgery in 1 patient. Overall, 17 patients (15%) underwent 19 shunt surgeries.CONCLUSION: The advances in valve technology, a careful opening pressure setting, and rigorous follow-up allow a significant reduction of complications, which can be usually managed nonsurgically within the first 3 to 6 mo.

AB - BACKGROUND: Ventriculoperitoneal shunt (VP-shunt) is the standard of treatment for idiopathic normal pressure hydrocephalus (iNPH). However, a thorough investigation of VP-shunt complications in this population is lacking.OBJECTIVE: To present the analysis and the rates of complications progressively occurring during the first year after shunt surgery in the patients with iNPH included in the European multicenter (EU-iNPH) study.METHODS: Patients (n = 142) were prospectively included in the EU-iNPH study by 13 institutions. All patients received a programmable VP-shunt. One hundred fifteen patients completed the 12-mo follow-up. Reexaminations were performed 1, 3, and 12 mo after surgery. Data regarding symptomatic over- or underdrainage, infections, malposition, subdural collections, and shunt surgery were collected and analyzed.RESULTS: Thirty patients (26%) experienced symptoms due to shunt underdrainage. Symptomatic overdrainage was reported in 10 (9%). Shunt adjustments were made in 43 (37%). Shunt malposition was recognized as the primary cause of shunt malfunction in 8 (7%), while only 1 infection (0.9%) occurred. Subdural hematoma was diagnosed in 7 (6%) and was treated by increasing the opening pressure of the valve in 5 patients. Hygroma was diagnosed in 10 (9%), requiring surgery in 1 patient. Overall, 17 patients (15%) underwent 19 shunt surgeries.CONCLUSION: The advances in valve technology, a careful opening pressure setting, and rigorous follow-up allow a significant reduction of complications, which can be usually managed nonsurgically within the first 3 to 6 mo.

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KW - Idiopathic normal pressure hydrocephalus

KW - Multicenter study

KW - Symptoms and signs

KW - Ventriculoperitoneal shunt

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U2 - 10.1093/ons/opy232

DO - 10.1093/ons/opy232

M3 - Journal article

C2 - 30169650

SN - 2332-4252

VL - 17

SP - 97

EP - 102

JO - Operative neurosurgery

JF - Operative neurosurgery

IS - 1

M1 - opy232

ER -

Ventriculoperitoneal Shunt Complications in the European Idiopathic Normal Pressure Hydrocephalus Multicenter Study

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