Document Detail

Comparison of revision rates following endoscopically versus nonendoscopically placed ventricular shunt catheters.
MedLine Citation:
PMID:  12765808     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Endoscopic placement of ventriculoperitoneal (VP) shunt catheters in pediatric patients has been increasingly used in an attempt to minimize the unacceptably high rates of revision. Although this procedure carries an increased expense, there is currently no evidence to support an improved long-term outcome. This paper compares the rates of revision following ventricular catheter placement for shunted hydrocephalus with and without the use of endoscopy. METHODS: We retrospectively reviewed the records of all pediatric patients who had undergone shunt placement for hydrocephalus between April 1992 and February 1998. All shunts placed before March 1995 were performed without the endoscope; all subsequent shunts were placed endoscopically. The independent effect of endoscopic versus nonendoscopic shunt placement on subsequent shunt failure was analyzed via multivariate proportional hazards regression model. Multiple logistic regression analyses were used to determine the independent effect of endoscopic placement on subsequent etiology of failure (infection, proximal obstruction, distal malfunction) in the 511 failing shunts. RESULTS: There were 447 pediatric patients who underwent a total of 965 shunt placements or revisions. Six hundred and five (63%) catheters were placed with the use of the endoscope. Three hundred and sixty (37.3%) were placed without the use of the endoscope. Neuroendoscopy did not independently affect the risk of subsequent shunt failure [Hazard Ratio (95% Confidence Interval) = 1.08 (0.84-1.41)]. Endoscopic placement independently decreased the odds [Odds Ratio (95% Confidence Interval) = 0.56 (0.32-0.93)] of proximal obstruction, increased the odds of distal malfunction [1.52 (1.02-2.72)], and was not associated with infection [1.42 (0.78-2.61)]. CONCLUSIONS: Endoscopic assisted ventricular catheter placement decreased the odds of proximal obstruction but failed to improve overall shunt survival in this 6 year experience.
Alan T Villavicencio; Jean-Christophe Leveque; Matthew J McGirt; John S Hopkins; Herbert E Fuchs; Timothy M George
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Surgical neurology     Volume:  59     ISSN:  0090-3019     ISO Abbreviation:  Surg Neurol     Publication Date:  2003 May 
Date Detail:
Created Date:  2003-05-26     Completed Date:  2003-06-10     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0367070     Medline TA:  Surg Neurol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  375-9; discussion 379-80     Citation Subset:  IM    
Pediatric Neurosurgery Service, Division of Neurosurgery, Duke University Medical Center, Durham, North Carolina 27710, USA.
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MeSH Terms
Cerebral Ventricles
Hydrocephalus / therapy*
Neurosurgical Procedures / methods*
Retrospective Studies
Treatment Outcome
Ventriculoperitoneal Shunt / methods*

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