Treatment of hydrocephalus in adults by placement of an open ventricular shunt

Abstract

Object. Ventricular shunt placement is the neurosurgical procedure most frequently associated with complications. Over the years, it has been a growing concern that the performance of most shunting devices does not conform to physiological parameters. An open ventriculoperitoneal (VP) bypass with a peritoneal catheter for which the cross-sectional internal diameter was 0.51 mm as a distinctive element for flow resistance was evaluated for use in the treatment of adult patients with hydrocephalus. Methods. During a 2-year period, open shunts were surgically implanted in 54 adults with hydrocephalus; conventional shunts were implanted in 80 matched controls. Periodic evaluations were performed using neuroimaging studies and measures of clinical status. All patients were followed from 12 to 36 months, 18.5 ± 4 months for patients with the open shunt and 19.1 ± 8.1 months for controls (mean ± standard deviation). The device continued to function in 50 patients with the open shunt (93%) and in 49 controls (61%; p < 0.001). The Evans index in patients with the open shunt was 0.33 ± 0.09 throughout the follow up. No cases of infection, overdrainage, or slit ventricles were observed; the index in controls was 0.28 ± 0.08; 60% of them developed slit ventricles. During the follow-up period occlusion occurred in four patients with the open shunt (7%) and in 31 controls (39%; p < 0.001). Conclusions. The daily cerebrospinal fluid (CSF) drainage through the open VP shunt is close to 500 ml of uninterrupted flow propelled by the hydrokinetic force generated by the combination of ventricular pressure and siphoning effect. It complies with hydrokinetic parameters imposed by a bypass connection between the ventricular and peritoneal cavities as well as with the physiological archetype of continuous flow and drainage according to CSF production. The open shunt is simple, inexpensive, and an effective treatment for hydrocephalus in adults.