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Iatrogenic Complications of CSF Shunting

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Complications of CSF Shunting in Hydrocephalus

Abstract

The concept of iatrogenic complications is intimately associated with untoward problems related to the execution of a medical or surgical procedure. There is no medical act devoid of the possibility of an iatrogenic incident. However, many of them seem to be preventable and occur in spite of the willingness or experience of the treating physician. Therefore, iatrogenesis is apt to occur even when a good medical practice has been carried out. The line that distinguishes iatrogenic incidents from true complications seems to be very thin and difficult to draw.

The aphorism “once a shunt always a shunt” obliges to consider, in the first place, the absolute need for establishing a reasoned indication for placing a CSF derivation (“the best shunt is no shunt”). Ventriculomegaly does not always mean hydrocephalus. Active, arrested, and compensated hydrocephalus are concepts that deserve consideration.

A carefully planned technique easily obviates some frequent complications pertaining to extrathecal shunts, for example, correct positioning of the ventricular catheter and adequate placement of the distal catheter within the peritoneal cavity. To prevent iatrogenic complications, we shall consider several aspects of shunting procedures that include those related to the patient, to the surgeon, and those related with the valve, the technique of placement, and the surgical environment. In addition, each type of shunting, be it ventriculoperitoneal, ventriculoatrial, pleural, etc., has its own possibilities of iatrogenesis, which demands both knowledge and expertise. The neurosurgeon must also be aware that an exquisite surgical manipulation at the time of shunt insertion is crucial for decreasing the rate of shunt-related infections. A better knowledge of failures in CSF shunting, and of preventive measures, will undoubtedly contribute to a decrease in many iatrogenic complications derived from its use.

Despite endoscopic third ventriculostomy (ETV) is progressively replacing many CSF shunting operations, neurosurgeons need to continue learning and mastering the techniques of insertion and of revision of CSF shunts, as many instances of hydrocephalus still require the insertion of a shunt. In this chapter, the authors discuss the identification, management, and prevention especially of iatrogenic complications of CSF shunting. A literature review shows that there is no valve clearly superior to others, but experience has taught that the best shunt (if it exists) is the one with which one is more familiar and of which we feel more confident after having learnt its advantages, problems, and tricks related with its use.

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Authors and Affiliations

  1. Pediatric Neurosurgery Section and Regional Service of Neurosurgery, Virgen de la Arrixaca University Hospital, El Palmar, Murcia, 30120, Spain

    Juan F. Martínez-Lage MD & Miguel Angel Pérez-Espejo MD

  2. Department of Radiology, Ankara Training and Research Hospital, Ankara, TR-06590, Turkey

    Ahmet Tuncay Turgut MD

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  1. Juan F. Martínez-Lage MD
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  2. Miguel Angel Pérez-Espejo MD
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  3. Ahmet Tuncay Turgut MD
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Correspondence to Juan F. Martínez-Lage MD .

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  1. Pediatric Neurosurgery, Catholic University Medical School, Rome, Italy

    Concezio Di Rocco

  2. Department of Neurosurgery, Adnan Menderes University School of Medi, Aydin, Turkey

    Mehmet Turgut

  3. Division of Pediatric Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland, USA

    George Jallo

  4. Regional Service of Neurosurgery and Unit of Pediatric Neurosurgery, Virgen de la Arrixaca University Hospital, Murcia, Spain

    Juan F. Martínez-Lage

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Martínez-Lage, J.F., Pérez-Espejo, M.A., Turgut, A.T. (2015). Iatrogenic Complications of CSF Shunting. In: Di Rocco, C., Turgut, M., Jallo, G., Martínez-Lage, J. (eds) Complications of CSF Shunting in Hydrocephalus. Springer, Cham. https://doi.org/10.1007/978-3-319-09961-3_5

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