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Noninvasive intracranial pressure monitoring throughout brain compliance guiding a ventriculoperitoneal shunt replacement in hydrocephalus—case report

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Abstract

Introduction

Ventriculoperitoneal (VP) shunt is the primary therapy for hydrocephalus in children; however, this technique is amenable to malfunctions, which could be detected through an assessment of clinical signs and imaging results. Furthermore, early detection can prevent patient deterioration and guide clinical and surgical treatment.

Case presentation

A 5-year-old female with a premedical history of neonatal IVH, secondary hydrocephalus, multiple VP shunts revisions, and slit ventricle syndrome was evaluated using a noninvasive intracranial pressure monitor device at the early stages of the clinical symptoms, evidencing increased intracranial pressure and poor brain compliance. Serial MRI images demonstrated a slight ventricular enlargement, leading to the use of a gravitational VP shunt, promoting progressive improvement. On the follow-up visits, we used the noninvasive ICP monitoring device to guide the shunt adjustments until symptom resolution. Furthermore, the patient has been asymptomatic for the past 3 years without requiring new shunt revisions.

Discussion

Slit ventricle syndrome and VP shunt dysfunctions are challenging diagnoses for the neurosurgeon. The noninvasive intracranial monitoring has allowed a closer follow-up assisting early assessment of brain compliance changes related to a patient's symptomatology. Furthermore, this technique has high sensitivity and specificity in detecting alterations in the intracranial pressure, serving as a guide for the adjustments of programmable VP shunts, which may improve the patient's quality of life.

Conclusion

Noninvasive ICP monitoring may lead to a less invasive assessment of patients with slit ventricle syndrome and could be used as a guide for adjustments of programmable shunts.

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Data availability

Data from this manuscript are available upon reasonable request.

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Author information

Authors and Affiliations

  1. Department of Neurology and Neurosurgery, School of Medicine, Federal University of São Paulo, São Paulo, Brazil

    Nelci Zanon

  2. Centro de Neurocirurgia Pediátrica - CENEPE, São Paulo, Brazil

    Nelci Zanon, Victor Hugo da Costa Benalia & Thiago Hoesker

  3. Scientific Department, Braincare Desenvolvimento e Inovação Tecnológica S.A., São Carlos, Brazil

    Cintya Yukie Hayashi & Gustavo Frigieri

  4. Division of Neurosurgery, Department of Neurology, Faculty of Medicine, University of Sao Paulo, Sao Paulo, Brazil

    Cintya Yukie Hayashi & Giselle Coelho

  5. Scientific Department, EDUCSIM Institute, São Paulo, Brazil

    Giselle Coelho

  6. School of Medicine, Faculdade Santa Marcelina, São Paulo, Brazil

    Giselle Coelho

Authors
  1. Nelci Zanon
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  2. Victor Hugo da Costa Benalia
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  3. Thiago Hoesker
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  4. Cintya Yukie Hayashi
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  5. Gustavo Frigieri
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  6. Giselle Coelho
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Contributions

N.Z., V.B., T.H., G.C., neurosurgical experts, wrote the case. C.H. and G.F. wrote the manuscript (technical device knowledge). V.B. English language review. V.B. and C.H. prepared the figures. All authors reviewed the manuscript.

Corresponding author

Correspondence to Nelci Zanon.

Ethics declarations

Ethics approval

This case report was approved by the local ethics committee (CAAE: 31589920.7.3001.5487—Protocol #4.860.944/2021) in compliance with the Declaration of Helsinki.

Consent to participate

Written informed consent was given by the patient's legal guardian regarding the publication of images and clinical data included in this report.

Conflict of interest

NZ has nothing to declare. VHCB has nothing to declare. TH has nothing to declare. CYH declares personal fees as employee (Clinical Research Nurse) from Braincare Desenvolvimento e Inovação Tecnológica S.A. during the conduct of this study. GF declares personal fees as an employee (Scientific Director) from Braincare Desenvolvimento e Inovação Tecnológica S.A. during this study. In addition, GF has a patent US9826934B2 issued and a patent US9993170B1 issued. GC has nothing to declare.

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Zanon, N., da Costa Benalia, V.H., Hoesker, T. et al. Noninvasive intracranial pressure monitoring throughout brain compliance guiding a ventriculoperitoneal shunt replacement in hydrocephalus—case report. Childs Nerv Syst 39, 2215–2219 (2023). https://doi.org/10.1007/s00381-023-05922-3

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  • DOI: https://doi.org/10.1007/s00381-023-05922-3

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