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Ventriculosinus shunt

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Abstract

Hydrocephalus can be managed successfully with cerebrospinal fluid shunting to extracranial compartments, most commonly the peritoneum. However, current shunt systems are not ideal with high revision rates on long-term follow-up. Draining the cerebrospinal fluid from the cerebral ventricles to the cerebral venous sinuses could mimic the physiological conditions with the added advantages of avoiding overdrainage and extracranial recipient site complications. A literature search was carried out using the keywords hydrocephalus, shunt, venous sinus and sagittal sinus. Seven clinical series of ventriculosinus shunts with a total of 265 patients were found. None of the patients developed venous sinus thrombosis, air embolism or intra-operative sinus bleeding. Ventriculosinus shunt is a potential alternative that can be done under local anaesthetic in ill patients where traditional shunts recipient sites are not feasible. However, further studies with extended follow-up period would provide better understanding of the suitability and indications of this technique.

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Disclosure

Mr. Toma and Mr. Tarnaris are supported by a grant from B. Braun/Aesculap.

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Authors and Affiliations

  1. Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK

    Ahmed K. Toma, Andrew Tarnaris, Neil D. Kitchen & Laurence D. Watkins

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  1. Ahmed K. Toma
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  2. Andrew Tarnaris
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  3. Neil D. Kitchen
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  4. Laurence D. Watkins
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Correspondence to Ahmed K. Toma.

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Comments

Andreas M. Stark, Kiel, Germany

The authors present an interesting literature review on ventriculosinus shunt operations. They found a total of seven studies matching the search criteria published between 1965 and 2005. The authors discuss details of the patient population, technical aspects of the operations and the (relatively low) follow-up of the original studies.

Undoubtedly, this operation will only be considered in very few patients where neuroendoscopy or ventriculo-peritoneal/atrial shunting is not possible.

Veit Rohde, Goettingen, Germany

The authors performed a literature review to evaluate the role of ventriculosinus shunts. They identified seven clinical series published between 1965 and 2005 with a total number of 265 patients. The shunt was used in children and in adults with a non-communicating and communicating hydrocephalus. The follow-up period in the second series of Børgesen et al. and the series of El-Shafei et al., who contributed the half of the patients, was only 132 days and 223 days (2–4). The revision rate was not given in three series, including the two series of Børgesen (1,2). In the remaining series, the revision rate varied between 12% and 37.5%. Complications related to catheter insertion into the sinus were not observed, but the overall complication rate according to Fig. 1 was 10% (5), around 20% (2–4, 8), 25% (7) and about 30% (1), which is considerable in the light of the short follow-up period. The authors conclude that ventriculosinus shunt is a potential alternative to ventriculo-atrial and ventriculo-peritoneal shunts.

I must admit that the theory behind the ventriculosinus shunt is intriguing and one might assume that the ventriculosinus shunt is better than other shunts. However, reality and theory are two different things and the ventriculosinus shunt is a good example for this. The ventriculosinus shunt did not make it into the clinical routine because the published series have significant flaws (inhomogeneous patient populations including adults and children; too short follow-up periods in most patients) and, thus, do not provide enough evidence that the ventriculosinus shunt is superior to ventriculo-atrial and ventriculo-peritoneal shunts, especially in times of programmable and gravity-controlled valves (6). More well-designed studies are needed to finally define the value of ventriculosinus shunts.

References

1. Børgesen SE, Gjerris F, Agerlin N: Shunting to the sagittal sinus. Acta Neurochir Suppl 81:11–14, 2002

2. Børgesen SE, Pieri A, Cappelen J, Agerlin N, Gjerris F: Shunting to the cranial venous sinus using SinuShunt. Childs Nerv Syst 20: 397–404, 2004

3. El-Shafei IL, El-Shafei HI: The retrograde ventriculosinus shunt: concept and technique for treatment of hydrocephalus by shunting the cerebrospinal fluid to the superior sagittal sinus against the direction of blood flow. Preliminary report. Childs Nerv Syst 17: 457–465, 2001

4. El-Shafei IL, El-Shafei HI: The retrograde ventriculosinus shunt (El Shafei RVS shunt). Rationale, evolution, surgical technique and long-term results. Pediatr Neurosurg 41: 305–317

5. Hash CJ, Shenkin HA, Crowder LE: Ventricle to sagittal sinus shunt for hydrocephalus. Neurosurgery 4: 394–400, 1979

6. Rohde V, Haberl H, Ludwig H, Thomale UW: First experiences with an adjustable gravitational valve in childhood hydrocephalus. J Neurosurg Pediatrics 3:81–89, 2009

7. Sharkey PC: Ventriculosagattal-sinus shunt. J Neurosurg 22: 362–367, 1965

8. Wen HL: Ventriculo-superior sagittal sinus shunt for hydrocephalus. Surg Neurol 17: 432–434, 1982

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Toma, A.K., Tarnaris, A., Kitchen, N.D. et al. Ventriculosinus shunt. Neurosurg Rev 33, 147–153 (2010). https://doi.org/10.1007/s10143-010-0242-0

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