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Strengths and weaknesses of frontal versus occipital ventriculoperitoneal shunt placement: A systematic review

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Abstract

Excessive accumulation of cerebrospinal fluid within the brain ventricles is called hydrocephalus, which results in increased intracranial pressure preventing brain growth or causing damage to intracranial structures due to raised intracranial pressure. One of the most common treatment options for this pathology includes the placement of a ventriculoperitoneal shunt to drain the excess fluid. The location of catheterization is traditionally considered as an important factor affecting shunt survival. In this study, we aimed to systematically review all available documents to determine the advantage and superiority of frontal or occipital shunt entry points as the two main approaches. A database search was performed in PubMed, Scopus, Embase, Web of Science, Medline, Ovid, and Google Scholar using “ventriculoperitoneal”, “shunt placement”, and “hydrocephalus” as the main key terms. Resultant articles were screened for relevancy based on predefined inclusion and exclusion criteria by two authors independently. After excluding irrelevant documents, the data of 11 related articles consisting of 3947 patients were extracted and qualitative data synthesis and pooled analysis were performed. The results of the included studies showed that although the outcomes of a higher percentage of the total review population were in favor of frontal shunt placement, there was no significant superiority for neither of these two approaches after pooled analysis of available failure rates. Findings have shown that each approach has benefits and drawbacks, and there may be other factors such as age and valve design besides the position of shunt placement that may affect the survival rate. Also, the accuracy of shunt placement as an independent factor affects the failure rate and can be improved with various image-guidance methods to minimize shunt failure.

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References

  1. Trevisi G, Frassanito P, Di Rocco C (2014) Idiopathic cerebrospinal fluid overproduction: case-based review of the pathophysiological mechanism implied in the cerebrospinal fluid production. Croat Med J 55(4):377–387

    Article  CAS  Google Scholar 

  2. Chan M, Amin-Hanjani S (2010) Cerebrospinal fluid and its abnormalities

    Book  Google Scholar 

  3. Lind CR, Tsai AM, Lind CJ, Law AJ (2009) Ventricular catheter placement accuracy in non-stereotactic shunt surgery for hydrocephalus. J Clin Neurosci 16(7):918–920

    Article  Google Scholar 

  4. Pattisapu JV (2001) Etiology and clinical course of hydrocephalus. Neurosurg Clin N Am 12(4):651–659 vii

    Article  CAS  Google Scholar 

  5. Kemp J, Flannery AM, Tamber MS, Duhaime AC (2014) Pediatric hydrocephalus: systematic literature review and evidence-based guidelines. Part 9: Effect of ventricular catheter entry point and position. J Neurosurg Pediatr 14(Suppl 1):72–76

    Article  Google Scholar 

  6. Fowler JB, Mesfin FB (2020) Ventriculoperitoneal Shunt. StatPearls. Treasure Island

  7. Tuli S, O'Hayon B, Drake J, Clarke M, Kestle J (1999) Change in ventricular size and effect of ventricular catheter placement in pediatric patients with shunted hydrocephalus. Neurosurgery. 45(6):1329–1333 discussion 33-5

    Article  CAS  Google Scholar 

  8. Riva-Cambrin J, Kestle JR, Holubkov R, Butler J, Kulkarni AV, Drake J et al (2016) Risk factors for shunt malfunction in pediatric hydrocephalus: a multicenter prospective cohort study. J Neurosurg Pediatr 17(4):382–390

    Article  Google Scholar 

  9. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JP et al (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ. 339:b2700

    Article  Google Scholar 

  10. Aldrich EF, Harmann P (1990) Disconnection as a cause of ventriculoperitoneal shunt malfunction in multicomponent shunt systems. Pediatr Neurosurg 16(6):309–311 discussion 12

    Article  Google Scholar 

  11. Sainte-Rose C, Piatt JH, Renier D, Pierre-Kahn A, Hirsch JF, Hoffman HJ, Humphreys RP, Hendrick EB (1991) Mechanical complications in shunts. Pediatr Neurosurg 17(1):2–9

    Article  Google Scholar 

  12. Robinson S, Kaufman BA, Park TS (2002) Outcome analysis of initial neonatal shunts: does the valve make a difference? Pediatr Neurosurg 37(6):287–294

    Article  Google Scholar 

  13. Nakahara K, Shimizu S, Utsuki S, Suzuki S, Oka H, Yamada M, Kan S, Fujii K (2009) Shortening of ventricular shunt catheter associated with cranial growth: effect of the frontal and parieto-occipital access route on long-term shunt patency. Childs Nerv Syst 25(1):91–94

    Article  Google Scholar 

  14. Wan KR, Toy JA, Wolfe R, Danks A (2011) Factors affecting the accuracy of ventricular catheter placement. J Clin Neurosci 18(4):485–488

    Article  Google Scholar 

  15. Kullmann M, Khachatryan M, Schuhmann MU (2018) Ultrasound-guided placement of ventricular catheters in first-time pediatric VP shunt surgery. Childs Nerv Syst 34(3):465–471

    Article  Google Scholar 

  16. Craven CL, Pradini-Santos L, Goel A, Thorne L, Watkins LD, Toma AK (2020) Approach to slitlike ventricles: parietal-occipital versus frontal burr catheter entry sites. World Neurosurg 135:e447–ee51

    Article  Google Scholar 

  17. Bierbrauer KS, Storrs BB, McLone DG, Tomita T, Dauser R (1990) A prospective, randomized study of shunt function and infections as a function of shunt placement. Pediatr Neurosurg 16(6):287–291

    Article  Google Scholar 

  18. Whitehead WE, Riva-Cambrin J, Kulkarni AV, Wellons JC 3rd, Rozzelle CJ, Tamber MS et al (2017) Ventricular catheter entry site and not catheter tip location predicts shunt survival: a secondary analysis of 3 large pediatric hydrocephalus studies. J Neurosurg Pediatr 19(2):157–167

    Article  Google Scholar 

  19. Drake JM, Kestle J (1996) Rationale and methodology of the multicenter pediatric cerebrospinal fluid shunt design trial. Pediatric Hydrocephalus Treatment Evaluation Group. Childs Nerv Syst 12(8):434–447

    Article  CAS  Google Scholar 

  20. Lind CR, Tsai AM, Law AJ, Lau H, Muthiah K (2008) Ventricular catheter trajectories from traditional shunt approaches: a morphometric study in adults with hydrocephalus. J Neurosurg 108(5):930–933

    Article  Google Scholar 

  21. Albright AL, Haines SJ, Taylor FH (1988) Function of parietal and frontal shunts in childhood hydrocephalus. J Neurosurg 69(6):883–886

    Article  CAS  Google Scholar 

  22. Bhargav AG, Rinaldo L, Lanzino G, Elder BD (2019) Comparison of complication and revision rates after frontal versus parietal approach for ventricular shunt placement in idiopathic normal pressure hydrocephalus. World Neurosurg 126:e1017–e1e22

    Article  Google Scholar 

  23. Dickerman RD, McConathy WJ, Morgan J, Stevens QE, Jolley JT, Schneider S et al (2005) Failure rate of frontal versus parietal approaches for proximal catheter placement in ventriculoperitoneal shunts: revisited. J Clin Neurosci 12(7):781–783

    Article  CAS  Google Scholar 

  24. Maruyama H, Nakata Y, Kanazawa A, Watanabe H, Shigemitsu Y, Iwasaki Y, Tokorodani C, Miyazawa M, Nishiuchi R, Kikkawa K (2015) Ventriculoperitoneal shunt outcomes among infants. Acta Med Okayama 69(2):87–93

    PubMed  Google Scholar 

  25. Hammersen S, Pietila TA, Brock M (2000) Accurate placement of the distal end of a ventriculoatrial shunt catheter using Alphacard: direct intraoperative comparison with fluoroscopy. Acta Neurochir 142(5):563–566

    Article  CAS  Google Scholar 

  26. Levitt MR, O’Neill BR, Ishak GE, Khanna PC, Temkin NR, Ellenbogen RG et al (2012) Image-guided cerebrospinal fluid shunting in children: catheter accuracy and shunt survival. J Neurosurg Pediatr 10(2):112–117

    Article  Google Scholar 

  27. Crowley RW, Dumont AS, Asthagiri AR, Torner JC, Medel R, Jane JA Jr, Jane JA, Kassell NF (2014) Intraoperative ultrasound guidance for the placement of permanent ventricular cerebrospinal fluid shunt catheters: a single-center historical cohort study. World Neurosurg 81(2):397–403

    Article  Google Scholar 

  28. Whitehead WE, Jea A, Vachhrajani S, Kulkarni AV, Drake JM (2007) Accurate placement of cerebrospinal fluid shunt ventricular catheters with real-time ultrasound guidance in older children without patent fontanelles. J Neurosurg 107(5 Suppl):406–410

    PubMed  Google Scholar 

  29. Della Pepa GM, Sabatino G, Peppucci E, Sturiale CL, Albanese A, Puca A, Olivi A, Marchese E, Perotti V (2018) Electrocardiographic-guided technique for placement of ventriculoatrial shunts: a valid and cost-effective technical simplification. World Neurosurg 109:455–459

    Article  Google Scholar 

  30. Jeremiah KJ, Cherry CL, Wan KR, Toy JA, Wolfe R, Danks RA (2016) Choice of valve type and poor ventricular catheter placement: modifiable factors associated with ventriculoperitoneal shunt failure. J Clin Neurosci 27:95–98

    Article  Google Scholar 

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Authors and Affiliations

  1. Neurosurgery Department, Akbar Children Hospital, Mashhad University of Medical Sciences, P.O. Box 9177897157, Kaveh Blvd, Mashhad, Iran

    Ehsan Keykhosravi & Amin Tavallaii

  2. Functional Neurosurgery Research Center, Shohada Tajrish Neurosurgical Comprehensive Center of Excellence, Shahid Beheshti University of Medical Sciences, Tehran, Iran

    Mohammad Reza Shahmohammadi

  3. Neurosurgery Department, Mashhad University of Medical Sciences, Mashhad, Iran

    Hamid Rezaee & Mohammad Ali Abouei Mehrizi

  4. Department of Biology, Mashhad Branch, Islamic Azad University, Mashhad, Iran

    Hale Sadat Tavakkol Afshari

Authors
  1. Ehsan Keykhosravi
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  2. Mohammad Reza Shahmohammadi
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  3. Hamid Rezaee
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  4. Mohammad Ali Abouei Mehrizi
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  5. Hale Sadat Tavakkol Afshari
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  6. Amin Tavallaii
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Correspondence to Amin Tavallaii.

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The authors declare that they have no conflict of interest.

Human participant or animal involvement

This is a systematic review of available data and there is no human participant or animal directly or indirectly involved in this study.

Informed consent or ethical approval

Because systematic reviews do not present individual data that can disclose patients’ identity, informed consent acquisition is not applicable. On the other hand, because systematic reviews use publicly available data for interpretation of results and do not include any interventions, institutional ethics approval was not obtained. But all relevant aspects of ethics in the research were considered and followed throughout the study.

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Keykhosravi, E., Shahmohammadi, M.R., Rezaee, H. et al. Strengths and weaknesses of frontal versus occipital ventriculoperitoneal shunt placement: A systematic review. Neurosurg Rev 44, 1869–1875 (2021). https://doi.org/10.1007/s10143-020-01391-3

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  • DOI: https://doi.org/10.1007/s10143-020-01391-3

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