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Yield of early postoperative computed tomography after frontal ventriculoperitoneal shunt placement

Despite being widely used, ventriculoperitoneal (VP) shunt placement is a procedure often associated with complications and revision surgeries. Many neurosurgical centers routinely perform early postoperative cranial computer tomography (CT) to detect postoperative complications (e.g., catheter malp...

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Autores principales: Kamenova, Maria, Rychen, Jonathan, Guzman, Raphael, Mariani, Luigi, Soleman, Jehuda
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6007904/
https://www.ncbi.nlm.nih.gov/pubmed/29920522
http://dx.doi.org/10.1371/journal.pone.0198752
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author Kamenova, Maria
Rychen, Jonathan
Guzman, Raphael
Mariani, Luigi
Soleman, Jehuda
author_facet Kamenova, Maria
Rychen, Jonathan
Guzman, Raphael
Mariani, Luigi
Soleman, Jehuda
author_sort Kamenova, Maria
collection PubMed
description Despite being widely used, ventriculoperitoneal (VP) shunt placement is a procedure often associated with complications and revision surgeries. Many neurosurgical centers routinely perform early postoperative cranial computer tomography (CT) to detect postoperative complications (e.g., catheter malposition, postoperative bleed, over-drainage). Because guidelines are lacking, our study aimed to evaluate the yield of early routine postoperative CT after shunt placement for adult hydrocephalus. We retrospectively reviewed 173 patients who underwent frontal VP shunting for various neurosurgical conditions. Radiological outcomes were proximal catheter malposition, and ventricular width in preoperative and postoperative imaging. Clinical outcomes included postoperative neurological outcome, revision surgery because of catheter malposition or other causes, mortality, and finally surgical, non-surgical, and overall morbidity. In only 3 (1.7%) patients did the early routine postoperative CT lead to revision surgery. Diagnostic ratios for CT finding 1 asymptomatic patient who eventually underwent revision surgery per total number to scan were 1:58 for shunt malposition, 1:86 for hygroma, and 1:173 for a cranial bleed. Five (2.9%) patients with clinically asymptomatic shunt malposition or hygroma underwent intervention based on early postoperative CT (diagnostic ratio 1:25). Shunt malposition occurred in no patient with normal pressure hydrocephalus and 2 (40%) patients with stroke. Lower preoperative Evans’ Index was a statistically significant predictor for high-grade shunt malposition. We found a rather low yield for early routine postoperative cranial CT after frontal VP-shunt placement. Therefore, careful selection of patients who might benefit, considering the underlying disease and preoperative radiological findings, could reduce unnecessary costs and exposure to radiation.
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spelling pubmed-60079042018-06-21 Yield of early postoperative computed tomography after frontal ventriculoperitoneal shunt placement Kamenova, Maria Rychen, Jonathan Guzman, Raphael Mariani, Luigi Soleman, Jehuda PLoS One Research Article Despite being widely used, ventriculoperitoneal (VP) shunt placement is a procedure often associated with complications and revision surgeries. Many neurosurgical centers routinely perform early postoperative cranial computer tomography (CT) to detect postoperative complications (e.g., catheter malposition, postoperative bleed, over-drainage). Because guidelines are lacking, our study aimed to evaluate the yield of early routine postoperative CT after shunt placement for adult hydrocephalus. We retrospectively reviewed 173 patients who underwent frontal VP shunting for various neurosurgical conditions. Radiological outcomes were proximal catheter malposition, and ventricular width in preoperative and postoperative imaging. Clinical outcomes included postoperative neurological outcome, revision surgery because of catheter malposition or other causes, mortality, and finally surgical, non-surgical, and overall morbidity. In only 3 (1.7%) patients did the early routine postoperative CT lead to revision surgery. Diagnostic ratios for CT finding 1 asymptomatic patient who eventually underwent revision surgery per total number to scan were 1:58 for shunt malposition, 1:86 for hygroma, and 1:173 for a cranial bleed. Five (2.9%) patients with clinically asymptomatic shunt malposition or hygroma underwent intervention based on early postoperative CT (diagnostic ratio 1:25). Shunt malposition occurred in no patient with normal pressure hydrocephalus and 2 (40%) patients with stroke. Lower preoperative Evans’ Index was a statistically significant predictor for high-grade shunt malposition. We found a rather low yield for early routine postoperative cranial CT after frontal VP-shunt placement. Therefore, careful selection of patients who might benefit, considering the underlying disease and preoperative radiological findings, could reduce unnecessary costs and exposure to radiation. Public Library of Science 2018-06-19 /pmc/articles/PMC6007904/ /pubmed/29920522 http://dx.doi.org/10.1371/journal.pone.0198752 Text en © 2018 Kamenova et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Kamenova, Maria
Rychen, Jonathan
Guzman, Raphael
Mariani, Luigi
Soleman, Jehuda
Yield of early postoperative computed tomography after frontal ventriculoperitoneal shunt placement
title Yield of early postoperative computed tomography after frontal ventriculoperitoneal shunt placement
title_full Yield of early postoperative computed tomography after frontal ventriculoperitoneal shunt placement
title_fullStr Yield of early postoperative computed tomography after frontal ventriculoperitoneal shunt placement
title_full_unstemmed Yield of early postoperative computed tomography after frontal ventriculoperitoneal shunt placement
title_short Yield of early postoperative computed tomography after frontal ventriculoperitoneal shunt placement
title_sort yield of early postoperative computed tomography after frontal ventriculoperitoneal shunt placement
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6007904/
https://www.ncbi.nlm.nih.gov/pubmed/29920522
http://dx.doi.org/10.1371/journal.pone.0198752
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