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. 2024 Jul 11;14(1):16009.
doi: 10.1038/s41598-024-66917-x.

Modified ventriculoperitoneal shunt applied to temporary external ventricular drainage

Zhixiong Lin  1   2 , Jintao Chen  3   4 , Weili Lin  3   4 , Bei Liu  3   4 , Chaoqun Weng  3   4 , Yongzhao Yang  3   4 , Congai Liu  3   4 , Rongbiao Zhang  3   4
Affiliations

Modified ventriculoperitoneal shunt applied to temporary external ventricular drainage

Zhixiong Lin et al. Sci Rep. .

Abstract

External ventricular drainage (EVD) is a common procedure in neurosurgical practice. Presently, the three methods used most often include direct EVD (dEVD), long-tunneled external ventricular drains (LTEVDs), and EVD via the Ommaya reservoir (EVDvOR). But they possess drawbacks such as limited duration of retention, vulnerability to iatrogenic secondary infections, and challenges in regulating drainage flow. This study aimed to explore the use of a modified ventriculoperitoneal shunt (mVPS)-the abdominal end of the VPS device was placed externally-as a means of temporary EVD to address the aforementioned limitations. This retrospective cohort study, included 120 cases requiring EVD. dEVD was performed for 31 cases, EVDvOR for 54 cases (including 8 cases with previously performed dEVD), and mVPS for 35 cases (including 6 cases with previously performed EVDvOR). The one-time success rate (no need for further other EVD intervention) for dEVD, EVDvOR, and mVPS were 70.97%, 88.89%, and 91.42%, dEVD vs EVDvOR (P < 0.05), dEVD vs mVPS (P < 0.05), EVDvOR vs mVPS (P > 0.05). Puncture needle displacement or detachment was observed in nearly all cases of EVDvOR, while no such complications have been observed with mVPS. Apart from this complication, the incidence of postoperative complications was 35.48%, 14.81%, and 8.5%, dEVD vs EVDvOR (P < 0.05), dEVD vs mVPS (P < 0.05), EVDvOR vs mVPS (P > 0.05). Mean postoperative retention for EVD was 14.68 ± 9.50 days, 25.96 ± 15.14 days, and 82.43 ± 64.45 days, respectively (P < 0.001). In conclusion, mVPS significantly extends the duration of EVD, which is particularly beneficial for patients requiring long-term EVD.

Keywords: External ventricular drainage; Hydrocephalus; Modified ventriculoperitoneal shunt; Ommaya reservoir.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1
Figure 1
Schematic diagram of three external ventricular drainage procedures. The actual picture, drainage tube reconstruction picture and simulation picture of direct external ventricular drainage are A/B/C, respectively; The actual picture, drainage tube reconstruction picture and simulation picture of external ventricular drainage with Ommaya reservoir are D/E/F, respectively; The actual picture, drainage tube reconstruction picture and simulation picture of ventriculoperitoneal shunt external peritoneal drainage are G/H/I/J, respectively.
Figure 2
Figure 2
CT imaging features of various acquired hydrocephalus. Imaging of secondary hydrocephalus due to intraventricular hemorrhage: Axial (A), coronal (B), and sagittal (C), Imaging of obstructive hydrocephalus caused by brain tumor: Axial (D), coronal (E), and sagittal (F), Imaging of secondary intracranial infection after ventriculoperitoneal shunt: Axial (G), coronal (H), and sagittal (I), Imaging of brain abscess with intracranial infection: Axial (J), coronal (K), and sagittal (L).
Figure 3
Figure 3
Comparison of the success rate of one-time target control (A), complications (B) and indwelling time (C) between the three kinds of external ventricular drainage.
Figure 4
Figure 4
Procedure of surgical selection for patients with temporary external ventricular drainage.
See this image and copyright information in PMC

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