• Journal of Korean Neurosurgical Society
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• v.53 no.3
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• pp.150-154
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• 2013

Objective : To evaluate the effect of electromagnetic (EM) navigation system on ventriculoperitoneal (VP) shunt failure rate through comparing the result of standard shunt placement. Methods : All patients undergoing VP shunt from October 2007 to September 2010 were included in this retrospective study. The first group received shunt surgery using EM navigation. The second group had catheters inserted using manual method with anatomical landmark. The relationship between proximal catheter position and shunt revision rate was evaluated using postoperative computed tomography by a 3-point scale. 1) Grade I; optimal position free-floating in cerebrospinal fluid, 2) Grade II; touching choroid or ventricular wall, 3) Grade III; tip within parenchyma. Results : A total of 72 patients were participated, 27 with EM navigated shunts and 45 with standard shunts. Grade I was found in 25 patients from group 1 and 32 patients from group 2. Only 2 patients without use of navigation belonged to grade III. Proximal obstruction took place 7% in grade I, 15% in grade II and 100% in grade III. Shunt revision occurred in 11% of group 1 and 31% of group 2. Compared in terms of proximal catheter position, there was growing trend of revision rate according to increase of grade on each group. Although infection rate was similar between both groups, the result had no statistical meaning (p=0.905, chi-square test). Conclusion : The use of EM navigation in routine shunt surgery can eliminate poor shunt placement resulting in a dramatic reduction in failure rates.

• Journal of Korean Neurosurgical Society
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• v.49 no.4
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• pp.217-221
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• 2011

Objective : This paper presents data from a retrospective study of endoscopic third ventriculostomy (ETV) in patients with shunt malfunction and proposes a simple and reasonable post-operative protocol that can detect ETV failure. Methods : We enrolled 19 consecutive hydrocephalus patients (11 male and 8 female) who were treated with ETV between April 2001 and July 2010 after failure of previously placed shunts. We evaluated for correlations between the success rate of ETV and the following parameters : age at the time of surgery, etiology of hydrocephalus, number of shunt revisions, interval between the initial diagnosis of hydrocephalus or the last shunt placement and ETV, and the indwelling time of external ventricular drainage. Results : At the time of ETV after shunt failure, 14 of the 19 patients were in the pediatric age group and 5 were adults, with ages ranging from 14 months to 42 years (median age, 12 years). The patients had initially been diagnosed with hydrocephalus between the ages of 1 month 24 days and 32 years (median age, 6 years 3 months). The etiology of hydrocephalus was neoplasm in 7 patients; infection in 5; malformation, such as aqueductal stenosis or megacisterna magna in 3; trauma in 1; and unknown in 3. The overall success rate during the median follow-up duration of 1.4 years (9 days to 8.7 years) after secondary ETV was 68.4%. None of the possible contributing factors for successful ETV, including age (p=0.97) and the etiology of hydrocephalus (p=0.79), were statistically correlated with outcomes in our series. Conclusion: The use of ETV in patients with shunt malfunction resulted in shunt independence in 68.4% of cases. Age, etiology of hydrocephalus, and other contributing factors were not statistically correlated with ETV success. External ventricular drainage management during the immediate post-ETV period is a good means of detecting ETV failure.

• Journal of Korean Neurosurgical Society
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• v.30 no.sup1
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• pp.79-84
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• 2001

To investigate contributory factors of CSF shunt failure, 237 patients, who underwent shunt placement from January 1995 to December 1998 at our hospital, were reviewed retrospectively. The causes of the hydrocephalus were tumor, hemorrhage, infection, congenital anomaly, normal pressure hydrocephalus, trauma and others. One hundred nine revisions of CSF shunting were done during follow up periods. The causes of shunt revisions were mechanical obstruction, malposition, infection and others. The contributory factors of CSF shunt failure and shunt survival rate were analyzed using SPSS. The shunt survival rate at 1, 2 and 3 years after procedure was 77.1%, 75.4%, 74.1% respectively. In the young age group below 10 years old, postinfectous hydrocephalus was the most common high risk factor for shunt revision. In conclusion, the most shunt failures developed in the first year after surgery and the age and causes of the hydrocephalus were major determinant factors of shunt revision.

• Archives of Reconstructive Microsurgery
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• v.23 no.2
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• pp.97-100
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• 2014

The number of patients with chronic renal failure who require renal replacement therapy is increasing and dialysis is still the mainly used renal replacement therapy. The first choice of surgical technique currently used is side-to-end anastomosis of the radial artery and the cephalic vein. The authors report on a case of an effective arteriovenous shunt operation performed using microscopy. A 53-year-old male with chronic renal failure was referred to plastic and reconstructive surgery department to undergo an arteriovenous shunt operation. Venography was performed before surgery in order to find the appropriate vessel for the arteriovenous shunt operation. The cephalic vein on the wrist showed a diameter of over 4 mm, which was appropriate for an arteriovenous shunt operation. Anastomosis of the vessels was performed under microscopy using Nylon #9-0. Blood flow and vessel diameter were evaluated by venography after surgery and showed well maintained function of the shunt. Complications such as bleeding, edema of the upper arm, and wound dehiscence did not occur. Many factors and certain complications may affect the long-term patency of an arteriovenous shunt; however, exquisite surgical technique is the most important factor in a successful operation. Thus, arteriovenous shunt operation using microscopy is thought to be a good treatment option.

• Journal of Korean Neurosurgical Society
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• v.29 no.2
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• pp.270-273
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• 2000

Ventriculoperitoneal(V-P) shunt has been used as a popular method for surgical treatment of hydrocephalus. But complications such as infection, mechanical obstruction and failure of flow rate sometimes make painful stress to neurosurgeons and patients. Of particular, migration of distal V-P shunt catheter to extraperitoneal space has rarely been reported. Even rarer is intracardiac migration of distal V-P shunt catheter. Authors report a such case and discuss the possible mechanism and preventive method.

• Journal of Chest Surgery
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• v.30 no.4
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• pp.378-382
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• 1997

To evaulate the effectiveness and risk factors for shunt failure of the Blalock-Taussig shunt in neonates, we analyzed the 21 neonates who were undergone Blalok-Taussig shunt operation at Dong-A University Hospital from December 1991 to Feburary 1996. We evaluated operative mortality, patency of the shunt. and distortion of pulmonary artery. We also determined the risk factors for the shunt failure. Age at operation was from 1 day to 30 days(mean 11.7 days). We ghts were 2.4 to 4.5kg(mean 3.1 kg). The underlying lesions included severe tetralogy of Fallot with pulmonary stenosls or atresia(N=11) and single ventricle varieties with. pulmonary stenosis or atresia(N=10). Prostaglandin El was given in 13 neonates prior to operation. The mean preoperative(prior to prostaglandin El therapy) and postoperative arterial oxygen tension were 30.1 mmHg and 46.3 mmHg respectively(P(0.01). The shunt was performed through a left thoracotomy in 11 patients and through a right thoracotomy In 10. A 5 mm graft was used in 15 patients and a 4 mm graft in 6 patients. The incidence of early shunt occlusion was 9.5%(2 patients). The hospital mortality was 9.5%(2 patients with early shunt occlusion). Univariate analysis revealed that body weight of 2.6 kg or less(p=0.021), pulmonary artery size of 3mm or less(p=0.008), and 4 mm graft (p=0.021) were risk factors predictive of early shunt failure. The patency rate of the shunt in hospital survivors was 100% at mean ollow-up of ll.3 months(There was not death or reoperation related to shunt failure). 10 patients were catheterized during postoperative follow-up. There was no significant distorsion of pulmonary artery. So we concluded that the modified Blalock-Taussig shunt in neonates was excellent in the hospital survivors.

• Journal of Chest Surgery
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• v.48 no.1
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• pp.52-54
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• 2015

Idiopathic pulmonary arterial hypertension eventually leads to right-sided heart failure and sudden death. Its mortality rate in children is still high, despite improvements in pharmacological therapy, and therefore novel treatments are necessary. The Potts shunt, which creates an anastomosis between the left pulmonary artery and the descending aorta, has been proposed as a theoretically promising palliative surgical technique to decompress the right ventricle. We report the case of a 12-year-old girl with suprasystemic idiopathic pulmonary hypertension and right ventricular failure who underwent a Potts shunt for palliation with good short-term results.

• Journal of Chest Surgery
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• v.15 no.2
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• pp.194-203
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• 1982

In this investigation we undertook to evaluate the utility of radionuclide cardiac angiography in the detection of cardiac shunts before and after surgical correction. Time-activity curves of ventricles and lungs were evaluated after bolus intravenous injection of 99mTc-human serum albumin in 512 preoperative patients and 551 post-operative patients. Omitting 31 cases of technical failure due to poor bolus, we detected shunts in 459 cases of 481 preoperative evaluations, so the detectability was 95.4%. The cases which couldn`t be detected by this method had small amount of shunt. Also the degree of shunt detected by radioisotope methods were well correlated with oxymetry method. [r=0.89, p<0.01 ] In postoperative evaluations, 18 out of 411 patients with left to right shunt and 10 out of 140 right to left shunt were found to have remnant shunts with radionuclide cardiac angiography. Of the 28 cases with failed operation, 2 were confirmed in reoperation, 2 by cardiac catheterization, 2 by two -dimensional echocardiography. All except one .f these patients had membranous ventricular septal defects and those with left to right shunts had moderate to severe pulmonary hypertension and shunt amount. Also those had larger septal defects than control group. We consider that radionuclide cardiac angiography is a simple and noninvasive method which can show the preoperative diagnosis and postoperative follow up of cardiac shunts.

• Journal of Korean Neurosurgical Society
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• v.66 no.2
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• pp.162-171
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• 2023

Objective : The goal of this study was to analyze the clinical outcomes of endoscopic third ventriculostomy (ETV) and endoscopic septostomy when shunt malfunction occurs in a patient who has previously undergone placement of a ventriculoperitoneal shunt. Methods : From 2001 to 2020 at Seoul National University Children's Hospital, patients who underwent ETV or endoscopic septostomy for shunt malfunction were retrospectively analyzed. Initial diagnosis (etiology of hydrocephalus), age at first shunt insertion, age at endoscopic procedure, magnetic resonance or computed tomography image, subsequent shunting data, and follow-up period were included. Results : Thirty-six patients were included in this retrospective study. Twenty-nine patients, 18 males and 11 females, with shunt malfunction underwent ETV. At the time of shunting, the age ranged from 1 day to 15.4 years (mean, 2.4 years). The mean age at the time of ETV was 13.1 years (range, 0.7 to 29.6 years). Nineteen patients remained shunt revision free. The 5-year shunt revision-free survival rate was 69% (95% confidence interval [CI], 0.54-0.88). Seven patients, three males and four females, with shunt malfunction underwent endoscopic septostomy. At the time of shunting, the age ranged from 0.2 to 12 years (mean, 3.9 years). The mean age at the time of endoscopic septostomy was 11.9 years (range, 0.5 to 29.5 years). Four patients remained free of shunt revision or addition. The 5-year shunt revision-free survival rate was 57% (95% CI, 0.3-1.0). There were no complications associated with the endoscopic procedures. Conclusion : The results of our study demonstrate that ETV or endoscopic septostomy can be effective and safe in patients with shunt malfunction.

• Journal of Chest Surgery
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• v.11 no.2
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• pp.227-231
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• 1978

Since January 1973 we have performed 47 arteriovenous shunts and 22 arteriovenous fistulas for 57 patients with acute or chronic renal failure. Of these 57 cases, 50 cases had chronic renal failure and the other 7 cases had acute renal failure. The most frequent complications after operations were thrombosis, bleeding and infection. Less frequently dislodgement of shunt and aneurysmal change of the fistula were found. After 47 arteriovenous shunts, 21 those complications [44%] were found. On the other hand after 22 arteriovenous fistulas, 5 complications were found. Now we are using the arteriovenous shunt only for the patients who need emergency short term hemodialysis and temporary dialysis until arteriovenous fistula could be used.