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Individualized Management of Subdural Effusion-Hematoma in Pediatric Shunt Patients

Year 2023, Volume: 11 Issue: 3, 214 - 219, 15.10.2023

Abstract

AİM
This study examines the challenges of managing subdural effusion-hematoma (SEH) following shunt procedures for treating hydrocephalus in a pediatric population. It raises questions about the effectiveness of fixed-pressure versus adjustable shunts, particularly in the management of SEH complications. While adjustable shunts have been lauded for their flexibility, neither option has fully eradicated the risk of SEH. The study aims to share clinical insights into managing these complications, given the lack of a one-size-fits-all solution.
MATERİAL AND METHODS
This study retrospectively analyzes data from 2011 to 2022 on 496 pediatric patients who underwent ventriculoperitoneal (VP) shunt surgery for hydrocephalus at the same hospital. The study focuses on 11 patients with shunt-related subdural effusion-hematoma (SEH).
RESULTS
This detailed study on 11 pediatric patients who developed subdural effusion-hematoma (SEH) after shunt placement reveals a diverse range of symptoms and treatments. Asymptomatic patients were closely monitored, while those with shunt infections had their shunts removed and underwent extra-ventricular drainage (EVD). In more severe cases, such as reduced consciousness, emergency interventions like shunt removal and hematoma surgery were performed. The outcomes varied, but many patients showed improvements and some were even able to continue without a shunt, based on individualized assessments and treatments.
CONCLUSION:
The study concludes that managing SEH in pediatric patients post-shunt placement is complex and individualized, emphasizing that treatment should be symptom-based rather than solely relying on radiological findings, thereby filling a gap in the literature that mostly focuses on adults.

References

  • 1) Tinois J, Bretonnier M , Proisy M , Morandi X, Riffaud L . Ruptured intracranial arachnoid cysts in the subdural space: evaluation of subduro-peritoneal shunts in a pediatric population. hilds Nerv Syst 2020;36(9):2073-78.
  • 2) Altwejri I S,. AlRaddadi K K, Alsager G A, Abobotain A H, Al Abdulsalam H K, AlQazlan S M and Almujaiwel N A. Patterns and prognosis of Ventriculoperitoneal shunt malfunction among pediatrics in Saudi Arabia. Neurosciences Journal October 2020, 25 (5) 356-61.
  • 3) Goodwin C R, Kharkar S, Wang P, Pujari S, Rigamonti D, Williams M A. Evaluation and treatment of patients with suspected normal pressure hydrocephalus on long-term warfarin anticoagulation therapy. Neurosurgery, 2007, 60 (3) 497–501.
  • 4) Toma A K, Tarnaris A, Kitchen N D, Watkins L D. Use of the proGAV shunt valve in normal-pressure hydrocephalus. Neurosurgery 2011;68(2 Suppl Operative):245-9.
  • 5) Pedersen S H, Lilja-Cyron A, Astrand R and Juhler M. Monitoring and Measurement of Intracranial Pressure in Pediatric Head Trauma. Front Neurol. 2019; 10: 1376.
  • 6) Pedersen S H, Lilja-Cyron A, Astrand R and Juhler M. The Relationship Between Intracranial Pressure and Age-Chasing Age-Related Reference Values. World Neurosurg 2018;110(2):119-23.
  • 7) Feletti A, d'Avella D, Wikkelsø C et al. Ventriculoperitoneal Shunt Complications in the European Idiopathic Normal Pressure Hydrocephalus Multicenter Study. Oper Neurosurg (Hagerstown). 2019 ; 1;17(1):97-102.
  • 8) Huang A, Kuo L, Lai DM, Yang SH, Kuo MF. Antisiphon device: A review of existing mechanisms and clinical applications to prevent overdrainage in shunted hydrocephalic patients. Biomed J. 2022;45(1):95-108.
  • 9) Serarslan Y, Yilmaz A, Çakır M, et al. Use of programmable versus nonprogrammable shunts in the management of normal pressure hydrocephalus: A multicenter retrospective study with cost–benefit analysis in Turkey. Medicine (2017) 96:39.
  • 10) Tervonen J, Adams H, Lindgren A. Shunt performance in 349 patients with hydrocephalus after aneurysmal subarachnoid hemorrhage. Acta Neurochir (Wien). 2021;163(10):2703-14.
  • 11) Sundström N, Lagebrant M, Eklund A, Koskinen L D, Malm J. Subdural hematomas in 1846 patients with shunted idiopathic normal pressure hydrocephalus: treatment and long-term survival. J Neurosurg. 2018;129(3):797-804.
  • 12) Oge D D, Arsava E M, Pektezel M Y, Gocmen R, Topcuoglu M A. Intracerebral hemorrhage volume estimation: Is modification of the ABC/2 formula necessary according to the hematoma shape? Clin Neurol Neurosurg. Agust 2021; 207:106779.
  • 13) Gasslander J, Sundström N, Eklund A, Koskinen L D, Malm J. Risk factors for developing subdural hematoma: a registry-based study in 1457 patients with shunted idiopathic normal pressure hydrocephalus. J Neurosurg. 2020; 10;1-10.
  • 14) Ros B, Iglesias S, Linares J, et al. Shunt Overdrainage: Reappraisal of the Syndrome and Proposal for an Integrative Model. J Clin Med 2021; 17;10(16):3620.

Pediatrik Şant Hastalarında Subdural Efüzyon-Hematoma'nın Bireyselleştirilmiş Yönetimi

Year 2023, Volume: 11 Issue: 3, 214 - 219, 15.10.2023

Abstract

AMAÇ
Bu çalışma, pediatrik bir popülasyonda hidrosefali tedavisi için şant prosedürleri sonrası subdural efüzyon-hematoma (SEH) yönetiminin zorluklarını incelemektedir. Sabit basınçlı ve ayarlanabilir şantlar arasındaki etkinliği, özellikle SEH komplikasyonlarının yönetimi açısından sorgulamaktadır. Ayarlanabilir şantlar esneklikleri için övülse de, hiçbir seçenek SEH riskini tamamen ortadan kaldırmamıştır. Çalışma, bu komplikasyonların yönetimine dair klinik içgörüler paylaşmayı amaçlamaktadır, çünkü tek tip bir çözüm yoktur.
MATERYAL VE YÖNTEMLER
Bu çalışma, 2011'den 2022'ye kadar aynı hastanede hidrosefali için ventriküloperitoneal (VP) şant ameliyatı geçirmiş 496 pediatrik hastanın verilerini retrospektif olarak analiz etmektedir. Çalışma, şantla ilgili subdural efüzyon-hematoma (SEH) gelişen 11 hastaya odaklanmaktadır.
SONUÇLAR
Şant yerleştirilmesi sonrası subdural efüzyon-hematoma (SEH) gelişen 11 pediatrik hastayı detaylı olarak inceleyen bu çalışma, çeşitli belirtiler ve tedaviler ortaya koymaktadır. Asemptomatik hastalar yakından izlenmiş, şant enfeksiyonları olanlarda ise şantlar çıkarılmış ve ekstra-ventriküler drenaj (EVD) yapılmıştır. Daha ciddi vakalarda, gibi bilincin azalması gibi durumlarda, şant çıkarılması ve hematoma ameliyatı gibi acil müdahaleler yapılmıştır. Sonuçlar farklılık gösterse de, birçok hasta iyileşme göstermiş ve bazıları bile bireyselleştirilmiş değerlendirmeler ve tedaviler temelinde şantsız devam edebilmiştir.
SONUÇ
Çalışma, şant yerleştirilmesi sonrası pediatrik hastalarda SEH yönetiminin karmaşık ve bireyselleştirilmiş olduğu sonucuna varmaktadır. Tedavinin belirti temelli olması gerektiğini vurgulamakta ve bu konuda çoğunlukla yetişkinlere odaklanan literatüre bir katkı sağlamaktadır.

References

  • 1) Tinois J, Bretonnier M , Proisy M , Morandi X, Riffaud L . Ruptured intracranial arachnoid cysts in the subdural space: evaluation of subduro-peritoneal shunts in a pediatric population. hilds Nerv Syst 2020;36(9):2073-78.
  • 2) Altwejri I S,. AlRaddadi K K, Alsager G A, Abobotain A H, Al Abdulsalam H K, AlQazlan S M and Almujaiwel N A. Patterns and prognosis of Ventriculoperitoneal shunt malfunction among pediatrics in Saudi Arabia. Neurosciences Journal October 2020, 25 (5) 356-61.
  • 3) Goodwin C R, Kharkar S, Wang P, Pujari S, Rigamonti D, Williams M A. Evaluation and treatment of patients with suspected normal pressure hydrocephalus on long-term warfarin anticoagulation therapy. Neurosurgery, 2007, 60 (3) 497–501.
  • 4) Toma A K, Tarnaris A, Kitchen N D, Watkins L D. Use of the proGAV shunt valve in normal-pressure hydrocephalus. Neurosurgery 2011;68(2 Suppl Operative):245-9.
  • 5) Pedersen S H, Lilja-Cyron A, Astrand R and Juhler M. Monitoring and Measurement of Intracranial Pressure in Pediatric Head Trauma. Front Neurol. 2019; 10: 1376.
  • 6) Pedersen S H, Lilja-Cyron A, Astrand R and Juhler M. The Relationship Between Intracranial Pressure and Age-Chasing Age-Related Reference Values. World Neurosurg 2018;110(2):119-23.
  • 7) Feletti A, d'Avella D, Wikkelsø C et al. Ventriculoperitoneal Shunt Complications in the European Idiopathic Normal Pressure Hydrocephalus Multicenter Study. Oper Neurosurg (Hagerstown). 2019 ; 1;17(1):97-102.
  • 8) Huang A, Kuo L, Lai DM, Yang SH, Kuo MF. Antisiphon device: A review of existing mechanisms and clinical applications to prevent overdrainage in shunted hydrocephalic patients. Biomed J. 2022;45(1):95-108.
  • 9) Serarslan Y, Yilmaz A, Çakır M, et al. Use of programmable versus nonprogrammable shunts in the management of normal pressure hydrocephalus: A multicenter retrospective study with cost–benefit analysis in Turkey. Medicine (2017) 96:39.
  • 10) Tervonen J, Adams H, Lindgren A. Shunt performance in 349 patients with hydrocephalus after aneurysmal subarachnoid hemorrhage. Acta Neurochir (Wien). 2021;163(10):2703-14.
  • 11) Sundström N, Lagebrant M, Eklund A, Koskinen L D, Malm J. Subdural hematomas in 1846 patients with shunted idiopathic normal pressure hydrocephalus: treatment and long-term survival. J Neurosurg. 2018;129(3):797-804.
  • 12) Oge D D, Arsava E M, Pektezel M Y, Gocmen R, Topcuoglu M A. Intracerebral hemorrhage volume estimation: Is modification of the ABC/2 formula necessary according to the hematoma shape? Clin Neurol Neurosurg. Agust 2021; 207:106779.
  • 13) Gasslander J, Sundström N, Eklund A, Koskinen L D, Malm J. Risk factors for developing subdural hematoma: a registry-based study in 1457 patients with shunted idiopathic normal pressure hydrocephalus. J Neurosurg. 2020; 10;1-10.
  • 14) Ros B, Iglesias S, Linares J, et al. Shunt Overdrainage: Reappraisal of the Syndrome and Proposal for an Integrative Model. J Clin Med 2021; 17;10(16):3620.
There are 14 citations in total.

Details

Primary Language English
Subjects Surgery (Other), Pediatric Emergency, Pediatric Neurology
Journal Section Original Articles
Authors

Derya Karaoğlu Gündoğdu 0000-0003-2345-8818

Burak Gezer 0000-0003-4881-8189

Publication Date October 15, 2023
Acceptance Date October 9, 2023
Published in Issue Year 2023 Volume: 11 Issue: 3

Cite

Vancouver Karaoğlu Gündoğdu D, Gezer B. Individualized Management of Subdural Effusion-Hematoma in Pediatric Shunt Patients. pediatr pract res. 2023;11(3):214-9.