Descargar aquí
Publique un comentario 
Complicaciones de la derivación ventriculoperitoneal en pacientes pediátricos. Revisión del tema
Resumen
Fundamento: La hidrocefalia es un desorden pediátrico frecuente y la colocación de una derivación ventriculoperitoneal es la técnica quirúrgica más usada para su tratamiento. La incidencia de las complicaciones en pacientes pediátricos es un problema frecuente que aumenta la morbilidad y mortalidad.
Objetivo: Sistematizar y actualizar los conocimientos relacionados con las complicaciones ventriculoperitoneal es en edad pediátrica.
Desarrollo: Las complicaciones asociadas a la derivación ventriculoperitoneal son frecuentes y se pueden dividir en tres grupos: mecánicas, infecciosas y funcionales relacionadas con el drenaje anómalo del líquido cefalorraquídeo, bien por defecto o por exceso. Dentro de las mecánicas, la obstrucción tiene la mayor incidencia seguida de las desconexiones y roturas por adherencias y por las calcificaciones que se forman en el trayecto subcutáneo a lo largo del tiempo. Las obstrucciones tardías predominan en el extremo distal y son motivo frecuente de reintervenciones. Las infecciones del sistema resultan las complicaciones más graves y complejas de tratar acompañándose de una alta mortalidad. Se pueden presentar de forma aguda, subaguda y de manera tardía. Se han identificado diferentes factores que pueden aumentar la incidencia de complicaciones, algunos relacionados con el tipo de válvula y la causa de la hidrocefalia.
Conclusiones: Las derivaciones del líquido cefalorraquídeo han sido durante mucho tiempo el tratamiento clásico de la hidrocefalia pediátrica, al poder resolver casi todas sus formas independientemente de la causa. La clave del éxito para evitar las complicaciones está en una adecuada valoración preoperatoria y una rigurosa técnica quirúrgica y garantizar las medidas para la prevención de las infecciones.
Palabras clave
Referencias
Gholampour S, Bahamani M, Shariati A. Comparing the efficiency of two treatment methods of hydrocephalus: shunt implantation and endoscopic third ventriculostomy. Basic Clin Neurosci [Internet]. 2019 [cited 2020 Jan 15];10(3):185-98. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6712634/pdf/BCN-10-185.pdf
Robinson S. Neonatal posthemorrhagic hydrocephalus from prematurity: pathophysiology and current treatment concepts: A review. J Neurosurg Pediatr. [Internet]. 2012 [cited 2020 Jan 15];9(3):242-58. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3842211/pdf/nihms528810.pdf
Vinukonda G, Zia MT, Ballabh P. Intraventricular hemorrhage induces deposition of proteoglycans in premature rabbits, but their in vivo degradation with chondroitinase does not restore myelination, ventricle size and neurological recovery. Exp Neurol. [Internet]. 2013 [cited 2020 Jan 15];247:630-44. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3742687/pdf/nihms466891.pdf
Salvador SF, Henriques JC, Munguambe M, Vas RM, Barros HP. Hydrocephalus in children less than 1 year of age in northern Mozambique. Surg Neurol Int [Internet]. 2014 [cited 2020 Jan 15];5:175. Available from: http://surgicalneurologyint.com/surgicalint_articles/hydrocephalus-in-children-less-than-1-year-of-age-in-northern-mozambique/
Kamalo P. Point of View: Exit ventriculoperitoneal shunt; enter endoscopic third ventriculostomy (ETV): contemporary views on hydrocephalus and their implications on management. Malawi Medic J [Internet]. 2013 [cited 2020 Jan 15];25(3):78-82. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3859993/pdf/MMJ2503-0078.pdf
Hanak BW, Bonow RH, Harris CA, Browd SR. Cerebospinal fluid shunting complications in children. Pediatr Neurosurg [Internet]. 2017 [cited 2020 Jan 15];52(6):381-400. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5915307/pdf/nihms959150.pdf
Zhao R, Shi W, Yu J, Gao X, Li H. Complete Intestinal Obstruction and Necrosis as a Complication of a Ventriculoperitoneal Shunt in Children. A Report of 2 Cases and Systematic Literature Review. Medicine [Internet]. 2015 [cited 2020 Jan 15];94(34):1-8. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4602928/pdf/medi-94-e1375.pdf
Hasslacher Arellano JF, Arellano Aguilar G, Funes Rodríguez JF, López Forcen S, Torres Zapiain F, Domínguez Carrillo LG. Derivación ventrículo-vesicular: una alternativa en el tratamiento de hidrocefalia. Cirugía y Cirujanos. [Internet]. 2016 [citado 6 Feb 2020];84(3):225-29. Disponible en: https://www.elsevier.es/es-revista-cirugia-cirujanos-139-pdf-S000974111500153X
Zhang Z, Wang H, Cheng H, Fan Y, Hang C, Sun K, et al. Management of hydrocephalus secondary to pineal region tumors. Clin Neurol Neurosurg [Internet]. 2013 [cited 2020 Jan 15];115(9):1809-13. Available from: https://www.sciencedirect.com/science/article/abs/pii/S0303846713001650?via%3Dihub
Yamada SM, Kitagawa R, Teramoto A. Relationship of the location of the ventricular catheter tip and function of the ventriculoperitoneal shunt. J Clin Neurosci [Internet]. 2013 [cited 2020 Jan 15];20(1):99-101. Available from: https://www.sciencedirect.com/science/article/abs/pii/S0967586812002858
Ziebell M, Wettersley J, Tisell M, Gluud C, Juhler M. Flow‐regulated versus differential pressure‐regulated shunt valves for adult patients with normal pressure hydrocephalus. Cochrane Database Syst Rev [Internet]. 2013 [cited 2020 Feb 6];31(5). Available from: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD009706.pub2/full#CD009706-abs-0001
Rivka AR. Surgical treatment of hydrocephalus: a historical perspective. Pediatr Neurosurg [Internet]. 1999 [cited 2020 Feb 6];30:296-304. Available from: https://www.karger.com/Article/Pdf/28814
Lekic T, Klebe D, Poblete R, Krafft PR, Rolland WB, Tang J. Neonatal Brain Hemorrhage (NBH) of Prematurity: Translational mechanisms of the vascular-neural network. Curr Med Chem [Internet]. 2015 [cited 2020 Feb 6];22(10):1214-38. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4495901/pdf/nihms-704501.pdf14.
Shaw R, Mahant N, Jacobson E, Owler B. A review of clinical outcomes for gait and other variables in the surgical treatment of idiopathic normal pressure hydrocephalus. Mov Disord Clin Pract [Internet]. 2016 [cited 2020 Feb 6];3(4):331-41. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6178707/pdf/MDC3-3-331.pdf
Woernle CM, Winkler KM, Burkhardt JK, Haile SR, Bellut D, Neidert MC, et al. Hydrocephalus in 389 patients with aneurysm-associated subarachnoid hemorrhage. J Clin Neurosci [Internet]. 2013 [cited 2020 Jan 15];20(6):824-6. Available from: https://www.sciencedirect.com/science/article/abs/pii/S0967586812005711
Zhu X, Di Rocco C. Choroid plexus coagulation for hydrocephalus not due to CSF overproduction: a review. Childs Nerv Syst [Internet]. 2013 [cited 2020 Jan 15];29(1):35-42. Available from: https://link.springer.com/article/10.1007/s00381-012-1960-0
Wang L, Ling SY, Fu XM, Niu CS, Qian R. Neuronavigation-assisted endoscopic unilateral cyst fenestration for treatment of symptomatic septum pellucidum cysts. J Neurol Surg A Cent Eur Neurosurg [Internet]. 2013 [cited 2020 Jan 15];74(4):209-15. Available from: https://pubmed.ncbi.nlm.nih.gov/23636910/
Medina Andrade MA, Sánchez Herrera F, Piña Garay MA, Gallardo Mesa FA, González Sánchez JM, Mendoza Moreno LF. Derivación ventrículo cava para hidrocefalia en casos extremos. Una alternativa Viable. Bol Med Hosp Infant Mex [Internet]. 2011 [citado 6 Feb 2020];68(6):447-50. Disponible en: http://www.scielo.org.mx/pdf/bmim/v68n6/v68n6a7.pdf
Vinchon M, Rekate H, Kulkami AV. Pediatric hydrocephalus outcomes: a review. Fluids Barriers CNS [Internet]. 2012 [cited 2020 Feb 6];9(1):2-10. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3584674/pdf/2045-8118-9-18.pdf
Baghbani R. An electrical model of hydrocephalus shunts incorporating the CSF Dynamics. Sci Rep [Internet]. 2019 [cited 2020 Jan 15];9:9751. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6611941/pdf/41598_2019_Article_46328.pdf
Blegvad C, Skjolding AD, Broholm H, Laursen H, Juhler M. Pathophysiology of shunt dysfunction in shunt treated hydrocephalus. Acta Neurochir (Wien) [Internet]. 2013 [cited 2020 Jan 15];155(9):1763-72. Available from: https://link.springer.com/article/10.1007%2Fs00701-013-1729-6
Abouhashem S, Taha MM, Ismail A, Rashed ME. Laparoscopic revision of the distally obstructed ventriculoperitoneal shunt. Turk Neurosurg [Internet]. 2013 [cited 6 Feb 2020];23(1):61-66. Available from: http://www.turkishneurosurgery.org.tr/pdf/pdf_JTN_1098.pdf
Khan F, Rehman A, Shamin MS, Bari ME. Factors affecting ventriculoperitoneal shunt survival in adult patients. Surg Neurol Int [Internet]. 2015 [cited 2020 Feb 6];6. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4338490/pdf/SNI-6-25.pdf
Winkler KM, Woernle CM, Seule M, Held U, Bernays R, Keller E. Antibiotic-impregnated versus silver-bearing external ventricular drainage catheters: preliminary results in a randomized controlled trial. Neurocrit Care [Internet]. 2013 [cited 2020 Jan 15];18(2):161-5. Available from: https://www.zora.uzh.ch/id/eprint/77966/1/Winkler_Woernle_EVD_2013.pdf
Sandoval Balanzario MA, Granados López R, Sandoval Olivares L, Olivares Peña JL, Santos Franco JA. Complicación de la derivación ventrículo peritoneal: perforación intestinal y migración del catéter distal a nivel del recto. Reporte de tres casos. Acta Médica Grupo Ángeles [Internet]. 2019 [citado 6 Feb 2020];17(4):409-412. Disponible en: https://www.medigraphic.com/pdfs/actmed/am-2019/am194q.pdf
Bakshi S. Spontaneus trans-anal extrusion of caudally migrated ventriculo-peritoneal shunt tip in a child: a case report. Surgical Case Report [Internet]. 2020 [cited 2020 Apr 25];6:2-4. Available from: https://surgicalcasereports.springeropen.com/articles/10.1186/s40792-020-00813-0
Arts SHHMJ, Boogaarts HD, van Linder EJ. Route of antibiotic prophilaxis for prevention of cerebrospinal fluid shunt infection. Cochrane Database Syst Rev [Internet]. 2019 [cited 2020 Jan 15];6(6):1-46. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6548496/pdf/CD012902.pdf
Wilkie MD, Hanson MF, Statham PF, Brennan PM. Infections of cerebrospinal fluid diversion devices in adults: the role of intraventricular antimicrobial therapy. J Infect [Internet]. 2013 [cited 2020 Jan 15];66(3):239-46. Available from: https://www.sciencedirect.com/science/article/abs/pii/S0163445312003404?via%3Dihub
Fernandes de Oliveira M, Muralho Pereira R, Gomes Pinto F. Updating technology of shunt valves. Medical Express [Internet]. 2014 [cited 2020 Jan 15];1(4). Available from: https://www.scielo.br/j/medical/a/6XpcpS6MwJV7KHGVwp4NCDr/?lang=en
Labidi M, Lavoie P, Lapointe G, Obaid S, Weil AG, Turmel A, et al. Predicting success of endoscopic third ventriculostomy: validation of the ETV Success score in a mixed population of adult and pediatric patients. J Neurosurg [Internet]. 2015 [citado 2020 Jan 15];123:1447-55. Available from: https://thejns.org/view/journals/j-neurosurg/123/6/article-p1447.xml?body=pdf-16286
Pinto FCG, Pereira RM, Saad F, Teixeira MJ. Performance of fixed-pressure valve with antisiphon device SPHERA((R)) in hydrocephalus treatment and overdrainage prevention. Arq Neuropsiquiatr [Internet]. 2012 [cited 2020 Jan 15];70(9):704-9. Available from: https://www.scielo.br/j/anp/a/g5GmN5PtDyVKs7K4h9w4G4P/?lang=en
Bouzerar R, Tekaya I, Baledent O. Dynamics of hydrocephalus: a physical approach. J Biol Phys [Internet]. 2012 [cited 2020 Feb 6];38(2):251-66. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3326150/pdf/10867_2011_Article_9239.pdf
Reddy GK, Bollam P, Shi R, Guthikonda B, Nanda A. Management of adult hydrocephalus with ventriculoperitoneal shunts: Long-term single-institution experience. Neurosurgery [Internet]. 2011 [cited 2020 Jan 15];69(4):774-81. Available from: https://academic.oup.com/neurosurgery/article-abstract/69/4/774/2555714?redirectedFrom=fulltext
Zhang J, Qu C, Wang Z, Wang C, Ding X, Pan S, et al. Improved ventriculoatrial shunt for cerebrospinal fluid diversion after multiple ventriculoperitoneal shunt failures. Surg Neurol [Internet]. 2009 [cited 2020 Jan 15];72(Suppl 1):29-33. Available from: https://www.sciencedirect.com/science/article/abs/pii/S0090301908003492?via%3Dihub
Patwardhan RV, Nanda A. Implanted ventricular shunts in the United States: The billion-dollar-a-year cost of hydrocephalus treatment. Neurosurgery [Internet]. 2005 [cited 2020 Jan 15];56(1):139-442. Available from:
http://neurodx.com/Studies/Patwardhan05%20%20Bil%20Hydro%20Mkt.pdf
Nishiyama K, Yoshimura J, Fujii Y. Limitations of neuroendoscopic treatment for pediatric hydrocephalus and considerations from future perspectives. Neurol Med Chir (Tokyo) [Internet]. 2015 [cited 2020 Jan 15];55(8):611-6. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4628151/pdf/nmc-55-611.pdf
Rashid QTA, Salat MS, Enam K, Kazim SF, Godil SS, Enam SA, et al. Time trends and age-related etiologies of pediatric hydrocephalus: Results of a groupwise analysis in a clinical cohort. Childs Nerv Syst [Internet]. 2012 [cited 2020 Feb 6];28(2):221-7. Available from: https://link.springer.com/article/10.1007/s00381-011-1527-5
Finneran MM, Nardone E, Marotta DA, Smith G, Gordhan A. Spontaneus migration of a ventriculoperitoneal shunt into the venous system: a multidisciplinary approach. Cureus [Internet]. 2020 [cited 2020 Apr 25];12(4). Available from: https://www.cureus.com/articles/30436-spontaneous-migration-of-a-ventriculoperitoneal-shunt-into-the-venous-system-a-multidisciplinary-approach
Zhao R, Shi W, Yu J, Gao X, Li H. Complete Intestinal Obstruction and Necrosis as a Complication of a Ventriculoperitoneal Shunt in Children. A Report of 2 Cases and Systematic Literature Review. Medicine [Internet]. 2015 [cited 2020 Jan 15];94(34). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4602928/pdf/medi-94-e1375.pdf
Tabuchi S, Kadowaki M. Neuroendoscopic surgery for ventriculitis and hydrocephalus after shunt infection and malfunction: Preliminary report of a new strategy. Asian J Endosc Surg [Internet]. 2015 [cited 2020 Jan 15];8(2):180-4. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4437183/pdf/ases0008-0180.pdf
Schulz M, Buhrer C, Spors B. Endoscopic neurosurgery in preterm and term newborn infants – a feasibility report. Childs Nerv Syst [Internet]. 2013 [cited 2020 Jan 15];29(5):771-9. Available from: https://link.springer.com/article/10.1007/s00381-012-2003-6
Salim AD, Elzain MA, Mohamed HA, Zayan BE. Shunt tube calcification as a late complication of ventriculoperitoneal shunting. Asian J Neurosurg [Internet]. 2015 [cited 2020 Jan 15];10(3):246-249. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4553745/
Katseuman GA, Harron R, Bhatia S. Shunt bronchial fistula with coughing up and swallowing of cerebrospinal fluid: rare complications of ventriculo pleural shunt. World Neurosurg X [Internet]. 2020 [cited 2020 Feb 6];5. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6909168/pdf/main.pdf
Esta obra está bajo una licencia de Creative Commons Reconocimiento-NoComercial 4.0 Internacional.
