Ever heard of overshunting?

JVIM 2023

December 13, 2024

Risk factors, treatment, and outcome in dogs and cats with subdural hematoma and hemispheric collapse after ventriculoperitoneal shunting of congenital internal hydrocephalus

Daniela Farke, Anna K. Siwicka, Agnieszka Olszewska, Adriana Czerwik, Kathrin Büttner, Martin J. Schmidt

Background
The study investigates the risk factors, treatment options, and outcomes for dogs and cats with subdural hematoma and hemispheric collapse following ventriculoperitoneal shunting (VPS) for congenital internal hydrocephalus. Overshunting and hemispheric collapse are recognized complications in veterinary and human medicine, with limited data on predisposing factors and management in animals.

Methods
A retrospective cohort study was conducted using medical records from 82 animals (75 dogs, 7 cats) treated between 2001 and 2021. Data included demographic variables, VPS details, and clinical signs. MRI was used to evaluate brain morphology, and statistical analyses identified risk factors for overshunting-related complications. Decompressive surgery outcomes were assessed for cases with subdural hematoma.

Results
Overshunting prevalence was 18%, with higher risk linked to increased ventricle-brain ratio (VBR) and biventricular hydrocephalus. No significant risk was associated with body weight, age, or valve type. Cats had a higher incidence of complications, correlating with high VBR. Decompressive surgery in 10 animals (8 dogs, 2 cats) resulted in clinical improvement for 8 cases.

Limitations
The retrospective nature and small sample sizes limit the generalizability. Potential biases include species-specific data and lack of control groups. The study could not comprehensively evaluate all variables' interplay.

Conclusions
Biventricular hydrocephalus and high VBR significantly increase the risk of overshunting complications. Decompressive surgery offers a favorable outcome, emphasizing its role in managing severe VPS complications. Further studies are needed to refine risk assessment and treatment strategies.

T2 weighted MRI pictures of a 49 months-old Italian greyhound before ventriculoperitoneal shunt (VPS) placement (A-C), 4 days after VPS placement with hemispheric collapse (D-F), and 3 months after bilateral craniotomy and suboccipital craniectomy (G-I). Note the concave contour of the ventricles at time of hemispheric collapse and the subarachnoid accumulation of T2 hyper- and hypointense material which compresses both cerebral hemispheres (D-F). The ventricular catheter is completely surrounded by brain tissue (E, F). There is severe cerebellar herniation through the foramen magnum (D). At 3 months control (G-I) there is still some hypointense lining following the left parietal bone (H, I), but the ventricular catheter is positioned within the ventricle (G, l) and there is no evidence for cerebellar herniation (G).

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