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J. Clin. Med. 2018, 7(8), 216; https://doi.org/10.3390/jcm7080216

Ventriculoperitoneal Shunts Equipped with On-Off Valves for Intraventricular Therapies in Patients with Communicating Hydrocephalus due to Leptomeningeal Metastases

1
Dr. Senckenberg Institute of Neurooncology, Goethe University Hospital, 60528 Frankfurt, Germany
2
University Cancer Center Frankfurt (UCT), 60590 Frankfurt, Germany
3
Institute of Neuroradiology, Goethe University Hospital, 60528 Frankfurt, Germany
4
Department of Neurosurgery, Goethe University Hospital, 60528 Frankfurt, Germany
5
Institute of Neurology (Edinger Institute), Goethe University Hospital, 60528 Frankfurt, Germany
6
German Cancer Consortium (DKTK), Partner Site Frankfurt/Mainz, 60590 Frankfurt, Germany
*
Author to whom correspondence should be addressed.
Received: 17 July 2018 / Revised: 28 July 2018 / Accepted: 10 August 2018 / Published: 14 August 2018
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Abstract

Ventriculoperitoneal shunts equipped with a reservoir and a valve to manually switch off the shunt function can be used for intraventricular injections of therapeutics in patients suffering from a communicating hydrocephalus caused by leptomeningeal metastases. These shunt devices avoid the risk of injecting therapeutics through the distal leg of the shunt system into the intraperitoneal space, which may cause toxicity. Furthermore, regular intraventricular injections of chemotherapeutics help to maintain sufficient concentrations in the ventricular space. Therefore, ventriculoperitoneal shunts equipped with an on-off valve are a useful tool to reliably inject chemotherapeutics into the ventricles. In order to systematically assess feasibility, safety, and efficacy of this procedure, we performed a retrospective analysis of all patients with leptomeningeal metastases who had received a shunt system at our institution. In total, six adult patients had a ventriculoperitoneal shunt equipped with an on-off valve implanted. Out of these six patients, two patients subsequently received intraventricular injections of chemotherapeutics. The configuration of the valve setting and the intraventricular injections were easily feasible in the setting of a neuro-oncology department. The complication of a shunt leakage occurred in one patient following the first intraventricular injection. No extra-central nervous system (CNS) toxicities were observed. In summary, ventriculoperitoneal shunts with on-off valves are useful tools for reliable intraventricular administration of therapeutics. View Full-Text
Keywords: leptomeningeal metastases; hydrocephalus; intraventricular chemotherapy; ventriculoperitoneal shunt leptomeningeal metastases; hydrocephalus; intraventricular chemotherapy; ventriculoperitoneal shunt
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This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. (CC BY 4.0).
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Burger, M.C.; Wagner, M.; Franz, K.; Harter, P.N.; Bähr, O.; Steinbach, J.P.; Senft, C. Ventriculoperitoneal Shunts Equipped with On-Off Valves for Intraventricular Therapies in Patients with Communicating Hydrocephalus due to Leptomeningeal Metastases. J. Clin. Med. 2018, 7, 216.

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