Analysis of Lumbar Puncture Test in 5 Patients with Good Prognosis of Shunt Operation for Normal Pressure Hydrocephalus

Five patients with favorable outcomes after a shunt operation in normal pressure hydrocephalus were analyzed with the aim of identifying consistent findings in a lumbar puncture (LP) test. The cases commonly showed improvement in at least one cognition and two gait LP parameters. We suggest that when judging the effects of LP on a shunt operation, the gait parameters need to be tailored to the gait status and the analyzed LP parameters should be evaluated at least twice at different times.

Clinical evaluation of In-utero fetal shunt operation using basket-shaped catheter: 5-year experience at Asan Medical Center / 대한산부인과학회지

OBJECTIVE: To evaluate the clinical outcomes of In-utero fetal shunt operations at Asan Medical Center. METHODS: We reviewed the medical records of 33 occasions in 28 pregnancies that underwent intrauterine shunt operations between December, 1998 and April, 2004. Fetal shunt operations were considered for cases of hydrothorax (N=10), congenital cystic adenomatoid malformation type I (CCAM Type I)(N=5), lower urinary tract obstruction (N=6), severe hydronephrosis (N=7) and severe fetal ascites (N=5). Selection criteria of fetus for the shunt operation required normal karyotype and negative infection. Basket-shaped catheter was used for the procedure. Kruskal-Wallis test, Mann-Whitney U test, and Chi-Square test were used for statistical analysis. P<0.05 was considered statistically significant. RESULTS: In CCAM Type I, the mean gestational age was 25.6+/-4.0 weeks at diagnosis, 26.0+/-4.4 weeks at shunt operation and 36.6+/-3.9 weeks at delivery. Perinatal survival rate was 66.7% (2/3). In hydrothorax, the mean gestational age was 26.7+/-3.3 weeks at diagnosis, 27.3+/-3.3 weeks at shunt operation and 34.9+/-3.0 weeks at delivery. Perinatal survival rate was 80.0% (4/5). In lower urinary tract obstruction, the mean gestational age was 18.5+/-3.7 weeks at diagnosis, 19.6+/-3.5 weeks at shunt operation and 34.5+/-2.9 weeks at delivery. Perinatal survival rate was 80.0% (2/3). In hydronephrosis, the mean gestational age was 25.3+/-5.3 weeks at diagnosis, 27.4+/-5.3 weeks at shunt operation and 36.9+/-2.2 weeks at delivery. Perinatal survival rate was 83.3% (5/6). In ascites, the mean gestational age was 29.6+/-3.9 weeks at diagnosis, 29.9+/-3.8 weeks at shunt operation and 34.1+/-3.0 weeks at delivery. Perinatal survival rate was 100.0% (5/5). Complications occurred in 48.5% (16/33) of the cases. The most common complication was shunt dislodgement (N=7). CONCLUSION: In-utero fetal shunt operation should be considered as a treatment option for hydrothorax, CCAM type I, lower urinary tract obstruction, severe hydronephrosis and severe ascites with a significant risk for pulmonary hypoplasia.

Frequency of Shunt Surgery according to the Timing and Method of Aneurysm Surgery: Analysis in 514 Cases with Ruptured Cerebral Aneurysms

The aim of the study was to evaluate the frequency of needed shunt surgeries in 514 patients who underwent surgery for a ruptured intracranial aneurysms. The patients were consisted of 207 patients who were treated from 1986 to 1988(historical control group) and 307 patients treated from 1994 to 1996(study group). In the study group, an earlier aneurysm surgery and more frequent use of adjunctive procedures applied(lumbar and cisternal drainage, and opening of the lamina terminalis and the Liliequist membrane) compared to the control group(p<0.005). Twent-one patients(6.8%) required shunt operations in the study group, while it was necessary in 32 patients(15.5%) of the control group(p<0.005). However, occurrence of a hydrocephalus in both groups were similar. It is concluded that the frequency of a shunt operation has been decreased in the study group presumably due to an earlier surgical intervention, and an aggressive drainage of the bloody cerebrospinal fluid from the cisterns and the ventricles during or after an aneurysm surgery.

Prognostic Factors of the Shunt Operation on the Hydrocephalus Following Subarachnoid Hemorrhage

Hydrocephalus is one of the major complications following spontaneous subarachnoid hemorrhage(SAH) as a result of intracranial aneurysm rupture. But the diagnosis and treatment of hydrocephalus is not often a straightforward task because of diagnostic uncertainties. From 1991 to 1995, twenty patients who developed hydrocephalus and received ventriculoperitoneal shunt operations(VP shunt) among total of one hundred ninetynine patients with ruptured intracerebral aneurysms were retrospectively studied. We investigated to obtain possible prognostic factors regarding to VP shunt operations among several parameters: such as age, sex, radiological findings, clinical findings, and their actual influence on the result of VP shunt operations. Of the twenty patients, thirteen patients(75%) showed clinical improvements after shunt operations. Cortical effacement on brain CT, gait disturbance, memory disturbance, and increased ventriculocranial volume ratio(>5%) were appeared to be significant prognostic factors for good results after VP shunt operations.

Epidural Analgesia in a Parturient following Splenorenal Shunt Operation for Liver Cirrhosis / 대한마취과학회지

Pregnancy with liver cirrhosis and/or portal hypertension is uncommon. Additionally, pregnancy in young women who previously underwent splenorenal shunt operation for portal hypertension due to liver cirrhosis is extremely rare. Esophageal variceal rupture, fatal hemorrhage and epidural hematoma must be considered during the management of such patients. This is a case of epidural analgesia for labor in a patient who previously underwent splenorenal shunt operation for portal hypertension due to liver cirrhosis.

Post-Shunt Complications in Hydrocephalus:Analysis of 64 Operated Patients

The operative treatment of hydrocephalus has been quite challenging to neurosurgeon, because so many kinds of complications were stirred by the procedure even though the operative technique has been steadily improved. All the more they were hardly managed with ease. In the paper, the authors trix to analyze post-shunt complications of 64 patients seen frm 1980 to 1987, to find out any precipitating factors of the complications and to suggest the way to overcome the factors. The rate of post-shunt complication was 31.5%, and the most common complications were shunt malfunction(14.1%), subdural fluid accumulation(10.9%) and infection(9.4%).

Clinical Analysis of Surgical Treatment of Postmeningitic Hydrocephalus

To evaluate the surgical results, the author made a clinical analysis on 70 patients of postmeningitic hydrocephalus who had been treated surgically. And the results were summarized as follows. 1) The tuberculous meningitis was the most common type causing the postmeningitic hydrocephalus(72.9%). 2) Among 70 patients, 51 were male and 19 were female. About 40% of cases were under 5 years old. 3) The most common clinical symptom was vomiting(67%). Headache, fever and generalized seizure were symptoms in order of frequency. Neurological sings represented neck stiffness, cranial nerve palsy and motor weakness. 4) The most common clinical condition on admission was stage 3 (advanced cases with unconciousness and severe neurological deficits). 5) The spinal fluid analysis showed more abnormal findings comparing to the ventricular fluid. But ventricular pressure was higher than spinal fluid pressure. 6) Plain skull x-rays, carotid angiograms were useful diagnostic methods but CT brain scan was though to be the most accurate, noninvasive method which showed size of ventricle and effectiveness of shunting procedures with Evans'ratio. In enhanced CT brain scans, the basal cistern enhancement was the most common finding beside ventricular enlargement (64.1%). 7) Ventriculoperitoneal shunting was the most common procedure in this series. 8) The initial revision rate was 12/70(19%) and the most of the revision was performed within 6 months after the initial shunting. 9) The revision rate in relation to shunting system and cerebrospinal fluid finding was not statistically significant. 10) The most common cause of the shunt malfuntion was obstruction of the ventricular catheter. 11) Forty one patients(58.6%) showed favorable outcome. The motality rate was 14/70(20%) and they were all belong to the stage 3. About half of the patients in stage 2 and stage 3 showed dramatic improvement after early shunting procedures. So the timing of operation was the most important factor influencing their outcome.