Ultrasound-guided ventriculoatrial shunt in treatment of hydrocephalus: An observation of outcome / 第二军医大学学报

Objective To investigate the clinical efficacy of ultrasound-guided ventriculoatrial shunt in the treatment of hydrocephalus. Methods The clinical data of 13 hydrocephalus patients were analyzed retrospectively; all of them underwent ultrasound-guided ventriculoatrial shunt. Salmon score was used to assess the clinical outcome after operation. The patients were followed up after operation by means of outpatient service and telephone. The diagnosis and treatment of complications of patients were recorded and the reasons were analyzed. Results The successful rate of first puncturing attempt was 100%, with the mean operative time being (1.5±0.31) h. The size of cerebral ventricles decreased to different degrees and the symptoms were greatly improved in 12 of the 13 patients. According to the efficacy standard of shunt therapy of Salmon, it was effective in 12 cases one month after operation, with an effective rate of 92.3%. Six months follow-up found no complications such as endocarditis, arrhythmia or thrombosis in the patients. Conclusion Ultrasound-guided ventriculoatrial shunt combined with ultrasound-guided central venous catheter placement has the advantage of mini-invasion, shorter operating time, and accurate location, making it worth popularizing in clinic.

Endovascular Intervention for Repositioning the Distal Catheter of Ventriculo-Atrial Shunt / 신경중재치료의학

Displacement of distal ventriculo-atrial (VA) shunt is not uncommon. However, misplacement of the distal catheter of VA shunt in the internal jugular vein is a possibility, especially when conducted without intraoperative monitoring. We describe a patient in whom a VA shunt was performed due to failure of ventriculo-peritoneal shunt and the distal catheter of the shunt was found to be misplaced in the left internal jugular vein. Endovascular intervention via femoral vein was used to retrieve the distal catheter.

Early shunt complications in 46 children with hydrocephalus / Complicações precoces de válvula de hidrocefalia em 46 crianças

OBJECTIVE: To determine the causes of early shunt complications in 46 children with hydrocephalus. METHOD: A retrospective study was conducted on 46 children submitted to ventriculoperitoneal shunt surgery between February 2005 and February 2007. RESULTS: Thirteen (28 percent) patients presented complications, which were due to infection in 9 (69 percent) and to malfunction of the shunt system in 4 (31 percent).The mean number of surgical procedures performed on patients who presented complications was 2.8 per patient, with a total of 46 surgeries in this group. All patients with infectious complications were identified during their hospital stay. CONCLUSIONS: Infection was the most common complication. The infection rate was proportional to the length of hospital stay. All patients with hydrocephalus due to tumors or myelomeningocele presented complications. A higher incidence of infections was observed in children older than 2 years.

OBJETIVO: Determinar e as causas das complicações precoces nas válvulas de hidrocefalia de 46 crianças. MÉTODO: Um estudo retrospectivo foi realizado com 46 crianças submetidas a colocação de válvula de hidrocefalia no período de fevereiro de 2005 a fevereiro de 2007. RESULTADOS: Obtivemos 13 (28 por cento) pacientes com complicações sendo 9 (69 por cento) causadas por infecção e 4 (31 por cento) por mal funcionamento da válvula de hidrocefalia. A média de procedimentos cirúrgicos realizados nos pacientes com complicações foi de 2,8 por paciente, sendo o total de 46 cirurgias neste grupo. Todos os pacientes com complicações infecciosas foram detectados durante a internação hospitalar. CONCLUSÕES: Infecção foi a complicação mais comum. O índice de infecção foi proporcional ao tempo de permanência hospitalar. Todos os pacientes portadores de hidrocefalia secundária a tumores ou mielomeningocele complicaram. As crianças maiores de 2 anos de idade tiveram maior incidência de infecções.

A Case of Ventriculoatrial Shunt-Associated Glomerulonephritis

A 8-year old girl with a ventriculoatrial shunt presented with fever and gross hematuria. Staphylococcus epidermidis was cultured from blood. Light electron microscopic findings in this patients were characteristic of shunt nephritis and serum complement levels were low. After shunt removal, hydrocephalus was so severe that ventriculoperitoneal shunt revision was performed opposite Kocher's point: continuous antibiotic therapy resulted in normalization of the clinical symptoms. A review of the literature is included.

Ventriculoperitoneal Shunt Malfunction during Pregnancy

A 24 year-old woman with a ventriculoperitoneal shunt is presented, who showed repeated episodes of shunt malfunction before and during pregnancy. Daily pumping of the flushing device relieved the symptoms at first, but reattack during the third trimester of pregnancy was managed with revision of the shunt to ventriculoatrial system. She delivered a healthy female baby successfully at term.