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Background: Ventriculo -peritoneal [VP] shunt is the most commonly used cerebrospinal ?uid (CSF) diversion procedure for the management of hydrocephalus. However, when the absorption of CSF from the peritoneum is defective, it results in abdominal distension with CSF ascites. In such cases, an alternate diversion procedure - the ventriculo-atrial [VA] shunt – may be performed. However, this procedure is also associated with several perioperative problems like arrhythmias, air embolism and infection. Materials and methods: A retrospective analysis of 40 cases on the perioperative concerns of VA shunt procedures, performed in our institute, was done. Indication of the shunt, preoperative status & work -up, intraoperative adverse events & management and immediate post-operative complications were assessed. Out of the 40 patients, there were 25 male Results: s and 15 females and there were a total of 12 paediatric patients. Blocked shunt, abdominal infection and CSF ascites were common indications for VA shunt. All patients received general endotracheal anaesthesia with preoperative hypovolemia correction. Intraoperative tachycardia and arrhythmia were noted. Various Conclusion : preoperative concerns like distended abdomen and compromised respiration increase risk of VA shunt procedures. A better understanding of the underlying disease pathology and anticipation of related complications along with cautious and meticulous management can help prevent most of the complications of VA shunt procedure and thereby improve outcome
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Objective:To study the past 10 years' experiences of neonatal hydrocephalus in a single-center.Methods:From January 2010 to December 2019, clinical data of infants with hydrocephalus admitted to Neonatology Department of our hospital were retrospectively analyzed. The infants were assigned into different groups according to gestational age, different etiologies and treatments. Their clinical characteristics and outcomes were compared.Results:A total of 223 infants with hydrocephalus were included. 136 (61.0%) infants were in the preterm group and 87 (39.0%) in the full-term group. The incidence of post-intracranial hemorrhage (ICH) hydrocephalus in preterm infants was significantly higher than full-term infants ( P<0.001). According to the etiologies, 58 infants (26.0%) had congenital hydrocephalus (congenital group), 82 cases (36.8%) developed post-ICH hydrocephalus (ICH group), 48 cases (21.5%) had post-CNS-infection hydrocephalus (infection group) and 35 cases (15.7%) had post-ICH+CNS-infection hydrocephalus (ICH+infection group). The incidences of perinatal asphyxia, neonatal resuscitation and endotracheal intubation within 3 d after birth in the ICH group were significantly higher than the other groups ( P<0.05). Among the four groups, the infection group had the highest incidence of neonatal sepsis, the congenital group had the highest incidence of patent ductus arteriosus and the ICH group had the highest incidence of respiratory diseases (all P<0.05).137 cases (61.4%) received non-surgical therapy, 48 cases (21.5%) had temporary drainage, 37 cases (16.6%) with permanent shunt and 1 case (0.4%) intracranial hematoma removal. The congenital group and ICH group with permanent shunt showed significantly higher rate of improvement than temporary drainage group and non-surgical group ( P<0.001). Conclusions:The main etiologies of neonatal hydrocephalus are ICH and CNS infection. The incidence of post-ICH hydrocephalus in premature infants was quite high. Hydrocephalus of different etiologies have different comorbidities. Maternal and infant care during pregnancy and delivery, prevention of neonatal sepsis and ICH are crucial in the prevention of hydrocephalus. More studies are needed for better treatment.
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Objective:To investigate the clinical efficacy of ventriculo-peritoneal shunt (VPS) in acquired immunodeficiency syndrome (AIDS) patients with cryptococcal neoformans meningitis (CNM).Methods:Patients with AIDS and CNM who were hospitalized in Guangzhou Eighth People′s Hospital, Guangzhou Medical University from January 2015 to June 2020 were included and divided into VPS group and conventional treatment group.The data including symptoms and signs of meningitis, cerebrospinal fluid (CSF) pressure, CSF routine examination, ink staining, Cryptococcus culture and Cryptococcus culture negative time were obtained, and the clinical efficacy compared between the two groups after six and 48 weeks of treatment.Two independent samples t test or chi-square test was used for statistical analysis. Results:Among 66 AIDS patients with CNM, 26 cases in VPS group were (35.7±11.9) years, and 11 cases (42.3%) had CSF pressure> 330 mmH 2O (1 mmH 2O=0.009 8 kPa) at admission, 25 cases (96.2%) were positive for ink staining, and 20 cases (76.9%) had positive culture of Cryptococcus neoformans in CSF. There were 40 cases in the conventional treatment group with age of (38.9±12.9) years, 15 cases (37.5%) had CSF pressure>330 mmH 2O, 32 cases (80.0%) were positive for ink staining, and 31 cases (77.5%) were positive for culture of Cryptococcus neoformans in CSF. There were no significant differences of age, the proportion of patients with CSF pressure>330 mmH 2O, positive rate of ink staining, positive rate of Cryptococcus culture between the two groups ( t=-1.02, χ2=0.15, 3.49 and 0.00, respectively; all P>0.050). All patients were administrated with antifungal treatment, decreasing CSF pressure treatment, nutritional support and symptomatic treatment after admission. VPS was performed in patients with poor responses after medical conservative treatment in VPS group. At week six of treatment, the recovery rate of CSF pressure in VPS group was 57.7%(15/26), and the partial remission rate was 73.1%(19/26), which were both higher than those in conventional treatment group (31.0%(9/29) and 47.5%(19/40), respectively). The differences were both statistically significant ( χ2=3.96 and 4.22, respectively, both P<0.050). At week 48 of treatment, the recovery rate of CSF pressure in VPS group was 92.3%(24/26), the negative rate of Cryptococcus culture in CSF was 100.0%(20/20), and the complete remission rate was 46.2%(12/26), which were all higher than those in conventional treatment group (37.9%(11/29), 67.7%(21/31) and 20.0%(8/40), respectively). The differences were all statistically significant ( χ2=17.52, 8.03 and 5.10, respectively, all P<0.050). In VPS group, 22 cases were complete or partial remission, four cases were ineffective, and no death occurred, while there were 23 cases of complete or partial remission, 12 cases of ineffective and five cases of death in the conventional treatment group. The proportion of ineffective or death in the VPS group was 15.4%(4/26), which was lower than 42.5%(17/40) in the conventional treatment group. The difference was statistically significant ( χ2=5.34, P=0.021). Conclusions:VPS in AIDS patients with CNM could significantly improve the treatment outcomes, and reduce the rates of treatment failure and mortality.
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INTRODUCCIÓN: Las infecciones asociadas a dispositivos de derivación de LCR son una complicación frecuente en su utilización. Lo más habitual es la presencia de cocáceas grampositivas, como Staphylococcus coagulasa negativa (50% en algunas series) y Staphylococcus aureus. Esta complicación agrega morbimortalidad al paciente neuroquirúrgico, aumentando la estadía hospitalaria y los costos de tratamiento. OBJETIVO: Conocer la incidencia de infecciones asociadas a dispositivos de derivación de LCR en un centro de referencia nacional. METODOLOGÍA: Estudio descriptivo, retrospectivo. Se recolectó la información de los pacientes pediátricos (bajo 18 años) entre 2018 y 2019. Se realizó un análisis estadístico descriptivo e inferencial utilizando el lenguaje estadístico R 3.4.0 y RStudio 1.3.9. Se calculó la incidencia acumulada para cada procedimiento, evaluando si existe diferencias significativas entre ellas. Estudio aprobado por el Comité de Ética Pediátrico del SSMO. RESULTADOS: En el período estudiado se realizaron 175 cirugías. Encontramos 19 casos de ventriculitis asociada a derivativa ventriculo-peritoneal y 7 casos en derivativa ventricular-externa. Los agentes más frecuentes fueron las cocáceas grampositivas. No se logró identificar factores de riesgo significativos.
BACKGROUND: Infections associated with CSF shunt devices are a frequent complication in their use. The most common is the presence of gram positive coccaceae, such as coagulase negative Staphylococcus (50% in some series) and Staphylococcus aureus. This complication adds morbidity and mortality to the neurosurgical patient, increasing hospital stay and treatment costs. AIM: To determine the incidence of infections associated with CSF shunt devices in a national referral center. METHODS: Retrospective, descriptive study. Information was collected on pediatric patients between 2018 and 2019. A descriptive and inferential statistical analysis was performed using the statistical language R 3.4.0 and RStudio 1.3.9. The cumulative incidence for each procedure was calculated, evaluating whether there were significant differences between them. This study was approved by the Pediatric Ethics Committee of the SSMO. RESULTS: In the period studied, 175 surgeries were performed. We found 19 cases of ventriculitis associated with ventriculoperitoneal derivative and 7 cases in ventricular-external derivative. The most frequent agents were grampositive coccaceae. It was not possible to identify significant risk factors.
Subject(s)
Humans , Child , Central Nervous System Infections , Hydrocephalus/surgery , Staphylococcus aureus , Retrospective Studies , Ventriculoperitoneal Shunt/adverse effects , HospitalsABSTRACT
Background: Hydrocephalus is a heterogeneous disease marked by abnormal dilatation of the cerebral ventricles secondary to varying etiologies. This study was aimed to determine the incidence, risk factors, severity, and outcome of hydrocephalic fetuses presenting to a tertiary healthcare hospital located in northern India.Methods: In this prospective observational study, pregnant women visiting the obstetrics outpatient department of our hospital from 01 July 2017 to 31 June 2018 were screened for hydrocephalic fetuses via ultrasonography along with a detailed history, and a comprehensive battery of diagnostic investigations. They were followed up for a minimum period of two months after delivery/termination of pregnancy.Results: A total of 3627 pregnant women were screened, of which 10 had hydrocephalic fetuses in the observed time period. The incidence of hydrocephalus was determined to be 2.75 per 1000 live births. Low socio-economic status was identified as a major risk factor. 50% of the hydrocephalic fetuses were severely afflicted and were discontinued. The remaining 50% were successfully delivered and were managed via a ventriculo-peritoneal shunt or are under close observation in the postnatal period without any adverse outcome.Conclusions: The burden of hydrocephalus is considerably high in India, as compared to western countries. In rural settings, low socioeconomic status and lack of folic acid supplementation have a major influence in the etiopathogenesis of hydrocephalus. Management of hydrocephalus requires a multidisciplinary approach and is tailored according to the severity of the presentation. Severe cases of hydrocephalus and cases with associated anomalies have a poor prognosis.
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The incidence of tubercular meningitis leading to obstructive hydrocephalus is extremely rare accounting for 1% cases and is even rarer during pregnancy. A 20-year-old 2nd Gravida presented at 32 weeks gestation with complaints of intermittent headache, decreased vision since 3 months and irrelevant talks and agitated behavior since 1 day. On examination patient had stable vital signs but constant irritable behavior. Obstetric examination revealed a pregnancy corresponding to 32 weeks with a live fetus. Patient had a past history of Anti-tubercular therapy taken 2 years back for tubercular meningitis. Neurological examination revealed a GCS of 12/15 and Ophthalmologic examination revealed patient to be having only Perception of Light with optic atrophy on fundoscopy. NCCT head revealed moderate dilatation of bilateral ventricles and 3rd ventricle without any periventricular ooze suggestive of Chronic Obstructive Hydrocephalus. Supportive therapy was instituted with Dexamethasone and Mannitol infusion after Neurosurgical consultation along with antenatal care. Decision for termination of pregnancy was taken at 35 weeks by an elective caesarean section with simultaneous ventriculo-peritoneal shunt insertion by neurosurgical team under general anesthesia. A live male baby of 2.25 kg was delivered. Patient with baby was discharged on 10th post-operative day. Obstructive hydrocephalous developing post tubercular meningitis in pregnancy is a rare event. Caesarean section was done along with shunt surgery in our case. Very few cases have been reported in the medical literature so far.
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Resumen Introducción: La derivación ventrículo-peritoneal (DVP) es el tratamiento para la hidrocefalia. El líquido cefalorraquídeo (LCR) se evalúa para el manejo de sus complicaciones; sin embargo, la información de los valores del citoquímico en esta población es insuficiente. Objetivo: Describir las características del citoquímico del LCR de niños en manejo con DVP. Materiales y Métodos: Estudio de tipo observacional descriptivo, desarrollado en Bogotá (Colombia), entre el año 2008 y 2016. Se revisaron los registros de procedimientos de DVP y relacionados. Se incluyeron pacientes entre 6 meses y 18 años de edad. Resultados: Se revisaron 285 registros e ingresaron 31 muestras. Los valores de LCR fueron, respectivamente, para la mediana y al percentil 90%: leucocitos totales: 0 y 7 céls/mm3, neutrófilos: 0 y 6,8 céls/mm3, linfocitos: 0 y 2 céls/mm3, proteínas: 13,4 y 67,2 mg/dL, glucosa: 59 y 27,4 mg/dL. Discusión: Los valores de glucosa presentan un rango normal hacia el extremo inferior más amplio, con valores de proteínas mayores a los valores esperados. El rango de celularidad es la variable que presenta menor variación. Conclusiones: Los valores del citoquímico de LCR en paciente con DVP no son equiparables a los de la población sana y deben interpretarse según las características propias de esta población.
Background: The ventriculo-peritoneal shunt (VPS) is the treatment for hydrocephalus, the cerebrospinal fluid (CSF) is evaluated for the management of its complications; however, information on the values of the cytochemistry in this population is insufficient. Aim: To describe the characteristics of the CSF cytochemistry of children in VPS management. Methods: Descriptive observational study, developed in Bogotá (Colombia), from 2008 to 2016. VPS and related procedures records were reviewed. Patients between 6 months and 18 years were included. Results: A total of 285 records were reviewed, 31 samples were entered. The CSF values were, respectively, for the median and 90% percentile: total leukocytes: 0 and 7 cells/mm3, neutrophils: 0 and 6.8 cells/mm3, lymphocytes: 0 and 2 cells/mm3, proteins: 13.4 and 67.2 mg/dL, glucose: 59 and 27.4 mg/dL. Discussion: Glucose values evinced a normal rank towards the widest inferior limit with protein values exceeding the values expected. Cellularity is the variable with the lowest variation. Conclusions: The values of the CSF cytochemistry in patients with VPS are not comparable to those of the healthy population and should be interpreted according to the characteristics of this population.
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Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Cerebrospinal Fluid/chemistry , Cerebrospinal Fluid Proteins/analysis , Ventriculoperitoneal Shunt , Histocytochemistry/standards , Cerebrospinal Fluid/cytology , Prospective Studies , Retrospective Studies , Glucose/cerebrospinal fluid , LeukocytesABSTRACT
OBJECTIVE: Ventriculoperitoneal (VP) shunt surgery is a common and effective treatment for hydrocephalus and cerebrospinal fluid disorders. Infection remains a major cause of morbidity and mortality after a VP shunt. There is evidence that a deep skin flora microbiome may have a role to play in post-operative infections. In this technical note, we present a skin preparation technique that addresses the issue of the skin flora beyond the initial incision.METHODS: The patient is initially prepped, as standard, with. a single layer of 2% CHG+70% isopropyl alcohol. The novel stage is the ‘double incision’ whereby an initial superficial incision receives a further application of povidone-iodine prior to completing the full depth incision.RESULTS: Of the 84 shunts inserted using the double-incision method (September 2015 to September 2016), only one developed a shunt infection.CONCLUSION: The double incision approach to skin preparation is a unique operative stage in VP shunt surgery that may have a role to play in reducing acute shunt infection.
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Humans , 2-Propanol , Cerebrospinal Fluid , Hydrocephalus , Methods , Microbiota , Mortality , Povidone-Iodine , Skin , Surgical Wound Infection , Ventriculoperitoneal ShuntABSTRACT
OBJECTIVE: Ventriculoperitoneal (VP) shunt surgery is a common and effective treatment for hydrocephalus and cerebrospinal fluid disorders. Infection remains a major cause of morbidity and mortality after a VP shunt. There is evidence that a deep skin flora microbiome may have a role to play in post-operative infections. In this technical note, we present a skin preparation technique that addresses the issue of the skin flora beyond the initial incision. METHODS: The patient is initially prepped, as standard, with. a single layer of 2% CHG+70% isopropyl alcohol. The novel stage is the ‘double incision’ whereby an initial superficial incision receives a further application of povidone-iodine prior to completing the full depth incision. RESULTS: Of the 84 shunts inserted using the double-incision method (September 2015 to September 2016), only one developed a shunt infection. CONCLUSION: The double incision approach to skin preparation is a unique operative stage in VP shunt surgery that may have a role to play in reducing acute shunt infection.
Subject(s)
Humans , 2-Propanol , Cerebrospinal Fluid , Hydrocephalus , Methods , Microbiota , Mortality , Povidone-Iodine , Skin , Surgical Wound Infection , Ventriculoperitoneal ShuntABSTRACT
Introducción: La colocación de un shunt ventrículo-peritoneal, a pesar de considerarse un procedimiento de baja complejidad, puede devenir en una serie de complicaciones. Nuestro equipo quirúrgico desarrolló e implementó a partir de junio de 2016 un nuevo protocolo. El objetivo del presente trabajo es: describir e ilustrar paso a paso la técnica quirúrgica utilizada y demostrar que el uso del "nuevo protocolo" disminuye significativamente las complicaciones asociadas al procedimiento. Material y métodos: Desde junio de 2014 a noviembre de 2017 se intervinieron 184 pacientes en relación a sistemas de derivación de LCR. Se realizó un estudio retrospectivo que incluyó los pacientes con colocación primaria de shunt ventrículo-peritoneal (n=114). El seguimiento promedio fue de 14,2 meses (rango 6-38). Para el análisis estadístico se dividió a la muestra en 2 grupos: "protocolo previo" (n=59) y "nuevo protocolo" (n=55). Para describir la técnica quirúrgica se utilizó el archivo fotográfico y los partes quirúrgicos. Resultados: Se describió la técnica quirúrgica en 7 fases. La cantidad de pacientes con alguna complicación fue significativamente menor luego de implementar el "nuevo protocolo" (20% versus 39% respectivamente; p=0,04). En el grupo "nuevo protocolo" no se registró infección alguna asociada a shunt. Conclusión: Se presentó e ilustró, de manera clara y detallada, la técnica de colocación de shunt ventrículo-peritoneal en 7 fases. Esta técnica, junto a una serie de normas, constituyen un "nuevo protocolo". La aplicación de éste disminuyó significativamente las complicaciones asociadas al procedimiento. La tasa de infección "cero" no es una utopía.
Introduction: Ventriculo-peritoneal shunting is considered a relatively straightforward procedure, though multiple complications might ensue. Our surgical team has developed and implemented a new protocol since June 2016. The objectives of this paper are to describe and illustrate the surgical technique we use step by step; and to demonstrate that using this "new protocol" significantly reduces the complications associated with the procedure. Methods: Ours was a retrospective, descriptive study of 184 patients with CSF-derived symptoms treated from June 2014 until November 2017. Of these 184, 114 met our inclusion criteria and were divided into two groups, based upon the treatment protocol followed: previous (n=59) or new (n=55). The new technique was detailed by photographic archives and surgical protocols. Results: A technique consisting of seven steps is described. With the new protocol, complications dropped, including no ventriculo-peritoneal shunt-associated infections post-operatively. Conclusions: A technique for ventriculo-peritoneal shunting, consisting of seven steps, is described thoroughly. This technique, combined with a series of rules, constitutes a new protocol. Protocol implementation reduced the number of procedure-related complications and resulted in a zero infection rate.
Subject(s)
Humans , Ventriculoperitoneal Shunt , Patients , Guidelines as Topic , HydrocephalusABSTRACT
Objective To investigate the effect of the perioperative cluster nursing on the postoperative infections in children patients after ventriculo-peritoneal shunt. Methods 92 patients with hydrocephalus from January 2016 to March 2017 in our hospital were included in the study.The control group who hospitalize from January to June 2016 were managed with routine nursing during the perioperative period.After the implementation,the cluster nursing measures constructed by the focus group interviews were added in the intervention group who hospitalized from July 2016 to March 2017. Results Compared with the pre-implementation,the positive rate of PCT was insignificantly different on days 2 and 4 after the operation (P>0.05).However the difference was statistically significant on the 6th day (P<0.05),the postoperative infection rate significantly lower than that of the control group and so it was with the hospital stay. Conclusion The cluster nursing by focus group interviews can lower the infectious rate and shorten the hospital stay,worthy of clinical promotion.
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@#Dandy-Walker malformation (DWM) is an uncommon congenital anomaly characterised by enlarged posterior fossa involving the cerebellum and fourth ventricle. Most of DWM patients with hydrocephalus require ventriculo-peritoneal shunt (VPS) especially in those with symptoms such as headache and seizures. In cases with worsening hydrocephalus although on VPS, computed tomography and magnetic resonance imaging can be performed to assess ventricular sizes, and an obstructed shunt may be confirmed with iodinated contrast media injection into shunt reservoir under fluoroscopy guidance. VPS scintigraphy is one of infrequently performed nuclear imaging studies that has the capability to assess shunt patency and detect site of blockage with minimal radiation exposure. We describe here a 32-year-old lady with underlying DWM and hydrocephalus on VPS complicated by refractory epilepsy. Radionuclide scintigraphy has proven to be a safe, simple and useful tool in evaluating shunt function and localising the site of VPS obstruction in this patient.
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Drug Resistant EpilepsyABSTRACT
Objective: To investigate the survival status and prognostic factors of patients with leptomeningeal metastasis (LM) from lung adenocarcinoma. Methods: The survival rate and prognostic factors of 65 patients with LM from lung adenocarcinoma, who had complete follow-up data, were retrospectively analyzed. Results: The median survival time of the 65 patients was 7.4 months,and the 1-year survival rate was 6.2% (4/65). Univariate analysis demonstrated that gender, age, smoking history, timing of LM and whether in combination with brain metastasis had no significant correlations with overall survival (all P > 0.05); while the Eastern Cooperative Oncology Group (ECOG) performance status (PS) score, ventriculo-peritoneal (V-P) shunt, epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI) targeted therapy, systemic chemotherapy (SC), whole-brain radiotherapy (WBRT), clinical signs of LM and EGFR gene status were associated with the overall survival (all P < 0.05). Multivariate analysis showed that EGFR gene status, ECOG PS score, SC and V-P shunt were independent prognostic factors of the prognosis of patients with LM from lung adenocarcinoma (all P < 0.05). Conclusion: The overall prognosis of patients with LM from lung adenocarcinoma is poor. The prognosis of patients with LM bearing EGFR mutation is relatively good. EGFR-TKI targeted therapy, SC and V-P shunt can prolong the survival time and improve the prognosis of patients with LM metastasis from lung adenocarcinoma.
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Ventriculo-Peritoneal shunt is the most commonly performed surgery for hydrocephalus, universally Many complications are reported, of which the shunt malfunction and infection are most commonly encountered. These common complications can be minimized, by precautions like– senior surgeons operating shunt cases, as the first case in the operation, with minimal personnel in the operation and thoroughly scrubbing the part for minimum five minutes. However, in few cases, – even in the experienced hands and with all precautions, some rare complications like extrusion of the lower end through anus, vagina, into scrotum were described. In our experience of over 15 years, wide range of complications was seen apart from malfunction and infection. Exposure of the part of shunt system, with excoriation of overlying skin, peritubal leaks, disconnection of shunt system with CSF leaking out, loculation in between the loops of bowel/ omentum, extrusion of the lower end through anus etc. were encountered and probable factors for these unusual complications were discussed.
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Background: Hydrocephalus, an abnormal expansion of cerebral ventricles caused by the accumulation of cerebrospinal fluid (CSF), is estimated to occur in about 3 of 1,000 live births. With a peak age of less than 10 years, hydrocephalus is more common in males than in females and is caused by brain tumours, central nervous system (CNS) infections and many other congenital malformations. Ventriculo-peritoneal (VP) shunts are basic diversionary CSF flow-channel neurosurgical procedures that are associated with a significant failure rate and a number of complications. The use of either frontal or posterior parietal VP shunts is selected based on the determined sites of insertion. Objectives: The aim of this study was to assess the differences in the complications and number of tappings between frontal and posterior parietal VP shunts. Patients and Methods: A prospective study was conducted on 113 patients with hydrocephalus of various aetiologies who were treated at a surgical specialties hospital in Baghdad between January 2010 and January 2013. The purpose of the study, which followed each patient for 6 months after surgery, was to determine the differences between 43 patients treated with frontal VP shunts and 70 patients treated with posterior parietal VP shunts with respect to the following factors: number of tappings to access the ventricle, steps of subcutaneous tunnelling, duration[.6] of procedure , complication rates and incidents of revision. A Codman & Shurtleff programmable shunt was used in both groups; no antibiotic-impregnated shunts were used. Results and Discussion: The mortality rate was 1.76%; 31.85% of all shunted patients experienced post-operative complications. Of a total 113 patients, 22 patients (31.42%) with posterior parietal VP shunts developed complications, and 14 patients (32.55%) with frontal VP shunts developed complications. Revisions were required in 25.7% of the patients with posterior parietal VP shunts and in 20.9% of the patients with frontal VP shunts. The most frequent complication was upper-end obstruction, which occurred in two patients (4.65%) after the frontal VP shunt procedure and in eight patients (11.42%) after posterior parietal VP shunt procedure. The wide difference in the number of occurrences of this complication clearly demonstrates that the frontal approach as a method of choice in applying a ventricular catheter. Other complications were also recorded (e.g. lower-end obstruction, infection, seizure, tube and valve exposure and subcutaneous collection. Conclusion: Age, gender and the cause of hydrocephalus were found to have no relation to the development of shunt complications. Upper-end obstruction, valve exposure and required revisions were more common in patients with posterior parietal VP shunts, while lower-end obstruction, infection and seizures were more common in patients with frontal VP shunts. However, these differences were not statistically significant.
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Background: Idiopathic intracranial hypertension (IIH) has been increasing in prevalence in the past decade, following the obesity epidemic. When medical treatment fails, surgical treatment options must be considered. However, controversy remains as to which surgical procedure is the preferred surgical option – optic nerve sheath fenestration (ONSF) or cerebrospinal fluid (CSF) shunting – for the long‑term treatment of this syndrome. Purpose: To provide a clinical update of the pros and cons of ONSF versus shunt placement for the treatment of IIH. Design: This was a retrospective review of the current literature in the English language indexed in PubMed. Methods: The authors conducted a PubMed search using the following terms: Idiopathic IIH, pseudotumor cerebri, ONSF, CSF shunts, vetriculo‑peritoneal shunting, and lumbo‑peritoneal shunting. The authors included pertinent and significant original articles, review articles, and case reports, which revealed the new aspects and updates in these topics. Results: The treatment of IIH remains controversial and lacks randomized controlled clinical trial data. Treatment of IIH rests with the determination of the severity of IIH‑related visual loss and headache. Conclusion: The decision for ONSF versus shunting is somewhat institution and surgeon dependent. ONSF is preferred for patients with visual symptoms whereas shunting is reserved for patients with headache. There are positive and negative aspects of both procedures, and a prospective, randomized, controlled trial is needed (currently underway). This article will hopefully be helpful in allowing the reader to make a more informed decision until that time.
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Objective To explore the advantages and application of adjustable shunt valve in treatment of chil-dren with Communicating hydrocephalus. Methods Eighty six consecutive children undergoing surgery treatment for Communicating hydrocephalus from January 2006 to July 2011 were included in this retrospective study. Fifty cases re-ceived adjustable shunt valve whereas the rest received standard shunt valve. Results The success rate was 84.00% in the adjustable shunt valve group and 63.89%in the standard shunt valve group. Complication rate was 16.00%in the ad-justable shunt valve group and 36.11% in the standard shunt valve group. Inadequate and excessive shunt rate was 69.23% in the standard shunt valve group and zero% in adjustable shunt valve group. Compared with standard shunt valve group, adjustable shunt valve group had significantly higher success rate and lower complication rate (All P<0.05). Conclusions Adjustable shunt valve effectively reduce the complication rate and improve the success rate. In addition, adjustable shunt valve is superior to standard shunt valve in the treatment of children with communicating hydrocephalus because it fits for the development of children.
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Objective To explore the surgical treatment of refractory cerebrospinal fluid rhinorrhea with recurrent bacterial meningitis.Methods The clinical data of 1 case of a 10-year-old boy who had 9 episodes of bacterial meningitis and underwent 4 surgical repair procedures for congenital cerebrospinal fluid rhinorrhea at the Children's Hospital Affiliated to Soochow University were analyzed,and the related literatures were reviewed.Results During the intervals of 9 episodes of bacterial meningitis,the patient experienced 4 neurosurgical repairs of cerebrospinal fluid rhinorrhea,including 2 endoscopic repairs via the lateral nasal cavity,a craniotomy approach repair via forehead epidural,and an endoscopic repair in combination with a ventriculo-peritoneal shunt.The first 3 surgeries were all failed,but the final surgery was successful,with no recurrence of cerebrospinal fluid rhinorrhea or bacterial meningitis in 3.5 years of follow-up.Conclusions For recurrent meningitis and refractory cerebrospinal fluid rhinorrhea,the ventriculo-peritoneal shunt can be considered in addition to conventional nasal endoscopic cerebrospinal fluid repair to eliminate the increased cerebrospinal fluid attributable to long-term chronic compensation,and effectively reduce postoperative intracranial hypertension to make the operation success.
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Ventriculo-peritoneal (VP) shunt is the most commonly performed procedure for the management of hydrocephalus. Although shunts have improved the morbidity and mortality associated with disordered Cerebrospinal fluid (CSF) mechanics over the past 30 years, they still are associated with many potentially avoidable complications in clinical practice. However, extrusion of VP shunt catheter is an unusual complication of VP shunt Surgery. We are presenting this unusual complication in five patients. The lower end of the shunt was seen extruding from anal opening in one patient, umbilicus in one, urethra in one, inguinal hernia sac in one and oral cavity in one patient. All of these patients were managed by shunt removal, intra venous antibiotics followed by shunt replacement on the other side except the patient with inguinal hernia sac.
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Background: Hydrocephalus secondary to tuberculous meningitis (TBM) continues to be a challenging condition to treat for neurosurgeons in developing countries. Shunt complications are reportedly more frequent in patients undergoing ventriculo-peritoneal shunt in patients with TBM than in those undergoing shunt surgeries for other causes. Aim: The aim of this study was to evaluate the relationship of cerebrospinal fluid (CSF) composition on shunt malfunction. Methods: We compared the CSF composition of 53 patients who had shunt malfunction during a five year period with that of 137 matched controls. Results: Patients who had shunt malfunction had a significantly higher concentration of CSF protein. The CSF cellularity and glucose concentration did not have any significant bearing in predicting shunt malfunction. Patients with CSF protein concentration of more than 200 mg/dL had a four times higher risk of having shunt malfunction than those with a concentration of less than 100 mg/dL. Patients with CSF protein in the 100-200 mg/dL range represent an intermediate zone. Conclusion: To conclude, patients with CSF protein concentration of more than 200 mg/dL have a significantly higher risk of shunt malfunction and hence have to be followed up closely.