CAUDAL MIGRATION AND TRANS-ANAL EXTRUSION OF VENTRICULOPERITONEAL SHUNT IN A CHILD : A CASE REPORT

We present an unusual case of anal extrusion of the peritoneal end of a ventriculo-peritoneal shunt (VP shunt) in a 5 year old male child. The patient was suffering from aqueductal stenosis for which the shunt was placed 2 years ago. Pertinent literature is reviewed regarding this rare complication in such a common surgery.

ETV in tuberculous meningitis with hydrocephalus and allergic reaction to VP shunt: a case report

Hydrocephalus is one of the most common complications of tuberculous meningitis (TBM) occurring in up to 85% of patients with the disease. The placement of a ventriculoperitoneal (VP) shunt is the most common form of treatment for hydrocephalus in tuberculous meningitis (TBM). Although allergic reactions to the silicone in shunt device are very rare, the authors describe a case of silicone allergy causing multiple VP shunt revisions. Alternative choice is endoscopic third ventriculostomy (ETV), but it is debatable. ETV has variable success in these patients and is generally not advisable in patients in the acute stages of the disease. A 19-year-old woman with hydrocephalus in tuberculous meningitis, who had undergone multiple VP shunt revisions, presented with shunt malfunction caused by allergic reaction of the tissue surrounding the shunt tubing. Laboratory examination demonstrated high level IgE, high level ESR, and PCR-TBC Positive, related to the allergic reaction. Patient with ETV success score of 50. Patients received ETV and release VSS Shunt. ETV has success in these patients. VP Shunts complications remain a difficult problem in neurosurgical clinical practice. The most typical complications are mechanical obstruction and infection. Allergy to the silicone shunt tubing is quite rare. Silicone allergy is an even more rare occurrence because of its high biocompatibility and low biological reactivity. It is a challenge for ETV when TBM has difficulty to recognize anatomical landmarks on this patient. It could also consider in patients who have shunt failure, and might be a better option than shunt revision.

Epidemiological Analysis Of Ventriculoperitoneal Shunt For Hydrocephalus

AIM: To identify the spectrum of patients for whom cereospinal fluid diversion is done and to study the pattern of presentation based on clinical criteria and symptomatology and radiological investigation . To study the indications for the ventriculoperitoneal shunt and the further course in the hospital from admission to discharge including the complications in the study period designated from January 2013 to December 2014 which spans 2 years and followed up the cases for around 6 months. OBJECTIVES : To study the indications of the cereospinal fluid diversion procedure and the course of the patient from the time of admission to discharge. This includes the presenting symptoms, radiological investigation, the admitting GCS (Glasgow Coma Scale) , cereospinal fluid study and the condition at discharge and complications . MATERIALS AND METHODS : It is a retrospective and prospective analysis of 100 patients in a tertiary care centre from January 2013 to December 2014 for a span of 2 years. OBSERVATION AND RESULTS:Out of the hundred patients who underwent ventriculoperitoneal shunt 59% were done among paediatric patients and 41% were done on adult patients and 77% underwent emergency ventriculoperitoneal shunt and 23% underwent elective VP Shunt. There is no significant short term outcome difference based on the side of shunt (either left or right). CONCLUSION : The incidence of hydrocephalous appears to be more in the paediatric population. Early emergency shunting of hydrocephalous carries good prognosis especially if the admitting GCS is 12 or above.

Surgical-outcome and Complication Differences between Frontal and Posterior Parietal Ventriculo-peritoneal Shunts in Iraqi.

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.

Complications after the Ventriculo-peritoneal Shunt according to the Time Course

The Ventriculo-peritoneal(VP) shunt is effective and easy method for the treatment of hydrocephalus. But it has a high complication rate including malfunction and infection. This study seeks to find out how to reduce reoperation and complication rates of previously VP shunt-treated patients by analyzing risk factors, complication, and the relstionship with the time course. The authors reviewed 714 cases with VP shunt performed from 1986 to 1994. The risk factors of VP shunt related complications were insufficient surgical skill, younger age group, and some causes of hydrocephalus which were meningitis, neurocysticercosis, and congenital orgin. The complications including shunt malfunction were most frequent within 1 month after the initial VP shunt and were most common at the proximal site of the shunt system.

Shunt Malfunction Manifested by Parkinsonism: Case Report

Although extrapyramidal features in normal pressure hydrocephalus(NPH) are not uncommon, presentations with Parkinson's syndrome as the predominant feature are rare, especially in children, and may give rise to diagnostic difficulties. We presents a case of NPH manifested by Parkinson's syndrome cured by shunt revision. The patient had the long history of Parkinson's syndrome not responded by drug therapy. Failure of patients with parkinsonism to respond to therapy, should alert one to the possibility of shunt malfunction and NPH.