Laparoscopic cholecystectomy in an adult patient with a ventriculoperitoneal shunt system

Adult patients with a ventriculoperitoneal shunt valve (VDVP) are not exempt from suffering from gastrointestinal diseases. Nowadays, with technological advances, it would be contradictory not to offer them the benefits of minimally invasive surgery. The case of a laparoscopic cholecystectomy of a 40-year-old male patient with VDVP who presented clinical signs of cholecystitis is presented. The patient's evolution was satisfactory and he was discharged home 72 hours after surgery. Currently, there are significant studies that demonstrate the benefit of minimally invasive surgery in patients with VDVP as a treatment for abdominal surgical pathologies, including biliary pathology. Therefore, in our experience and with the published cases, we conclude that patients with VDVP do benefit from minimally invasive surgery for any abdominal surgical pathology, including pathology of biliary origin.

Factores de riesgo asociados a la persistencia de hidrocefalia posterior a la resección de tumores de fosa posterior / Risk factors associated with hydrocephalus persistence after posterior fossa tumors resection

Introducción. Las neoplasias de fosa posterior son los tumores de sistema nervioso central más frecuentes en la población pediátrica y una causa frecuente de hidrocefalia. El objetivo del presente trabajo es analizar los factores de riesgo asociados a hidrocefalia luego de las cirugías de resección de tumores de fosa posterior en una población pediátrica. Material y métodos. Se realizó un estudio observacional retrospectivo de pacientes pediátricos operados de tumores de fosa posterior en un único hospital. Se analizaron potenciales factores de riesgo pre y post quirúrgicos. Se consideró como variable respuesta la necesidad de derivación definitiva para tratar la hidrocefalia a los 6 meses de la resección tumoral. Resultados. En el análisis univariado se detectaron múltiples factores de riesgo significativos. Sin embargo, solamente 3 se mantuvieron en el modelo multivariado: grado de resección (Subtotal: OR 7.86; Parcial: OR 20.42), infección postoperatoria (OR 17.31) y ausencia de flujo de salida postoperatorio en IV ventrículo (OR 4.29). Éste modelo presentó una buena capacidad predictiva (AUC: 0.80, Sensibilidad 80.5%, Especificidad 76.3%). Conclusión. La realización de tercer ventriculostomía endoscópica preoperatoria no redujo la incidencia de hidrocefalia postoperatoria. El grado de resección tumoral, la presencia de infección postoperatoria y la obstrucción de salida del IV ventrículo fueron los factores de riesgo más importantes para el requerimiento de sistema derivativo definitivo luego de la resección de un tumor de fosa posterior. Ésto podría influir en la toma de decisiones respecto al tratamiento en este grupo de pacientes pediátricos

Background. Posterior fossa tumors are the most frequent central nervous system neoplasms in the pediatric population and a frequent cause of hydrocephalus. The objective of this study is to analyze the risk factors associated with hydrocephalus after posterior fossa tumors resection in a pediatric population. Methods. A retrospective observational study was conducted on pediatric patients who underwent posterior fossa tumor resection in a single hospital. Potential pre- and post-operative risk factors were analyzed. The need for definitive shunt placement to treat hydrocephalus at 6 months after tumor resection was considered as the outcome variable. Results. Univariate analysis identified multiple significant risk factors. However, only 3 factors remained in the multivariate model: extent of resection (subtotal: OR 7.86; partial: OR 20.42), postoperative infection (OR 17.31), and absence of postoperative outflow of the fourth ventricle (OR 4.29). This model showed good predictive capacity (AUC: 0.80, Sensitivity 80.5%, Specificity 76.3%). Conclusion. Preoperative endoscopic third ventriculostomy did not reduce the incidence of postoperative hydrocephalus. The extent of tumor resection, presence of postoperative infection, and obstruction of fourth ventricle outflow were the most important risk factors for the requirement of a definitive shunt system after posterior fossa tumor resection. This could influence treatment decisions in this group of pediatric patients

Factores de riesgo asociados a la persistencia de hidrocefalia posterior a la resección de tumores de fosa posterior / Risk factors associated with hydrocephalus persistence after posterior fossa tumors resection

Introducción: Las neoplasias de fosa posterior son los tumores de sistema nervioso central más frecuentes en la población pediátrica y una causa frecuente de hidrocefalia. Objetivo: Analizar los factores de riesgo asociados a hidrocefalia luego de las cirugías de resección de tumores de fosa posterior en una población pediátrica. Material y Métodos: Se realizó un estudio observacional retrospectivo de pacientes pediátricos operados de tumores de fosa posterior en un único hospital. Se analizaron potenciales factores de riesgo pre y post quirúrgicos. Se consideró como variable respuesta la necesidad de derivación definitiva para tratar la hidrocefalia a los 6 meses de la resección tumoral. Resultados: En el análisis univariado se detectaron múltiples factores de riesgo significativos. Sin embargo, solamente 3 se mantuvieron en el modelo multivariado: grado de resección (Subtotal: OR 7.86; Parcial: OR 20.42), infección postoperatoria (OR 17.31) y ausencia de flujo de salida postoperatorio en IV ventrículo (OR 4.29). Éste modelo presentó una buena capacidad predictiva (AUC: 0.80, Sensibilidad 80.5%, Especificidad 76.3%). Conclusión: La realización de tercer ventriculostomía endoscópica preoperatoria no redujo la incidencia de hidrocefalia postoperatoria. El grado de resección tumoral, la presencia de infección postoperatoria y la obstrucción de salida del IV ventrículo fueron los factores de riesgo más importantes para el requerimiento de sistema derivativo definitivo luego de la resección de un tumor de fosa posterior. Ésto podría influir en la toma de decisiones respecto al tratamiento en este grupo de pacientes pediátricos(AU)

Background: Posterior fossa tumors are the most frequent central nervous system neoplasms in the pediatric population and a frequent cause of hydrocephalus. Objective: Analyze the risk factors associated with hydrocephalus after posterior fossa tumors resection in a pediatric population. Methods: A retrospective observational study was conducted on pediatric patients who underwent posterior fossa tumor resection in a single hospital. Potential pre- and post-operative risk factors were analyzed. The need for definitive shunt placement to treat hydrocephalus at 6 months after tumor resection was considered as the outcome variable. Results: Univariate analysis identified multiple significant risk factors. However, only 3 factors remained in the multivariate model: extent of resection (subtotal: OR 7.86; partial: OR 20.42), postoperative infection (OR 17.31), and absence of postoperative outflow of the fourth ventricle (OR 4.29). This model showed good predictive capacity (AUC: 0.80, Sensitivity 80.5%, Specificity 76.3%). Conclusion: Preoperative endoscopic third ventriculostomy did not reduce the incidence of postoperative hydrocephalus. The extent of tumor resection, presence of postoperative infection, and obstruction of fourth ventricle outflow were the most important risk factors for the requirement of a definitive shunt system after posterior fossa tumor resection. This could influence treatment decisions in this group of pediatric patients

Corneal Perforation associated with "Silent Brain Syndrome" / Perfuração corneana associada à "síndrome do cérebro silencioso"

ABSTRACT This case report describes the clinical characteristics and ophthalmic management of a patient who developed corneal perforation due to severe enophthalmos consistent with "silent brain syndrome." A 27-year-old man with a history of congenital hydrocephalus and ventriculoperitoneal shunt was referred with complaints of "sinking of the eyeballs" and progressively decreasing vision in the left eye. Examination revealed severe bilateral enophthalmos in addition to superonasal corneal perforation with iris prolapse in the left eye. The patient underwent therapeutic keratoplasty the next day. Orbital reconstruction with costochondral graft and shunt revision of the intracranial hypotension were performed the next month to prevent further progression.

RESUMO Este relato de caso descreve as características clínicas e o manejo cirúrgico de um paciente que teve perfuração da córnea devido à enoftalmia grave consistente com a "síndrome do cérebro silencioso". Um homem de 27 anos com história de hidrocefalia congênita e derivação ventrículo-peritoneal foi encaminhado com queixas de "afundamento dos globos oculares" e diminuição progressiva da visão no olho esquerdo. O exame revelou enoftalmo bilateral importante, além de perfuração superonasal da córnea com prolapso iriano no olho esquerdo. A paciente foi submetida à ceratoplastia terapêutica no dia seguinte. Foi realizado no mês seguinte a reconstrução da órbita com enxerto costocondral e revisão do shunt para evitar progressão e piora do caso.

Surgical management of Dandy-Walker syndrome in infants and the literature review / 中国综合临床

Dandy-Walker syndrome is one of the posterior fossa malformations, which is easily confused with arachnoid cyst or cerebellar dysplasia in clinical practice, leading to misdiagnosis. Dandy-Walker syndrome is easy to be combined with hydrocephalus, resulting in increased intracranial pressure, increased head circumference, growth retardation, spastic hemiplegia and other manifestations, and can also be accompanied by other nervous system malformations. On February 27, 2021, a child with Dandy-Walker syndrome with growth retardation as the primary manifestation was admitted to Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine. After multiple surgical treatment, the child's hydrocephalus was significantly improved. Through the analysis of the clinical data of the child's operation and the treatment of complications, it is helpful to improve the clinicians' understanding of the surgical treatment of the disease.

Cluster management in secondary hydrocephalus / 中华神经医学杂志

Objective:To explore the clinical value of cluster management in secondary hydrocephalus.Methods:Seventy-seven patients with secondary hydrocephalus admitted to Department of Neurosurgery, Shenzhen Second People's Hospital from January 2016 to June 2021 were chosen; they were divided into traditional management group ( n=30) and cluster management group ( n=47) according to different management methods. Patients in traditional management group accepted craniocerebral CT and 3 consecutive times of cerebrospinal fluid tests, and normal results were achieved and then ventriculoperitoneal shunt (VPS) was performed. In patients from the cluster management group, on the basis of management treatment, cranial plain and enhanced MRI and DNA metagenomic next generation sequencing of cerebrospinal fluid were performed before surgery, and rapid test of cerebrospinal fluid and ventriculoscope observation were performed during surgery; after exclusion of intracranial infection, VPS was performed. The differences of shunt failure rate were compared between the two groups and the positive rates of intracranial infection detected by above 4 methods were compared in the cluster management group. Results:There was significant difference in shunt failure rate between the cluster management group and traditional management group (2.1% vs. 20.0%, P<0.05). The positive rates of intracranial infection by DNA metagenomics (61.7%) and ventriculoscopy (68.1%) were significantly higher than those by preoperative cranial plain and enhanced MRI (14.9%) and rapid test of cerebrospinal fluid (6.4%, P<0.05). Conclusion:Cluster management can effectively decrease the VPS failure rate in secondary hydrocephalus; DNA metagenomics and ventriculoscopy have high efficiency in detecting intracranial infection.

New Technique Seeking Prophylaxis in the Displacement of Distal Ventriculoperitoneal Shunt Catheter ­ Case Report / Nova técnica buscando profilaxia no desacoplamento do cateter distal de derivação ventriculoperitoneal ­ Relato de caso

Idiopathic intracranial hypertension is a comorbidity treated in neurosurgical practice today with the ventriculoperitoneal derivation technique. However, despite its great safety and efficacy, this technique is susceptible to infrequent failures, such as displacement of the catheter leading to the need for reoperation. In the present article, we report a case involving a peritoneal catheter tip retropulsion for subcutaneous tissue in an obese patient with posterior correction using an extending connector to the distal catheter, without harming the drainage flow. In our case report, the patient went on without complications and without the occurrence of new displacement after 8 months of surgery. The results obtained by this technique supported the idea that this alternative construction minimizes the risk of displacement of the peritoneal tip catheter in obese patients and with high intra-abdominal pressure, helping to reduce the need for reoperations. In addition, the present case report supports the need for further studies and clinical trials on the subject.

A hipertensão intracraniana idiopática é uma comorbidade tratada na prática neurocirúrgica usualmente com técnica de derivação ventriculoperitoneal. No entanto, apesar de sua grande segurança e eficácia, a técnica é sujeita a falhas, pouco frequentes, como o desacoplamento do cateter, levando à necessidade de reoperação. Relatamos, no presente artigo, um caso de correção cirúrgica a partir de prolongamento do cateter distal com a utilização de conector extensor sem prejuízo ao fluxo de drenagem em paciente obeso acometido por recidiva de migração da ponta do cateter peritoneal para o tecido subcutâneo. Em nosso relato de caso, o paciente seguiu sem complicações e sem a ocorrência de novos desacoplamentos após 8 meses do ato operatório. Os resultados obtidos pelo estudo corroboram a necessidade de maiores investigações buscando o conhecimento da eficácia e segurança da técnica empregada buscando minimizar os riscos de migração da ponta do cateter peritoneal em pacientes obesos e de elevada pressão intra-abdominal, ajudando a diminuir a necessidade de reoperações.

Circumbilical Access for Ventriculoperitoneal Bypass Insertion in Adults / Acesso Circumbilical para Inserção de Derivação Ventriculoperitoneal em Adultos

Introduction The use of a minilaparotomy for catheter implantation can bring important complications such as adhesions, intestinal lesions, incisional hernias and postoperative pain. In neurosurgery, the umbilical access, currently widely used by surgeons of different specialties mainly for its aesthetic results, is still restricted by the unfamiliarity of the access. Material and Method During the period between 2019 and 2020, a total of 12 patients who required ventricular bypass were selected, using circumbilical access for insertion of the peritoneal catheter and followed up for 12 months to analyze possible complications. Description of the Technique The surgeon responsible for the abdomen performs an umbilical incision bordering the upper edge of the upper ring, avoiding the mamelon, quickly finding the linea alba under the umbilical plane, which after dissection allows reaching the peritoneum, without breaking the rectus muscles. The peritoneum can then be opened under visual control. Results All patients presented resolution of hydrocephalus with good aesthetic results and without complications. Discussion The aesthetic result of the transumbilical procedure was the stimulus for the development of the technique that proved to be easy, safe, cheap, and aesthetic. Initially, the ease of access to the peritoneal cavity is clear, in addition to avoiding manipulation of the rectus abdominis muscle, which improves postoperative pain. Conclusion The circumbilical access for the implantation of a ventriculoperitoneal shunt is safe, effective and has a better aesthetic result for adult patients and should be part of the operative arsenal of neurosurgeons.

Introdução O uso de uma minilaparotomia para o implante do cateter pode trazer importantes complicações como adesões, lesões intestinais, hérnias incisionais e dor pós-operatória. O acesso umbilical, atualmente muito utilizado por cirurgiões de diversas especialidades principalmente por seus resultados estéticos, na neurocirurgia ainda é restrito pela não familiaridade do acesso. Material e Método Foram selecionados 12 pacientes, durante o período de 2019 e 2020, que necessitavam de derivação ventricular, sendo utilizada o acesso circumbilical para inserção do cateter peritoneal e acompanhada por doze meses para análise de possíveis complicações. Descrição da Técnica O cirurgião responsável pelo abdome realiza uma incisão umbilical margeando a borda superior no rodete superior, fugindo do mamelão, encontrando rapidamente a linha alba sob o plano umbilical que após dissecção permite-se chegar ao peritônio, sem romper os músculos retos. O peritônio pode então ser aberto sob controle visual. Resultados Todos os pacientes apresentaram resolução da hidrocefalia com bom resultado estético e sem complicações. Discussão O resultado estético do procedimento transumbilical foi o estímulo para o desenvolvimento da técnica que se mostrou fácil, segura, barata e estética. Inicialmente é nítido a facilidade do acesso à cavidade peritoneal, além de evitar a manipulação do musculo reto abdominal, o que melhora a dor pós-operatória. Conclusão O acesso circumbilical para a implantação de derivação ventriculoperitoneal é seguro, efetivo e possui melhor resultado estético para pacientes adultos, devendo fazer parte do arsenal operatório de neurocirurgiões.

Ten Steps for NPH Management: Advancements in Diagnosis and Treatment of Adult Hydrocephalus / Dez etapas para o manejo da NPH: avanços no diagnóstico e tratamento da hidrocefalia em adultos

Objectives The authors of the present study intend to describe a straightforward protocol for normal pressure hydrocephalus diagnosis and management, with the employment of a multidisciplinary team approach effort. Methods Using a strict methodological approach for initial diagnosis, taking into consideration occupational therapy and physical therapy assessment, the authors have set out to elaborate a simple protocol for suspicion and, once diagnosed, treatment of normal pressure hydrocephalus. We have used the MoCA (Montreal Cognitive Assessment) and walking assessment that included speed, independence, and distance (SID), 10 m walk test, TUG (timed up and go) evaluation, 6-minute Walk Test, MiniBESTest, as the main factors for pre and post lumbar drainage assessment, after which, the alternatives were deliberated and followed, or not, by ventriculoperitoneal shunt insertion. Results The authors have described a protocol, consisting of ten easy steps, which involves a multidisciplinary team, including occupational therapy and physical therapy professionals, as well as neurologists and neurosurgeons for improved and objective assessment prior to insertion of lumbar drain and, thereafter, detecting the population at most benefit for ventriculoperitoneal shunt insertion. We have described the Ten Step Approach for Normal Pressure Hydrocephalus management, including from initial clinical presentation and imaging, to pre and post lumbar drainage, for lastly deciding upon necessity for ventriculoperitoneal shunt insertion. Conclusions A straightforward protocol for normal pressure hydrocephalus seems not only feasible, but simple to implement in most neurosurgical departments, with good accuracy of prediction of lumbar drainage assessment to shunting outcomes.

Epidemiological, therapeutic and evolution aspects of hydrocephalus in children in Madagascar

Hydrocephalus is a disorder of the hydrodynamics of the CSF resulting in an increase in the volume of CSF in the cranial cavity. Hydrocephalus is frequent in Madagascar. We conducted a multicenter and retrospective study of operated hydrocephalic children in 3 neurosurgical departments in Madagascar over a 3-year period. We report 71 cases of hydrocephalus in operated children. Infants predominated in 90.1% of cases. Postmeningeal etiology was found in 42.3%. Ventriculo-peritoneal shunting was undertaken in 92.9% of cases. After the operation, the evolution was favourable in 84.5% of cases. Complications were reported. After discharge from hospital, 59.1% of the children were lost to follow-up within the first month. Hydrocephalus in children predominates in infants. Meningitis remains the most frequent etiology. Ventriculo-peritoneal shunting is the technique most commonly used in Madagascar. The result is favourable in the majority of cases.

Clinical efficacy and safety of laparoscopically assisted ventriculoperitoneal shunting for the treatment of hydrocephalus in older adult patients / 中国基层医药

Objective:To investigate the clinical efficacy and safety of laparoscopically assisted ventriculoperitoneal shunting for the treatment of hydrocephalus in older adult patients.Methods:Sixty-four older adult patients with hydrocephalus who received treatment in Yiwu Fuyuan Private Hospital from June 2017 to December 2019 were included in this study. They were randomly divided into study and control groups, with 32 patients in each group. The control group was given ventriculoperitoneal shunting and the study group was given laparoscopically assisted ventriculoperitoneal shunting. The Fugl-Meyer assessment of motor recovery, the activity of daily life score, hydrocephalus grading score, excellent and good efficacy rate, and incidence of complications were compared between the two groups.Results:After treatment, the Fugl-Meyer score and activity of daily life score in the study group were (77.05 ± 18.54) points and (84.83 ± 17.75) points, which were significantly higher than (63.25 ± 16.18) points and (63.76 ± 15.04) points in the control group ( t = 3.17, P = 0.002; t = 5.12, P < 0.001). Hydrocephalus grading score in the study group was significantly lower than that in the control group [(3.77 ± 2.41) points vs. (6.61 ± 2.75) points, t = 4.39, P < 0.001]. Excellent and good efficacy rate in the study group was significantly higher than that in the control group [93.75% (30/32) vs. 75.00% (24/32), χ2 = 4.26, P < 0.05]. The incidence of complications in the study group was significantly lower than that in the control group [9.38% (3/32) vs. 40.63% (13/32), χ2 = 8.33, P < 0.005]. Conclusion:Laparoscopically assisted ventriculoperitoneal shunting can accurately locate the catheter and is more effective in the treatment of hydrocephalus in older adult patients compared with ventriculoperitoneal shunting. It can accelerate the recovery of neurological function and is highly safe.

Correlations of cerebrospinal fluid routines and biochemical indexes before ventriculoperitoneal shunt with postoperative intracranial infection in adult patients with hydrocephalus / 中华神经医学杂志

Objective:To study the correlations of cerebrospinal fluid (CSF) routines and biochemical indexes before ventriculoperitoneal shunt with postoperative intracranial infection in adult patients with hydrocephalus.Methods:A retrospective case-control study was conducted on 347 adult patients who underwent ventriculoperitoneal shunt in Department of Functional Neurosurgery, Neurosurgery Center, Zhujiang Hospital of Southern Medical University from January 2016 to December 2021. According to the appearance of postoperative infection or not, these patients were divided into infection group ( n=27) and non-infection group ( n=320). General clinical data and CSF routines and biochemical indexes test results were analyzed and compared between the two groups. The correlations of postoperative intracranial infection with preoperative levels of white blood cells, chlorine, glucose, lactic acids and proteins in the CSF were analyzed by multivariate Logistic regression. Results:There was no significant difference in age, gender, or primary diseases between infection group and non-infection group ( P>0.05). As compared with the non-infection group, the infection group had significantly decreased glucose content and significantly increased lactic acid content in the CSF ( P<0.05). Multivariate Logistic regression analysis showed that glucose content ( OR=21.825, 95%CI: 4.994-95.394, P<0.001) and lactic acid content ( OR=18.430, 95%CI: 6.023-56.391, P<0.001) were independently correlated with infections after ventriculoperitoneal shunt. Risk of patients with glucose content<2.5 to develop intracranial infection after surgery was 21.825 times that of patients with preoperative glucose content≥2.5 mmol/L. Risk of patients with lactic acid content>2.5 mmol/L to develop intracranial infection after surgery was 18.430 times that of patients with preoperative lactic acid content≤2.5 mmol/L. Conclusion:For adult hydrocephalus patients without intracranial infection but only with abnormal CSF (glucose content<2.5 mmol/L or lactic acid content>2.5 mmol/L), ventriculoperitoneal shunt should only be performed after further improvement of CSF indexes to avoid increasing postoperative infection.

Le pseudo kyste abdominal: une complication de la dérivation ventricule péritonéale à propos d'un cas / The abdominal pseudocyst: a complication of ventriculoperitoneal bypass about a case

Le pseudokyste abdominal est une complication rare pouvant survenir chez les sujets porteurs d'une dérivation ventriculo-péritonéale (DVP). Nous rapportons le cas d'un adolescent de 11 ans, chez qui une DVP a été réalisée pour une hydrocéphalie congénitale. Il présentait une distension abdominale progressive sans notion de troubles de transit. L'imagerie (échographie, urosacnner) a permis de mettre en évidence un épanchement péritonéal de grande abondance organisé, à paroi fine et régulière, exerçant un effet de masse sur la vessie et les uretères, responsable d'une urétérohydronéphrose bilatérale. Le bout distal du cathéter de DVP a été visualisé dans la collection

The abdominal pseudocyst is a rare complication that can occur in subjects with a ventriculoperitoneal drain (VPD). We report the case of an 11-year-old adolescent with congenital hydrocephalus antecedent, for whom a ventriculoperitoneal shunt was made. He presented a progressive abdominal distension without notion of transit disorders. Abdominal ultrasound and uroscanner revealed an organized peritoneal effusion of great abundance, thin and regular wall, exerting a mass effect on the bladder and the ureters responsible for bilateral uretero-hydronephrosis. Above all, it has made it possible to individualize the distal ventriculo-peritoneal bypass catheter projecting in the effusion

Extrinsic Compression of the Gastric Wall by a Ventriculoperitoneal Shunt Catheter: Case Report and Literature Review / Compressão extrínseca de parede gástrica por cateter de derivação ventriculoperitoneal: Relato de caso e revisão de literatura

Introduction Ventriculoperitoneal (VP) shunt is commonly used in the treatment of hydrocephalus and may present complications in up to 30% of patients. The present report addresses an uncommon complication in the abdominal cavity, in which the catheter caused extrinsic compression of the gastric wall. Case report A 30-year-old man presented a decreased level of consciousness, associated with severe headache and vomiting. He had a history of congenital neurotoxoplasmosis and VP shunt insertion at 7 years of age. Imaging exams demonstrated the formation of an encapsulated retrogastric pseudocyst and extrinsic compression of the gastric wall by a VP shunt catheter. Through videolaparoscopy, decompression of the gastric wall and removal of the pseudocyst were performed, with the reestablishment of the drainage of cerebrospinal fluid. An analysis of the distal fragment of the removed catheter revealed obstruction by fibrotic material. The patient was discharged with a reestablished baseline after four days of hospitalization. Comments The literature shows that 47% of the complications presented by patients are related to the distal end of the catheter, and 8.2% of these come from migration to the abdominal cavity. However, there is an extreme paucity of studies that demonstrate extrinsic compression of the gastric wall by a VP shunt catheter. Therefore, we suggest that further studies on complications involving the VP shunt be performed to improve diagnostic and therapeutic results, in addition to comple menting the literature on this complication.

Introdução A derivação ventriculoperitoneal (DVP) é comumente empregada no tratamento da hidrocefalia, e pode apresentar complicações em até 30% dos pacientes. Este relato aborda uma complicação incomum na cavidade abdominal, em que o cateter promoveu compressão extrínseca da parede gástrica. Relato de caso Um homem de 30 anos apresentou rebaixamento do nível de consciência associado a cefaleia de forte intensidade e vômitos. O paciente tinha histórico de neurotoxoplasmose congênita e inserção de DVP aos 7 anos. Os exames de imagem demonstraram formação de pseudocisto encapsulado retrogástrico e compressão extrínseca de parede gástrica por cateter de DVP. Por meio de videolaparoscopia, foram realizadas a descompressão da parede gástrica e a remoção do pseudocisto, com o restabelecimento da drenagem de líquido cefalorraquidiano. Uma análise do fragmento distal do cateter removido revelou obstrução por material fibrótico. O paciente recebeu alta com quadro basal reestabelecido após quatro dias de internação. Comentários A literatura mostra que 47% das complicações apresentadas pelos pacientes relacionam-se com a extremidade distal do cateter, sendo que 8,2% destas são oriundas de migração para a cavidade abdominal. Entretanto, há extrema escassez de estudos que demonstrem a compressão extrínseca da parede gástrica por cateter de DVP. Portanto, sugerimos que novos estudos envolvendo complicações de DVP sejam realizados, a fim de melhorar os resultados diagnósticos e terapêuticos, além de complementar a literatura acerca dessa complicação.

Spontaneous Anal Extrusion of Ventriculoperitoneal Shunt Catheter: Case Report / Extrusão anal espontânea de catéter de derivação ventriculoperitoneal: Relato de caso

Background Ventriculoperitoneal shunt (VPS) has become the standard treatment for congenital hydrocephalus. In the neurosurgical practice, it is a common procedure which usually results in low rates of complication. However, some serious complications can occur, including infections, intestinal perforation, and even death. Case Description A 19-year-old, female, asymptomatic patient, with a history of appendectomy and revision of the VPS 6 years before, presented spontaneous transanal extrusion of the catheter. Abdominal radiographs and tomography scans showed perforation of the descending colon without peritonitis, with expulsion of the distal tip of the catheter through the anus. The patient underwent removal of the proximal part of the VPS and installation of an external ventricular drain (EVD). On the second postoperative day, there was spontaneous elimination of the distal portion of the catheter, dispensing any additional surgical procedures. With antimicrobial prophylaxis and the contralateral VPS performed, the patient evolved without further complications until discharge. Diverging from cases reported in the literature, the patient in question did not present any abdominal manifestations. Conclusion Intestinal perforation by VPS may be asymptomatic until anal extrusion occurs. However, the early approach should avoid infections, which are associated with increased mortality. Removing only the proximal catheter, together with antimicrobial prophylaxis, can be an effective, safe and less invasive alternative to manage this complication of VPS.

Hepatic Liquoric Cyst as a Complication of Ventriculoperitoneal Shunt Insertion: A Case Report

Background The ventriculoperitoneal shunt (VPS) procedure is still themost used technique for management of hydrocephalus. This article reports a case of hepatic cerebrospinal fluid (CSF) pseudocyst as a rare, but important, complication of the VPS insertion. Case Description An 18-year-old male presented to the hospital complaining of temporal headache and visual turbidity for approximately 3 months with a history of VPS insertion for treatment of hydrocephalus and revision of the valve in adolescence. The diagnosis was based on abdominal imaging, demonstrating an extra-axial hepatic CSF pseudocyst free from infection. Following the diagnosis, the management of the case consisted in the removal and repositioning of the catheter on the opposite site of the peritoneum. Conclusion The hepatic CSF pseudocyst is an infrequent complication of VPS procedure, but it needs to be considered when performing the first evaluation of the patient. Several techniques are considered efficient for the management of this condition, the choice must be made based on the variables of each individual case.

Intervenciones de prevención y tratamiento en recién nacidos con defectos del tubo neural / Prevention and treatment interventions in newborns with neural tube defects

Introducción: los defectos de tubo neural son anomalías congénitas del sistema nervioso central; estas malformaciones elevan el grado de morbimortalidad en los recién nacidos durante los diez primeros años de vida. Objetivo: definir las intervenciones que el profesional de enfermería puede realizar en el recién nacido con defectos del tubo neural tomando en cuenta aspectos de prevención y tratamiento. Material y métodos: se realizó una búsqueda sistematizada en las bases de datos de PudMed y BVS de julio-septiembre 2021, que incluyo artículos completos relacionados con intervenciones de enfermería a recién nacidos con defectos del tubo neural publicados entre 2016-2021 y artículos médicos de revisión literaria. Resultados: se seleccionaron 41 artículos para definir las intervenciones, a saber: a. intervenciones preventivas con el consumo de ácido fólico, control prenatal y educación sanitaria, b. intervenciones relacionadas al tratamiento enfocadas al cuidado de las derivaciones ventriculoperitoneales y cuidado de heridas quirúrgicas, c. intervenciones ante complicaciones. Discusión: las tasas de mortalidad y discapacidad infantil han incrementado en los últimos años a pesar de los avances en la medicina preventiva, por lo que toma relevancia el consumo de ácido fólico, educación sanitaria y métodos de cuidado hospitalarios. Conclusiones: la enfermera neonatal puede participar con cuidados estandarizados en beneficio de los recién nacidos considerando intervenciones para evitar retraso en el crecimiento y desarrollo de los hitos motores y cognitivos, reducir complicaciones y mejorar las posibilidades de una óptima condición de vida.

Introduction: neural tube defects are congenital anomalies of the central nervous system; These malformations increase the degree of morbidity and mortality in newborns during the first ten years of life. Objective: define the interventions that the nursing professional can be carried out in newborns with neural tube defects, considering aspects of prevention and treatment. Material and methods: systematized search was carried out in the databases of PudMed and BVS during July-September 2021, which included complete articles related to nursing interventions for newborns with neural tube defects published between 2016-2021 and medical literature review articles. Results: forty-one articles were selected to define the interventions: a. Preventive interventions in the consumption of folic acid, prenatal control and health education, b. Interventions related to treatment focused on the care of ventriculoperitoneal shunt and surgical wound care, c. interventions for complications. Discussion: infant mortality and disability rates have increased in recent years despite advances in preventive medicine, which is why the consumption of folic acid, health education and hospital care methods are relevant. Conclusions: neonatal nurse can participate with standardized care for the benefit of newborns, considering interventions to avoid delayed growth and development of motor and cognitive milestones, reduce complications and improve the chances of an optimal life condition.

Complicaciones de la derivación ventriculoperitoneal en pacientes pediátricos. Revisión del tema / Pediatric complications of ventriculoperitoneal shunt. Topic review

RESUMEN Fundamento: La hidrocefalia es un desorden pediátrico frecuente y la colocación de una derivación ventriculoperitoneal es la técnica quirúrgica más usada para su tratamiento. La incidencia de las complicaciones en pacientes pediátricos es un problema frecuente que aumenta la morbilidad y mortalidad. Objetivo: Sistematizar y actualizar los conocimientos relacionados con las complicaciones ventriculoperitoneal es en edad pediátrica. Desarrollo: Las complicaciones asociadas a la derivación ventriculoperitoneal son frecuentes y se pueden dividir en tres grupos: mecánicas, infecciosas y funcionales relacionadas con el drenaje anómalo del líquido cefalorraquídeo, bien por defecto o por exceso. Dentro de las mecánicas, la obstrucción tiene la mayor incidencia seguida de las desconexiones y roturas por adherencias y por las calcificaciones que se forman en el trayecto subcutáneo a lo largo del tiempo. Las obstrucciones tardías predominan en el extremo distal y son motivo frecuente de reintervenciones. Las infecciones del sistema resultan las complicaciones más graves y complejas de tratar acompañándose de una alta mortalidad. Se pueden presentar de forma aguda, subaguda y de manera tardía. Se han identificado diferentes factores que pueden aumentar la incidencia de complicaciones, algunos relacionados con el tipo de válvula y la causa de la hidrocefalia. Conclusiones: Las derivaciones del líquido cefalorraquídeo han sido durante mucho tiempo el tratamiento clásico de la hidrocefalia pediátrica, al poder resolver casi todas sus formas independientemente de la causa. La clave del éxito para evitar las complicaciones está en una adecuada valoración preoperatoria y una rigurosa técnica quirúrgica y garantizar las medidas para la prevención de las infecciones.

ABSTRACT Background: Hydrocephalus is a common pediatric disorder and ventriculoperitoneal shunting is the most commonly surgical technique used for its treatment. The prevalence of pediatric complications is a frequent problem that increases morbidity and mortality. Objective: To systematize and update knowledge on pediatric ventriculoperitoneal complications. Development: Complications associated to ventriculoperitoneal shunting are frequent and can be divided into three groups: mechanical, infectious and functional related to inconsistent drainage of cerebrospinal fluid, either by defect or excess. Within mechanical complications, obstruction has the highest incidence followed by disconnections and ruptures due to adhesions and calcifications formed in the subcutaneous tract over time. Late obstructions predominate in the distal end being a frequent cause of reinterventions. Infections of the system are the most serious and complex complications to treat and are accompanied by high mortality. They can be acute, subacute and late. Unlike identified factors may increase the incidence of complications, some related to the type of valve and the cause of hydrocephalus. Conclusions: Cerebrospinal fluid shunts have been long the classic treatment for pediatric hydrocephalus, able to solve almost all of its different forms regardless of the cause. The key to success in avoiding complications lies in an adequate preoperative assessment and a rigorous surgical technique also endorsing infection prevention measures.

Complicaciones inusuales de las derivaciones ventrículoperitoneales. A propósito de 2 casos pediátricos / Unusual complications of ventriculoperitoneal shunts. About 2 pediatric cases

Introducción: Durante el seguimiento de los pacientes con derivación ventrículoperitoneal (DVP) para el tratamiento de la hidrocefalia se pueden presentar complicaciones habituales relacionadas a la derivación, tales como infecciones u obstrucción/ruptura del sistema derivativo. Sin embargo, raramente se pueden observar complicaciones más raras y graves que pueden afectan a órganos como el corazón y el pulmón. Pacientes y métodos: Presentamos 2 pacientes con raras complicaciones relacionadas a la DVP. El primero, un paciente de 10 años, que después de 7 años de la implantación de una DVP presentó episodios de neumonía recurrente secundaria a la migración intrapulmonar del catéter distal. El segundo caso, un paciente de 3 años, que 5 meses posteriores a la colocación de una DVP presentó síntomas de hipertensión endocraneana secundarios a migración intracardíaca del catéter distal. Conclusión: La migración intrapulmonar e intracardíaca del catéter distal son complicaciones extremadamente raras, pero que pueden producir morbilidad importante. Los pacientes con derivación ventrículoperitoneal deben ser controlados de forma rutinaria de por vida, con la finalidad de evitar comorbilidades asociadas a sus complicaciones.

Introduction: during the follow-up of patients with ventriculoperitoneal (VP) shunts for the treatment of hydrocephalus, common complications may occur, such as infections or obstruction/rupture of the shunt system. However, more rare and serious complications that affect organs such as the heart and lungs can be observed Patients and methods: we present 2 patients with rare complications related to VP shunts. The first, a 10-year-old patient, who 7 years after implantation of a VP shunt, presented episodes of recurrent pneumonia secondary to intrapulmonary migration of the distal catheter. The second case, a 3-year-old patient, who 5 months after the placement of a VP shunt, presented with symptoms of intracranial hypertension secondary to intracardiac migration of the distal catheter. Conclusion: intrapulmonary and intracardiac migration of the distal catheter are extremely rare complications, but they can cause significant morbidity. Patients with ventriculoperitoneal shunts should be routinely monitored for life by neurosurgeons, in order to avoid comorbidities associated with potential complications.

Galen Vein Aneurysm: Problem of Management in an Under-Equipped Neurosurgical Environment about a Case and Review of the Literature

Vein of GALEN aneurysmal malformation (VGAM) is a rare congenital disease caused by arteriovenous shunts between the choroidal arteries and the porencephalic ectatic vein. The diagnosis is often made in utero or during infancy, endovascular treatment remains the most suitable therapeutic means in a well-equipped environment. Here we report here the case of a patient complaining of headache for 1 year, and whose brain CT imaging showed the presence of Galen veinaneurysm with associated non-communicating hydrocephalus. In the absence of the appropriate technical platform, the placement of a ventriculoperitoneal shunt relieved our patient’s symptoms