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Sargut TA, Thomale UW, Schulz M, Schaumann A, Schneider UC, Bayerl SH, Spindler P, Vajkoczy P, Ferdowssian K. Navigated bedside implantation of external ventricular drains with mobile health guidance: technical note and case series. Acta Neurochir (Wien) 2024; 166:76. [PMID: 38340225 PMCID: PMC10858832 DOI: 10.1007/s00701-024-05955-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 11/27/2023] [Indexed: 02/12/2024]
Abstract
PURPOSE External ventricular drain (EVD) implantation is one of the fundamental procedures of emergency neurosurgery usually performed freehand at bedside or in the operating room using anatomical landmarks. However, this technique is frequently associated with malpositioning leading to complications or dysfunction. Here, we describe a novel navigated bedside EVD insertion technique, which is evaluated in a clinical case series with the aim of safety, accuracy, and efficiency in neurosurgical emergency settings. METHODS From 2021 to 2022, a mobile health-assisted navigation instrument (Thomale Guide, Christoph Miethke, Potsdam, Germany) was used alongside a battery-powered single-use drill (Phasor Health, Houston, USA) for bedside EVD placement in representative neurosurgical pathologies in emergency situations requiring ventricular cerebrospinal fluid (CSF) relief and intracranial pressure (ICP) monitoring. RESULTS In all 12 patients (8 female and 4 male), navigated bedside EVDs were placed around the foramen of Monro at the first ventriculostomy attempt. The most frequent indication was aneurysmal subarachnoid hemorrhage. Mean operating time was 25.8 ± 15.0 min. None of the EVDs had to be revised due to malpositioning or dysfunction. Two EVDs were converted into a ventriculoperitoneal shunt. Drainage volume was 41.3 ± 37.1 ml per day in mean. Mean length of stay of an EVD was 6.25 ± 2.8 days. Complications included one postoperative subdural hematoma and cerebrospinal fluid infection, respectively. CONCLUSION Combining a mobile health-assisted navigation instrument with a battery-powered drill and an appropriate ventricular catheter may enable and enhance safety, accuracy, and efficiency in bedside EVD implantation in various pathologies of emergency neurosurgery without adding relevant efforts.
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Affiliation(s)
- Tarik Alp Sargut
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Ulrich-Wilhelm Thomale
- Division of Pediatric Neurosurgery, Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Matthias Schulz
- Division of Pediatric Neurosurgery, Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Andreas Schaumann
- Division of Pediatric Neurosurgery, Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | | | - Simon Heinrich Bayerl
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Philipp Spindler
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Peter Vajkoczy
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Kiarash Ferdowssian
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
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Issa M, Nofal M, Miotk N, Seitz A, Unterberg A, El Damaty A. ShuntScope-Guided Versus Free-Hand Technique for Ventricular Catheter Placement: A Retrospective Comparative Study of Intraventricular Catheter Tip Position and Complication Rate. J Neurol Surg A Cent Eur Neurosurg 2023; 84:521-527. [PMID: 35144299 DOI: 10.1055/a-1768-3892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND The position of the ventricular catheter (VC) is essential for a proper function of cerebrospinal fluid diversion system. A ShuntScope-guided (SG) method might be helpful in reducing complications. The purpose of this study is to compare the accuracy of catheter placement and the complication and revision rates between SG and free-hand (FH) techniques. METHODS This is a retrospective study based on a prospectively acquired database of patients who underwent VC placement between September 2018 and July 2021. Accuracy of catheter placement was graded on postoperative imaging using the 3-point Hayhurst grading system. Complication and revision rates were documented and compared between both groups with an average follow-up period of 20.84 months. RESULTS Fifty-seven patients were included. The SG technique was used in 29 patients (mean age was 6.3 years, 1.4-27.7 years, 48.1% females), and the FH technique was used in 28 patients (mean age was 26.7 years, 0.83-79.5 years, 67.9% female). The success rate for the optimal placement of the VC with grade I on the Hayhurst scale was significantly higher in the SG group (93.1%) than in the FH group (60.7%), p = 0.012. The revision rate was higher in the FH group with 35.7% versus 20.7% in the SG group, p = 0.211. CONCLUSION VC placement using the SG technique is a safe and effective procedure, which enabled a significantly higher success rate and lower revision and complication rate. Accordingly, we recommend using the SG technique especially in patients with difficult anatomy.
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Affiliation(s)
- Mohammed Issa
- Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Mohammed Nofal
- Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Nikolai Miotk
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Angelika Seitz
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Andreas Unterberg
- Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Ahmed El Damaty
- Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany
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Unal TC, Dolas I, Sahin D, Gulsever CI, Dolen D, Aras Y, Aydoseli A, Sabanci PA, Sencer A. Intraoperative ultrasound-guided ventricular cannulation in patients with normal-sized ventricles. Neurochirurgie 2023; 69:101463. [PMID: 37393990 DOI: 10.1016/j.neuchi.2023.101463] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 06/05/2023] [Accepted: 06/19/2023] [Indexed: 07/04/2023]
Abstract
INTRODUCTION Many pathologies require normal-sized ventricle cannulation, which may be technically challenging even with neuronavigation guidance. This study presents a series of ventricular cannulation of normal-sized ventricles using intraoperative ultrasound (iUS) guidance and the outcomes of patients treated by this technique, for the first time. METHODS The study included patients who underwent ultrasound-guided ventricular cannulation of normal-sized ventricles (either ventriculoperitoneal (VP) shunting or Ommaya reservoir) between January 2020 and June 2022. All patients underwent iUS-guided ventricular cannulation from the right Kocher's point. The inclusion criteria for normal-sized ventricles were as follows: (1) Evans index <30%, and (2) widest third ventricle diameter <6mm. Medical records and pre-, intra- and post-operative imaging were retrospectively analyzed. RESULTS Nine of the 18 included patients underwent VP shunt placement; 6 had idiopathic intracranial hypertension (IIH), 2 had resistant cerebrospinal fluid fistula following posterior fossa surgery, and 1 had iatrogenic intracranial pressure elevation following foramen magnum decompression. Nine patients underwent Ommaya reservoir implantation, 6 of whom had breast carcinoma and leptomeningeal metastases and 3 hematologic disease and leptomeningeal infiltration. All catheter tip positions were achieved in a single attempt, and none were placed suboptimally. Mean follow-up was 10 months. One IIH patient (5.5%) had early shunt infection which necessitated shunt removal. CONCLUSION iUS is a simple and safe method for accurate cannulation of normal-sized ventricles. It provides an effective real-time guidance option for challenging punctures.
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Affiliation(s)
- T C Unal
- Department of Neurosurgery, Istanbul University, Istanbul Faculty of Medicine, Istanbul Tip Fakultesi, Nörolojik Bilimler Binasi, Fatih/Istanbul 34093, Turkey.
| | - I Dolas
- Department of Neurosurgery, Istanbul University, Istanbul Faculty of Medicine, Istanbul Tip Fakultesi, Nörolojik Bilimler Binasi, Fatih/Istanbul 34093, Turkey
| | - D Sahin
- Department of Neurosurgery, Istanbul University, Istanbul Faculty of Medicine, Istanbul Tip Fakultesi, Nörolojik Bilimler Binasi, Fatih/Istanbul 34093, Turkey
| | - C I Gulsever
- Department of Neurosurgery, Istanbul University, Istanbul Faculty of Medicine, Istanbul Tip Fakultesi, Nörolojik Bilimler Binasi, Fatih/Istanbul 34093, Turkey
| | - D Dolen
- Department of Neurosurgery, Istanbul University, Istanbul Faculty of Medicine, Istanbul Tip Fakultesi, Nörolojik Bilimler Binasi, Fatih/Istanbul 34093, Turkey
| | - Y Aras
- Department of Neurosurgery, Istanbul University, Istanbul Faculty of Medicine, Istanbul Tip Fakultesi, Nörolojik Bilimler Binasi, Fatih/Istanbul 34093, Turkey
| | - A Aydoseli
- Department of Neurosurgery, Istanbul University, Istanbul Faculty of Medicine, Istanbul Tip Fakultesi, Nörolojik Bilimler Binasi, Fatih/Istanbul 34093, Turkey
| | - P A Sabanci
- Department of Neurosurgery, Istanbul University, Istanbul Faculty of Medicine, Istanbul Tip Fakultesi, Nörolojik Bilimler Binasi, Fatih/Istanbul 34093, Turkey
| | - A Sencer
- Department of Neurosurgery, Istanbul University, Istanbul Faculty of Medicine, Istanbul Tip Fakultesi, Nörolojik Bilimler Binasi, Fatih/Istanbul 34093, Turkey
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Tian Q, Yi J, Wu Y, Wang S, Qu Y, Cai Q. Precise location of the ventricular catheter tip in ventriculoperitoneal shunt placement guided by 3D printed individualized guide. Clin Neurol Neurosurg 2023; 229:107730. [PMID: 37086587 DOI: 10.1016/j.clineuro.2023.107730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 04/18/2023] [Indexed: 04/24/2023]
Abstract
OBJECTIVE Improper placement of the ventricular catheter tip is the most common cause of shunting disorders after ventriculoperitoneal shunt (VPS) placement surgery. Here, through two illustrative cases, we described a novel method of precise ventricular catheter tip location. METHODS Three-dimensional (3D) Slicer software was used to define the ventricle puncture path and determine the ventricle catheter tip location preoperatively, and the 3D individualized guide model was printed. RESULTS The ventricular puncture was performed under the guidance of the 3D guide to achieve precise ventricle catheter tip location intraoperatively. CONCLUSIONS This technique is safe, simple, efficient and cost-effective, which facilitates its clinical implementation and promotion.
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Affiliation(s)
- Qilong Tian
- Department of Neurosurgery, Tangdu hospital, Air Force Medical University, Xi'an, Shaanxi, China
| | - Jiangpu Yi
- 3D Printing Research Center, Tangdu Hospital, Air Force Medical University, Xi'an, Shaanxi, China
| | - Yingxi Wu
- Department of Neurosurgery, Tangdu hospital, Air Force Medical University, Xi'an, Shaanxi, China
| | - Shoujie Wang
- Department of Neurosurgery, Tangdu hospital, Air Force Medical University, Xi'an, Shaanxi, China
| | - Yan Qu
- Department of Neurosurgery, Tangdu hospital, Air Force Medical University, Xi'an, Shaanxi, China.
| | - Qing Cai
- Department of Neurosurgery, Tangdu hospital, Air Force Medical University, Xi'an, Shaanxi, China.
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Hamed EA, Mohammad SA, Awadallah SM, Abdel-Latif AMM, Abd-Elhameed AM. MRI as a one-stop destination for evaluation of CSF shunt malfunction. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2023. [DOI: 10.1186/s43055-023-00991-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023] Open
Abstract
Abstract
Background
Despite the high-frequency rate of cerebrospinal fluid shunt malfunction, radiological evaluation of CSF shunts has remained deficient, focusing mainly on demonstrating secondary signs of shunt failure rather than evaluating the shunt tube itself. We aimed to study the utility of different MR pulse sequences in evaluating the cranial and abdominal ends of CSF shunts in order to identify the potential cause of shunt failure and its impact on patient management.
Results
Twenty-five patients (18 males, 7 females, median age 2.5 years, IQR 0.75–15) were enrolled in the study, having 28 ventriculo-peritoneal shunts and single ventriculo-gallbladder shunt. The catheter lumen and fine intraventricular septae were only demonstrated in 3D-DRIVE sequences (p < 0.001). Except for three patients (having cranial end-related complications), all patients with cranial and/or abdominal end-related complications received surgery (p < 0.001, positive likelihood and negative likelihood ratios = 7.27, 0.3, respectively, sensitivity = 0.7 and specificity = 0.9). MRI findings (luminal occlusion, disconnection, CSF collection, or migration) were consistent with operative data. There is no significant difference between patients who underwent surgery and those with conservative management, or symptomatic and asymptomatic patients in terms of the prevalence of ventricular dilatation or white matter signal abnormality. The results of the abdomino-pelvic fat-suppressed T2-WI showed excellent agreement with ultrasound findings (Cohen’s Kappa 0.9). Quantitative PC could give insights into CSF dynamics, which depend on the site and cause of shunt malfunction.
Conclusions
MRI could be a one-stop destination for evaluating patients with suspected non-acute shunt malfunction. It was found to have clinical relevance in terms of accurately locating the exact site and possible cause of shunt-related complications.
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Ventricular Peritoneal Shunting Using Modified Keen’s Point Approach: Technical Report and Cases Series. SURGERIES 2022. [DOI: 10.3390/surgeries3040034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Ventricular peritoneal shunting (VPS) is a frequent procedure in neurosurgery, unfortunately still burdened with a significant rate of complications. The frontal Kocher’s point is the most frequently used landmark for ventricular puncture. Keen’s point (posterior parietal approach) seems to be a valid alternative. We report a newly described access to the lateral ventricle located in posterior temporal area and the results of a large series of adult patients. Methods: Retrospective analysis of a series of 188 cases of VPS performed with this approach. Results: Mean surgical time was 51.5 +/− 13.1 min (range 25–90 min). Twenty-one patients (11.2%) were subjected to revision surgery: eight cases (4.3%) for displacement or malfunction of ventricular catheter, eight cases (4.3%) for abdominal issues, three cases (1.6%) for hardware failure, and two cases (1.1%) for infection. Optimal catheter placement was reached in 90.1%. Conclusions: The modified Keen’s point approach seems to be safe, technically feasible, and reproducible, showing some potential advantages such as short surgical time, precision in ventricular catheter placement, and short tunneling tract. The need for surgical revision is similar to that reported in the literature, while the rate of catheter malpositioning and infections seems to be low; hemorrhages around catheter and seizures were not reported.
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Bazrafshan H, Masoudi MS, Bazrafshan M, Asadi-Pooya AA. Is Shunt Location a Risk Factor for the Development of De Novo Post-shunt Seizures? IRANIAN JOURNAL OF MEDICAL SCIENCES 2022; 47:139-142. [PMID: 35291428 PMCID: PMC8919312 DOI: 10.30476/ijms.2021.88641.1934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 11/19/2020] [Accepted: 03/13/2021] [Indexed: 11/19/2022]
Abstract
Background While ventriculo-extracranial shunting procedures have been the standard treatment option for hydrocephalus for a long time, their long-term morbidity, including the development of post-shunt de Novo seizures, should be taken into account. This study aimed to investigate the rate and risk factors of the occurrence of de Novo post-shunt seizures in patients with hydrocephalus. Methods In this retrospective longitudinal study, all patients with hydrocephalus who had ventriculo-peritoneal shunt insertion from 2014 to 2017 at Namazi Hospital, (Shiraz, Iran) were studied. Phone calls were made to all patients to obtain their postoperative seizure outcome and other data (e.g., sex, age at surgery, shunt insertion location, history of seizures before surgery, history of seizures after surgery, any other type of brain surgery, and the etiology of their hydrocephalus). The Pearson Chi Square was used for the analysis of binary variable (e.g., sex) differences, and the t test for the analysis of differences in the means of numerical variables (e.g., age). Bonferroni correction tests were also utilized. P values less than 0.05 were considered significant. Results A total of 114 patients were included in the study. Overall, 68 (60%) patients had a frontal location of shunt insertion and 46 (40%) had a parietal site. Twenty-four (21%) patients reported experiencing de Novo post-shunt seizures, 15 of which had a frontal location and nine a parietal location for shunt insertion (P=0.824). Conclusion De Novo post-shunt seizures are common occurrences. However, shunt location is not a significant risk factor for the development of de Novo post-shunt seizures.
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Affiliation(s)
- Hanieh Bazrafshan
- Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Mehdi Bazrafshan
- Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Akbar Asadi-Pooya
- Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran,
Jefferson Comprehensive Epilepsy Center, Department of Neurology, Thomas Jefferson University, Philadelphia, Pennsylvania, PA, USA
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Unal TC, Gulsever CI, Sahin D, Dagdeviren HE, Dolas I, Sabanci PA, Aras Y, Sencer A, Aydoseli A. Versatile Use of Intraoperative Ultrasound Guidance for Brain Puncture. Oper Neurosurg (Hagerstown) 2021; 21:409-417. [PMID: 34624101 DOI: 10.1093/ons/opab330] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 07/18/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Intraoperative ultrasound (iUS) is an effective guidance and imaging system commonly used in neuro-oncological surgery. Despite the versatility of iUS, its utility for single burr hole puncture guidance remains fairly underappreciated. OBJECTIVE To highlight the simplicity, versatility, and effectiveness of iUS guidance in brain puncture by presenting the current case series and technical note collection. METHODS We present 4 novel uses of iUS guidance for single burr hole brain puncture: cannulation of normal-sized ventricles, endoscopic third ventriculostomy (ETV) guidance, evacuation of interhemispheric empyema, and stereotactic biopsy assistance. RESULTS All techniques were performed successfully in a total of 16 patients. Normal-sized ventricles were cannulated in 7 patients, among whom 5 underwent Ommaya reservoir placement and 2 underwent ventriculoperitoneal shunt placement for idiopathic intracranial hypertension. No more than 1 attempt was needed for cannulation. All ventricular tip positions were optimal as shown by postoperative imaging. iUS guidance was used in 5 ETV procedures. The working cannula was successfully introduced to the lateral ventricle, providing the optimal trajectory to the third ventricular floor in these cases. Interhemispheric subdural empyema was aspirated with iUS guidance in 1 patient. Volume reduction was clearly visible, allowing near-total evacuation of the empyema. iUS guidance was used for assistive purposes during stereotactic biopsy in 3 patients. No major perioperative complications were observed throughout this series. CONCLUSION iUS is an effective and versatile guidance system that allows for real-time imaging and can be easily and safely employed for various brain puncture procedures.
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Affiliation(s)
- Tugrul Cem Unal
- Department of Neurosurgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Cafer Ikbal Gulsever
- Department of Neurosurgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Duran Sahin
- Department of Neurosurgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Huseyin Emre Dagdeviren
- Department of Neurosurgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ilyas Dolas
- Department of Neurosurgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Pulat Akin Sabanci
- Department of Neurosurgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Yavuz Aras
- Department of Neurosurgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Altay Sencer
- Department of Neurosurgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Aydin Aydoseli
- Department of Neurosurgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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Jenkins FS, Vasella F, Padevit L, Mutschler V, Akeret K, Velz J, Regli L, Sarnthein J, Neidert MC. Preoperative risk factors associated with new focal neurological deficit and other major adverse events in first-time intracranial meningioma neurosurgery. Acta Neurochir (Wien) 2021; 163:2871-2879. [PMID: 34259901 PMCID: PMC8437836 DOI: 10.1007/s00701-021-04897-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 05/26/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Neurosurgical resection is the mainstay of meningioma treatment. Adverse event (AE) rates of meningioma resections are significant, but preoperative risk factors for major AEs in patients undergoing first-time meningioma surgery are largely unknown. The aim of this study was to explore major AEs and identify preoperative risk factors in patients undergoing first-time meningioma surgery. METHODS Data on all meningioma resections performed at the University Hospital Zurich from 1 January 2013 to 31 December 2018 were collected in a prospective registry. All AEs that occurred within 3 months of surgery were documented in detail and classified as "minor" or "major." Statistical analysis included initial individual bivariate analyses of all preoperative factors and the occurrence of major AEs. Statistically significant variables were then included in a logistic regression model to identify predictors. RESULTS Three hundred forty-five patients were included in the study. Mean age was 58.1 years, and 77.1% of patients were female. The overall major AE rate was 20.6%; the most common of which was a new focal neurological deficit (12.8% of patients). Six preoperative factors showed a significant association with the occurrence of major AEs in bivariate analysis. All variables included in the logistic regression model showed increased odds of occurrence of major AE, but only tumor complexity as measured by the Milan Complexity Scale was a statistically significant predictor, with a score of 4 or more having twice the odds of major AEs (OR: 2.00, 95% CI: 1.15-3.48). CONCLUSION High tumor complexity is an independent predictor of the occurrence of major AEs following meningioma resection. Preoperative assessment of tumor complexity using the Milan Complexity Scale is warranted and can aid communication with patients about AE rates and surgical decision-making.
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Hariharan P, Sondheimer J, Petroj A, Gluski J, Jea A, Whitehead WE, Sood S, Ham SD, Rocque BG, Marupudi NI, McAllister JP, Limbrick D, Del Bigio MR, Harris CA. A multicenter retrospective study of heterogeneous tissue aggregates obstructing ventricular catheters explanted from patients with hydrocephalus. Fluids Barriers CNS 2021; 18:33. [PMID: 34289858 PMCID: PMC8293524 DOI: 10.1186/s12987-021-00262-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 06/16/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Implantation of ventricular catheters (VCs) to drain cerebrospinal fluid (CSF) is a standard approach to treat hydrocephalus. VCs fail frequently due to tissue obstructing the lumen via the drainage holes. Mechanisms driving obstruction are poorly understood. This study aimed to characterize the histological features of VC obstructions and identify links to clinical factors. METHODS 343 VCs with relevant clinical data were collected from five centers. Each hole on the VCs was classified by degree of tissue obstruction after macroscopic analysis. A subgroup of 54 samples was analyzed using immunofluorescent labelling, histology and immunohistochemistry. RESULTS 61.5% of the 343 VCs analyzed had tissue aggregates occluding at least one hole (n = 211) however the vast majority of the holes (70%) showed no tissue aggregates. Mean age at which patients with occluded VCs had their first surgeries (3.25 yrs) was lower than in patients with non-occluded VCs (5.29 yrs, p < 0.02). Mean length of time of implantation of occluded VCs, 33.22 months was greater than for non-occluded VCs, 23.8 months (p = 0.02). Patients with myelomeningocele had a greater probability of having an occluded VC (p = 0.0426). VCs with occlusions had greater numbers of macrophages and astrocytes in comparison to non-occluded VCs (p < 0.01). Microglia comprised only 2-6% of the VC-obstructing tissue aggregates. Histologic analysis showed choroid plexus occlusion in 24%, vascularized glial tissue occlusion in 24%, prevalent lymphocytic inflammation in 29%, and foreign body giant cell reactions in 5% and no ependyma. CONCLUSION Our data show that age of the first surgery and length of time a VC is implanted are factors that influence the degree of VC obstruction. The tissue aggregates obstructing VCs are composed predominantly of astrocytes and macrophages; microglia have a relatively small presence.
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Affiliation(s)
- Prashant Hariharan
- Wayne State University Dept. of Biomedical Engineering, 6135 Woodward Avenue, Detroit, MI, 48202, USA
| | - Jeffrey Sondheimer
- Wayne State University Dept. of Chemical Engineering and Materials Science, 6135 Woodward Avenue, Detroit, MI, 48202, USA
| | - Alexandra Petroj
- Wayne State University Dept. of Chemical Engineering and Materials Science, 6135 Woodward Avenue, Detroit, MI, 48202, USA
| | - Jacob Gluski
- Dept. of Neurosurgery, Wayne State University School of Medicine, 540 E. Canfield Avenue, Detroit, MI, 48201, USA
| | - Andrew Jea
- Riley Hospital for Children at IU Health, 705 Riley Hospital Drive, Indianapolis, IN, 46202, USA
| | | | - Sandeep Sood
- Departments of Neurosurgery and Pediatric Neurosurgery, Wayne State University School of Medicine and Children's Hospital of Michigan, 3901 Beaubien Boulevard, 2nd Floor Carl's Building, Detroit, MI, 48201, USA
| | - Steven D Ham
- Departments of Neurosurgery and Pediatric Neurosurgery, Wayne State University School of Medicine and Children's Hospital of Michigan, 3901 Beaubien Boulevard, 2nd Floor Carl's Building, Detroit, MI, 48201, USA
| | - Brandon G Rocque
- Department of Neurosurgery, University of Alabama At Birmingham, Birmingham, AL, USA
| | - Neena I Marupudi
- Children's Hospital of Michigan Dept. of Neurosurgery, 3901 Beaubien Boulevard, 2nd Floor Carl's Building, Detroit, MI, 48201, USA
| | - James P McAllister
- School of Medicine Dept. of Neurological Surgery, Washington University, 425 S. Euclid Avenue, St. Louis, MO, 63110, USA
| | - David Limbrick
- School of Medicine Dept. of Neurological Surgery, Washington University, 660 S. Euclid Avenue, St. Louis, MO, 6311, USA
| | - Marc R Del Bigio
- Department of Pathology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Carolyn A Harris
- Wayne State University Dept. of Chemical Engineering and Materials Science, 6135 Woodward Avenue, Detroit, MI, 48202, USA.
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Sabanci PA, Unal TC, Ozturk O, Dolen D, Dolas I, Peker B, Saka E, Ali A, Aydoseli A, Aras Y, Sencer A, Hepgul K, Izgi N, Barlas O. Effect of Intraoperative Computed Tomography on Ventriculoperitoneal Shunt Survival. World Neurosurg 2021; 153:e373-e379. [PMID: 34217860 DOI: 10.1016/j.wneu.2021.06.106] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 06/22/2021] [Accepted: 06/24/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND In patients with hydrocephalus who undergo ventriculoperitoneal shunt placement, the ventricular catheter tip position is one of the most important prognostic factors influencing shunt survival. The aim of this study was to present our findings of ventriculoperitoneal shunt placement performed with intraoperative computed tomography (CT) and to evaluate the effect of intraoperative CT-based image guidance on optimal catheter positioning and overall shunt survival. METHODS Of the study enrolled 345 patients with hydrocephalus who underwent ventriculoperitoneal shunt placement for the first time between 2008 and 2018. Ventricular catheters were inserted freehand via the Kocher point into the lateral ventricle in all patients. In 163 patients, intraoperative CT was performed to confirm the tip position. In this group of patients, if the tip position was nonoptimal, the catheter was ejected and reinserted during the surgery. In the remaining 182 patients, the tip position was assessed with routine postoperative CT. The effect of performing intraoperative CT on catheter tip positioning and shunt failure was investigated. RESULTS Nonoptimal tip position was significantly correlated with shunt dysfunction even when excluding nonobstructive causes (P < 0.001). In the intraoperative CT group, 11 ventricular catheters (6.7%) were intraoperatively repositioned. The repositioning significantly improved the optimal tip position rate from 54% to 58.3% (P = 0.007). Intraoperative CT usage also showed direct correlation with shunt survival (P = 0.006). CONCLUSIONS Intraoperative CT is an effective tool for increasing the rate of optimal tip positioning and thereby overall shunt survival.
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Affiliation(s)
- Pulat Akin Sabanci
- Department of Neurosurgery, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Tugrul Cem Unal
- Department of Neurosurgery, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey.
| | - Onur Ozturk
- Department of Neurosurgery, Cerkezkoy State Hospital, Tekirdag, Turkey
| | - Duygu Dolen
- Department of Neurosurgery, Yuksekova State Hospital, Hakkari, Turkey
| | - Ilyas Dolas
- Department of Neurosurgery, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Baris Peker
- Department of Neurosurgery, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Esra Saka
- Department of Neurosurgery, Cerkezkoy State Hospital, Tekirdag, Turkey
| | - Achmet Ali
- Department of Anesthesiology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Aydin Aydoseli
- Department of Neurosurgery, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Yavuz Aras
- Department of Neurosurgery, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Altay Sencer
- Department of Neurosurgery, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Kemal Hepgul
- Department of Neurosurgery, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Nail Izgi
- Department of Neurosurgery, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Orhan Barlas
- Department of Neurosurgery, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
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Altwejri IS, AlRaddadi KK, Alsager GA, Abobotain AH, Al Abdulsalam HK, AlQazlan SM, Almujaiwel NA. Patterns and prognosis of ventriculoperitoneal shunt malfunction among pediatrics in Saudi Arabia. ACTA ACUST UNITED AC 2021; 25:356-361. [PMID: 33459283 PMCID: PMC8015599 DOI: 10.17712/nsj.2020.5.20200038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Objectives: To examine the predictors of pediatric ventriculoperitoneal (VP) shunt malfunction in a university hospital. Methods: A retrospective cohort was conducted. Patients under 18 years old who underwent VP shunt revision at least once between 2016 and 2019 were included. Data were stratified based on age, gender, diagnosis, type of valve, valve position, cause of revision, and part revised. Results: A total of 45 patients (64% males and 36% females) were included in this study. Eighty-two revision surgeries were identified. The most common revised part was the entire shunt system. The most common type of valve which required revision was the low-pressure valve (15.5%). Since a p-value of less than 0.05 was considered significant, no significant differences among the 4 groups for different points. Conclusions: Younger age at initial VP shunt insertion is associated with a higher rate of shunt malfunction. Valve mechanical failures followed by infections are the most common causes for the first 3 revisions. A prospective multi-center study to confirm the current findings is recommended.
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Affiliation(s)
- Ikhlass S Altwejri
- Division of Neurosurgery, Department of Surgery, King Saud University, College of Medicine and King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia. E-mail:
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Mammadkhanli O, Dogan I, Tuna H. Diagnosis of Shunt Failure in the Lack of Hydrocephalus: a Case Report. Indian J Surg 2020. [DOI: 10.1007/s12262-020-02209-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Vega-Moreno DA, Córdoba-Mosqueda ME, Aguilar-Calderón JR, Hernández-Resendiz RE, Valdivia-Chiñas H, Castañeda-Ramírez EA, Medina-Carrillo Ó, Sánchez-Mata R. Ventriculopleural shunt dysfunction as the first sign of a hidden aneurysmal Subarachnoid Hemorrhage: A case report. Ann Med Surg (Lond) 2020; 58:48-51. [PMID: 32953100 PMCID: PMC7484500 DOI: 10.1016/j.amsu.2020.08.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 08/11/2020] [Accepted: 08/12/2020] [Indexed: 11/28/2022] Open
Abstract
Introduction Subarachnoid Hemorrhage (SAH) is caused by an aneurysmatic origin in 80% of cases. In the adult population, the risk of shunt dysfunction is about 16% in the first year, with proximal mechanical obstruction being the most frequent cause. Case report An 81-year-old man with a history of shunt system placement presented among clinical data of shunt dysfunction. The brain Computed Tomography (CT) showed dilation of the ventricular system, with no other associated injury. The cause of the dysfunction was a SAH determined by a lumbar puncture (LP) study. We performed an angiography reporting 3 aneurysms. Discussion The risk of shunt dysfunction at one year is 40% and at two years, the risk ups to 53% with obstruction of the system and infection being the two principal causes. The usefulness of a lumbar puncture for late detection of SAH lies in the red cells in the Cerebrospinal Fluid (CSF). When the CT is negative and the clinical suspicion remains, the lumbar puncture (LP) continues with higher sensitivity despite is over 12 hours of the onset clinic symptoms. Conclusion This case encourages to follow a rigorous protocol study for patients with multiple shunt dysfunction and chronic hydrocephalus. Also, this case invites to consider a hidden SAH secondary to a vascular pathology as a differential diagnosis for a multiple shunt dysfunction.
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Affiliation(s)
- Daniel Alejandro Vega-Moreno
- Neurosurgery Department, Hospital Central Sur de Alta Especialidad, PEMEX, Periférico sur 4091, Fuentes del Pedregal, Tlalpan, 14140, Mexico City, Mexico
| | - María Elena Córdoba-Mosqueda
- Neurosurgery Department, Hospital Central Sur de Alta Especialidad, PEMEX, Periférico sur 4091, Fuentes del Pedregal, Tlalpan, 14140, Mexico City, Mexico
| | - José Ramón Aguilar-Calderón
- Neurosurgery Department, Hospital Central Sur de Alta Especialidad, PEMEX, Periférico sur 4091, Fuentes del Pedregal, Tlalpan, 14140, Mexico City, Mexico
| | | | - Heberseleth Valdivia-Chiñas
- Neurosurgery Department, Hospital General Zona 33, Av. Félix U. Gómez, Centro, 64010, Monterrey, Nuevo León, Mexico
| | | | - Óscar Medina-Carrillo
- Neurosurgery Department, Hospital Central Sur de Alta Especialidad, PEMEX, Periférico sur 4091, Fuentes del Pedregal, Tlalpan, 14140, Mexico City, Mexico
| | - Rafael Sánchez-Mata
- Neurosurgery Department, Hospital Central Sur de Alta Especialidad, PEMEX, Periférico sur 4091, Fuentes del Pedregal, Tlalpan, 14140, Mexico City, Mexico
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