1
|
Chen SM, Chen LY, Lin JH, Salazar N, Yeh TH, Lo WL, Lui TN, Hsieh YC, Chien LN. Comparison of endoscopic third ventriculostomy versus cerebrospinal fluid shunt procedures for the treatment of pediatric hydrocephalus in Taiwan. Childs Nerv Syst 2024; 40:2883-2891. [PMID: 38806857 DOI: 10.1007/s00381-024-06469-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 05/16/2024] [Indexed: 05/30/2024]
Abstract
PURPOSE Pediatric hydrocephalus is the most common cause of surgically treatable neurological disease in children. Controversies exist whether endoscopic third ventriculostomy (ETV) or cerebrospinal fluid (CSF) shunt placement is the most appropriate treatment for pediatric hydrocephalus. This study aimed to compare the risk of re-operation and death between the two procedures. METHODS We performed a retrospective population-based cohort study and included patients younger than 20-years-old who underwent CSF shunt or ETV for hydrocephalus from the Taiwan National Health Insurance Research Database. RESULTS A total of 3,555 pediatric patients from 2004 to 2017 were selected, including 2,340 (65.8%) patients that received CSF shunt placement and 1215 (34.2%) patients that underwent ETV. The incidence of all-cause death was 3.31 per 100 person-year for CSF shunt group and 2.52 per 100 person-year for ETV group, with an adjusted hazard ratio (HR) of 0.79 (95% confidence interval [CI] = 0.66-0.94, p = 0.009). The cumulative incidence competing risk for reoperation was 31.2% for the CSF shunt group and 26.4% for the ETV group, with an adjusted subdistribution HR of 0.82 (95% CI = 0.70-0.96, p = 0.015). Subgroup analysis showed that ETV was beneficial for hydrocephalus coexisting with brain or spinal tumor, central nervous system infection, and intracranial hemorrhage. CONCLUSION Our data indicates ETV is a better operative procedure for pediatric hydrocephalus when advanced surgical techniques and instruments are available.
Collapse
Affiliation(s)
- Shu-Mei Chen
- Department of Neurosurgery, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan
- Department of Surgery, School of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Li-Ying Chen
- Health Data Analytics and Statistics Center, Office of Data Science, Taipei Medical University, Taipei, Taiwan
| | - Jiann-Her Lin
- Department of Neurosurgery, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan
- Department of Surgery, School of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Nicole Salazar
- Julius L. Chambers Biomedical/Biotechnology Institute and Department of Biological & Biomedical Sciences, North Carolina Central University, Durham, NC, USA
| | - Tu-Hsueh Yeh
- Department of Neurology, Taipei Medical University Hospital, Taipei Taipei Medical University, Taipei, Taiwan
- Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Wei-Lun Lo
- Department of Surgery, School of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Neurosurgery, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
| | - Tai-Ngar Lui
- Department of Neurosurgery, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
| | - Yi-Chen Hsieh
- The PhD Program in Medical Neuroscience, College of Medical Science and Technology, Taipei Medical University, 250 Wu-Hsing Street, Taipei, Taiwan.
| | - Li-Nien Chien
- Institute of Health and Welfare Policy, College of Medicine, National Yang Ming Chiao Tung University, No.155, Sec. 2, Linong St., Beitou District, Taipei, Taiwan.
- Graduate Institute of Data Science, College of Management, Taipei Medical University, Taipei, Taiwan.
| |
Collapse
|
2
|
Takahashi M, Hana T, Tanaka S, Saito N. Accurate Preoperative and Intraoperative Evaluation Reduces Surgical Costs and Patient Invasiveness in Ventriculoperitoneal Shunt Revision. Cureus 2024; 16:e62334. [PMID: 39011180 PMCID: PMC11247248 DOI: 10.7759/cureus.62334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2024] [Indexed: 07/17/2024] Open
Abstract
The ventriculoperitoneal (VP) shunt is one of the most common surgical procedures in neurosurgery, frequently resulting in malfunctions. Shunt malfunctions, which can include mechanical failure, obstruction, infection, or disconnection, occur in a significant percentage of patients, often necessitating multiple revisions. These revisions can lead to increased healthcare costs due to additional surgeries or treatments. Therefore, addressing the economic impacts of these revisions is crucial. Our report presents a cost-effective approach to shunt revisions, demonstrated through a case study of an 82-year-old woman with hydrocephalus. Although initially treated with a VP shunt, she required a revision after six years due to shunt malfunction. Through comprehensive preoperative and intraoperative evaluations, including a shuntogram with iodine contrast and meticulous examination, we identified the cause of malfunction as a connective tissue sac blocking the peritoneal catheter. The surgery involved flushing the catheter lumen with saline to confirm the obstruction and careful removal of the obstructive tissue. This accurate diagnosis facilitated a minimally invasive revision, enabling the reuse of existing shunt components and avoiding the need for new devices, thus reducing costs and surgical invasiveness. Our study serves as a call to action for healthcare providers and surgeons to consider more cost-effective and patient-friendly approaches in managing VP shunt malfunctions, ultimately benefiting both the healthcare system and the patients it serves.
Collapse
Affiliation(s)
- Marina Takahashi
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, JPN
| | - Taijun Hana
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, JPN
- Department of Neurosurgery, Saitama Medical Center, Saitama Medical University, Saitama, JPN
| | - Shota Tanaka
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, JPN
- Department of Neurosurgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, JPN
| | - Nobuhito Saito
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, JPN
| |
Collapse
|
3
|
Awwad AR, S H Odeh M, Asad D, Y M H Abu Rmeileh B, M M Dweik A, N M Baraka S, A F Karami M, I M Awad I, W M Jobran A. Ventriculoperitoneal Shunt Migration Into the Transverse Colon: A Case Report. Cureus 2024; 16:e52334. [PMID: 38361682 PMCID: PMC10867295 DOI: 10.7759/cureus.52334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2024] [Indexed: 02/17/2024] Open
Abstract
A ventriculoperitoneal (VP) shunt is a connection between the cerebral ventricles and the peritoneal cavity. One of the rare complications of this procedure is shunt migration and perforation of the bowel. Our case report presents the case of a 19-month-old male patient who underwent VP shunt insertion due to hydrocephalus at the age of 8 months. He suffered from two episodes of bacterial meningitis at the ages of 11 and 15 months, requiring hospital admission. The patient's parents brought him to the emergency department after noticing a blood-stained diaper and seeing a part of the shunt extruding from the anal opening. Upon physical examination, the patient was active, neither in distress nor tachycardic. with unremarkable abdominal examination and negative peritoneal signs. A digital rectal examination showed normal anal tone, with normal-coloured stool with no blood at the tip of the finger, together with a compressible VP shunt. Complications of this type of migration include faecal contamination and possible infections such as ascending meningitis. This case report highlights the extrusion of the shunt through the anal orifice in a 19-month-old male patient which serves as an example of the uncommon but serious consequence of VP shunt insertion in the pediatric population. While VP shunt insertion remains a widely used and effective treatment for hydrocephalus, healthcare providers need to recognize and address potential complications associated with this procedure. Additionally, this case emphasizes the importance of diligent monitoring and regular radiographic imaging to confirm the correct positioning of shunt components, particularly in the paediatric population.
Collapse
Affiliation(s)
- Ahmad R Awwad
- General Practice, Rafidia Governmental Hospital, Nablus, PSE
| | - Manar S H Odeh
- Medicine, Faculty of Medicine, Al-Quds University, Jerusalem, PSE
| | - Diya Asad
- Medicine, Faculty of Medicine, Al-Quds University, Jerusalem, PSE
| | | | - Aya M M Dweik
- Medicine, Faculty of Medicine, Al-Quds University, Jerusalem, PSE
| | - Saja N M Baraka
- Medicine, Faculty of Medicine, Al Quds-University, Jerusalem, PSE
| | - Malek A F Karami
- Medicine, Faculty of Medicine, Al-Quds University, Jerusalem, PSE
| | - Iyas I M Awad
- Medicine, Faculty of Medicine, Al-Quds University, Jerusalem, PSE
| | - Afnan W M Jobran
- Medicine, Faculty of Medicine, Al-Quds University, Jerusalem, PSE
| |
Collapse
|
4
|
Podgoršak A, Flürenbrock F, Trimmel NE, Korn L, Oertel MF, Stieglitz L, Fernandes Dias S, Hierweger MM, Zeilinger M, Weisskopf M, Schmid Daners M. Toward the "Perfect" Shunt: Historical Vignette, Current Efforts, and Future Directions. Adv Tech Stand Neurosurg 2024; 50:1-30. [PMID: 38592526 DOI: 10.1007/978-3-031-53578-9_1] [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] [Indexed: 04/10/2024]
Abstract
As a concept, drainage of excess fluid volume in the cranium has been around for more than 1000 years. Starting with the original decompression-trepanation of Abulcasis to modern programmable shunt systems, to other nonshunt-based treatments such as endoscopic third ventriculostomy and choroid plexus cauterization, we have come far as a field. However, there are still fundamental limitations that shunts have yet to overcome: namely posture-induced over- and underdrainage, the continual need for valve opening pressure especially in pediatric cases, and the failure to reinstall physiologic intracranial pressure dynamics. However, there are groups worldwide, in the clinic, in industry, and in academia, that are trying to ameliorate the current state of the technology within hydrocephalus treatment. This chapter aims to provide a historical overview of hydrocephalus, current challenges in shunt design, what members of the community have done and continue to do to address these challenges, and finally, a definition of the "perfect" shunt is provided and how the authors are working toward it.
Collapse
Affiliation(s)
- Anthony Podgoršak
- Product Development Group Zurich, Department of Mechanical and Process Engineering, ETH Zurich, Zurich, Switzerland
| | - Fabian Flürenbrock
- Institute for Dynamic Systems and Control, Department of Mechanical and Process Engineering, ETH Zurich, Zurich, Switzerland
| | - Nina Eva Trimmel
- Center for Preclinical Development, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Leonie Korn
- Institute for Dynamic Systems and Control, Department of Mechanical and Process Engineering, ETH Zurich, Zurich, Switzerland
| | - Markus Florian Oertel
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Lennart Stieglitz
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Sandra Fernandes Dias
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Melanie Michaela Hierweger
- Center for Preclinical Development, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Melanie Zeilinger
- Institute for Dynamic Systems and Control, Department of Mechanical and Process Engineering, ETH Zurich, Zurich, Switzerland
| | - Miriam Weisskopf
- Center for Preclinical Development, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Marianne Schmid Daners
- Institute for Dynamic Systems and Control, Department of Mechanical and Process Engineering, ETH Zurich, Zurich, Switzerland.
| |
Collapse
|
5
|
Sanker V, Kundu M, El Kassem S, El Nouiri A, Emara M, Maaz ZA, Nazir A, Bekele BK, Uwishema O. Posttraumatic hydrocephalus: Recent advances and new therapeutic strategies. Health Sci Rep 2023; 6:e1713. [PMID: 38028696 PMCID: PMC10652704 DOI: 10.1002/hsr2.1713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 10/28/2023] [Accepted: 11/01/2023] [Indexed: 12/01/2023] Open
Abstract
Background Hydrocephalus or ventriculomegaly is a condition brought on by an overabundance of cerebrospinal fluid (CSF) in the ventricular system. The major contributor to posttraumatic hydrocephalus (PTH) is traumatic brain injuries (TBIs), especially in individuals with occupations set in industrial settings. A variety of criteria have been employed for the diagnosis of PTH, including the combination of neurological symptoms like nerve deficits and headache, as well as an initial improvement followed by a worsened relapse of altered consciousness and neurological deterioration, which is detected by computed tomography-brain imaging that reveals gradual ventriculomegaly. Aim In this article, we discuss and summarize briefly the current understandings and advancements in the management of PTH. Methods The available literature for this review was searched on various bibliographic databases using an individually verified, prespecified approach. The level of evidence of the included studies was considered as per the Centre for Evidence-Based Medicine recommendations. Results The commonly practiced current treatment modality involves shunting CSF but is often associated with complications and recurrence. The lack of a definitive management strategy for PTH warrants the utilization of novel and innovative modalities such as stem cell transplantations and antioxidative stress therapies. Conclusion One of the worst complications of a TBI is PTH, which has a high morbidity and mortality rate. Even though there hasn't been a successful method in stopping PTH from happening, hemorrhage-derived blood, and its metabolic by-products, like iron, hemoglobin, free radicals, thrombin, and red blood cells, may be potential targets for PTH hindrance and management. Also, using stem cell transplantations in animal models and antioxidative stress therapies in future studies can lower PTH occurrence and improve its outcome. Moreover, the integration of clinical trials and theoretical knowledge should be encouraged in future research projects to establish effective and updated management guidelines for PTH.
Collapse
Affiliation(s)
- Vivek Sanker
- Oli Health Magazine Organization, Research and EducationKigaliRwanda
- Society of Brain Mapping and TherapeuticsLos AngelesCaliforniaUSA
| | - Mrinmoy Kundu
- Oli Health Magazine Organization, Research and EducationKigaliRwanda
- Institute of Medical Sciences and SUM HospitalBhubaneswarIndia
| | - Sarah El Kassem
- Oli Health Magazine Organization, Research and EducationKigaliRwanda
- Faculty of MedicineBeirut Arab UniversityBeirutLebanon
| | - Ahmad El Nouiri
- Oli Health Magazine Organization, Research and EducationKigaliRwanda
- Faculty of MedicineBeirut Arab UniversityBeirutLebanon
| | - Mohamed Emara
- Oli Health Magazine Organization, Research and EducationKigaliRwanda
- College of MedicineUniversity of SharjahSharjahUnited Arab Emirates
| | - Zeina Al Maaz
- Oli Health Magazine Organization, Research and EducationKigaliRwanda
- Faculty of MedicineBeirut Arab UniversityBeirutLebanon
| | - Abubakar Nazir
- Oli Health Magazine Organization, Research and EducationKigaliRwanda
| | - Bezawit Kassahun Bekele
- Oli Health Magazine Organization, Research and EducationKigaliRwanda
- School of MedicineAddis Ababa UniversityAddis AbabaEthiopia
- Milken Institute of Public HealthGeorge Washington UniversityWashingtonDistrict of ColumbiaUSA
| | - Olivier Uwishema
- Oli Health Magazine Organization, Research and EducationKigaliRwanda
- Department of medicineClinton Global Initiative UniversityNew YorkNew YorkUSA
- Faculty of MedicineKaradeniz Technical UniversityTrabzonTurkey
| |
Collapse
|
6
|
Siala S, Homen D, Smith B, Guimaraes C. Imaging of the septum pellucidum: normal, variants and pathology. Br J Radiol 2023; 96:20221058. [PMID: 37194993 PMCID: PMC10607410 DOI: 10.1259/bjr.20221058] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 04/10/2023] [Accepted: 04/13/2023] [Indexed: 05/18/2023] Open
Abstract
The septum pellucidum is a largely neglected anatomical midline structure during post-natal neuroimaging interpretation. Conversely, it is one of the anatomical landmarks used on pre-natal ultrasound to access normal midline formation. Because of its importance during the pre-natal period, the awareness of its primary malformative abnormalities is much higher than its disruptive acquired pathologies, often leading the misinterpretation. In this article, we will review the normal septum pellucidum formation, anatomy, and anatomical variants and will describe the imaging findings in primary malformative and secondary disruptive abnormalities affecting the septum pellucidum.
Collapse
Affiliation(s)
- Selima Siala
- Department of Radiology, University of North Carolina at Chapel Hill, North Carolina, United States
| | - Dean Homen
- Department of Radiology, University of North Carolina at Chapel Hill, North Carolina, United States
| | - Benjamin Smith
- Department of Radiology, University of North Carolina at Chapel Hill, North Carolina, United States
| | - Carolina Guimaraes
- Department of Radiology, University of North Carolina at Chapel Hill, North Carolina, United States
| |
Collapse
|
7
|
Low SYY, Kestle JRW, Walker ML, Seow WT. Cerebrospinal fluid shunt malfunctions: A reflective review. Childs Nerv Syst 2023; 39:2719-2728. [PMID: 37462810 DOI: 10.1007/s00381-023-06070-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 07/05/2023] [Indexed: 10/29/2023]
Abstract
PURPOSE Pediatric hydrocephalus is a common and challenging condition. To date, the ventriculoperitoneal shunt (VPS) is still the main lifesaving treatment option. Nonetheless, it remains imperfect and is associated with multiple short- and long-term complications. This paper is a reflective review of the current state of the VPS, our knowledge gaps, and the future state of shunts in neurosurgical practice. METHODS AND RESULTS The authors' reflections are based on a review of shunts and shunt-related literature. CONCLUSION Overall, there is still an urgent need for the neurosurgical community to actively improve current strategies for shunt failures and shunt-related morbidity. The authors emphasize the role of collaborative efforts amongst like-minded clinicians to establish pragmatic approaches to avoid shunt complications.
Collapse
Affiliation(s)
- Sharon Y Y Low
- Neurosurgical Service, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore.
- Department of Neurosurgery, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore.
- SingHealth Duke-NUS Neuroscience Academic Clinical Program, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore.
- SingHealth Duke-NUS Paediatrics Academic Clinical Program, 100 Bukit Timah Road, 229899, Singapore, Singapore.
| | - John R W Kestle
- Department of Neurosurgery, University of Utah, 50 North Medical Drive, Salt Lake City, UT, 84132, USA
| | - Marion L Walker
- Division of Pediatric Neurosurgery, Department of Neurosurgery, University of Utah School of Medicine, Primary Children's Hospital, 100 N. Mario Capecchi Dr., Ste. 3850, Salt Lake City, UT, 84113, USA
| | - Wan Tew Seow
- Neurosurgical Service, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore
- Department of Neurosurgery, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore
- SingHealth Duke-NUS Neuroscience Academic Clinical Program, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore
| |
Collapse
|
8
|
Wright SR, Gabby LC, Nguyen BT. Cerebrospinal fluid as vaginal discharge: ventriculoperitoneal shunt migration following Cesarean section. Minerva Obstet Gynecol 2023; 75:498-501. [PMID: 37768257 DOI: 10.23736/s2724-606x.22.05091-6] [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: 09/29/2023]
Abstract
Congenital hydrocephalus was once a permanently disabling and even fatal disease. With the advent of ventriculoperitoneal shunts, affected women are now surviving to their reproductive years and beyond. Pregnancy outcomes in this population are generally positive. However due to possible shunt complications, including infection, migration, and organ perforation, perinatal care for pregnant individuals with a ventriculoperitoneal shunt is complex and requires input from both obstetric and neurosurgical providers. We present the case of a 28-year-old G1P1 with a history of congenital hydrocephalus and ventriculoperitoneal shunt who presented to the emergency department at two months postpartum with clear fluid leaking from her vagina. The shunt's distal end had migrated and perforated the uterus causing cerebrospinal fluid to leak into the uterine cavity. Surgical repair was required of both the uterine hysterotomy and ventriculoperitoneal shunt, and the patient's symptoms ultimately resolved. Patients with a history of shunt placement who later undergo abdominal surgery, including cesarean section, are at risk for shunt complications. Shunt-dependent patients presenting in the post-partum period with new neurological or abdominopelvic complaints should undergo evaluation by a multidisciplinary team.
Collapse
Affiliation(s)
- Steffanie R Wright
- Department of Obstetrics and Gynecology, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA -
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA -
| | - Lauryn C Gabby
- Department of Obstetrics and Gynecology, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
- Department of Maternal Fetal Medicine, University of California, San Diego, CA, USA
| | - Brian T Nguyen
- Department of Obstetrics and Gynecology, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| |
Collapse
|
9
|
Alghubaishi SA, Saeed M, Abujamous F, Osman H, Alasmari BG. Recurrent Meningitis and Its Rare Association With Ligneous Conjunctivitis and Congenital Plasminogen Deficiency. Cureus 2023; 15:e44813. [PMID: 37818495 PMCID: PMC10561533 DOI: 10.7759/cureus.44813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 09/06/2023] [Indexed: 10/12/2023] Open
Abstract
This case report explores the rare association of recurrent meningitis, hydrocephalus, ligneous conjunctivitis, and congenital plasminogen deficiency in a term baby boy. Born at 39 weeks with a history of hydrocephalus, the neonate later developed ligneous conjunctivitis and a serious bout of meningitis. Genetic analyses confirmed a homozygous mutation in the PLG gene, indicative of congenital plasminogen deficiency. Despite intensive treatment, including a ventriculoperitoneal shunt for hydrocephalus and intravenous antibiotics for meningitis, the child succumbed to upper airway obstruction before reaching one year of age. This report underscores the medical complexity and severity of these interconnected conditions and advocates for further research to understand the interplay between them. Although this study is limited by its single-case nature and is not generalizable, it emphasizes the necessity for early recognition and a multidisciplinary treatment approach for better patient outcomes.
Collapse
Affiliation(s)
| | - Muhammad Saeed
- Pediatric Neurology, Armed Forces Hospital - Southern Region, Khamis Mushait, SAU
| | - Fadi Abujamous
- Pediatrics, Armed Forces Hospital - Southern Region, Khamis Mushait, SAU
| | - Hussam Osman
- Ophthalmology, Armed Forces Hospital - Southern Region, Khamis Mushait, SAU
| | - Badriah G Alasmari
- Pediatrics, Armed Forces Hospital - Southern Region, Khamis Mushait, SAU
| |
Collapse
|
10
|
Ghritlaharey RK. Management of ventriculoperitoneal shunt complications in children: A review of 34 cases. Afr J Paediatr Surg 2023; 20:109-115. [PMID: 36960505 PMCID: PMC10209765 DOI: 10.4103/ajps.ajps_68_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 06/09/2022] [Accepted: 06/22/2022] [Indexed: 01/06/2023] Open
Abstract
Objectives The primary objective of this study was to analyse the demographics of the children who presented with ventriculoperitoneal shunt (VPS) complications. The secondary objectives were to review the clinical characteristics, surgical procedures performed for the management of VPS complications and the final outcome. Materials and Methods This is a single-institution observational study that included children below 12 years of age who required VPS revisions during the study period. Results During the study period of 10 years, n = 336 VPS catheters were implanted for the treatment of hydrocephalus in children. Forty (11.90%) children developed various VPS complications and required VPS revisions in the follow-up period. A total of n = 30 (8.92%) children (n = 21 boys and n = 9 girls) were selected/recruited for the present study, and they required n = 34 revision procedures. The mean interval from VPS insertion to the diagnosis of the complication was 7.29 months. VPS complications that required revisions occurred in the following order of frequency: (1) VPS catheter, cerebrospinal fluid (CSF) or shunt tract infection n = 8 (2.38%); (2) malfunction of distal VPS catheter n = 7 (2.08%); (3) coiling of distal VPS catheter at abdominal area n = 6 (1.78%); (4) extrusion of VPS catheter n = 5 (1.48%); (5) CSF leak from abdominal wound site/umbilicus n = 4 (1.19%); (6) malfunction of ventricular catheter n = 3 (0.89%) and (7) CSF pseudocyst peritoneal cavity n = 1 (0.29%). Surgical procedures were performed for the treatment of abovementioned complications in the following order of frequency: (1) revision of distal VPS catheter n = 14 (4.16%), (2) removal of entire VPS catheter ± external ventricular drainage (EVD) n = 7 (2.08%), (3) distal VPS catheter converted as EVD n = 6 (1.78%), (4) revision of proximal VPS catheter n = 3 (0.89%), (5) revision of entire VPS catheter n = 3 (0.89%) and (6) CSF pseudocyst excision n = 1 (0.29%). This study also documented n = 2 (6.6%) deaths during the post-operative period. Conclusion VPS insertion done for the treatment of hydrocephalus in infants and children was associated with various complications. Seventy per cent of the complications occurred within the first 6 months after the VPS insertion. Two-thirds of the complications were related to the distal VPS catheter.
Collapse
Affiliation(s)
- Rajendra Kumar Ghritlaharey
- Department of Paediatric Surgery, Gandhi Medical College and Associated Kamla Nehru and Hamidia Hospitals, Bhopal, Madhya Pradesh, India
| |
Collapse
|
11
|
Javeed F, Mohan A, Wara UU, Rehman L, Khan M. Ventriculoperitoneal Shunt Surgery for Hydrocephalus: One of the Common Neurosurgical Procedures and Its Related Problems. Cureus 2023; 15:e35002. [PMID: 36938269 PMCID: PMC10022834 DOI: 10.7759/cureus.35002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2023] [Indexed: 02/17/2023] Open
Abstract
Objective This study was conducted to assess the outcome in patients with hydrocephalus who underwent ventriculoperitoneal (VP) shunt surgery. Methods This retrospective study was conducted at the neurosurgery department of a tertiary care hospital. The time frame was three years and five months from January 2017 to May 2020 with a follow-up of six months. Results This study included 1030 patients, out of whom 64.2% were male and 35.8% were female. While the majority of the patients were more than 11 years of age (466), age did not have any significant impact on the outcome of the ventriculoperitoneal shunt surgery. The most common cause of hydrocephalus was congenital (47.6%). A good outcome was seen in 63.4%, mortality was 10.6%, and complications were identified for 25.8%. The underlying pathology had a significant impact on the outcome in our study (p-value < 0.05) where the congenital cause of hydrocephalus showed a better outcome than any other cause. Conclusion Ventriculoperitoneal shunt is a good way to manage hydrocephalus, but there is always a high risk of complications.
Collapse
Affiliation(s)
- Farrukh Javeed
- Neurological Surgery, Jinnah Postgraduate Medical Centre, Karachi, PAK
| | - Anmol Mohan
- Medicine, Karachi Medical and Dental College, Karachi, PAK
| | - Um Ul Wara
- Medicine and Surgery, Karachi Medical and Dental College, Karachi, PAK
| | - Lal Rehman
- Neurosurgery, Jinnah Postgraduate Medical Centre, Karachi, PAK
| | - Maham Khan
- Radiation Oncology, Aga Khan University Hospital, Karachi, PAK
| |
Collapse
|
12
|
Mustroph C, Saberian S, Burch K, Parker P, Wrubel D, Sawvel M. Open Retroperitoneal Inferior Vena Cava Cannulation for Distal Ventriculoatrial Shunt Catheter Placement. Cureus 2022; 14:e21555. [PMID: 35228918 PMCID: PMC8865606 DOI: 10.7759/cureus.21555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2022] [Indexed: 11/05/2022] Open
Abstract
Multiple alternative sites for distal ventriculoperitoneal shunts have been described including pleural, atrial, ureteral, fallopian, and gallbladder placement. In medically complex patients the sites for cerebrospinal fluid (CSF) diversion can be exhausted. We present a case where open retroperitoneal inferior vena cava cannulation was used for successful atrial catheter placement in a 17-month-old female. The patient had a complex abdominal, pulmonary, and vascular history precluding placement of the distal catheter in other sites or atrial placement through more peripheral venous cannulation. The patient underwent uncomplicated open retroperitoneal exposure of her inferior vena cava (IVC) with cannulation and placement of atrial catheter under fluoroscopic guidance. At the follow-up one year after surgery, the patient did not require revision with appropriate placement of the distal atrial catheter.
Collapse
|
13
|
Ghritlaharey R. Systematic literature review of the management of transanal extrusion of distal ventriculoperitoneal shunt catheter: 1966–2020. MEDICAL JOURNAL OF DR. D.Y. PATIL VIDYAPEETH 2022. [DOI: 10.4103/mjdrdypu.mjdrdypu_149_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
14
|
Wubie AB, Teshome GS, Ayele WE, Abebe F, Nigussie TM, Alemu YB, Mekonnen MS. Survival status and predictors of mortality among children who underwent ventriculoperitoneal shunt surgery at public hospitals in Addis Ababa, Ethiopia. Int J Neurosci 2021:1-9. [PMID: 34643151 DOI: 10.1080/00207454.2021.1986492] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Background: Despite the increase in ventriculoperitoneal shunt surgeries performed for children with hydrocephalus, the potential complications and survival of patients after the procedure remains the major challenge for both clinical and public health aspects. This study intends to assess the survival status and scrutinize the predictive factors of mortality among children after a ventriculoperitoneal shunt.Methods: A retrospective cohort study was employed by reviewing charts of 337 systematically selected children who have undergone a ventriculoperitoneal shunt from 2016 to 2018 in Addis Ababa. The extraction tool was used for data collection, Epi-data version 4.4.2 for data entry, and Stata version-14 for cleaning and analysis. Kaplan-Meier curve, log-rank test, and life table were used to describe the data. Cox proportional hazard regression model was used for analysis. Any variable at p < 0.25 in the bi-variable analysis was fitted to multivariate analysis, and significance was declared at p ≤ 0.05. Then, AHR with 95% CI was used to report the association and test the statistical significance. Finally, texts and tables were used to present the results.Results and Conclusion: The incidence rate of mortality was 58.4 per 1000 child-months of observation with a median survival time of 12 months (95%CI: 9.04-14.96). Communicative hydrocephalus (AHR: 1.99, 95% CI: 1.18-3.36), post-traumatic brain injury (AHR: 7.43, 95% CI: 3.21-16.88), emergency surgery (AHR: 1.86, 95% CI: 1.17-3.13) as well as revised shunt procedure (AHR: 8.01, 95% CI: 6.12-13.43) were independent predictors of death. Besides, sunset eye (ARH: 2.01; 95% CI: 1.17-3.47), rapidly increased head size (ARH: 2.05, 95% CI: 1.14-3.37), prolonged antibiotics treatment (AHR: 2.46, 95% CI: 1.82-7.37), and gram-negative infections (AHR: 1.95, 95% CI: 1.60-12.64) were also significantly associated. Hence, health professionals ought to give special attention to patients with identified predictors.
Collapse
Affiliation(s)
- Azene Bantie Wubie
- College of Health Science, Debre Markos University, Debre Markos, Ethiopia
| | | | | | | | | | | | | |
Collapse
|
15
|
Azzam M, Wathoni RTZ, Suryaningtyas W, Parenrengi MA. Pediatric shunt revision analysis within the first year of shunt placement: A single center experience. Surg Neurol Int 2021; 12:419. [PMID: 34513183 PMCID: PMC8422432 DOI: 10.25259/sni_283_2021] [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: 03/18/2021] [Accepted: 07/30/2021] [Indexed: 11/04/2022] Open
Abstract
Background Hydrocephalus is a common problem in neurosurgery with shunt placement remains the mainstay of the management. However, shunt placement generally requires following surgical procedures, including shunt revision. Despite the recent developments, the incidence of shunt failure remains high, approximately 30-51% in the 1st year following the shunt placement. Methods An observational retrospective study of pediatric neurosurgery patients whom underwent CSF shunting procedure, both primary and repeated VPS, VAS, CPS, and subdural-peritoneal shunt procedures between January 2018 and May 2019. The patients were observed for 12 months for potential complication requiring shunt revision following the shunt placement. Results A total of 142 patients underwent shunt placement. The shunt revision within 12 months was found in 26 patients (18.3%), 25 cases were VPS (96.2%) and one case was CPS (3.8%). The mean period of time between shunt placement to shunt revision was 3.96 months. Age of under 6 months old during the shunt placement showed significantly higher risk for shunt revision (RR 2.32 CI 1.13-4.74, P = 0.018). The most common diagnosis requiring shunt revision was congenital anomaly (16 cases, 61.5%). The most common cause of revision was shunt malfunction, with 21 cases (80.8%) followed by infected shunt with 5 cases (19.2%). Conclusion The 1st year observation showed relatively high rate for shunt revision. The patient underwent shunt procedure should be regularly followed up in long period for better evaluation of the outcome. The application of shunt registry in some countries appears to be efficient and beneficial for sustainable follow-up in patients underwent shunt placement.
Collapse
Affiliation(s)
- Muhammad Azzam
- Department of Neurosurgery, Dr. Soetomo General Academic Hospital, Surabaya, East Java, Indonesia
| | | | - Wihasto Suryaningtyas
- Department of Neurosurgery, Universitas Airlangga - Faculty of Medicine, Dr. Soetomo Academic General Hospital, Surabaya, East Java, Indonesia
| | | |
Collapse
|
16
|
Abstract
BACKGROUND Despite advances in hydrocephalus shunt technology and improvement in hydrocephalus management, many patients have chronic disability and require multiple surgeries throughout their lifetime. There is limited data from patients' perspective regarding the impact of shunt devices on quality-of-life. METHODS A cross-sectional survey was developed to evaluate the impact of shunt devices on patient quality-of-life. The survey was distributed via social media platforms of the Hydrocephalus Association, and patients self-selected to anonymously complete the online questionnaire. A literature review was performed to contextualize the findings from the survey. RESULTS A total of 562 survey responses were obtained from a network encompassing 35,000 members. The mean age was 30 years old (0.5-87), and 65% identified as female. Eighty one percent underwent at least 1 shunt revision surgery, with a reported average of 10 shunt revision surgeries per patient (1-200 surgeries). Occlusion, shunt migration and infection were the leading causes for revision at 60%, 47%, and 35%, respectively. In addition, 72% of patients reported pain and discomfort from the device, and 68% expressed avoidance of certain activities due to "fear of bumping shunt." Despite numerous articles discussing shunt technology, a review of the literature indicated a paucity of studies specifically evaluating the burden of shunt devices from a patient/caregiver perspective. CONCLUSIONS The findings from this study suggest long-term physical and psychosocial burden associated with shunt devices. Importantly, this study highlights the need for concerted efforts to develop validated tools to study patient reported outcomes as it relates to neurocranial implanted devices.
Collapse
|
17
|
Mullens CL, Twist J, Meltzer HS, Parrish DW. The "SHIFT" technique: Suprahepatic IntraFalciform tubing for placement of ventriculoperitoneal shunts. J Pediatr Surg 2021; 56:1246-1250. [PMID: 33752912 DOI: 10.1016/j.jpedsurg.2021.02.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 01/27/2021] [Accepted: 02/21/2021] [Indexed: 10/22/2022]
Abstract
Ventriculoperitoneal (VP) shunts in pediatric patients are an important aspect of management for patients with hydrocephalus and are fraught with complications. Surgical revision rates for VP shunts in the pediatric population are currently high, which necessitates innovation in operative techniques for placing VP shunts in attempt to decrease complication risks. Here we describe a novel approach for placement of VP shunts that we hypothesize can reduce potential morbidity among pediatric patients. By utilizing the falciform ligament of the liver and the suprahepatic recess to suspend and maintain the shunt, outcomes may portend fewer iatrogenic intra-abdominal injuries, enhanced ease of shunt removal, provide a large surface area for absorption of drained cerebrospinal fluid, and result in fewer adhesions secondary to device placement. We are referring to the operative technique as the "SupraHepatic IntraFalciform Tubing" (SHIFT) technique. In summary, the SHIFT shunt is fashioned by creating a window through the falciform ligament, inserting the shunt, and placing tubing in the suprahepatic recess.
Collapse
Affiliation(s)
| | - Joanna Twist
- West Virginia University School of Medicine, Morgantown, WV, United States
| | - Hal S Meltzer
- Department of Neurosurgery, Division of Pediatric Neurosurgery, West Virginia University School of Medicine, Morgantown, WV, United States
| | - Dan W Parrish
- Department of Surgery, Division of Pediatric Surgery, West Virginia University School of Medicine, Morgantown, WV, United States
| |
Collapse
|
18
|
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.
Collapse
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:
| | | | | | | | | | | | | |
Collapse
|
19
|
Chaurasia A, Shinde A, Baveja S. Bacteriological Profile and Antimicrobial Susceptibility Pattern of Cerebrospinal Fluid Shunt Infections in Infants and Children. J Pediatr Neurosci 2021; 16:143-148. [PMID: 35018183 PMCID: PMC8706585 DOI: 10.4103/jpn.jpn_216_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 10/03/2020] [Accepted: 10/20/2020] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Despite the advent of modern neurosurgical techniques, new antibiotics, and modern imaging techniques, infection after ventriculoperitoneal (VP) shunt insertion and/or ventriculostomy is still a serious issue. AIM The aim of this work was to study bacteriological profile and antimicrobial susceptibility pattern of cerebrospinal fluid shunt infections in infants and children. MATERIALS AND METHODS A total of 90 patients under the age of 12 years undergoing cerebrospinal fluid shunt procedures were included. The CSF shunt fluid, external ventricular drain (EVD), shunt tube tip specimens were processed as per standard microbiological techniques. The organisms isolated were subjected to antimicrobial susceptibility using the Kirby-Bauer disk diffusion method. RESULTS Of 20 infected patients 10 (50%) were culture positive. Most common organisms isolated were Acinetobacter baumannii 03 (30%) followed by Enterococcus faecalis 2 (20%). Two isolates of A. baumannii and one isolate of Klebsiella pneumoniae showed carbapenem resistance, which were sensitive to colistin. All Gram-positive isolates were sensitive to vancomycin and linezolid. Reinfection was found only in one (8.33%) patient. In 12 (60%) infected cases with shunt failure, revision of shunt was done. The shunt related mortality in this study was 1.11%. CONCLUSION Most common organisms isolated were A. baumannii followed by E. faecalis. Carbapenem resistance was noted in these isolates which were sensitive to colistin. All Gram-positive isolates were sensitive to vancomycin and linezolid.
Collapse
Affiliation(s)
- Ankita Chaurasia
- Department of Microbiology, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, Maharashtra, India
| | - Alka Shinde
- Department of Microbiology, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, Maharashtra, India
| | - Sujata Baveja
- Department of Microbiology, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, Maharashtra, India
| |
Collapse
|
20
|
Khan B, Hamayun S, Haqqani U, Khanzada K, Ullah S, Khattak R, Zadran N, Bibi Z, Khan AW. Early Complications of Ventriculoperitoneal Shunt in Pediatric Patients With Hydrocephalus. Cureus 2021; 13:e13506. [PMID: 33786215 PMCID: PMC7993285 DOI: 10.7759/cureus.13506] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objective Ventriculoperitoneal shunt (VPS) is the most commonly used procedure for the treatment of hydrocephalus (HDC), especially in children. However, this is prone to many complications, and requires repeated surgeries, which as such increases the morbidity of the patients. It is estimated that majority of the complications occurs in the immediate post-operative period and the rate of complications decreases over the time, with no impunity to these, though. We conducted this study to know about the complications of VPS in the early post-operative period, in pediatric patients with hydrocephalus. Materials and methods This descriptive study was conducted in the Department of Neurosurgery, Lady Reading Hospital, Peshawar, between June 2019 and January 2020 (seven months). All patients with hydrocephalus below 12 years of age, operated for the first time were included after taking an informed consent, while those with repeated shunt procedures and elderly patients requiring shunt were excluded from the study. Patients’ details like age, gender, location, contact number, cause of hydrocephalus, date of shunt placement, type of surgery (elective or emergency) and any follow-up complications like failure, erosion, infections, ileus were noted on a predesigned proforma. After the surgery, patients were followed for a period of one month, and contacted either through the telephone or asked to visit in the outpatients on the specified days, and were evaluated for any shunt-related complications, and any of these complications suspected were further evaluated and noted. The data was analyzed using the statistical program SPSS version 19 (IBM Corp., Armonk, NY). Results are presented in the form of charts, tables and graph. Results During the study period, we evaluated a total of 151 patients; there were 78 (51.65%) males and 73 (48.34%) females with a male to female ratio approaching 1.1:1. The age range was from 22 days to 12 years. The mean age was 38.46 ± 7.53 months. The primary indications for the insertion of VP shunt were: congenital hydrocephalus in 70 (46.4%), post infectious hydrocephalus in 57 (37.7%), hydrocephalus due to tumor in 22 (14.6%), and post traumatic hydrocephalus in two (1.4%) patients. Among the total number of patients, 85 patients (55.6%) were done as elective cases and 66 patients (44.4%) were done as emergency cases. Complications were encountered in 30 patients (19.87%) during the follow-up of 30 days. Complications occurred between day 1 and day 20 of follow-up with a mean of 9.10 ± 1.69 2SD days. Conclusion VP shunt is the most widely used treatment for HDC, but is predisposed to complications and almost every fifth case of VP shunt comes across with complications. Shunt blockage, infections and abdominal wound-related complications are common earlier complications in pediatric patients with hydrocephalus.
Collapse
Affiliation(s)
- Bilal Khan
- Neurosurgery, Lady Reading Hospital-Medical Teaching Institutions (MTI), Peshawar, PAK
| | | | - Usman Haqqani
- Neurosurgery, Qazi Hussain Ahmed Medical Complex, Nowshera, PAK
| | | | - Sajjad Ullah
- Neurosurgery, Khyber Teaching Hospital-Medical Teaching Institutions (MTI), Peshawar, PAK
| | - Rizwanullah Khattak
- Neurosurgery, Hayatabad Medical Complex-Medical Teaching Institutions (MTI), Peshawar, PAK
| | | | - Zohra Bibi
- Psychiatry, Lady Reading Hospital-Medical Teaching Institutions (MTI), Peshawar, PAK
| | - Abdul Wali Khan
- Internal Medicine, College of Physicians and Surgeons Pakistan, Peshawar, PAK.,Internal Medicine, Hayatabad Medical Complex Peshawar, Peshawar, PAK
| |
Collapse
|
21
|
Ferreira Furtado LM, Da Costa Val Filho JA, Moreira Faleiro R, Lima Vieira JA, Dantas Dos Santos AK. Abdominal Complications Related to Ventriculoperitoneal Shunt Placement: A Comprehensive Review of Literature. Cureus 2021; 13:e13230. [PMID: 33585146 PMCID: PMC7877257 DOI: 10.7759/cureus.13230] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Ever since the shunt device became the gold standard treatment for hydrocephalus, complications due to infections and mechanical problems have increased while lives have been saved. In addition, abdominal complications have become an important issue as the peritoneum is now the main place to insert the distal catheter. The most common complications were abdominal pseudocyst, distal catheter migration, inguinal hernia, catheter disconnection, and intestinal obstruction. The pediatric population is more prone to develop most of these complications due to their rapidly growing body, weaker abdominal musculature, and increased intraabdominal pressure. The goal of this review was to study the main aspects associated with abdominal complications after ventriculoperitoneal shunt (VPS) insertion, including the pathophysiology, epidemiological aspects, as well as the rationale for management and prevention according to the current “state-of-the-art.” It is paramount to recognize the risk factors associated with various types of complications to manage them properly.
Collapse
Affiliation(s)
| | | | - Rodrigo Moreira Faleiro
- Department of Neurosurgery, João XXIII Hospital/Fundação Hospitalar do Estado de Minas Gerais (FHEMIG), Belo Horizonte, BRA
| | | | | |
Collapse
|
22
|
Suryaningtyas W, Ranuh IGMAR, Parenrengi MA. Shunt exposure as a ventriculoperitoneal shunt complication: A case series. Int J Surg Case Rep 2021; 79:484-491. [PMID: 33757268 PMCID: PMC7873374 DOI: 10.1016/j.ijscr.2021.01.084] [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: 12/16/2020] [Revised: 01/20/2021] [Accepted: 01/20/2021] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Shunting is a technique in neurosurgery for treating hydrocephalus. Shunting is an effective choice for both cases of obstructive or communicative hydrocephalus. However, in some rare cases, complications, such as exposed shunt, can occur. In this case series, the author discusses 6 cases of hydrocephalus patients with exposed shunts. The risk factors, diagnosis, and management of exposed VP shunt will be discussed further in this case series report. METHODS This study was an analysis of all cases treated in a period of 1 year from January to December 2018 with an inclusion criterion of history of exposed shunt of any age group. This study is a single-centre retrospective report of the clinical presentation and radiology examination before and after treatment. Clinical and radiology evaluation were performed in immediate post procedural period. A detailed clinical examination was performed to look for exposed shunt complication. RESULTS In this series of studies 6 patients with hydrocephalus who had shunts were reported. All patients were pediatric patients. Six patients had exposed shunt on the scalp or abdomen. Radiological examinations including CT scan, chest X-ray or babygram were performed to evaluate the location of the shunt. The data reported was from January to December 2018 and there were 301 VP shunt installment cases. Management included surgical revisions and treatments to prevent further complications. CONCLUSION Shunting is still a routine therapy in the field of neurosurgery, although other modalities such as endoscopic third ventriculostomy (ETV) have started to be performed more frequently. Complications such as exposed shunt are rare in the treatment of pediatrics with hydrocephalus. We presented that exposed shunt is a rare complication (2.3% incidence rate) which might be caused by certain risk factors, such as age of patient when the shunting was performed, and nutritional status. Early diagnosis and treatment are important to prevent further complications, especially infections. Subpericranial technique for shunt tunneling might be useful in preventing exposure of shunts with associated morbidity factors.
Collapse
Affiliation(s)
- Wihasto Suryaningtyas
- Department of Neurosurgery, Faculty of Medicine, Universitas Airlangga, Dr Soetomo Academic Medical Center Hospital, Indonesia
| | - I G M Aswin R Ranuh
- Department of Neurosurgery, Faculty of Medicine, Universitas Airlangga, Dr Soetomo Academic Medical Center Hospital, Indonesia.
| | - Muhammad Arifin Parenrengi
- Department of Neurosurgery, Faculty of Medicine, Universitas Airlangga, Dr Soetomo Academic Medical Center Hospital, Indonesia.
| |
Collapse
|
23
|
Prognosis regarding shunt revision and mortality among hydrocephalus patients below the age of 2 years and the association to patient-related risk factors. Acta Neurochir (Wien) 2020; 162:2475-2485. [PMID: 32219607 DOI: 10.1007/s00701-020-04299-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 03/19/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Little is known about the prognosis regarding shunt revision and mortality among hydrocephalus patients below 2 years of age. The aims of this study were to investigate (1) the cumulative risks of shunt revision (SR) and mortality and (2) the potential associations between prematurity, low weight for gestational age (LWGA), underlying aetiology, sex, age of the child at shunt placement, and the risk of SR. METHOD This was a purely register-based cohort study including all shunted hydrocephalic infants in Denmark 1996-2015. The cumulative risks of SR and mortality were estimated using the Aalen-Johansen and Kaplan-Meier estimators, respectively. A multivariable Cox-regression model was used to estimate hazard ratios (HRs) for SR according to the listed patient-related risk factors. RESULTS Among 374 shunted infantile hydrocephalus patients accounting for 1047 SRs, the 3-month and 1-year cumulative risks of SR were 36% and 50%, respectively. The overall 10-year cumulative mortality was 12%, and for non-tumour subgroups 7-16% (isolated hydrocephalus 7%). The 10-year cumulative mortality for children born with LWGA was 21%. Except for aetiology, we observed no strong overall associations between the investigated risk factors and the risk of SR but interaction analyses for aetiology showed that patients with Dandy-Walker malformation born with LWGA had a higher risk of SR compared to patients of similar aetiology with normal WGA (HR 2.47, 95% CI: 1.39-4.40). CONCLUSIONS We found very high cumulative risks of SR and mortality among this youngest group of hydrocephalus patients, disregarding aetiology, but none of them were strongly related to the investigated risk factors.
Collapse
|
24
|
Habibi Z, Golpayegani M, Ashjaei B, Tayebi Meybodi K, Nejat F. Suprahepatic space as an alternative site for distal catheter insertion in pseudocyst-associated ventriculoperitoneal shunt malfunction. J Neurosurg Pediatr 2020; 26:247-254. [PMID: 32413860 DOI: 10.3171/2020.3.peds19772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 03/09/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Distal catheter malfunction due to pseudocyst formation or intraabdominal adhesion is a significant problem, especially in pediatric patients who have limited sites for distal catheter insertion. In this study, the authors present a series of 12 patients with intractable distal shunt malfunctions due to peritoneal pseudocyst formation who underwent distal catheter replacement in the suprahepatic space to reduce the risk of distal catheter malfunction. METHODS Twelve consecutive patients with shunt malfunction due to pseudocyst formation who had undergone ventriculosuprahepatic shunting from 2014 to 2019 were identified. According to medical records, after primary evaluations, shunt removal, and antibiotic therapy, they underwent revision surgeries with placement of a distal catheter into the suprahepatic space. RESULTS Nine boys and 3 girls, ranging in age from 5 months to 14 years, with one or more episodes of pseudocyst formation, underwent shunt revision with placement of a distal catheter into the suprahepatic space. After a median follow-up of 31 months, none of the patients experienced further distal malfunction. CONCLUSIONS The suprahepatic space appears to be a safe place to secure the distal end of a ventricular catheter following pseudocyst formation, with less risk of re-adhesion. This lower risk might be attributable to the lack of omentum in the suprahepatic space.
Collapse
Affiliation(s)
| | | | - Bahar Ashjaei
- 2Pediatric Surgery, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | | |
Collapse
|
25
|
Kerscher SR, Schweizer LL, Haas-Lude K, Bevot A, Schuhmann MU. Changes of third ventricle diameter (TVD) mirror changes of the entire ventricular system at acute shunt failure and after shunt revision in pediatric hydrocephalus. Childs Nerv Syst 2020; 36:2033-2039. [PMID: 32215715 DOI: 10.1007/s00381-020-04570-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Accepted: 03/06/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE In hydrocephalic children, regular investigations of the ventricles are important for initial diagnosis and after initial treatment. Our recent study showed that changes of the third ventricle diameter (TVD) reliably reflect changes of the entire ventricular system at diagnosis and following initial therapy. This study compares changes of TVD with changes of ventricle indices at acute shunt failure and after shunt revision in hydrocephalic children. METHODS A total of 117 children with hydrocephalus were included in this study. MRI/CT images of 30 children were evaluated at the time of acute shunt dysfunction and after subsequent shunt revision. Measurements included axial TVD and three standard measures of lateral ventricles (Evans index, frontal occipital horn ratio (FOHR), and cella media index (CMI)). In 97 children, correlation between axial and coronal/diagonal TVD was evaluated at the time of initial diagnosis of hydrocephalus. RESULTS At acute shunt dysfunction, the best linear correlation was found between TVD and CMI (r = 0.702, p < 0.01). Changes of TVD correlated very well to changes of FOHR (r = 0.74, p < 0.01) after shunt revision. The correlation between axial and coronal/diagonal TVD was outstanding (r = 0.995, p < 0.01). CONCLUSION TVD showed a significant correlation with all lateral ventricle indices at acute shunt dysfunction and after shunt revision. It is therefore not only an excellent mirror of ventricular changes at initial hydrocephalus diagnosis and therapy, but it can also reliably reflect changes of the ventricular system in relevant clinical situations associated with the lifelong treatment of pediatric hydrocephalus.
Collapse
Affiliation(s)
- Susanne R Kerscher
- Pediatric Neurosurgery, Department of Neurosurgery, University Hospital of Tuebingen, Hoppe-Seyler-Str.3, 72076, Tübingen, Germany. .,Department of Neurosurgery, University Hospital of Tuebingen, Tübingen, Germany.
| | - Louise L Schweizer
- Pediatric Neurosurgery, Department of Neurosurgery, University Hospital of Tuebingen, Hoppe-Seyler-Str.3, 72076, Tübingen, Germany
| | - Karin Haas-Lude
- Department of Pediatric Neurology and Developmental Medicine, Children's Hospital, University of Tuebingen, Tübingen, Germany
| | - Andrea Bevot
- Department of Pediatric Neurology and Developmental Medicine, Children's Hospital, University of Tuebingen, Tübingen, Germany
| | - Martin U Schuhmann
- Pediatric Neurosurgery, Department of Neurosurgery, University Hospital of Tuebingen, Hoppe-Seyler-Str.3, 72076, Tübingen, Germany.,Department of Neurosurgery, University Hospital of Tuebingen, Tübingen, Germany
| |
Collapse
|
26
|
Farke D, Kolecka M, Czerwik A, Wrzosek M, Schaub S, Kramer M, Failing K, Schmidt MJ. Prevalence of seizures in dogs and cats with idiopathic internal hydrocephalus and seizure prevalence after implantation of a ventriculo-peritoneal shunt. J Vet Intern Med 2020; 34:1986-1992. [PMID: 32918850 PMCID: PMC7517859 DOI: 10.1111/jvim.15890] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 08/07/2020] [Accepted: 08/18/2020] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Seizures are considered a clinical sign in dogs with internal hydrocephalus but are not found in recent studies. Seizure prevalence due to ventricular enlargement and the prevalence of postoperative seizures in animals is not known. OBJECTIVES To determine seizure prevalence in dogs and cats with idiopathic internal hydrocephalus, to identify risk factors for seizure development, and to determine seizure prevalence in a 2-year period after ventriculo-peritoneal shunting (VPS). ANIMALS Records and MRIs of 197 animals from 2001 to December 2019 were investigated. A total of 121 animals (98 dogs and 23 cats) were included in the study. METHODS A retrospective multicenter case cohort study was conducted. Databases were searched for dogs and cats with internal hydrocephalus. MRI and CSF examinations were evaluated for signs of additional underlying disorders. Prevalence of seizures was estimated for animals showing only hydrocephalus internus. Risk factors were evaluated according to age, morphometric and morphological findings in the brain. All animals that underwent surgery were reexamined 2 years after surgery. RESULTS One hundred twenty-one animals (98 dogs and 23 cats) with internal hydrocephalus met the inclusion criteria. Seizure prevalence in dogs and cats with internal hydrocephalus was low (1.7%; <5.8% CI 95%). Seizures were not observed in the 2-year period after surgery. CONCLUSION AND CLINICAL IMPORTANCE Seizure prevalence in dogs and cats diagnosed with hydrocephalus internus is low. Seizures in association with VPS do not seem to be a complication of the procedure.
Collapse
Affiliation(s)
- Daniela Farke
- Department of Veterinary Clinical Sciences, Small Animal ClinicJustus‐Liebig‐UniversityGiessenGermany
| | - Malgorzata Kolecka
- Department of Veterinary Clinical Sciences, Small Animal ClinicJustus‐Liebig‐UniversityGiessenGermany
| | - Adriana Czerwik
- Department of Veterinary Clinical Sciences, Small Animal ClinicJustus‐Liebig‐UniversityGiessenGermany
| | - Marcin Wrzosek
- Department of Internal Medicine and Clinic for Horses, Dogs and Cats, The Faculty of Veterinary MedicineWrocław University of Environmental and Life SciencesWrocławPoland
| | - Sebastian Schaub
- Department of Veterinary Clinical Sciences, Small Animal ClinicJustus‐Liebig‐UniversityGiessenGermany
| | - Martin Kramer
- Department of Veterinary Clinical Sciences, Small Animal ClinicJustus‐Liebig‐UniversityGiessenGermany
| | - Klaus Failing
- Unit for Biomathematics and Data Processing, Faculty of Veterinary MedicineJustus Liebig‐University‐GiessenGiessenGermany
| | - Martin Jürgen Schmidt
- Department of Veterinary Clinical Sciences, Small Animal ClinicJustus‐Liebig‐UniversityGiessenGermany
| |
Collapse
|
27
|
Ahmadvand S, Dayyani M, Etemadrezaie H, Ghorbanpour A, Zarei R, Shahriyari A, Emadzadeh M, Ganjeifar B, Zabihyan S. Rate and Risk Factors of Early Ventriculoperitoneal Shunt Revision: A Five-Year Retrospective Analysis of a Referral Center. World Neurosurg 2019; 134:e505-e511. [PMID: 31669687 DOI: 10.1016/j.wneu.2019.10.108] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Revised: 10/17/2019] [Accepted: 10/18/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Cerebral shunts are the mainstay treatment of hydrocephalus. Because most previous studies have focused on factors related to long-term outcomes of shunt surgery, we aimed to assess the rates and causes of 30-day ventriculoperitoneal shunt (VPS) failure in a single referral center over 5 years in both adult and pediatric patients. METHODS Patients who underwent VPS surgery from February 2012 to February 2017 in Ghaem Teaching Hospital, Mashhad, Iran were evaluated retrospectively through clinical history, operative reports, imaging studies, and follow-up notes. Data of 12 possible factors related to shunt failure were collected comprising age, gender, household income, level of education, cause of hydrocephalus, causes of revision, type of failure, anatomic site, duration of operation, time of surgery, surgeons' level of expertise, and Glasgow Coma Scale (GCS) score. RESULTS Among 403 VPS placements, 121 VPS revisions were performed, and 82 eligible patients were included in the study (57.3% male and 42.7% female). The 30-day shunt failure rate was 24.4% among all revisions. Obstruction and malposition were the most common causes of early revisions. Six factors were statistically significant in the univariate analysis. After adjustment in a logistic regression model, 2 factors, namely surgeons' level of expertise (odds ratio, 10.33; 95% confidence interval, 1.08-98.80) and anatomic site of the shunt (odds ratio, 10.28; 95% confidence interval, 1.21-87.35) were associated with early shunt revision. CONCLUSIONS Shunt surgeries performed by junior residents and shunts placed in the frontal site were associated with early shunt failure.
Collapse
Affiliation(s)
- Saba Ahmadvand
- Faculty of Medicine, Islamic Azad University of Mashhad, Mashhad, Iran
| | - Mojtaba Dayyani
- Department of Neurosurgery, Ghaem Teaching Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hamid Etemadrezaie
- Department of Neurosurgery, Ghaem Teaching Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ahmad Ghorbanpour
- Department of Neurosurgery, Ghaem Teaching Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Reyhaneh Zarei
- Faculty of Medicine, Islamic Azad University of Mashhad, Mashhad, Iran
| | - Ali Shahriyari
- Faculty of Medicine, Islamic Azad University of Mashhad, Mashhad, Iran
| | - Maryam Emadzadeh
- Clinical Research Unit, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Babak Ganjeifar
- Department of Neurosurgery, Ghaem Teaching Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Samira Zabihyan
- Department of Neurosurgery, Ghaem Teaching Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
| |
Collapse
|
28
|
Chan AC, Woo PY, Au Y, Chan K, Wong H. Scrotal migration of a ventriculoperitoneal shunt. SURGICAL PRACTICE 2019. [DOI: 10.1111/1744-1633.12367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
| | | | - Yiu‐Kai Au
- NeurosurgeryKwong Wah Hospital Hong Kong
| | - Kwong‐Yau Chan
- Department of General SurgeryKwong Wah Hospital Hong Kong
| | - Hoi‐Tung Wong
- Department of General SurgeryKwong Wah Hospital Hong Kong
| |
Collapse
|