Efficacy Of Shunt Surgery Research Articles

Optimization of number and range of shunt valve performance levels in infant hydrocephalus: a machine learning analysis.

Shunt surgery is the main treatment modality for hydrocephalus, the leading cause of brain surgery in children. The efficacy of shunt surgery, particularly in infant hydrocephalus, continues to present serious challenges in achieving improved outcomes. The crucial role of correct adjustments of valve performance levels in shunt outcomes has been underscored. However, there are discrepancies in the performance levels of valves from different companies. This study aims to address this concern by optimizing both the number and range of valve performance levels for infant hydrocephalus, aiming for improved shunt surgery outcomes. We conducted a single-center cohort study encompassing infant hydrocephalus cases that underwent initial shunt surgery without subsequent failure or unimproved outcomes. An unsupervised hierarchical machine learning method was utilized for clustering and reporting the valve drainage pressure values for all patients within each identified cluster. The optimal number of clusters corresponds to the number of valve performance levels, with the valve drainage pressure ranges within each cluster indicating the pressure range for each performance level. Comparisons based on the Silhouette coefficient between 3-7 clusters revealed that this coefficient for the 4-cluster (4-performance level) was at least 28.3% higher than that of other cluster formations in terms of intra-cluster similarity. The Davies-Bouldin index for the 4-performance level was at least 37.2% lower than that of other configurations in terms of inter-cluster dissimilarity. Cluster stability, indicated by a Jaccard index of 71% for the 4-performance level valve, validated the robustness, reliability, and repeatability of our findings. Our suggested optimized drainage pressure ranges for each performance level (1.5-5.0, 5.0-9.0, 9.0-15.0, and 15.0-18.0cm H2O) may potentially assist neurosurgeons in improving clinical outcomes for patients with shunted infantile hydrocephalus.

Efficacy of shunt surgery in pediatric middle cranial fossa arachnoid cysts

Amaç: Araknoid kistlerin yarıdan fazlası orta fossa yerleşimlidir. Literatürde tedavi zamanlaması ve şekli konusunda tam bir görüş birliği bulunmamaktadır. Biz kliniğimizde orta kraniyal fossa araknoid kistlerde şant cerrahisi uyguladığımız hastaların sonuçlarını sunarak bu hastaların tedavileri konusuna katkıda bulunmayı amaçladık.
 
 Yöntemler: 2015 ve 2021 yılları arasında kliniğimizde orta kranial fossada tip 3 araknoid kist nedeniyle kistoperitoneal şant cerrahisi uyguladığımız 6 hastayı retrospektif olarak inceledik. Tüm hastaların operasyon öncesi ve sonrası klinik ve radyoljik durumları incelenerek not edildi. Operasyon sonrası 1. yıl klinik ve radyolojik kontrolleri de mevcut olan hastalar çalışmaya dâhil edildi.
 
 Bulgular: Tüm hastaların araknoid kist yerleşim yeri kranial orta fossa idi ve tüm hastalar kistoperitoneal şant ile tedavi edildiler. 2 yaş altı tüm hastalarda tespit edilmiş şikayet veya bulgu hareket ve tepkilerde azalma ve fontonel gerginliği iken 2 yaş üstünde şiddetli baş ağrısıydı. Tüm hastaların araknoid kistleri sınıflandırmada tip 3’tü ve radyolojik incelemelerde bası bulguları vardı. Hastaların tümünün cerrahi sonrası semptom ve şikayetleri azaldı. Bir hastada slit kist sendromunu düşündürecek klinik bulgular oluştu. Bu hasta dışında hiçbir hastada kontrol süresince herhangi bir komplikasyon görülmedi.
 
 Sonuç: Çalışmamız pediatrik orta kraniyal fossa tip 3 araknoid kistli hastalarda kistoperitoneal şant cerrahisinin, ilk tedavi yöntemi olarak da uygulanabilecek etkili ve güvenli tedavi yöntemi olduğu görüşünü desteklemektedir.

Management of Variceal Hemorrhage in Children with Extrahepatic Portal Venous Obstruction-Shunt Surgery Versus Endoscopic Sclerotherapy

Extrahepatic portal venous obstruction (EHPVO) is a common cause of portal hypertention in children. Esophageal variceal hemorrhage is a major cause of morbidity and mortality in these patients. For many decades, portal systemic shunts were considered as the most effective treatment of variceal hemorrhage. Endoscopic injection sclerotherapy (EIS) was first introduced for emergency management of bleeding varices and subsequently as definitive treatment to prevent recurrent hemorrhage. The purpose of the study was to compare the safety and efficacy of shunt surgery and endoscopic sclerotherapy for patients with proven esophageal variceal bleeding due to EHPVO. The study was a prospective randomized study of 61 children with bleeding esophageal varices due to EHPVO carried out jointly by the department of General Surgery and Gastroenterology at Sher-i-Kashmir Institute of Medical Sciences, Srinagar, between March 2001 and September 2003. Thirty patients received surgery and other 31 patients received EIS. Overall incidence of rebleeding was 22.6% in sclerotherapy group and 3.3% in shunt surgery group. Treatment failure occurred in 19.4% patients in sclerotherapy group and 6.7% in shunt surgery group. The rebleeding rate of sclerotherapy is significantly higher than that of shunt surgery. However, the therapy failure rate of sclerotherapy is not significantly different from that of shunt surgery.

Impact of Shunt Surgery for Variceal Bleeding in the Natural History of Ascites in Cirrhosis: A Retrospective Study

Despite the efficacy of shunt surgery in the treatment of variceal bleeding, less effective nonoperative therapies are being substituted because surgical shunt does not modify survival and increases hepatic encephalopathy. However, the real impact of shunt surgery on the natural history of ascites and its complications has not been established. The course of 204 Child-Pugh A and B cirrhotic patients with variceal bleeding included in three controlled trials of our units who survived first hospitalization was updated. Ninety-eight patients (group I) were treated by portacaval (56 patients) or distal splenorenal (42 patients) shunt, whereas 106 (group II) were treated by nonshunt procedures (sclerotherapy in 89 patients and staple transection in 17 patients). As expected, the 5-yr probability of variceal rebleeding was lower (13% vs. 44%) and hepatic encephalopathy higher (50% vs. 28%) in group I than in group II, and survival was similar (67% vs. 60%). Shunt surgery had a great impact on the natural history of ascites and its complications. The probability of occurrence of ascites (15% vs. 73%; p < 0.0001), spontaneous bacterial peritonitis (2% vs. 21%; p < 0.0001) and hepatorenal syndrome (4% vs. 21%; p < 0.01) was greatly reduced. These beneficial effects accounted for the lower percentage patients requiring readmissions (51% vs. 70%; p = 0.02) and shorter total time spent in hospital (14 +/- 22 vs. 26 +/- 39 days/patient; p = 0.01) in group I. These data indicate that shunt surgery, in addition to reducing the probability of rebleeding, markedly decreases the probability of ascites, spontaneous bacterial peritonitis and hepatorenal syndrome development.(ABSTRACT TRUNCATED AT 250 WORDS)