Peritoneal Shunt Research Articles

Laparoscopic Versus Open Ventriculoperitoneal Shunt Placement: A Non-inferiority Study

Ventriculoperitoneal shunt (VPS) insertion into the abdominal cavity had been done for decades via an open approach. Recently, the laparoscopic insertion of the peritoneal portion of the shunt has become an option. The aim of this study is to compare outcomes between these two approaches. We performed a single institution retrospective review of 104 consecutive adult patients between 2015 and 2017. Patients had peritoneal catheters placed either via an open approach by the neurosurgical team, or laparoscopically by general surgeons. Patient demographics and outcomes were compared using a non-inferiority analysis. Independent variables in the analysis included patient age, gender, race, BMI, surgery performed, previous VPS placement, previous abdominal procedures, and VPS indication, while dependent variables included length of stay (LOS), estimated blood loss (EBL), occurrence of shunt failure, and postoperative complications. Cohort analysis included 62 open and 42 laparoscopic cases with similar baseline characteristics. In terms of patient outcomes, EBL and hospital stay duration were shown to be non-inferior in the open group as compared to the laparoscopic group. We could not prove non-inferiority based on risk for overall or distal shunt failure. Neurosurgeons may reasonably continue to place peritoneal shunt catheters using a “traditional” method.

Venous sinus stenting for idiopathic intracranial hypertension patients with functioning ventriculoperitoneal shunts: A case series

Idiopathic intracranial hypertension (IIH) is a disease defined by increased intracranial pressure and associated with a variety of symptoms ranging from headaches to tinnitus. Ventricular peritoneal shunting has been the mainstay treatment for patients with IIH. Although VPS’s have shown efficacy in treating IIH, some patients complain of refractory symptoms even with functioning VPS’s. Venus stenting has emerged as a new technique for treating these refractory symptoms. Despite the scarce literature pertaining its efficacy and safety profile, several small studies have shown promising results. In this case series, four patients with IIH complained of refractory symptoms despite functioning VPS’s and were treated with venous stenting.

Neonatal Giant and Open Neural Tube Defects: Challenges and Lesions Learnt

Abstract Background: Management of large/open neural tube defects (NTDs) is challenging and outcome is demanding. Aims: To analyze the outcomes in giant NTDs. Materials and Methods: The data between June 2017 and September 2022 were analyzed. Those with incomplete data, not giving consent or lost to follow-up, were excluded. All underwent closure using primary closure, Z plasty, or rhomboid flap. Dura closure was achieved with native dura augmented with thoracolumber fascia. The outcome was analyzed with respect to duration of surgery, blood loss, requirement of Z plasty for closure, wound infection, blackening of the flaps, cerebrospinal fluid leak, and features of sepsis. Result: 164 out of 243 cases formed the study group. Mean age at presentation was 4 days (range 0–28 days). Mean duration of surgery was 2 days (range 1–3 days). Mean operating time was 1.15 hours (range 0.45–3.15 hours). Hydrocephalous was present in 146 cases and all required ventriculo peritoneal shunt. Lower limb paraplegia and spasticity were present in 63 and 23 cases. Skin closure was achieved by primary closure in 23, double Z plasty in 76, and rhomboid flap in 65 cases. Wound infection and blackening of flap were seen in 13 and 1 case in double Z plasty and 6 and 7 cases in rhomboid flap group, respectively (P = 0.7). cerebrospinal fluid leak was seen in 8 cases. Wound dehiscence and sepsis were seen in 10 and 28 cases, respectively. Conclusion: Management of large defect requires adequate planning. cerebrospinal fluid shunting and flap/Z plasty are often required.

Risk Factors Associated with Ventricular Peritoneal Shunt Infections and their Clinical Outcome in Children: A Case-Control Study of the Past 5 Years

Objectives: To determine the risk factors associated with the development of ventricular peritoneal shunt infection and time to infection, as the number of days from most recent shunt intervention to the diagnosis of the infection and clinical outcomes and the antimicrobial susceptibility pattern in children admitted with the ventricular peritoneal shunt. Study Design: Retrospective case-control study Place and duration of study: Aga Khan University Hospital Karachi, Pakistan between January 2015 to December 2020 Results: A total of 460 patients of ages 0-20 years with ventricular peritoneal shunt were selected. Out of 460, 52 individuals met the criteria of the case and were recruited for the study. The findings from multivariable logistic regression, after accounting for potential confounding factors, indicated that the odds of shunt infection were extremely high for patients undergoing surgery in the current admission (adjusted OR 167.3, 95% CI: 8.96 – 3130.86). Likewise, the odds of infection were approximately 12 times more for patients with fever (95% CI: 1.28 – 113.26) and tory of shunt removal (95% CI: 2.06– 67.20). Conclusion: Through a thorough analysis of medical records, the study revealed that several risk factors, such as younger age, previous shunt infections, surgery in current admission, shunt removal/replacement, previous revisions, current complication and fever were associated with a higher risk of shunt infection. Keywords: Risk factors, ventricular peritoneal, shunt infections, clinical outcome,

Safety of laparoscopic cholecystectomy in patients with a cerebrospinal fluid shunt in the peritoneal cavity.

The management of patients with a cerebrospinal fluid (CSF) shunt located in the peritoneal cavity undergoing laparoscopic surgery is an issue that has not yet been settled. These patients are at risk of increased intracranial pressure caused by peritoneal insufflation, shunt dysfunction, and shunt infection/retrograde meningitis. This study aimed to determine the need for perioperative shunt intervention in CSF shunt patients undergoing laparoscopic cholecystectomy. We reviewed and analyzed five shunt patients who underwent laparoscopic cholecystectomy in our institution between 2012 and 2022, as well as 17 patients described in previous reports. Among the 22 patients, shunt type was ventriculoperitoneal in 14 and lumboperitoneal in eight. The most common indication for CSF shunt was hydrocephalus caused by cerebral vascular accident (50.0%). Laparoscopic cholecystectomy was performed for cholecystolithiasis in 13 patients (59.1%), acute cholecystitis in eight (36.4%), and gallbladder polyp in one (4.5%). Shunt clamping or externalization was performed in six patients. Two patients in the group that did not undergo shunt clamping or externalization experienced complications (intra abdominal abscess and subcutaneous emphysema). However, the incidence of short-term complications (both overall and shunt-related) and median length of hospital stay did not significantly differ between the two groups. Routine shunt clamping, externalization, or removal might not be necessarily required in patients with a ventriculoperitoneal or lumboperitoneal shunt undergoing laparoscopic cholecystectomy.

Ventriculoperitoneal (VP) Shunt Surgery and their Complications in Children: A Prospective Observational Study

Background: Ventriculoperitoneal shunting is the main technique for extra-thecal cerebrospinal fluid (CSF) diversion. Even though VP shunts are the standard of care for many types of hydrocephalus, they tragically have many problems that require surgery more frequently than initial shunt insertions. The objective of this study was to analyze the hydrocephalic children who had undergone Ventriculo peritoneal shunt surgeries with regard to the etiology, clinical profile and complication. Methods: This is a prospective observational study that was conducted at department of Pediatric Neuro Surgery, Bangladesh Shishu Hospital & Institute (BSH&I) for a period of 5 years from January 2017 to January 2022. This study included 92 patients out of 240 patients of hydrocephalus (HCP) who underwent VP shunt placement and had complications. Results: A total of 92 patients (38.3%) out of 240 patients who presented with various patterns of complications over the period of the study were examined. The average age was 15.5±8.1 months, with 62 (67.4%) male and 30 (32.6%) female and mortality rate was 4.2%. 75 (81.5%) of the 92 patients experienced single complication, while the remaining 17(18.5%) had multiple complications. Forty-five (48.9%) patients had ventricular end malfunction and 26 (28.3%) patients had peritoneal end malfunction, 21(22.8%) patients had both ventricular and peritoneal end malfunction. Patient of early infective complications were 24(26.1%) and late infective complications were 6(6.5%). Moreover, numbers of early and late mechanical complication were 25(27.2%) and 37(40.2%) respectively. Conclusion: Pediatric patients frequently experience difficulties from VP shunts despite the best efforts of neurosurgeons worldwide to reduce these issues. A great care should be taken during insertion of the shunt system starting from scrubbing to avoid complications. Despite complications, the VP shunt remains the main surgical procedure used for hydrocephalus management.

Treatment strategy for giant thrombosed aneurysm of the basilar artery with associated obstructive hydrocephalus.

There is no established adequate treatment for thrombosed aneurysm of the basilar artery with obstructive hydrocephalus. We conducted coil embolization and peritoneal shunting followed by placement of a stent expected to exert flow diversion (FD) effects to treat 2 patients with giant thrombosed aneurysms of the basilar artery with associated obstructive hydrocephalus, with good results. From April 2019 to March 2021, consecutive two cases of symptomatic hydrocephalus due to giant thrombosed aneurysms in the posterior cranial fossa at our hospital were treated. At first, coil embolization was performed to prevent aneurysm rupture. After coil embolization, ventriculoperitoneal shunting was performed. Finally, stent-assisted coil embolization was performed with flow re-direction endoluminal device (FRED) or low-profile visualized intraluminal support device (LVIS) stent. Both patients were discharged after recovering well, with no postoperative hemorrhagic or ischemic complications. Staged surgery using a FRED for flow diverter or an LVIS stent expected to have FD effects may offer an effective treatment option.

Light without TORCH: Periventricular Haemorrhage and Group B Streptococcal Meningitis in a Neonate

Post-infectious hydrocephalus is a common entity needing attention of paediatricians and neurosurgeons. Periventricular Haemorrhage (PVH) affects both preterm and term babies. Risk factors include male gender, short gestation, labour and vaginal delivery. Congenital infections such as Toxoplasma and CMV are associated with hydrocephalus and intracranial calcification. We present an unusual association of Group B Streptococcal infection with periventricular haemorrhage. A Caucasian female was born at 37 weeks gestation by normal vaginal delivery. Birth weight was 2.72kg and OFC was 33cm (50th centile). There were no antenatal problems or maternal infections. On day 2 of life, the patient presented with unusual cry, lethargy and reduced feeding. Group B Streptococcal meningitic septicaemia was confirmed with positive CSF and blood cultures. At 7 weeks, she presented with a two-week history of increasing head circumference. Ventriculo Peritoneal (VP) shunt was inserted for post-infectious hydrocephalus. There was difficulty in waking the patient up post-operatively and subsequent CT Brain showed the presence of multiple high attenuation foci in the periventricular region suggestive of haemorrhage or calcification. MR imaging confirmed numerous foci of abnormal signal intensity in the periventricular white matter, most likely blood products. To our knowledge, this is the first report of an association between Group B Streptococcal meningitis and PVH.

Magnitude of Hydrocephalus in Neonates: Its Surgical Management and Complications

Abstract: Background: To determine magnitude of congenital or acquired hydrocephalus and its possible management and complications. Materials and Methods: This Hospital based Retrospective observational study was conducted in department of pediatric surgery King Edward medical university / Mayo hospital Lahore from January 2021 to March 2022. All patients presented from neonatal life till 3 months of age with hydrocephalus due to congenital or acquired reasons were included in this study. There were 55 male and 28 female patients with male predominance. A detailed Proforma was made giving patients information, associated congenital or acquired anomaly and surgical management of hydrocephalus. All patients were operated on elective operation theatre list. Post-operative complications were noticed on admission files and addressed. Results: During the study period, 83(n=1) patients with hydrocephalus were admitted in department of pediatric surgery Mayo hospital Lahore. Among these patients, 56(67.5%) patients have hydrocephalus associated with myelomeningocele while 10(12%) patients with encephalocele. 11(13.3%) patients showed hydrocephalus due to post tuberculosis meningitis while 3(3.6%) patients with Arnold chiari 2 malformation. 1(1.2%) patients presented with hydrocephalus due to Congenital obstruction of cerebral aqueduct while 2(2.4%) with Intracranial hemorrhage ventriculoperitoneal shunting was performed in 55(66.3%) patients to treat hydrocephalus. Conservative management of hydrocephalus was done in 24(28.9%) patients while in 4(4.8%) patients ventricular taping was done. Wound infection was major post-operative complication and was noted in in 13 (15.7%) patients. Conclusion: Ventriculo peritoneal shunting is main treatment modality for obstructed hydrocephalus. Major complication of ventriculo pertoneal shunting is infection which can be prevented by proper prophylactic antibiotics as well as sterile environment of operation theatre.

Ventricular Peritoneal Shunting Using Modified Keen’s Point Approach: Technical Report and Cases Series

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.

Ventriculorenal shunts in the treatment of pediatric and adult hydrocephalus-historical perspective and analysis of current practice.

Hydrocephalus is a complex pathology that can have a significant impact on the quality of life in all age groups. Cerebrospinal fluid (CSF) diversions from the lateral ventricle to the peritoneal cavity are regarded as the treatment of first intent, but they have a high revision rate, and there are multiple factors which can impair their proper insertion and function. One of the many alternatives to peritoneal shunting is redirecting the CSF towards the renal system. A literature search was conducted to identify the particularities of these types of shunts and what clinical context rendered themfeasible in pediatric and adult patient populations. Twenty-eight studies were found to meet the selection criteria. The shunts were classified into ventriculopyeloureteral, ventriculoureteral, and ventriculovesical. Their main advantage was that they did not depend on absorptionproperties of the tissues, like in the case of the peritoneum. However, several issues with ascending infections, bladder pressure imbalance, distal shunt migration, and calculus formation were noted. Literature suggests that the urinary tract can have the potential of diverting CSF when the peritoneum or atrium is not available, but further research is required to establish their proper role in current practice.

Malignant transformation of a cerebral dermoid cyst into a squamous cell carcinoma with malignant intraperitoneal spreading along a ventriculoperitoneal shunt: illustrative case.

BACKGROUNDMalignant progression of intracranial dermoid cysts into squamous cell carcinoma is extremely rare with only three reports published so far. Intracranial dermoid cysts are uncommon benign tumors lined by stratified squamous epithelium of embryonic ectodermal origin.OBSERVATIONSHere, the authors present the case of a 64-year-old female with a recurrent temporal dermoid cyst. After surgery for the recurrent dermoid cyst, once in the early 1990s and another 16 years later, the patient presented with headache and nausea due to hydrocephalus. After implantation of a ventriculoperitoneal shunt, she deteriorated rapidly and died only 60 days after admission. Autopsy revealed malignant transformation of the epithelial lining of the dermoid cyst into a squamous cell carcinoma resulting in neoplastic meningiosis and intraperitoneal tumor spread along a previously implanted ventriculoperitoneal shunt.LESSONSMalignant transformation should be considered in patients with dermoid cyst who show new leptomeningeal contrast enhancement. In the case of hydrocephalus, alternatives to peritoneal shunting should be considered.

An Adult Female with Obstructive Hydrocephalus who Presented with Neurogenic Stunned Myocardium during a Neuroendoscopic Procedure: A Case Report

Neurogenic stunned myocardium (NSM) is a condition wherein a neurologic pathology results in myocardial injury.This is a case of an adult patient who developed intraoperative NSM presenting as hypertension and tachycardiaprogressing to supraventricular tachycardia and ST-elevation during an emergency endoscopic septostomy, biopsy and ventricular peritoneal shunt (VPS) insertion. It is important for the anesthesiologist to be familiar with this condition to ensure prompt recognition and management as well as to avoid significant morbidity and mortality.

Peritoneal Shunt Extraction in Children Using Laparoscopy: A Case Report

Laparoscopy is one way to perform various simple procedures or surgeries in the abdominal cavity. Laparoscopy can be useful in the management of ventriculo-peritoneal shunt (VP Shunt) fractures. The peritoneal component of the shunt remaining in the abdominal cavity can be removed using laparoscopy. A pediatric patient with hydrocephalus with a history of VP Shunt insertion 5 years ago, came with complaints of weakness, vomiting and difficulty eating. Physical examination revealed the presence of edema in the chamber area. A CT scan of the head and plain abdominal radiographs were performed. The diagnosis was made as a shunt fracture, with the peritoneal component of the shunt remaining in the abdominal cavity. The patient received treatment in the form of a revised VP shunt and peritoneal shunt extraction using standard laparoscopy which is commonly used for adult patients. The patient's condition improved after the procedure. Peritoneal shunt extraction in cases of VP shunt fracture can be safely performed using laparoscopy. If there are limited tools, this procedure can still be performed on children using standard laparoscopy which is usually used for adult patients. Authors report this case due to no previous report in Mojokerto area were known.

Functional hemispherotomy for epilepsy in the very young.

Epilepsy is one of the most common neurological disorders in children. Among very young children, one-third are resistant to medical treatment, and lack of effective treatment may result in adverse outcomes. Although functional hemispherotomy is an established treatment for epilepsy, its outcome in the very young child has not been widely reported. In this study the authors investigated seizure and developmental results after hemispherotomy in children younger than 3 years. The authors reviewed a prospective database of all children younger than 3 years with medically intractable epilepsy who underwent functional hemispherotomy at the authors' institution during the period between 2012 and 2020. Demographic data, epilepsy history, underlying etiology, operative and transfusion details, and seizure and developmental outcomes were analyzed. Twelve patients were included in this study. The mean age (± SD) at seizure onset was 3 ± 2.6 months and at surgery was 1.3 ± 0.77 years, with a mean follow-up of 4 years. Diagnoses included hemimegalencephaly (n = 5), hemidysplasia (n = 2), hypoxic/hemorrhagic (n = 2), traumatic (n = 1), Sturge-Weber syndrome (n = 1), and mild hemispheric structural abnormality with EEG/PET correlates (n = 1). Eleven patients achieved an Engel class I outcome, and 1 patient achieved Engel class IV at last follow-up. No deaths, infections, cerebrovascular events, or unexpected long-term neurological deficits were recorded. All children progressed neurodevelopmentally following surgery, but their developmental levels remained behind their chronological age, with an overall mean composite Vineland Adaptive Behavior Scale score of 58 (normal: 86-114, low: < 70). One patient required insertion of a subdural peritoneal shunt, 1 patient required dural repair for a CSF fluid leak, and 1 patient required aspiration of a pseudomeningocele. In 2 patients, both of whom weighed less than 5.7 kg, the first operation was incomplete due to blood loss. Hemispherotomy in children younger than 3 years offers excellent seizure control and an acceptable risk-to-benefit ratio in well-selected patients. Families of children weighing less than 6 kg should be counseled regarding the possibility of staged surgery. Postoperatively, children continue to make appropriate, despite delayed, developmental progress.

Endoscopic Fenestration of Posterior Fossa Arachnoid Cysts

Introduction: Posterior Fossa arachnoid cysts (PFAC) are rare lesions in the childhood. Owing to the wide variety of cystic malformations within the posterior cranial fossa, PFAC have long attracted the attention of pediatric neurosurgeons because they can produce not only neurological symptons but also behaviro and learning deficts, in addition to presenting major surgical challenges. Surgical treatment is warranted in symptomatic patients. Nowadays, neuroendoscopic techniques have established themselves as the treatment of choice of these lesions.&#x0D; Patients and Methods: We present four cases of symptomatic PFAC which were treated using endoscopic neurosurgery. Endoscopic approaches were defined by the presence of hydrocephalus, and discussed in each case.&#x0D; Results : Two cases of quadrigeminal plate cysts, predominantly occupying the infratentorial compartment , one case of supracerebellar cyst and one case of cerebellopontine angle were treated with good results. However, one case of quadrigeminal plate cyst developed a communicating hydrocephalus, requiring placement of cyst-ventricle peritoneal shunt, guided by the neuroendoscope.&#x0D; Discussion and Conclusion : A literature review was performed. The clinical features, the advantages and disadvantages of several surgical treatments are discussed. Symptomatic PFAC should be treated. The relatively good results using endoscopic fenestration buttresses our use as a first-line surgery.

Non-adjustable gravitational valves or adjustable valves in the treatment of hydrocephalus after aneurysmal subarachnoid hemorrhage patients?

PurposeHydrocephalus requiring permanent CSF shunting after aneurysmal subarachnoid hemorrhage (aSAH) is frequent. It is unknown which type of valve is optimal. This study evaluates if the revision rate of gravitational differential pressure valves (G-DPVs, GAV® system (B Braun)) (G-DPV) is comparable to adjustable pressure valves (Codman Medos Hakim) (APV) in the treatment of post-aSAH hydrocephalus.MethodsThe use of a gravitational differential pressure valve is placed in direct comparison with an adjustable pressure valve system. A retrospective chart review is performed to compare the revision rates for the two valve systems.ResultsWithin the registry from Radboud University Medical Center, 641 patients with a SAH could be identified from 1 January 2013 until 1 January 2019, whereas at the Heinrich Heine University, 617 patients were identified, totaling 1258 patients who suffered from aSAH. At Radboud University Medical Center, a gravitational differential pressure valve is used, whereas at the Heinrich Heine University, an adjustable pressure valve system is used. One hundred sixty-six (13%) patients required permanent ventricular peritoneal or atrial shunting. Shunt dysfunction occurred in 36 patients: 13 patients of the 53 (25%) of the gravitational shunt cohort, and in 23 of the 113 (20%) patients with an adjustable shunt (p = 0.54). Revision was performed at a mean time of 3.2 months after implantation with the gravitational system and 8.2 months with the adjustable shunt system. Combined rates of over- and underdrainage leading to revision were 7.5% (4/53) for the gravitational and 3.5% (4/113) for the adjustable valve system (p = 0 .27).ConclusionThe current study does not show a benefit of a gravitational pressure valve (GAV® system) over an adjustable pressure valve (CODMAN ® HAKIM®) in the treatment of post-aSAH hydrocephalus. The overall need for revision is high and warrants further improvements in care.

Pleural effusion and respiratory compromise from spontaneous migration of a ventriculoperitoneal shunt catheter in a patient with normal-pressure hydrocephalus

Background: Ventriculoperitoneal shunt (VPS) insertion is one of the most common neurosurgical procedures done around the world to treat hydrocephalus. The occurrence of spontaneous migration of the peritoneal shunt catheter into the thoracic cavity is a very rare complication; we report here case number 27 of respiratory complications of a VPS in a patient with normal-pressure hydrocephalus (NPH).Case Description: A 76-year-old woman with Alzheimer’s disease and anosognosia was diagnosed idiopathic NPH treated surgically with a VPS. Pleural effusion and pulmonary complications occurred 4 weeks after the insertion of the shunt due to the spontaneous migration of the peritoneal catheter of the VPS into the thoracic cavity. The hydrothorax of cerebrospinal fluid was drained and the distal catheter was removed and replaced. The patient made an uneventful recovery.Conclusion: Due to the rarity of this complication, there are no standard corrective procedures. Some of the methods used to diagnose and successfully treat this rare complication of the VPS are presented.

Treatment Strategies and Challenges to Avoid Cerebrospinal Fluid Shunting for Pediatric Hydrocephalus

Treatment for pediatric hydrocephalus aims not only to shrink the enlarged ventricle morphologically but also to create an intracranial environment that provides the best neurocognitive development and to deal with various treatment-related problems over a long period of time. Although the primary diseases that cause hydrocephalus are diverse, the ventricular peritoneal shunt has been introduced as the standard treatment for several decades. Nevertheless, complications such as shunt infection and shunt malfunction are unavoidable; the prognosis of neurological function is severely affected by such factors, especially in newborns and infants. In recent years, treatment concepts have been attempted to avoid shunting, mainly in the context of pediatric cases. In this review, the current role of neuroendoscopic third ventriculostomy for noncommunicating hydrocephalus is discussed and a new therapeutic concept for post intraventricular hemorrhagic hydrocephalus in preterm infants is documented. To avoid shunt placement and achieve good neurodevelopmental outcomes for pediatric hydrocephalus, treatment modalities must be developed.

Ultrasonography for Serial Monitoring and Management of Cerebrospinal Fluid Dynamic Disorders After Decompressive Craniectomy.

Decompressive craniectomy (DC) is widely used to treat intracranial hypertension following severe head injury. However, impairments of cerebrospinal fluid (CSF) hydrodynamics such as hydrocephalus and subdural effusion are common complications that occur after DC. Therefore, monitoring of intracranial pressure is a staple of neurocritical care post-DC. The aim of this study was to assess the usefulness of transcranial duplex sonography (TDS) for serial monitoring and management of CSF disorders after DC. A total of 100 patients who underwent DC between June 2016 and May 2019 were recruited for the study. Transcranial duplex sonography examinations were performed between 1-day and 1-year post-DC. Transcranial duplex sonography was mainly used for monitoring changes in ventricle size and morphology, and also to monitor intraventricular hemorrhage, hydrocephalus, intracranial hygromas, and ventricle changes during CSF release procedures. A total of 456 TDS examinations were performed on patients after DC. Of these, 402 were performed in the neuro-intensive care unit. Two patients had intraventricular hemorrhage and underwent TDS-guided external ventricular drainage. Twenty-nine patients were diagnosed with hydrocephalus. The results of TDS were consistent with those of cranial computed tomography. Three cases of ventriculoperitoneal shunt and 1 case of lumbar peritoneal shunt underwent valve pressure reset according to TDS, to obtain satisfactory ventricle size. Transcranial duplex sonography was used to monitor ventricle changes and control drainage volume during CSF release procedures, including 2 external ventricular drainage, 6 external lumbar drainage, and 10 lumbar punctures. Eighteen patients were detected with single or multiple intracranial effusions, including 16 subdural hygromas, 5 longitudinal fissure hygromas, and 6 brain cysts. Transcranial duplex sonography can efficiently help monitor changes in ventricle size and morphology and intracranial effusions. Due to its noninvasive nature, suitability for bedside application, real-time, and inexpensiveness, TDS can significantly replace cranial computed tomography and become part of the patient's daily inspection work after DC.