Postoperative Shunt Research Articles

Effectiveness of subgaleal topical vancomycin powder in reducing infection rates and shunt revisions in pediatric ventriculoperitoneal shunt surgery: a promising prophylactic approach.

This study aims to evaluate the effectiveness of two prophylactic strategies in preventing shunt infections in pediatric patients undergoing ventriculoperitoneal shunt surgery. This retrospective study included pediatric patients who underwent ventriculoperitoneal shunt surgery between 2017 and 2024. Patients were divided into two groups based on the prophylactic method used: Group 1 (VS) where the shunt was washed with vancomycin solution before placement, and Group 2 (TVP) where vancomycin powder was applied to the subgaleal and subcutaneous tissues after shunt placement. Data collected included age, gender, preoperative CRP values, operation length, hospitalization duration, wound site problems, and rates of early (within 3days) and late (within 36months) postoperative infections and shunt revisions. Data from 56 pediatric patients were analyzed. The TVP group had significantly lower rates of early postoperative infections compared to the VS group (3.3% vs. 26.9%, p < 0.05). Late postoperative infections were also lower in the TVP group (3.3% vs. 30.7%, p < 0.05). Shunt revision was required in 26.9% of patients in the VS group, but none in the TVP group (p < 0.05). Wound site problems were a critical factor, with all patients experiencing wound site infections also developing early postoperative infections (p < 0.05). The use of subgaleal topical vancomycin powder is a promising prophylactic method in ventriculoperitoneal shunt surgery, particularly for pediatric patients who are prone to skin problems, as it effectively avoids systemic toxic effects while reducing infection rates and the need for shunt revisions.

Electromagnetic Navigation Improves Accuracy and Reduces Complications of Ventriculoperitoneal Shunts in Patients with Idiopathic Normal Pressure Hydrocephalus: A Single-Center Clinical Experience

BackgroundVentriculoperitoneal (VP) shunt surgery is the primary treatment for patients with idiopathic normal pressure hydrocephalus (iNPH). This study compares the outcomes of VP shunt placement using electromagnetic (EM) navigation versus standard methods in iNPH patients, focusing on catheter accuracy and post-operative complication rates. MethodsThis retrospective study included 31 iNPH patients who underwent standard shunts using anatomical landmarks and 50 iNPH patients who underwent EM-guided shunts. Parameters assessed included shunt placement grade, catheter tip position, catheter angle, puncture attempts, operative duration, postoperative infection rates, intraparenchymal hemorrhage rates, and shunt malfunction rates. Patients were followed up at 3, 6, 12, and 24 months after surgery or until shunt failure. ResultsIn the EM-guided group, a higher percentage of Grade 1 shunt placements (92% vs. 71%, p = 0.03) and fewer Grade 3 placements (2% vs. 13%, p = 0.068) were observed. The catheter tip position at the foramen of Monro was significantly more accurate (p < 0.001), with smaller lateral catheter deviation angles in both coronal (19.69° vs. 24.2°, p < 0.0001) and sagittal sections (21.75° vs. 39.3°, p < 0.01). The EM-guided group had fewer puncture attempts, shorter operative durations, lower incidence of intraparenchymal hemorrhage (p < 0.01), and fewer shunt malfunctions over the 2-year follow-up period (2% vs. 26%, p = 0.0003). ConclusionsThe use of EM navigation in VP shunts for iNPH patients improves catheter placement accuracy, reduces postoperative complications and shunt malfunction rates, and provides precise and individualized surgical treatment.

Evaluation of mid-term outcomes of partial and intermediate atrioventricular canal defect surgery.

The risk factors for reoperation and mortality after partial and intermediate atrioventricular canal defect repair are unclear. This study assessed the mid-term outcomes and risk factors for reoperation and mortality after partial and intermediate atrioventricular canal defect surgery. Ninety-seven patients who underwent primary repair of intermediate (n = 45) or partial (n = 52) atrioventricular canal defect between 2005 and 2019 were included in this single-centre study. The median age was 5 years (2.7-8.9 years). The median follow-up time was 32 months (1.6-90.8 months). The estimated freedom from reoperation at 1, 5, and 10 years was 97%, 91%, and 73%, respectively.In multivariable analyses, post-operative left atrioventricular valve regurgitation of grade II or higher (odds ratio [OR]: 5.3, 95% confidence interval [CI]: 1.8-15.5, p = 0.01) and post-operative residual intracardiac shunt (OR: 11.6, 95% CI: 1.6-85.8, p = 0.02) were risk factors for reoperation.In multivariable analyses, perioperative reoperation (OR: 93.4, 95% CI: 3.9-218.7, p = 0.01) and the need for right atrioventricular valve repair (OR: 11.2, 95% CI: 1.0 - 123.3, p = 0.04) were risk factors for mortality. Mortality was higher in patients under 2.6 years of age. For patients undergoing repair of partial or intermediate atrioventricular canal defect, those with post-operative left atrioventricular valve regurgitation of grade II or higher and post-operative residual intracardiac shunt have an increased reoperation risk. Higher mortality can be expected after a perioperative reoperation, and in patients requiring right atrioventricular valve repair during the index procedure.

The Ratio of Baseline Ventricle Volume to Total Brain Volume Predicts Postoperative Ventriculo-Peritoneal Shunt Dependency after Sporadic Vestibular Schwannoma Surgery.

Background/Objectives: Obstructive hydrocephalus associated with vestibular schwannoma (VS) is the most common in giant VS. Despite tumor removal, some patients may require ongoing ventriculo-peritoneal (VP) surgery. This investigation explores the factors contributing to the requirement for VP surgery following VS surgery in instances of persistent hydrocephalus (HCP). Methods: Volumetric MRI analyses of pre- and postoperative tumor volumes, cerebellum, cerebrum, ventricle system, fourth ventricle, brainstem, and peritumoral edema were conducted using Brainlab Smartbrush and 3D Slicer. The total brain volume was defined as the sum of the cerebrum, cerebellum, and brainstem. ROC analyses were performed to identify the optimum cut-off values of the volumetric data. Results: Permanent cerebrospinal fluid (CSF) diversion after surgery was indicated in 12 patients (12/71; 16.9%). The ratio of baseline volume fraction of brain ventricles to total brain ventricle volume (VTB ratio) was found to predict postoperative VP shunt dependency. The AUC was 0.71 (95% CI: 0.51-0.91), and the optimum threshold value (</≥0.449) yielded a sensitivity and specificity of 67% and 81%, respectively. Multivariable logistic regression analyses of imaging data (pre- and postoperative VS volume, VTB ratio, and extent of resection (%) (EoR)) and patient-specific factors revealed that an increased VTB ratio (≥0.049, OR: 6.2, 95% CI: 1.0-38.0, p = 0.047) and an EoR < 96.4% (OR: 9.1, 95% CI: 1.2-69.3, p = 0.032) were independently associated with postoperative VP shunt dependency. Conclusions: Primary tumor removal remains the best treatment to reduce the risk of postoperative persistent hydrocephalus. However, patients with an increased preoperative VTB ratio are prone to needing postoperative VP shunt surgery and may benefit from perioperative EVD placement.

Congenital Brain Tumors: Surgical Outcomes and Long-Term Prognostic Factors

ObjectiveTo evaluate long-term outcomes of surgical resection for congenital brain tumors (CBTs) in infants under one year of age and to identify factors related to survival. MethodsOur retrospective study analyzed infants who underwent gross total (GTR) or subtotal resection (STR) for CBTs between 2001 and 2019. Data were obtained from medical records, including demographics, clinical presentation, diagnosis, tumor characteristics, and presence of hydrocephalus. Additional factors such as pre- and/or postoperative ventriculoperitoneal shunt (VPS) placement and adjuvant chemotherapy or radiotherapy were also reviewed. Cox regression analysis was used to identify factors associated with survival. ResultsThe study included 70 patients, with median age at surgery of 198.5 days, and 28 (40%) were girls. Seizures (31.4%) and vomiting (24.3%) were the most common presenting symptoms. High-grade tumors were present in 29 (41.4%) patients. GTR was achieved in 64.3% of cases, with surgical mortality rate of 7.1%. Overall survival rates at 5 and 10 years were 78% and 63%, respectively. Long-term follow-up data were available for 61 patients (87%), with median follow-up of 74.2 months. Among 45 long-term survivors, 55.5% had neurological sequelae. Factors associated with reduced survival included high-grade, preoperative hydrocephalus, larger tumor size, and VPS placement. The extent of resection improved survival only in low-grade tumor cases. Multivariable Cox regression analysis identified tumor grade and size as independent predictors of poor prognosis. ConclusionsSurgical resection remains crucial for treating CBTs in infants under one year, yet the aggressive nature of malignant tumors results in suboptimal outcomes regarding prognosis.

QOL-50. THE ROLE OF TUMOR SIZE IN COGNITIVE FUNCTIONING AMONG SURVIVORS TREATED FOR MEDULLOBLASTOMA

Abstract BACKGROUND Medical and treatment variables, including presence of post-operative cerebellar mutism syndrome (CMS), shunt placement, craniospinal radiation, and total radiotherapy (RT) dose, have been evaluated as potential risk factors for adverse cognitive effects among pediatric patients diagnosed and treated for medulloblastoma. Larger brain tumor size is associated with increased risk of medical complications, but cognitive risk of larger tumor size remains unknown. METHODS Cognitive scores were examined for 40 participants diagnosed and treated for medulloblastoma. The age-appropriate Wechsler Intelligence Scale was administered at the start of RT and up to 10 years post-RT (M=4.96, SD=3.78). A total of 162 evaluations were examined across participants. Linear mixed models examined change in Wechsler Index scores over time since RT based on tumor size, which was dichotomized at the median diameter (small ≤4.6cm versus large &amp;gt;4.6cm), covarying for maternal education, total RT dose, and presence of CMS. RESULTS Patients (72.5% male) were diagnosed with medulloblastoma and began RT at a mean age of 8.89 years. Groups did not differ on demographic or medical variables with the exception of presence/absence of CMS, with a higher proportion of patients diagnosed with CMS having large-size tumors (40%) versus small-size tumors (5%). Tumor size did not predict change in IQ, working memory, or processing speed performance over time since RT after accounting for covariates. CMS was associated with significant decline in processing speed (p&amp;lt;.001) and IQ over time (p&amp;lt;.05); RT dose was associated with significant working memory and IQ decline (both p&amp;lt;.05); and maternal education was associated with decline in processing speed, working memory, and IQ (all p&amp;lt;.05). CONCLUSIONS While tumor size may be associated with treatment intensity and other medical risk factors, CMS and RT dose significantly increase cognitive risk, independent of tumor size. Lower socioeconomic status also increases cognitive risk post-RT, which may illuminate pathways for prevention and intervention efforts.

Ventriculoperitoneal Shunt Surgery in Pediatrics: Does Preoperative Skin Antisepsis with Chlorhexidine/Alcohol Reduce Postoperative Shunt Infection Rate?

In pediatrics, shunt infection is considered the most common complication of ventriculoperitoneal (VP) shunt insertion and the main cause of shunt failure. Careful surgical technique and hygienic skin preparations are highly important for prevention of shunt infections. Our objective was to assess the significance of using preoperative chlorhexidine/alcohol as a skin antiseptic in reducing the infection rate in pediatric VP shunts surgery. We conducted a retrospective, case control study of 80 pediatric patients with active hydrocephalus. The control group (a single step of preoperative skin antisepsis using povidone-iodine and isopropyl alcohol) comprised 40 patients who underwent a shunt surgery between January 2019 and June 2020 and the study group (two steps of preoperative skin antisepsis using 2% chlorhexidine gluconate in 70% isopropyl alcohol as a first step followed by povidone-iodine as a second step) comprised 40 patients who underwent a shunt surgery between July 2020 and January 2022. Shunt infection was encountered in 11 (13.7%) patients. It was significantly higher in preterm babies (p = 0.010), patients with a previous shunt revision (p < 0.001), and those with a previous shunt infection (p < 0.001). The incidence of infection was 22.5% in the control group and 5% in study group, with a statistically significant difference (p = 0.023). Two steps of preoperative skin antisepsis, first using chlorhexidine/alcohol and then povidone-iodine scrub solution, may significantly reduce the infection rate in pediatric VP shunt surgeries.

502 Endoscopic Versus Microsurgery Resection of Third Ventricle Colloid Cysts: A Single-center Case-series of 140 Consecutive Patients

INTRODUCTION: The resection of colloid cysts of third ventricle can be done with either open microsurgery or endoscopy with each having different cons and pros. METHODS: Data of patients who underwent surgical resection of third ventricle colloid cyst via either endoscopic or microsurgery approach by a single surgeon between 2005-2020 were retrospectively collected. After administration of criteria, 140 records were retrieved (60 through endoscopic and 80 by trans-cranial microsurgery). Clinical and surgical measures were compared between approaches after adjustment for confounders with generalized linear multivariate regression. RESULTS: Length of hospital stay, postoperative meningitis, and operation time, cyst size, and baseline comorbidities did not differ between groups. Gross total resection (GTR) was achieved for all cases in microsurgery group while in endoscopic group it was lower (90% vs 100%; p = 0.005). Intraoperative hemorrhage occurred in 14 (23.3%) of endoscopic patients while for microscopic group it was zero (p &lt; 0.001). Post-operative shunt was required for two patients (one in endoscopic group and the other in microscopic group). Two patients had tumor recurrence, both being in endoscopic group. No mortality was detected in either group. Multivariate analyses were insignificant for the effects of clinical and demographic factors in occurrence of worse surgical outcomes (non-GTR and hemorrhage). CONCLUSIONS: Rate of intra-operative hemorrhage was higher in endoscopic method and GTR was lower, even after adjustment for other factors. This could be due to technologic shortcomings and limited space for resection maneuvers and complication management.

Risk factors for postoperative ventriculoperitoneal shunt requirement in pediatric patients with brain tumors invading or adjacent to CSF circulation pathways.

Hydrocephalus is a common comorbidity of brain tumors in children that may persist following brain tumor resection. This study aimed to explore perioperative risk factors associated with postoperative ventriculoperitoneal shunt (VPS) placement for tumors located at or adjacent to the CSF circulation pathway. Patients aged 0-18 years with tumors invading or adjacent to the CSF circulation pathways who underwent brain tumor resection between October 2015 and September 2021 were included in this study. The outcome metric was whether patients underwent VPS placement within 6 months of tumor resection. Patients were followed up every 3-6 months after surgery. Demographic and perioperative imaging characteristics, clinical variables, and long-term treatments, including radiotherapy or chemotherapy, were included in the analysis. Two hundred sixty-five children were included in this study. Of these patients, 38 (14.34%) underwent VPS placement within 6 months of tumor resection. One hundred thirty-two patients (49.81%) presented with preoperative hydrocephalus. Results from the multivariate analysis showed that medulloblastoma (OR 4.15, 95% CI 1.74-9.91, p = 0.001), lateral/third ventricle tumors (OR 4.07, 95% CI 1.33-12.30, p = 0.014), postoperative intraventricular hematoma (OR 3.36, 95% CI 1.53-7.38, p = 0.003), and presence of subdural hygroma in the nonoperated area within 48 hours after tumor resection (OR 2.78, 95% CI 1.15-6.74, p = 0.024) were independent risk factors for postoperative VPS placement. Postoperative lateral/third ventricle hematoma and subdural hygroma in the nonoperated area, anatomical location, and tumor histology may be potential risk factors for a postoperative VPS after brain tumor resection.

Postoperative shunt failure following hemispherectomy in pediatric patients with pre-existing hydrocephalus

ObjectiveThe risk of hydrocephalus following hemispherectomy for drug resistant epilepsy (DRE) remains high. Patients with pre-existing hydrocephalus pose a postoperative challenge, as maintaining existing shunt patency is necessary but lacks a clearly defined strategy. This study examines the incidence and predictors of shunt failure in pediatric hemispherectomy patients with pre-existing ventricular shunts.MethodsWe performed a retrospective chart review at our center to identify pediatric patients diagnosed with DRE who were treated with ventricular shunt prior to their first hemispherectomy surgery. Demographic and perioperative data were obtained including shunt history, hydrocephalus etiology, epilepsy duration, surgical technique, and postoperative outcomes. Univariate analysis was performed using Fisher’s exact test and Pearson correlation, with Bonferroni correction to a = 0.00625 and a = 0.01, respectively.ResultsFive of nineteen (26.3%) patients identified with ventriculoperitoneal shunting prior to hemispherectomy experienced postoperative shunt malfunction. All 5 of these patients underwent at least 1 shunt revision prior to hemispherectomy, with a significant association between pre- and post-hemispherectomy shunt revisions. There was no significant association between post-hemispherectomy shunt failure and valve type, intraoperative shunt alteration, postoperative external ventricular drain placement, hemispherectomy revision, lateralization of shunt relative to resection, postoperative complications, or postoperative aseptic meningitis. There was no significant correlation between number of post-hemispherectomy shunt revisions and age at shunt placement, age at hemispherectomy, epilepsy duration, or shunt duration prior to hemispherectomy.ConclusionsEarlier shunt revision surgery may portend a subsequent need for shunt revision following hemispherectomy. These findings may guide neurosurgeons in counseling patients with pre-existing ventricular shunts prior to hemispherectomy surgery.

Cerebrospinal fluid shunting for the management of cryptococcal meningitis: a scoping review

Objective: This scoping review aimed to describe studies that evaluate the management of cryptococcal meningitis (CM) using cerebrospinal fluid (CSF) shunts, types of shunts used, and clinically relevant patient outcomes. Methods: We searched in the following databases: PubMed, Web of Science/Core collection, Embase, the Cochrane Library, and clinicaltrials.gov on 1 April 2022. We included two-arm and one-arm cohort studies that evaluated clinically relevant patient outcomes. Case reports were used to describe the type of CSF shunts used and the rationale behind its selection. The selection and extraction processes were independently performed by two authors. Results: This study included 20 cohort studies and 26 case reports. Only seven cohort studies compared two groups. Ventriculoperitoneal shunt was the most commonly used type of shunt (82.1%). The main indications for placing a shunt were persistently high opening pressure (57.1%) and persisting neurological symptoms or deterioration (54.3%). Cohort studies suggest that patients with shunt showed improvement in some outcomes such as neurological symptoms and hospital stay length. The most common shunt complications were post-operative fever (1–35.6%) and shunt obstruction (7–16%). Conclusion: CSF shunts may improve some clinically relevant outcomes in patients with CM, but the evidence is very uncertain.

Post-Infarction Ventricular Septal Defect: A quarter century experience.

Post-infarction ventricular septal defect (VSD) is one of the known complications after acute myocardial infarction. This study investigated the clinical results after surgical repair of VSD. This retrospective study included all patients undergoing surgical repair of VSD from 1996 to 2020 in Oman. Out of a total of 75 patients, 62.5% were men, with a mean age of 59 years. The mean follow-up was 17.2 (7.5) years. Of the 75 patients, 34 (45.3%) patients died within 30 days. Total survival was 41.3% at 5 years, while the 10-year survival rate was 33.3%. Outcomes and predictors for 30 days mortality were the number of concomitant coronary involvement and anastomoses performed, residual postoperative shunt and postoperative dialysis. Even with surgical repair, early mortality of post-infarction septal defect is still considerably high. Early repair and the anatomically posterior rupture are predictors of early mortality. In patients surviving the immediate postoperative period, long-term survival is limited by pre-existing coronary artery disease, postoperative renal failure and the presence of a residual postoperative shunt.

Effect of endoscopic third ventriculostomy on the prevention of hydrocephalus and the need for shunting in patients undergoing surgery for posterior fossa masses, a comparative study

BackgroundDue to the compressive effect of the brain masses, hydrocephalus treatment is mainly achieved by shunting and discharge of fluid. However, some reports have shown the potential adverse effects of this method and its potential contraindications that result in focusing on preventive approaches like endoscopic third ventriculostomy (ETV). Hence, in the present study, the authors undertook a study to examine the hypothesis that preoperative ETV could reduce the likelihood of hydrocephalus and the need for shunting in patients undergoing surgery for posterior fossa tumors. MethodsIn the current cross-sectional study, 40 consecutive patients were scheduled for surgery to remove posterior fossa masses using ETV preoperatively (n = 23) or were considered as the controls with no preoperative ETV (n = 17). Afterward, these patients were followed up for 2 months after surgery regarding hydrocephalus and the need for shunt insertion. The postoperative change in the ventricular-cranial ratio (VCR) was also compared in 2 groups. ResultsOf 23 patients in the ETV group, none required postoperative shunting due to the lack of evidence supporting hydrocephalus; however, 7 patients were found to require shunting in the non-ETV group. Notably, the value of VCR significantly reduced in both groups with no significant difference. ConclusionETV protocol before the surgical removal of posterior fossa tumors can effectively reduce the rate of postoperative hydrocephalus, decreasing the need for postoperative shunting.

Randomized trial of shunt infection rates comparing intraoperative Vancomycin versus Gentamicin in ventriculoperitoneal shunt system preparation

BackgroundVentriculoperitoneal (VP) shunt is the mainstay of surgical management of patients with hydrocephalus. The insertion of ventriculoperitoneal shunt may be accompanied by many potentially life-threatening complications including shunt infection. Concerted efforts have been made to reduce shunt infection rates, including use of saline- antibiotic solutions containing antibiotics such as Gentamicin, mixture of Gentamicin and Vancomycin in shunt system preparation. We therefore set out to determine the infection rates following the use of intraoperative Gentamicin and Vancomycin in ventriculoperitoneal shunt system preparation and compare the infection rates. Therefore, a randomized single blind comparative study was carried out for a period of seventeen months, among 56 patients that presented to 2 tertiary health centers in Nigeria diagnosed of hydrocephalus. Patients were randomized into Vancomycin- and Gentamicin-shunt preparation groups. The outcome measure was postoperative shunt infection rates. Statistical analysis was performed using SPSS software (version) 21. Group comparisons were made using the Student's t-test for numerical variables, and chi-square test or fisher’s exact test for categorical variables. Statistical significance was inferred at p-value < 0.05.ResultFifty-six patients were included in the study. One patient was lost to follow-up in Vancomycin group. Another patient died in Gentamicin group of sudden death without the patient exhibiting symptoms of shunt infection leaving a total of 54 for analysis. All the patients included in the study were followed up for six months. Their mean ages were between 1688.5 ± 665.3 (days) for Vancomycin group and 10,222 ± 6635.8 (days) for Gentamicin group. There was male preponderance of 55.6% as against female of 44.4%. Majority of the hydrocephalus were of congenital cause accounting for 64.8%. There was one shunt infection in the Gentamicin group giving rise to an infection rate of 1.9% which was not statistically significant (P –value—0.313). The organism isolated was Pseudomonas species.ConclusionVentriculoperitoneal shunt infection rates can be reduced to the barest minimum if standard concentration of antibiotics is used to prepare the shunt hardware employing a standard surgical technique.

Postoperative Left Atrial Shunt in a Child with Ventricular Septal Defect Repair

Postoperative Left Atrial Shunt in a Child with Ventricular Septal Defect Repair

Predicting Factors for Mortality in Patients After the Modified Blalock-Taussig Shunt Procedure in Developing Countries: A Retrospective Study.

Blalock-Taussig (BT) is a palliative procedure that preserves blood circulation to the lungs and alleviates cyanosis in patients with congenital heart diseases and reduced pulmonary blood flow. BT shunt remains a routinely performed procedure in developing countries before definitive surgery. However, evidence on predictor factors of mortality after this procedure is still scarce in Indonesia. This study evaluated the predictive factors of mortality after the BT shunt procedure. This retrospective study evaluated the medical record data of all postoperative BT shunt patients at Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia, from 2016 to 2020. We performed univariate and multivariate analyses to identify the predictors of in-hospital mortality. The total subjects in this study were 197 children, 107 (54.3%) boys and 90 (45.7%) girls. The median values for age and body weight at the time of surgery were 20 months (11 days - 32 years) and 7.9 (2.7-42) kg. The most prevalent diagnosis was the Tetralogy of Fallot, found in 80 (40.6%) patients. In-hospital postoperative mortality was 20.8% (41 patients). Based on multivariate analysis, predictors associated with mortality were weight <4.25 kg (OR 20.9; 95% CI 7.4-59.0; p < 0.0001) and emergency procedures (OR 3.5; 95% CI 1.3-9.5; p = 0.016). The mortality rate after BT shunt at PJT Rumah Sakit Cipto Mangunkusumo was 20.8%. Based on multivariate analysis, weight <4.25 kg and emergency procedures are two predictors of mortality in BT shunt.

Minimally invasive surgical closure for ventricular septal defects through a horizontal right axillary minithoracotomy: early results at one center

Objectives: To investigate the early outcomes and cosmetic results of a horizontal right axillary minithoracotomy for closure of ventricular septal defects (VSDs) at Hanoi Heart Hospital.[1]&#x0D; Methods: a descriptive cross-sectional study. We retrospectively reviewed 119 children who underwent horizontal right axillary minithoracotomy for ventricular septal defects closure at Hanoi Heart Hospital from January 2022 to December 2022.&#x0D; Results: the average weight was 11.1 ± 8.2 kg, from 2.6 to 51.0 kg. The number of children below 6 months old accounted for 34.5% (41 patients). The rates of perimembranous VSD, infundibular VSD, inlet VSD, and muscular VSD were 68.1%, 27.7%, 3.4%, and 0.8%, respectively. The aortic cross-clamping time was 53.1 ± 23.5 minutes, the duration of cardiopulmonary bypass was 77.9 ± 29.7 minutes. The length of postoperative hospital stay was 7.4 ± 2.3 days. Postoperative residual shunt accounted for 5.9%, the rate of severe complications and hospital mortality were 0%.&#x0D; Conclusion: ventricular septal defects repair through a horizontal right axillary minithoracotomy at Hanoi Heart Hospital provided good early outcomes with satisfactory aesthetic results.

Prospective Study Comparing Outcome following Complete Polypropylene Suture Ligation versus Partial Thin Film Band Attenuation of Congenital Portosystemic Shunts in Dogs.

The main objective was to conduct a prospective study reporting the outcome for dogs with an extrahepatic congenital portosystemic shunt (CPSS) treated with a 'complete ligation where possible' philosophy. The second aim was to compare the outcomes following complete (C) polypropylene suture ligation versus partial thin film band (TFB) attenuation of a CPSS in dogs. Dogs that could not tolerate acute complete shunt ligation at surgery received partial shunt attenuation with TFB. Peri-operative complications, mortality, follow-up imaging findings, pre- and post-operative bile acid stimulation test results and details of any revision surgery performed were recorded. A follow-up health-related quality of life questionnaire enabled the calculation of a postoperative clinical shunt score, a quality of life score, and determined if any dogs were still on a hepatic diet and/or other medical management at a minimum of 6 months after surgery. Of the 110 dogs enrolled, 57 received complete ligation and 53 received partial TFB attenuation. Peri-operative mortality, the occurrence of post-attenuation neurological complications, the occurrence of multiple acquired shunts, the postoperative clinical shunt score and quality of life score were not significantly different between the two groups. Dogs in the C group were older, heavier and demonstrated a greater number of shunt classifications where the entry into the systemic circulation was the phrenic vein or azygous vein. Dogs in the TFB group had a greater number of unchanged bile acid concentrations after surgery, were more likely to remain on the hepatic diet and/or medical management after surgery and underwent a greater number of revision surgeries. There was variability in the precision of both ultrasound and computed tomographic angiography follow-up imaging compared to intra-operative mesenteric portovenography findings at revision surgery. Overall, dogs with an extrahepatic portosystemic shunt receiving either complete acute shunt ligation or partial TFB shunt attenuation are expected to have an excellent long-term clinical outcome and there is no reason to suggest that a dog able to tolerate complete acute shunt closure should be denied the benefit of this.

Staged or simultaneous operations for ventriculoperitoneal shunt and cranioplasty: Evidence from a meta-analysis.

To date, there is no consensus on the surgery strategies of cranioplasty (CP) and ventriculoperitoneal shunt (VPS) placement. This meta-analysis aimed to investigate the safety of staged and simultaneous operation in patients with comorbid cranial defects with hydrocephalus to inform future surgery protocols. A meta-analysis of PubMed, Ovid, Web of Science, and Cochrane Library databases from the inception dates to February 8, 2023 adherent to PRISMA guidelines was conducted. The pooled analyses were conducted using RevMan 5.3 software. The outcomes included postoperative infection, reoperation, shunt obstruction, hematoma, and subdural effusion. Of the 956 studies initially retrieved, 10 articles encompassing 515 patients were included. Among the total patients, 193 (37.48%) and 322 (62.52%), respectively, underwent simultaneous and staged surgeries. The finding of pooled analysis indicated that staged surgery was associated with lower rate of subdural effusion (14% in the simultaneous groups vs. 5.4% in the staged groups; OR = 2.39, 95% CI: 1.04-5.49, p = 0.04). However, there were no significant differences in overall infection (OR = 1.92, 95% CI: 0.74-4.97, p = 0.18), central nervous system infection (OR = 1.50, 95% CI: 0.68-3.31, p = 0.31), cranioplasty infection (OR = 1.58, 95% CI: 0.50-5.00, p = 0.44), shunt infection (OR = 1.30, 95% CI: 0.38-4.52, p = 0.67), reoperation (OR = 1.51, 95% CI: 0.38-6.00, p = 0.55), shunt obstruction (OR = 0.73, 95% CI: 0.25-2.16, p = 0.57), epidural hematoma (OR = 2.20, 95% CI: 0.62-7.86, p = 0.22), subdural hematoma (OR = 1.20, 95% CI: 0.10-14.19, p = 0.88), and intracranial hematoma (OR = 1.31, 95% CI: 0.42-4.07, p = 0.64). Moreover, subgroup analysis failed to yield new insights. Staged surgery is associated with a lower rate of postoperative subdural effusion. However, from the evidence of sensitivity analysis, this result is not stable. Therefore, our conclusion should be viewed with caution, and neurosurgeons in practice should make individualized decisions based on each patient's condition and cerebrospinal fluid tap test.

Efficacy and outcomes of shunt surgery for secondary hydrocephalus

Records of secondary hydrocephalus patients undergoing shunt surgery in the Department of Neurosurgery of Peking Union Medical College Hospital from September 2012 to April 2022 and their clinical characteristics and outcomes were retrospectively reviewed and analyzed. Among 121 patients who received first time shunt placement, the most common causes of secondary hydrocephalus were brain hemorrhage (55, 45.5%) and trauma (35, 28.9%). Cognition decline (106, 87.6%), abnormal gait (50, 41.3%) and incontinence (40, 33.1%) were the most prevalent manifestations. Postoperative central nervous system infection (4, 3.3%), shunt obstruction (3, 2.5%) and subdural hematoma/effusion (4, 3.3%) were the most frequent neurological complications. Overall incidence of postoperative complications was 9% (11 cases) in the current cohort. And 50.5% (54/107) of the patients receiving shunting achieved a Glasgow outcome scale (GOS) score of at least 4. Shunt surgery is preferred for secondary hydrocephalus, especially for secondary normal pressure hydrocephalus. Moreover, it is recommended to complete cranioplasty in staged operation or one-stage operation for the patients with decompressive craniectomy.