Shunt Surgery For Hydrocephalus Research Articles

The necessity of gait evaluation on the 7th day after tap tests for the idiopathic normal pressure hydrocephalus patients

BackgroundA tap test is established as an evaluation method to indicate shunt surgery for hydrocephalus, especially idiopathic normal pressure hydrocephalus (iNPH). The timing of gait assessment after the test is still controversial, while some studies reported the effectiveness of the gait evaluation up to 2nd day after tap tests. Our study explored whether the gait evaluation on the 7th day after a tap test is necessary.MethodsWe retrospectively evaluated 129 consecutive cases with possible iNPH who performed gait assessment on all 1st, 3rd, and 7th days after tap tests between May 2020 and February 2022. We reviewed the following items of the patients: age, sex, modified Rankin scale, iNPH grading scale, Mini-Mental State Evaluation (MMSE), and neurological imaging. The number of probable iNPH patients who improved their gait each day after the test was analyzed. We also assessed the number of definite iNPH patients and revealed the background characteristics of the patients who showed gait improvement on the 7th day after the tests.ResultsOf the 129 patients who met our inclusion criteria, 57 were judged as probable iNPH on the 1st day, 28 were new on the 3rd, and 23 were new on the 7th. The number of probable iNPH patients up to the 7th day after tests was significantly more extensive than that of those up to the 3rd (108 [83.7%] vs. 85 [65.9%]; 95% confidence interval [CI], p < 0.0001). The number of definite iNPH patients was also significantly more prominent when the evaluation after the tests was performed on all of the 1st, the 3rd, and the 7th days than just on the 1st (72 vs. 42; 95% CI, p = 0.00016) or both of the 1st and the 3rd (72 vs. 61; 95% CI, p = 0.00074). No statistically significant difference existed in the patients’ backgrounds except for the pre-tap test MMSE.ConclusionGait evaluation on the 7th day after tap tests, in addition to the first few days, may reduce the number of iNPH patients who miss the opportunity of getting beneficial treatment.

Clinical and ethical perspective of neurosurgical care in patients from beyond the southern border of Turkey: challenges of patients in war

Because an increasing number of patients travel internationally to seek medical care, Turkey offers comprehensive and outstanding services under extraordinary conditions as a neighboring country to countries that have been at war for long periods. In the past 5 years, the number of foreign patients arriving in Turkey for surgery has increased fivefold. The clinical and surgical data for non-immigrant foreign neurosurgery patients presenting for elective surgery within a 3.5-year-period are reported in this study. Data for 148 patients were assessed. The majority of these non-refugee patients were from Iraq. Ethical and social problems related to patients’ hospitalizations, follow-up, and adjuvant therapies are discussed, as well as the variety of surgeries performed. In total, 167 neurosurgical procedures were performed. Fifteen patients were previously operated on in other hospitals. Forty operations were performed for intracranial tumoral lesions including endoscopic transsphenoidal approaches. Nine shunt operations for hydrocephalus and six for congenital diseases were conducted. Eighty-four operations for spinal degenerative diseases/traumas and four for spinal tumors were performed. Eleven functional neurosurgery and four peripheral nerve procedures were performed. Other types of operations were also included. In a major surgery branch, it is generally difficult to treat foreign patients due to surgical, language, cultural/social, financial, and ethical problems. These problems and solutions are also discussed. Turkey is a preferred destination for medical tourism incorporating health screening, hospitalization, and surgical operations. Given the abundance and seriousness of surgical interventions, it is clear that larger and better supervised official organizations should be established, including paramedical and social workers as well as health care professionals.

Feasibility of fast brain diffusion MRI to quantify white matter injury in pediatric hydrocephalus.

Traditionally, diffusion MRI (dMRI) has been performed in parallel with high-resolution conventional MRI, which requires long scan times and may require sedation or general anesthesia in infants and young children. Conversely, fast brain MRI permits image acquisition without the need for sedation, although its short pulse sequences, susceptibility to motion artifact, and contrast resolution have limited its use to assessing ventricular size or major structural variations. Here, the authors demonstrate the feasibility of leveraging a 3-direction fast brain MRI protocol to obtain reliable dMRI measures. Fast brain MRI with 3-direction dMRI was performed in infants and children before and after hydrocephalus treatment. Regions of interest in the posterior limbs of the internal capsules (PLICs) and the genu of the corpus callosum (gCC) were drawn on diffusion-weighted images, and mean diffusivity (MD) data were extracted. Ventricular size was determined by the frontal occipital horn ratio (FOHR). Differences between and within groups pre- and posttreatment, and FOHR-MD correlations were assessed. Of 40 patients who met inclusion criteria (median age 27.5 months), 15 (37.5%), 17 (42.5%), and 8 (20.0%) had posthemorrhagic hydrocephalus (PHH), congenital hydrocephalus (CH), or no intracranial abnormality (controls), respectively. A hydrocephalus group included both PHH and CH patients. Prior to treatment, the FOHR (p < 0.001) and PLIC MD (p = 0.027) were greater in the hydrocephalus group than in the controls. While the mean gCC MD in the hydrocephalus group (1.10 × 10-3 mm2/sec) was higher than that of the control group (0.98), the difference was not significant (p = 0.135). Following a median follow-up duration of 14 months, decreases in FOHR, PLIC MD, and gCC MD were observed in the hydrocephalus group and were similar to those in the control group (p = 0.107, p = 0.702, and p = 0.169, respectively). There were no correlations identified between FOHR and MDs at either time point. The utility of fast brain MRI can be extended beyond anatomical assessments to obtain dMRI measures. A reduction in PLIC and gCC MD to levels similar to those of controls was observed within 14 months following shunt surgery for hydrocephalus in PHH and CH infants. Further studies are required to assess the role of fast brain dMRI for assessing clinical outcomes in pediatric hydrocephalus patients.

The risk of ventricular catheter misplacement and intracerebral hemorrhage in shunt surgery for hydrocephalus

Abstract Ventricular shunt insertion is a commonly performed neurosurgical procedure but few studies evaluate the rates of ventricular catheter (VC) misplacement and postoperative intracerebral hemorrhage (ICH) after shunt surgery. In this study, we evaluated the rate of VC misplacement and ICH after shunt insertion in hydrocephalus patients. A consecutive series of adult patients (n = 240) that received a ventricular shunt for hydrocephalus were included in the study. Misplacement was defined as tip of the VC located in the contralateral ventricle or intraparenchymal. The event of ICH was based on verification of intraparenchymal blood on an early ( Misplacement of the VC tip was found in 76 patients (33%); 70 patients with the VC tip in the contralateral ventricle and six patients (3%) with the VC tip intraparenchymal. ICH occurred in 8% of the patients. The shunt revision rate for accurately placed VCs was 17% compared to 21% for misplaced VC (p = 0.37). Proximal shunt failure occurred in 11% of the patients with VC misplacement compared to 5% of the patients with accurate VC placement (p = 0.07). VC misplacement occurred in one third and ICH was evident in 8% of the patients. However, VC misplacement did not significantly increase the shunt revision rate. Still, measures to optimize VC placement may be important to reduce risks following ventricular shunt placement.

The risk of ventricular catheter misplacement and intracerebral hemorrhage in shunt surgery for hydrocephalus

Communicating hydrocephalus is caused by an accumulation of cerebrospinal fluid (CSF) that is often treated with a ventricular shunt. There are few studies on the rates of ventricular catheter (VC) misplacement and postoperative intracerebral hemorrhage (ICH) after shunt surgery. In this study, we evaluated the rate of VC misplacement and ICH after shunt surgery. In addition, VC misplacement was correlated to postoperative ICH and shunt revision within six months, respectively.

An Intra-Abdominal Pseudocyst around a Ventriculoperitoneal Shunt due to Streptococcus Infection 7 Years after Shunt Surgery.

In 1999, a 50-year-old woman underwent ventriculoperitoneal (VP) shunt surgery for hydrocephalus after subarachnoid hemorrhage. She was hospitalized for fever and recurrent systemic seizures in November 2006. Head computed tomography (CT) showed only old changes. The seizures and fever were controlled by medicinal therapy. However, in December, her consciousness level suddenly decreased, and she showed progressive lower abdominal distension. Head CT showed marked ventriculomegaly, and abdominal CT showed a giant cystic mass at the shunt-tube tip in the lower abdominal cavity. Because thick pus was aspirated from the intra-abdominal mass, we diagnosed the patient with acute obstructive hydrocephalus due to an infected abdominal pseudocyst. Laparotomy and direct cyst drainage were performed, and antibiotic therapy against Streptococcus, the causative pathogen, was administered. The VP shunt tube was replaced. The postoperative course was uneventful, and postoperative CT showed hydrocephalus improvement and no pseudocyst recurrence. Abdominal pseudocysts, which are rare after VP shunt surgeries, usually occur after the subacute postoperative course in younger cerebral hemorrhagic cases. Our case was quite rare because the cyst developed in the chronic phase in an older patient and was caused by streptococcal infection. The cyst components should be examined before cyst drainage when choosing surgical strategies.

CSF hydrothorax: neither migration of peritoneal catheter into the chest nor ascites. Case report and review of the literature

Complications of ventriculoperitoneal (V/P) shunt surgery are generally due to infection, or mechanical or dynamic dysfunction. Thoracic complications like cerebrospinal fluid (CSF) hydrothorax are rarely seen. We present a CSF hydrothorax patient as a rare complication of V/P shunt surgery and review of the literature. The patient was a 7-month-old girl who had V/P shunt surgery for hydrocephalus. Six months after surgery, she was admitted to hospital with the complaint of cough. As the chest X-ray revealed hydrothorax, a chest tube was inserted. Although her shunt tip was in the abdominal cavity in shuntograms, positive beta-2 transferrin in liquid sample and Tc 99m cisternography proved that it was CSF. After we replaced her V/P shunt with a ventriculoatrial shunt, the liquid coming from the chest tube progressively diminished and disappeared, and her chest tube was removed. There are 36 CSF hydrothorax cases, including the present case, in the literature. There is peritoneal catheter migration into the chest in 22 of them (61.1 %). Half of the remaining 14 cases (38.9 %) without catheter migration have also CSF ascites. But, in the other half (seven cases), there is neither catheter migration nor CSF ascites as in the present case. CSF hydrothorax following V/P shunt surgery is a very rare complication that may cause serious respiratory distress. It is important to keep in mind that peritoneal catheter migration into the chest may or may not occur. Even ascites may not accompany CSF hydrothorax in a patient without peritoneal catheter migration.

Identification of Extremely Premature Infants at High Risk of Rehospitalization

Extremely low birth weight infants often require rehospitalization during infancy. Our objective was to identify at the time of discharge which extremely low birth weight infants are at higher risk for rehospitalization. Data from extremely low birth weight infants in Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network centers from 2002-2005 were analyzed. The primary outcome was rehospitalization by the 18- to 22-month follow-up, and secondary outcome was rehospitalization for respiratory causes in the first year. Using variables and odds ratios identified by stepwise logistic regression, scoring systems were developed with scores proportional to odds ratios. Classification and regression-tree analysis was performed by recursive partitioning and automatic selection of optimal cutoff points of variables. A total of 3787 infants were evaluated (mean ± SD birth weight: 787 ± 136 g; gestational age: 26 ± 2 weeks; 48% male, 42% black). Forty-five percent of the infants were rehospitalized by 18 to 22 months; 14.7% were rehospitalized for respiratory causes in the first year. Both regression models (area under the curve: 0.63) and classification and regression-tree models (mean misclassification rate: 40%-42%) were moderately accurate. Predictors for the primary outcome by regression were shunt surgery for hydrocephalus, hospital stay of >120 days for pulmonary reasons, necrotizing enterocolitis stage II or higher or spontaneous gastrointestinal perforation, higher fraction of inspired oxygen at 36 weeks, and male gender. By classification and regression-tree analysis, infants with hospital stays of >120 days for pulmonary reasons had a 66% rehospitalization rate compared with 42% without such a stay. The scoring systems and classification and regression-tree analysis models identified infants at higher risk of rehospitalization and might assist planning for care after discharge.

The pulsatility curve—the relationship between mean intracranial pressure and pulsation amplitude

The amplitude of cardiac-related pulsations in intracranial pressure has recently been suggested as useful for selecting patients for shunt surgery in hydrocephalus. To better understand how shunting affects these pulsations, we aim to model the relationship between mean pressure and pulsation amplitude in a wide range, including low pressures typically found after shunt surgery. Twenty-five patients with probable idiopathic normal pressure hydrocephalus were examined with lumbar constant pressure infusion investigations including drainage of cerebrospinal fluid. Mean pressure and pulsation amplitude were determined for consecutive 1.5 s intervals, starting at peak pressure (ca 35 mmHg), after infusion, continuing during spontaneous return to baseline and drainage to 0 mmHg. The amplitude versus pressure relationship revealed a linear phase at higher pressures (14–32 mmHg, lack of fit test: p = 0.79), a transitional phase and an essentially constant phase at low pressures (0–10 mmHg, slope = −0.02, lack of fit test: p = 0.88). Individual patients' baseline values were found in all three phases. The model and methodology presented in this paper can be used to preoperatively identify patients with potential for postoperative amplitude decrease and to predict how much the amplitude can be reduced.

Outcome analysis of shunt surgery in hydrocephalus

Aim:To study the clinical outcome of shunt surgeries in children suffering from hydrocephalus.Methods:A prospective study of 50 children with hydrocephalus who underwent a ventriculo-peritoneal shunt insertion over a period of two years. These patients were then followed up for shunt related complications, shunt revisions and outcome.Results:Twenty six of the 50 patients (52%) suffered from complications. The most common complications were shunt blockage (n=7) and shunt infection (n=6). These complications necessitated repeated shunt revisions.Conclusions:Infective complications of hydrocephalus are more likely to leave behind an adverse neurological outcome in the form of delayed milestones and mental retardation.

Shunt surgery for hydrocephalus in tuberculous meningitis: a long-term follow-up study

Hydrocephalus is a common complication of tuberculous meningitis. Case studies of 114 patients with tuberculous meningitis and hydrocephalus, who underwent shunt surgery between July, 1975, and June, 1986, were reviewed to evaluate the long-term outcome and to outline a management protocol for these patients based on the results. Seven factors were studied in each case: 1) age at admission; 2) grade on admission (I to IV, classified by the authors; Grade I being the best and Grade IV being the worst); 3) duration of alteration of sensorium; 4) cerebrospinal fluid (CSF) cell content at initial examination; 5) CSF protein levels at initial examination; 6) number of shunt revisions required; and 7) the necessity for bilateral shunts. During a long-term follow-up period ranging from 6 months to 13 years (mean 45.6 months), the mortality rate was 20% for patients in Grade I; 34.7% for patients in Grade II; 51.9% for patients in Grade III; and 100% for patients in Grade IV. Only the grade at the time of admission was found to be statistically significant in determining final outcome (p less than 0.001). Based on these results, the authors advocate early shunt surgery for Grade I and II patients. For patients in Grade III, surgery may be performed either if external ventricular drainage causes an improvement in sensorium or without selection. All patients in Grade IV should undergo external ventricular drainage and only those who show a significant change in their neurological status within 24 to 48 hours of drainage, should have shunt surgery.

Bacteraemia by &lt;i&gt;P. aeruginosa &lt;/i&gt;Associated with Nephrotic Syndrome After Shunt Operation for Hydrocephalus

One patient of sepsis by P. aeruginosa after the implanting of a ventriculoatrial valve following extirpation of an expansive intracranial process is studied. During the evolution of the septic process there appeared as associated nephrotic syndrome with histologic lesions corresponding to an acute exudative glomerular nephritis. The germ became resistant to the antibiotics used, carbenicillin plus gentamicin, being later sensitive only to fosfomycin with which finally complete cure was achieved.

Glomerulonephritis associated with shunt operations for hydrocephalus

Glomerulonephritis associated with shunt operations for hydrocephalus

NEPHROTIC SYNDROME ASSOCIATED WITH BACTERÆMIA AFTER SHUNT OPERATIONS FOR HYDROCEPHALUS

NEPHROTIC SYNDROME ASSOCIATED WITH BACTERÆMIA AFTER SHUNT OPERATIONS FOR HYDROCEPHALUS

PERSISTENT BACTERAEMIA FOLLOWING VENTRICULO-CAVAL SHUNT OPERATIONS FOR HYDROCEPHALUS IN INFANTS.

SUMMARYNineteen cases of persistent bacteraemia occurred in a series of 300 children who had ventriculo‐caval shunts using the Holter valve. These children were operated on between 1958 and April 1962 and were followed up to December 1962. Six cases occurred in children whose valves had become exposed by pressure necrosis. These were all due to Staph. aureus. Eight infections were due to Staph. albus, either alone or in combination with another organism.A description is given of an epidemic of four cases of bacteraemia caused by an unusual organism, atypical Serratia marcescens. Efforts made to trace the source of this infection were inconclusive. The remaining three infections were due to other organisms.Removal of the shunt was the only effective method of treatment in all cases. Four patients died.Theories of the causation of the persistent bacteraemia are discussed.RÉSUMÉ Bactériémie persistante comme complication de l'opération de la dérivation ventriculo‐cavale effectuée au cours du traitement de l'hydrocéphalie chez les nourrissons. L'auteur décrit 19 cas de bactériémie persistante survenus dans un groupe de 300 enfants ayant une dérivation ventriculo‐cavale utilisant la valve de Holter. Ces enfants ont été opérés entre 1958 et avril 1962 et suivis jusqu'en décembre 1962. Six cas se sont produits chez des enfants dont les valves s'étaient dćnudées par nécrose dûe á la pression. Staph. aureusétait l'organisme responsable dans tous les cas. 8 autres infections étaient provoquées par Staph. albus seul ou associéà un autre germe.L'auteur décrit une épidémie de 6 cas de bactériémie causée par un organisme inhabituel: Serratia marcescens atypique. Toute tentative pour découvrir l'origine de cette infection a été vaine. Les 3 dernières infections étaient dûes à d'autres organismes.La suppression de la dérivation était la seule méthode de traitement efficace dans tous les cas. 4 patients sont morts. L'auteur discute les théories sur l'étiologie de la bactériémie persistante.Andauernde Bakteraemie als Komplikation bei Ventrikulo‐Vena‐Cava Shunt Operation bei der Behandlung von kindlichem HydrozephalusEs werden 19 Fälle von andauernder Bakteraemie beschrieben. Diese traten in einer Reihe von 300 Kindern auf, die eine ‘Shunt’ Operation mit Anwedung der Holter Klappe durchgemacht hatten. Die Operationen wurden zwischen 1958 und April 1962 ausgeführt und die Fälle bis Dezember 1962 nachuntersucht. In 6 Fällen handelte es sich um Kinder deren Herzklappen durch Drucknekrose blosgelegt worden waren. In allen von diesen war der Staph. aureus der Krankheitserregar. 8 Infektionen wurden von Staph, albus verursacht, der enweder als einziger Erreger oder inZUSAMMENFASSUNGEs wird eine Epidemie von 4 Fällen von Bakteraemie beschrieben, die von einem seltenen Erreger erzeugt wurde, nämlich dem atypischen Serratia marcescens. Es wurde versucht auf den Grund dieser Infektion zu kommen, doch erwiesen sich die Resultate als unüberzeugend. Die weiteren 3 Infektionen waren von anderen Erregern verursacht worden.In allen Fällen erwies sich die Entfernung des ‘Shunts’ als die einzig wirksame Behand‐lungsmethode. 4 Patienten starben. Es werden die Theorien über die Åtiology der andauern‐den Bakteraemie besprochen.

EARLY SHUNT OPERATIONS FOR HYDROCEPHALUS.

EARLY SHUNT OPERATIONS FOR HYDROCEPHALUS.