Shunt System Research Articles

Contactless Ultrasonic Cavitation for the Prevention of Shunt Obstruction in Hydrocephalus: A Proof-of-Concept Study.

Obstructive failure of implanted shunts is the most common complication in the treatment of hydrocephalus. Biological material and debris accumulate in the inner walls of the valve and catheters block the normal flow of the drained cerebrospinal fluid causing severe symptoms with high morbidity and mortality. Unfortunately, at present, there is no effective preventive protocol or cleaning procedure available. To assess whether externally applied, focused ultrasound beams can be used to resuspend deposits accumulated in brain shunts safely. A computational model of an implanted brain shunt was implemented to test the initial design parameters of a system comprising several ultrasound transducers. Under laboratory conditions, configurations with 3 and 4 transducers were arranged in a triangle and square pattern with their radiation axis directed towards a target model of the device, 2 catheters and a brain shunt filled with water and deposited graphite powder. The ultrasound beams were then concentrated on the device across a head model. The computational model revealed that by using only 3 transducers, the acoustic field intensity on the valve was approximately twice that on the brain surface suggesting that acoustic cavitation could be selectively achieved. Resuspension of graphite deposits inside the catheters and the valve were then physically demonstrated and video-recorded with no temperature increase. The technology presented here has the potential to be used routinely as a noninvasive, preventive cleaning procedure to reduce the likelihood of obstruction-related events in patients with hydrocephalus treated with an implanted shunt.

Maneuver protocol for outpatient telemetric intracranial pressure monitoring in hydrocephalus patients

IntroductionTelemetric intracranial pressure measurement (tICPM) offers new opportunities to acquire objective information in shunted and non-shunted patients. The sensor reservoir (SR) provides tICPM modality at a decent sampling rate as an integrated component of the CSF shunt system. The aim of this study is to perform tICPM during a defined protocol of maneuvers in an outpatient setting as feasibility study including either shunt-dependent patients or candidates for possible shunt therapy.MethodsA total of 17 patients received a SR and were investigated within a protocol of maneuver measurements involving different body postures (90°, 10°, 0°, and − 10°), breathing patterns (hypo- and hyperventilation), and mild venous congestion (Valsalva, Jugular vein compression), while the latter two were performed in lying postures (10° and 0°). The cohort included 11 shunted and 6 non-shunted (stand-alone-SR) patients. All measurements were evaluated using an ICP-analysis software (ICPicture, Miethke, Germany) looking at ICP changes and amplitude (AMP) characteristics.ResultsThe shunted patient group consisted of 11 patients (median age: 15.8 years; range: 4–35.2 years) with either a primary shunt (n=9) and 2 patients received a shunt after stand-alone-SR tICPM. Six patients were enrolled with a stand-alone SR (median age 11.9 years, range 3.6–17.7 years). In the stand-alone SR group, maneuver related ICP and AMP changes were more sensitive compared to shunted patients. Postural maneuvers caused significant ICP changes in all body positions in both groups. The highest ICP values were seen during Valsalva maneuver, provoked by the patients themselves. In the stand-alone group, significant higher ICP values during hyperventilation were observed compared to shunted individuals. In shunted patients, a significant correlation between ICP and AMP was observed only during hyperventilation maneuver, while this correlation was additionally seen in Valsalva and jugular vein compression in stand-alone patients.ConclusionSR-related tICPM is helpful to objectify diagnostic evaluation in patients with CSF dynamic disturbances. The defined protocol did result in a wide range of ICP changes with promising potential for effective outpatient tICPM investigation. Since the correlation of ICP and AMP was observed during mild venous congestion maneuvers it appears to be specifically helpful for the evaluation of intracranial compliance. Further investigations of maneuver-related tICPM in a larger population, including variable pathologies, are needed to further establish the protocol in the clinical practice.

Trans anal Extrusion of VP Shunt: Early Management Produce Better Outcome

An 11 months old male child, with congenital HCP presented with extrusion of shunt tube form the anus after defecation. He was managed by VP shunt 8 months back; 6 months later lower end was revised for obstruction. Lower end of shunt exteriorized and the distal end was cut and pulled out per rectally. Later ETV done patient discharged uneventfully.Key words: VP Shunt, Trans anal, Extrusion, Management, Outcome. Bang. J Neurosurgery 2022; 11(2): 138-140

Successful management of symptomatic hydrocephalus using a temporary external ventricular drain with or without endoscopic third ventriculostomy in pediatric patients with germinoma.

The objective of this study was to describe the management of hydrocephalus in a cohort of pediatric patients with germinoma. The authors conducted a retrospective chart review of patients with germinoma and symptomatic hydrocephalus treated at the Hospital for Sick Children between 2002 and 2020. Descriptive data included tumor location, CSF diversion procedure (external ventricular drain [EVD], endoscopic third ventriculostomy [ETV], ventriculoperitoneal [VP] shunt) and outcomes. The frontooccipital horn ratio (FOR) method was used to determine the presence of ventriculomegaly. Of 39 patients with germinoma, 22 (73% male) had symptomatic hydrocephalus at diagnosis (11 pineal, 4 suprasellar, and 7 bifocal). Management of hydrocephalus included EVD (n = 5, 22.7%), ETV (n = 5, 22.7%), and combination ETV and EVD (n = 7, 31.8%), whereas 5 patients (22.7%) did not undergo surgical intervention. The median FOR at diagnosis was 0.42 (range 0.38-0.58), which correlated with moderate to severe ventriculomegaly. Carboplatin and etoposide-based chemotherapy induced fast tumor shrinkage, avoiding CSF diversion (n = 5) and resolving hydrocephalus with a transient EVD (n = 5). The median duration until EVD removal was 7 days (range 2-10 days). Two of 12 patients with EVD ultimately required a VP shunt. Kaplan-Meier overall survival was 100% and progression-free survival was 96.4% at a median follow-up of 10.4 years. Timely initiation of chemotherapy is imperative to rapidly reduce tumor bulk in children with germinoma and limits the need for VP shunt insertions. In children in whom CSF diversion is required, hydrocephalus may be successfully managed with a temporary EVD ± ETV.

Other Central Nervous System Infections(Including Fungal Infection, Tuberculosis, and Parasitic Infection)

This review describes cryptococcal meningoencephalitis, tuberculous meningitis, neurosyphilis, and toxoplasma encephalitis. Central nervous system infections are neurological emergencies associated with mortality or other outcomes. Therefore, early diagnosis and treatment are critical. Fungal or gondii infections are rare and affect compromised hosts who are HIV positive, have diabetes, or take immunosuppressive or anticancer drugs. Cryptococcal antigens in the serum and cerebrospinal fluid are useful for the diagnosis of cryptococcal meningoencephalitis. RPR and TPHA tests are useful for the diagnosis of neurosyphilis. Cryptococcal meningoencephalitis and tuberculous meningitis often develop into hydrocephalus, making VP shunt necessary. Antifungal drugs for cryptococcal meningitis are limited by the blood-brain barrier, making a full recovery difficult; in such situations, intraventricular antifungal treatment is required.

Shunt Migration in Children: A Patient Level Systematic Review of Risk Factors and Outcome.

Ventriculoperitoneal shunt insertion is one of the most common pediatric neurosurgical procedures performed. Shunt migration is one of the infrequent complications of shunt insertion and often requires a change of the shunt system. The objective of the study is to systematically review the sites of shunt migration and factors associated with mortality in children. Comprehensive search and review of the literature were done according to the PRISMA guidelines. Citations were selected using the following inclusion criteria: 1. Shunt migration in ventriculoperitoneal shunts was the primary inclusion criteria, 2. Age of the study participants <18 years, and 3. Patient-level data available in the study. Exclusion criteria were 1. Age >18 years, 2. Patient-level data not available, 3. Full text of the article not available, and 4. Article not in the English language. Sites of migration and risk factors for mortality were assessed. In total, 111 studies out of 161 studies were included in the final analysis. The scrotum was the most common site of shunt migration (30.67%), followed by anal migration, migration into the bowel, chest wall/thoracic migration, and intracranial/subgaleal migration. Univariate analysis showed the presence of infection and site of migration to be significantly associated with mortality. Multivariate analysis showed the presence of infection and age at presentation to be significant predictors of mortality. This study highlights that presence of infection is a significant predictor of mortality in cases of shunt migration. Infection should be managed expeditiously for optimum management of shunt migration.

Characteristic and management of pediatric arachnoid cysts: A case series

Background/Aim: Arachnoid cysts (ACs) are the collection of fluid, which is similar in composition to cerebrospinal fluid, within the congenitally duplicated arachnoid membrane. ACs are clinically silent lesions, but sometimes they can manifest themselves with headache, convulsion, focal neurological deficits, cognitive decline, torticollis, and macrocephaly. Although the appropriate surgical approach is less clear, there is a consensus on the need for surgical treatment in symptomatic ACs. This study aims to reveal the advantages and disadvantages of cystoperitoneal shunt and microsurgical fenestration techniques.&#x0D; Methods: One hundred ninety-one consecutive patients from 1 month to 15 years old with AC were evaluated for suitability. Sixteen patients who underwent surgery were included in the study. Medical records of the patients with AC managed at our institutions were retrospectively collected and analyzed. Sixteen of 191 patients underwent surgical treatment via craniotomy for microsurgical cyst fenestration (CF) and cysto-peritoneal shunting (CS). CF was performed with partial cyst wall excision in all patients.&#x0D; Results: Seizure was the most common presentation in the patients, followed by headache and trauma, respectively. In our series the most common indications of the surgery were increased intracranial pressure (IICP). CF was performed in nine patients, and CS was performed in seven as the primary treatment. CS-related complications, such as infection (n = 2), dysfunction (n = 2) and intraabdominal abscess (n = 1) were the most commonly observed complications. No infections were observed after CF, but subdural hematoma was observed in one child.&#x0D; Conclusions: Although the most common symptoms in cases with arachnoid cysts are headache, rare symptoms, such as torticollis, may exist. Due to this, clinicians should reveal the cyst-complaint relationship first. Given the increased complications of CS, in addition to shunt independency and being free from shunt-related complications, the microsurgical CF with wide excision of the membranes seems to be the more preferable surgical option.

Lumboperitoneal Shunt Preference in Treatment of Patients with Normal Pressure Hydrocephalus

Objective: To demonstrate the advantages of Lumboperitoneal (LP) shunt surgery applied to patients with normal pressure hydrocephalus (NPH).Methods: Preoperative, intraoperative and postoperative data of 20 patients who underwent LP shunt surgery for NPH between 01/01/2012 and 07/04/2022 at the Neurosurgery Clinic of Ordu University Training and Research Hospital were analyzed. The demographic, clinical and laboratory data of the patients as well as their medical records were reviewed. Patients who underwent LP shunt with the diagnosis of normal pressure hydrocephalus in our clinic were screened retrospectively, and the success rates and complications after the surgical intervention applied to these patients were recorded.Results: Statistically significant improvements were recorded in Modified Ranking Scale Scores and Mini-Mental State Examination Scores at the end of the first year. The incidence of Gait Disturbance did not differ significantly by gender, The incidence of dementia did not differ significantly by gender, The incidence of urinary incontinence showed a significant change according to gender While all of the women diagnosed with normal pressure hydrocephalus had urinary incontinence in the preoperative period, this rate was seen in only 66.7% of the men. Gait disturbance improved in 80%, urinary incontinence in 60%, and cognitive functions in 60% of patients. No neurogenic complication developed in our operated patients. Wound infection occurred at the abdominal incision site in only two patients (10%). Subcutaneous hematoma occurred in the abdominal region in one patient (5%). Conclusion: LP shunt surgery has a lower complication rate than VP shunt surgery and is a more easily applicable surgical technique. LPS surgery is a safe and minimally invasive treatment method. It has lower complication rates compared to VPS . LPS surgery is an effective surgical technique. It can be used as an alternative to the VPS procedure in the treatment of NPH patients

Large-Scale Multimedia Communication on A Cloud Computing Platform

Abstract: This research examines the creation of a multimedia communication platform to expand the size of multimedia communication based on cloud computing (CC). The research focuses on high-quality material, multimedia profit avenues, and copyright awareness. Big data diversion under cloud computing optimizes data grouping and pattern identification. Cloud computing's typical large data shunting technology uses open-source embedded system architecture. The connecting coil ties the shunting system's switch to the cloud computing platform's switch, resulting in data loss and corruption. Using this method, it has been shown that CC cannot reach the ideal resource utilization, SLA violation rate, and energy use. Experiments reveal a divergence from this research. The major goal of media development is now the growth and self-awareness of media. Largescale multimedia communication needs an architecture for cloud computing with dynamic growth, efficient processing, and flexible resource scheduling

Thyroid Hormones and Health-Related Quality of Life in Normal Pressure Hydrocephalus Patients before and after the Ventriculoperitoneal Shunt Surgery: A Longitudinal Study.

Objective: The aim of this study was to explore the serum levels of thyroid-stimulating hormone (TSH), free thyroxine (FT4), and free triiodothyronine (FT3), and to correlate the hormone levels among iNPH patients with their self-reported quality of life before and three months after the surgery. Methods: Twenty-five patients (52% women), mean age 63.5 (SD 9.5) years, were operated on by inserting a VP shunt. Patients with FT3 level ≤3.34 pmol/L were diagnosed as having low T3 syndrome. Results: The changes in thyroid hormones resulted in a U-shaped curve throughout the follow-up period. The significant changes occurred the next day after the surgery, including a decrease in TSH, FT3, and an increase in FT4. Additionally, the decrease occurred in mean FT3 for six patients with preoperative low T3 syndrome. Three months after the surgery, thyroid hormones were restored to their baseline and/or normal values. All six patients with preoperative low T3 syndrome had significant improvement in all SF-36 subscales (except for the role emotional and physical). Patients with preoperative normal high FT3 and low FT4 had increased FT3/FT4 ratio which was associated with deterioration in all SF-36 subscales 3 months after the surgery. Conclusion: Routine assessment of the FT3/FT4 ratio might be a simple and effective tool for the risk stratification of iNPH patients before VP shunt surgery.

Male Predisposition in Cerebellar Mutism Syndrome: a Cohort Study.

The aim of this study was to explore the association between sex and cerebellar mutism syndrome and to examine other potential risk factors. This ambispective cohort study examined 218 pediatric patients (132 boys) with a posterior fossa tumor who underwent tumor resection from July 2013 to March 2021. The patients' demographics and tumor characteristics were examined and statistically analyzed to explore the associations among the variables. Multivariable and subgroup analyses were conducted to validate the independent risk factors for cerebellar mutism syndrome (CMS). The male and female patients did not differ significantly in terms of age, tumor size, tumor location, tumor consistency, VP shunt placement before resection, extent of resection, or surgeon, as well as with respect to the presence of hydrocephalus or paraventricular edema. The overall incidence of CMS was 32.6%. The incidence of CMS was significantly higher in male patients than that in female patients (41.7% vs. 18.6%; P = 0.001). In the multivariable analysis, male sex (adjusted odds ratio [OR], 3.27; P = 0.001), solid tumor consistency (adjusted OR, 5.61; P = 0.001), midline location (adjusted OR, 3.78; P = 0.004), and hydrocephalus (adjusted OR, 2.56; P = 0.047) were independent risk factors for the CMS. Chi-square analysis revealed that solid tumor consistency and midline location were associated with medulloblastoma (P < 0.001). Male patients had a higher risk of developing CMS after a posterior fossa tumor resection. Midline location, solid tumor consistency, and hydrocephalus were independent risk factors for CMS.

Assessment of nurse’s knowledge about care of children treated with Ventricular Peritoneal Shunt

Background:Hydrocephalus in children can treated medically or surgically, mostly surgical treatment managed preferred, usually by an opening of the obstructive lesion carried out by ventriculostomy or a shunt (ventriculoatrial, ventriculoperitoneal) insertion. The most common procedure is the insertion of a ventricular peritoneal VP shunt in neurosurgical intervention preferred treatment for hydrocephalus, which is an effective procedure for drainage the CSF from the brain ventricles in to peritoneal cavity. Aim: assessment nurse’s knowledge toward care of children treated with ventricular peritoneal shunt. Construct and Apply an interventional program for nurse’s according to their need assessment. Methods: A pre experimental design that perform to the interventional program at Mosul Teaching Hospitals. from 3ed of December / 2021 till 30th of March / 2022. The sample of the study was chosen purposively (non-probability). The participant was (30) nurses from morning and evening shift.The format of questionnaire consists of two parts (demographic data, knowledge questionnaire). Results: the total nurses' knowledge about care for children treatment with ventricular peritoneal shunt, that 53.3% (16) of the sample at Poor Knowledge level with mean (1.53) and standard deviation (0.629) of knowledge in assessment result. Conclusions: Most nurses in age between (20-29 years) and bachelor level of education. The years of work in hospital was between (1-5 years). The nurses have less than five years of experience in neurosurgery unit. And two thirds of nurses did not receive training courses about VP shunt. The result of total nurse’s knowledge during assessment was poor.

Extrusion of the Peritoneal Catheter of Ventriculoperitoneal Shunt Through the Rectum

A ventriculoperitoneal shunt is a common procedure for hydrocephalus. It is a life-saving procedure but is not risk-free. Some of the most common complications are shunt blockage and infection but they can also present with uncommon presentations. We report A child who presented with extrusion of a shunt catheter through the rectum. It was treated as an infected shunt. Externalization of the shunt was done through the abdominal site and the exposed shunt was removed through the rectum by gentle traction. Once CSF was clear a new shunt was placed on the opposite side. Keywords: VP shunt, shunt infection, anal extrusion. Key Message: Exposure to a shunt catheter through the rectum is an uncommon presentation. It should be treated as an infected shunt. Most of these cases do not cause peritonitis or meningitis. The exposed shunt catheter should be removed through the rectum by gentle traction. Abbreviations: VP-Ventriculoperitoneal, CSF: Cerebrospinal fluid. ETV -Endoscopic Third Ventriculostomy.

Per-Operative External Ventricular Drainage Results in Children with Posterior Fossa Tumors and Hydrocephalus

Objective: We determined the outcome of per operational external ventricular drainage in pediatric patients with posterior fossa tumors and hydrocephalus.&#x0D; Material And Methods: 54 patients included presenting with posterior fossa tumors and mild to moderate hydrocephalous were considered for per operative external ventricular drainage. The external ventricular drain was then weaned off in one week. If it cannot be removed due to persistent hydrocephalous it was converted into a permanent ventriculoperitoneal shunt.&#x0D; Results: In the study, the mean age was 7 years. Twenty-seven children had ependymoma, 19% of children had medulloblastoma, and 54% of children had pilocytic astrocytoma. Moreover, 67% of children had weaned off and 33% of children had converted to VP shunt. There existed an insignificant difference in the outcome (yes/ no) concerning age groups, gender, and tumor type.&#x0D; Conclusion: Our study concludes that the outcome of per operative external ventricular drainage was weaned off (67%) and converted to VP shunt (33%) in pediatrics with posterior fossa tumors and hydrocephalous.

Efficacy of endoscopic management of primary central nervous system lymphoma: a multicentric study and literature review.

To date, confined intra-ventricular localization of primary central nervous system lymphoma (PCNSL) has been usually managed with open surgical resection and/or stereotactic biopsy; nonetheless, the endoscopic approach to such localization can provide many advantages over standard microsurgery and/or stereotactic biopsy. Here we present our experience in managing such a rare pathology through the endoscopic approach. In order to gather more information about such a rare pathology, a retrospective multicentric study on a prospectively built database has been performed during a 5year period. Ten different European centers have been involved. A total of 60 patients, 25 women and 35 men, have been enrolled in the study. The mean age was 65.3years. The mean lesion size was 40.3mm. Among all selected patients, 40 (66.6%) had superficial lesions within the ventricle, whereas the remaining 20 (33.4%) had lesions involving/extending to deeper structures. All surgical procedures were uneventful and ETV was deemed necessary only in 20/60 cases. In our experience, endoscopic management of intraventricular PCNSL is an effective option. It should be considered after a careful examination of neurological and immunological status, alternative options for diagnostic sampling, location of the lesion, and presence or absence of hydrocephalus. Endoscopic management could be considered as a safe and minimally invasive option to obtain: (a) a biopsy sample of the lesion for further diagnostic workup, (b) CSF diversion through third ventriculostomy or VP shunt for the management of hydrocephalus, and (c) insertion of ventricular access devices for long term medical management and whenever necessary as a rescue option for ventricular tap.

Modified Tunneling (Capsule Modification Technique) for Subcutaneous Placement of Ventriculo-Peritoneal Shunt in Patients with Hydrocephalus: Technical Note

AbstractOne of the first procedures that a neurosurgical resident/trainee assists and performs is the placement of a ventriculoperitoneal shunt, the commonest being the Chhabra shunt system. However, no modification has been done or proposed in performing this procedure keeping in mind the position of the chamber of the Chhabra shunt system. As the tunneller has to pass through the subcutaneous plane having tight adhesions, it is essential to have a proper and adequate space for the chamber. Utilization of instruments such as artery forceps or Penfield dissectors for the same results in the creation of inappropriate or a roughly estimated space, which is either inadequate, causing kinking of tubing, or too roomy that results in the peri-catheter collection of cerebrospinal fluid with the risk of infection.We propose a novel method of utilizing a modified tunneller with a distal “Capsule” that provides just enough space both, at the appropriate distance and for adequate length, for the chamber to fit snugly and thus avoid procedure-related risks and complications as well as reduce the total duration of surgery, thereby decreasing the chances of infection.

Outcome of microsurgical clipping of ruptured intracranial aneurysms: An early experience

Introduction: Rupture of intracranial aneurysm is a catastrophic event with a mortality rate of 25% to 50%. Despite recent advances in endovascular techniques, microsurgical clipping is the standard modality of treatment due to its relative low cost and feasibility. We prospectively analyzed the cases of microsurgically clipped aneurysms with an aim to evaluate the overall outcome and the pretreatment variables predicting outcomes. Materials and methods: This is the prospective study of 15 consecutive microsurgical clippings of ruptured intracranial aneurysms conducted in the Department of Neurosurgery at College of Medical Sciences Teaching Hospital, Chitwan, Nepal from April 2018 to March 2020. Patients were followed up for at least three months and assessed according to modified Rankin Scale (mRS). Results: The mean age of patients was 55.47 years with female predominance. The most common location of aneurysms was Middle cerebral artery bifurcation (53%). Favorable outcome (mRS score 1 to 3) was achieved in 60% of patients whereas 40% had unfavorable outcome (mRS score 4 to 6). Poor Hunt and Hess at presentation and presence of vasospasm/infarction were associated with poor outcome. Overall mortality rate was 27%. Three patients required VP shunt whereas three patients each had vasospasm/Delayed ischemic neurological deficit (DIND) and intra-operative rupture. Conclusion: Microsurgical clipping of aneurysms is a standard treatment modality with good results despite recent advances in endovascular techniques. Favorable outcome can be achieved in patients with good Hunt and Hess grade at presentation and without clinical vasospasm/DIND.

Long-term quality of life after ETV or ETV with consecutive VP shunt placement in hydrocephalic pediatric patients

PurposeEndoscopic third ventriculostomy (ETV) and ventriculoperitoneal shunting are well-established treatments of obstructive hydrocephalus (HCP) in adult and pediatric patients. However, there is a lack of data with regard to the quality of life (QoL) of these patients during long-term follow-upMethodsInclusion criteria were pediatric patients with endoscopic treatment of hydrocephalus at the University Medicine Greifswald between 1993 and 2016. Patients older than 14 years at present were assessed with the Short Form-12 (SF-12) questionnaire. Patients younger than 14 years of age were assessed with the KINDL-R questionnaire that was completed by their parents. Patients’ values were compared with the scores of a corresponding age-matched group of the healthy population and with patients who received later shunt treatment. Information about comorbidities, current symptoms, and educational level were gained by an additional part. Comparative analysis between patients with ETV success and failure (defined as shunt implantation after ETV) was performed.ResultsA total of 107 patients (53 m, 54f) were included. Fifty-seven/107 patients (53.3%) were considered as ETV success. Mean age at ETV was 6.9 ± 5.9 years. Fifty-four statements of 89 patients that are still alive were gained (response rate 63%). Of these, 49 questionnaires were complete and evaluable (23 m, 26f; mean age 19.8 ± 10.0 years with an average follow-up period of 13.7 ± 7.2 years). Twenty-six/49 patients (53.1%) are considered ETV success. No statistically significant differences could be obtained between patients with ETV success and ETV failure. Patients older 14 years show QoL within normal range, patients younger than 14 years show significantly lower result regarding their environment of peers and social contacts. Patients younger than 6 months at the time of ETV and patients with posthemorrhagic HCP show significantly lower physical QoL. Gait disturbance, fatigue, and seizures are associated with a lower QoL, and educational level is lower than in the normal population.ConclusionsPatients who underwent ETV in childhood do not have a lower health-related QoL in general. Subsequent insertions of ventriculoperitoneal (vp) shunts do not lower QoL. Certain subgroups of the patients show lower results compared to the healthy population.

Actions of N-acetylcysteine, daptomycin, vancomycin, and linezolid on methicillin-resistant Staphylococcus aureus biofilms in the ventriculoperitoneal shunt infections: an experimental study

BackgroundShunt systems are used to provide cerebrospinal fluid drainage in the treatment of hydrocephalus. Recently, antibiotic-impregnated shunt systems are used to prevent colonization in the ventriculoperitoneal catheters. Methicillin-resistant Staphylococcus aureus (MRSA) is the most common causative microorganism of shunt infections. The aim of the study is to investigate effects of several substances on MRSA biofilms in the ventriculoperitoneal catheters.MethodsThe present study consists of mainly eight groups (each has two subgroups as antibiotic-impregnated and nonantibiotic-impregnated catheters). In addition, each group contains six molds using MRSA strains. In this study, daptomycin (DAPT) (2 mg/ml), vancomycin (VAN) (10 mg/ml), linezolid (LIN) (2 mg/ml), N-acetylcysteine (NAC) (6 mg/ml), and various combinations of these substances were used to evaluate the treatment against MRSA using scanning electron microscope (SEM) images and microbiological enumeration.ResultsThe colony count in the antibiotic-impregnated samples significantly decreased compared to nonantibiotic-impregnated samples in the MRSA, MRSA + DAPT, and MRSA + LIN groups (p < 0.01), respectively. Conversely, the colony count in antibiotic-impregnated samples significantly increased compared to nonantibiotic-impregnated samples in NAC + DAPT and NAC + VAN groups (p < 0.01), respectively.ConclusionsThe results showed that the use of antibiotic-impregnated catheters has a significant impact on the prevention of infection whereas the combination of NAC and DAPT showed better antibiofilm and antibacterial effects than other combinations on the prevention and treatment of nonantibiotic-impregnated catheter infections.

The “P” Shaped Siphon Filter of the VP Shunt Instead of the “S” Shaped: A Follow up Clarification

In a previous published paper entitle “Proposal of a Cleanable VP Shunt for Hydrocephalus”, and published by the same author of this paper. It used the term “S” shaped VP shunt by a mistake; therefore this paper comes to correct what have been published in that paper.