Use Of Ventriculoperitoneal Shunt Research Articles

Letter: Difficulty in Tracing Manufacturer and Brand Names on Ventriculoperitoneal Shunt Catheters and Valves.

Letter: Difficulty in Tracing Manufacturer and Brand Names on Ventriculoperitoneal Shunt Catheters and Valves.

The safety profile of Tumor Treating Fields (TTFields) therapy in glioblastoma patients with ventriculoperitoneal shunts

IntroductionTumor Treating Fields (TTFields, 200 kHz) therapy is a noninvasive, locoregional cancer treatment approved for use in newly diagnosed glioblastoma (GBM), recurrent GBM, and malignant pleural mesothelioma. GBM patients with hydrocephalus may require implantation of a ventriculoperitoneal (VP) shunt, however, the current TTFields therapy label does not include the use of VP shunts in GBM patients due to insufficient safety data. This analysis evaluates the safety of TTFields therapy use in this population.MethodsUnsolicited post-marketing global surveillance data from patients with GBM and a VP shunt (programmable/non-programmable) who received TTFields therapy between November 2012–April 2021 were retrospectively analyzed. Adverse events (AEs) were assessed using the Medical Dictionary for Regulatory Activities version 24.0.ResultsOverall, 156 patients with VP shunts were identified and included in this analysis. In total, 77% reported ≥ 1 AE; the most common TTFields therapy-related AEs were non-serious and localized, beneath-array skin AEs (43%). The incidence and categories of AEs were comparable between patients with or without VP shunts. Six patients with VP shunts experienced seven serious TTFields therapy-related AEs: skin erosion at the shunt site (n = 3); wound dehiscence at the shunt site (n = 2) and at the resection scar (n = 2). No shunt malfunctions were deemed related to TTFields therapy.ConclusionsIn the real-world setting, TTFields therapy in GBM patients with VP shunts demonstrated good tolerability and a favorable safety profile. There was no evidence that TTFields therapy disrupted VP shunt effectiveness. These results suggest TTFields therapy may be safely used in patients with VP shunts.

Potential Risk Factors for Ventriculoperitoneal Shunt Implantation in Paediatric Patients with Posthemorrhagic Hydrocephalus of Prematurity Treated with Subcutaneous Reservoir: An Institutional Experience.

Posthemorrhagic hydrocephalus of prematurity (PHHP) is a result of intraventricular hemorrhage (IVH). IVH occurs in 6 to 23% of the preterms in countries with advanced medical health care. Most of these patients will eventually require the use of ventriculoperitoneal shunt (VPS). The purpose of this study is to assess the risk factors of VPS implantation in patients with PHHP who have been treated with ventricular catheter with subcutaneous reservoir (VCSR). The retrospective study was conducted evaluating 35 premature patients who suffered from severe IVH. Their mean gestational age was 28 weeks. The assessment included antenatal factors such as gestational age, birth weight, and intrauterine and perinatal infection. Postparturient period factors such as the IVH grade, time between diagnosis, and VCSR implantation and body weight on VCSR implantation were also considered in the study. Postprocedural complications, such as bacterial cerebrospinal fluid (CSF) infection, sepsis, and skin lesions, were evaluated. Data were calculated with R program, version 4.04. From among 35 evaluated patients, 23 (65.71%) required a VPS. Median of birth weight was 1,190 g. Infections were observed in 11 (31.43%) cases. Mean time between IVH diagnosis and VCSR implantation was 2.6 weeks. Postprocedural complications occurred in 19 (54.29%) patients. None of the evaluated factors has proven its statistical significance (p > 0.05) for being a potential risk factor for VPS implantation. External factors seem to not affect the necessity of VPS implantation in patients after the severe IVH. Ostensibly, there seems to be no difference between the grades III and the IV of Papile's IVH scale regarding VPS implantation necessity.

FACTORS ASSOCIATED WITH DE-HOSPITALIZATION OF CHILDREN AND ADOLESCENTS WITH COMPLEX CHRONIC CONDITION.

ABSTRACTObjective:To assess the factors associated with the de-hospitalization of children and adolescents with complex chronic condition.Methods:This cross-sectional and retrospective study investigated a sample of children and adolescents admitted to the Dehospitalization Training Unit, from January 2012 to December 2017. Data were collected by consulting medical records and patient record books, from November 2018 to June 2019. The length of stay in the unit, de-hospitalization, readmissions, frequency and cause of death, age, sex, diagnosis, place of residence, number of caregivers and kinship, and use of devices were studied. The chi-square test was used to verify the association between the dependent variable (de-hospitalization) and the independent variables (age, sex, place of residence, use of devices, and clinical diagnosis).Results:A total of 93 patient records were analyzed, 37.6% aged between 7 months and 2 years old, 58.1% boys, 95.7% used tracheostomy, 92.5% gastrostomy, and 71% invasive mechanical ventilation. Hypoxic-ischemic encephalopathy was the diagnosis of 40.3% of the sample. Average hospitalization time was 288 ± 265 days; 60.2% were hospitalized between 31 days and one year, representing 50% of deaths. Of those de-hospitalized, 76.3% were discharged to the Ventilatory Assistance Homecare Program. De-hospitalization was associated with the child or adolescent's place of residence (p=0.027) and use of ventriculoperitoneal shunt (p=0.021).Conclusions:This study identified that de-hospitalization may be associated with the place of residence of the child or adolescent, with the highest number of discharges to the state capital, and non-dehospitalization when using ventricular-peritoneal shunt.

PRENATAL MYELOMENINGOCELE REPAIR – A CHANCE TO IMPROVE THE QUALITY OF LIFE

Spina bifida (myelomeningocele) is the most prevalent developmental defect of the nervous system. In different regions of the world it affects from 0.3 to 5 per 1000 of living neonates. It is known that the defect develops during the early fetal life however no explicit cause has been found yet. Recently it has been accepted that one of the major factors contributing to spina bifida is deficiency of folic acid in the mother's body before and during pregnancy. The first attempts to cure myelomeningocele were taken in ancient times. More extensive knowledge of aetiology and effects of spina bifida and development of new surgical techniques allowed for management not only of the defect itself but also the consequent complications. Prenatal spina bifida repair has been performed in the USA for 20 years now while European surgeons (Poland and Switzerland) have operated myelomeningocele for 12 years. Comparative analysis carried out to evaluate the patients operated for spina bifida prenatally and postnatally pointed that those after fetal repair demand the use of ventriculoperitoneal shunt for hydrocephalus twice less frequently. Thanks to shortened exposure of the spinal cord and the spinal nerves to the toxic effect of amniotic fluid and reduced exposure to mechanical injuries, prenatal myelomeningocele repair offers better opportunities to improve motor, urinary and alimentary functions, contributing then statistically to higher quality of lives of children with spina bifida.

Concomitant insertion of peritoneal dialysis catheter and ventriculoperitoneal shunt in children: a report of two cases

The aim of this study was to know and validate whether the use of ventriculoperitoneal shunt (VPS) and peritoneal dialysis catheter (PDC) is a safe and acceptable option in children requiring PD and VPS. A case of myelomeningocele with accompanied paraplegia and hydrocephalus was treated surgically in the neonatal period with placement of VPS. Later the child developed a neurogenic bladder with recurrent cystitis, which culminated into severe bilateral ureterohydronephrosis and progressive chronic renal disease. In a second case, a boy with an immaculate past history, admitted in a local hospital for meningitis complicated by hydrocephalus, necessitating the insertion of VPS, was treated. During the course of his illness, the child developed acute renal failure, volume overload, and severe hypertension and ended up in our pediatric ICU. We experienced two cases in our artificial kidney unit with concomitant insertion of VPS and PDC with an excellent outcome. On the basis of the outcomes of our patients as well as results from other centers, we conclude that the concurrent use of a VPS and PDC is a safe and acceptable option in child requiring PD and VPS.

Biofilm Formation by Cryptococcus neoformans

The fungus Cryptococcus neoformans possesses a polysaccharide capsule and can form biofilms on medical devices. The increasing use of ventriculoperitoneal shunts to manage intracranial hypertension associated with cryptococcal meningoencephalitis highlights the importance of investigating the biofilm-forming properties of this organism. Like other microbe-forming biofilms, C. neoformans biofilms are resistant to antimicrobial agents and host defense mechanisms, causing significant morbidity and mortality. This chapter discusses the recent advances in the understanding of cryptococcal biofilms, including the role of its polysaccharide capsule in adherence, gene expression, and quorum sensing in biofilm formation. We describe novel strategies for the prevention or eradication of cryptococcal colonization of medical prosthetic devices. Finally, we provide fresh thoughts on the diverse but interesting directions of research in this field that may result in new insights into C. neoformans biology.

Treatment of Hydrocephalus with Ventriculoperitoneal Shunting in Twelve Dogs

To report use of ventriculoperitoneal shunt in dogs for management of hydrocephalus for which no cause could be identified. Case series. Dogs with hydrocephalus (n=12). Medical records (June 2003-June 2009) were reviewed to determine preoperative clinical findings, initial postoperative, and long-term outcome. Additional follow-up information was obtained from owners and referring veterinarians. All dogs had signs of forebrain dysfunction, 7 had vestibular signs and 3 had signs of spinal pain. Postoperative complications included pain (n=4), undershunting because of shunt kinking (n=1) and seizures (n=1). Initial improvement occurred in all dogs and was sustained in 9 dogs, 1 of which required revision surgery. Sustained clinical improvement can be achieved in hydrocephalus with no active underlying cause by use of ventriculoperitoneal shunting.

Role of shunts with antisiphon device in treatment of pediatric hydrocephalus

Objective The use of ventriculo-peritoneal shunts having antisiphon device has been reported in adult patients, but there is a dearth of experience with such shunts in pediatric age group. This study is being undertaken to compare the effectiveness of these types of shunt for the treatment of congenital hydrocephalus. Patients and methods Forty patients with congenital hydrocephalus with or without neural tube were divided randomly into two groups (A and B). Patients in antisiphon group were treated with shunts with differential valve including antisiphon device (Vygon ® shunt) while patients in non-antisiphon group were treated with differential valve shunts (Chhabra shunt and Ceredrain ®). Mann–Whitney test, asymmetric t-test and Chi-square test were used to assess the correlation and the significance. Results The mean age was 3.5 months and 3.4 months in antisiphon group and non-antisiphon group, respectively. The M:F ratio was 2.3:1 in antisiphon group while it was 3:1 in non-antisiphon group. The mean decrease in OFC was more in non-antisiphon group than antisiphon group during the follow up from 3 months to 6 months while mean decrease in MEI was more in non-antisiphon group from 0 month to 3 months than antisiphon group. There were two cases of shunt overdrainage in non-antisiphon group. The shunt blockage rate was 20% in antisiphon group and 15% in non-antisiphon group, respectively. There was 20% and 15% shunt infection rate in antisiphon group and non-antisiphon group, respectively. This study demonstrated overdrainage syndrome in two of the patients of differential valve shunts. Conclusion Though rare, complication associated with overdrainage is certainly a problem in children. In our study, the patients who received shunts with antisiphon device do not show any overdrainage.

Ultrasound guidance for distal insertion of ventriculo-atrial shunt catheters: technical note

Ventriculo-atrial (VA) shunts are often used for CSF diversion in situations involving abdominal pathology that preclude the use of ventriculo-peritoneal shunts. Distal (venous) catheters of VA shunts have historically been inserted using a cut-down on the internal jugular vein (IJV). Less invasive placement of atrial catheters may minimize operative times and attenuate post-operative incisional discomfort. We describe a method for atrial catheter placement using ultrasound guidance to visualize the IJV and facilitate percutaneous venous puncture in 17 adult patients (23 total insertions) undergoing treatment for hydrocephalus or pseudotumor cerebri. The IJV and carotid artery were visualized by ultrasound in 23 (100%) cases. Venous penetration and successful atrial catheter placement was achieved on the first attempt in 23 (100%) cases. Pneumothorax, carotid artery puncture or need for venous cut-down occurred in no cases. The utilization of ultrasound guidance for distal VA shunt catheter insertion may increase comfort with this procedure and ultimately decrease complication rate and operative time.

O.110 Follow-up of 50 infants treated with the Codman adjustable valve – Retrospective analysis of clinical overdrainage and valve re-adjustment

The use of ventriculo-peritoneal shunts having antisiphon device has been reported in adult patients, but there is a dearth of experience with such shunts in pediatric age group. This study is being undertaken to compare the effectiveness of these types of shunt for the treatment of congenital hydrocephalus.Forty patients with congenital hydrocephalus with or without neural tube were divided randomly into two groups (A and B). Patients in antisiphon group were treated with shunts with differential valve including antisiphon device (Vygon® shunt) while patients in non-antisiphon group were treated with differential valve shunts (Chhabra shunt and Ceredrain®). Mann–Whitney test, asymmetric t-test and Chi-square test were used to assess the correlation and the significance.The mean age was 3.5 months and 3.4 months in antisiphon group and non-antisiphon group, respectively. The M:F ratio was 2.3:1 in antisiphon group while it was 3:1 in non-antisiphon group. The mean decrease in OFC was more in non-antisiphon group than antisiphon group during the follow up from 3 months to 6 months while mean decrease in MEI was more in non-antisiphon group from 0 month to 3 months than antisiphon group. There were two cases of shunt overdrainage in non-antisiphon group. The shunt blockage rate was 20% in antisiphon group and 15% in non-antisiphon group, respectively. There was 20% and 15% shunt infection rate in antisiphon group and non-antisiphon group, respectively. This study demonstrated overdrainage syndrome in two of the patients of differential valve shunts.Though rare, complication associated with overdrainage is certainly a problem in children. In our study, the patients who received shunts with antisiphon device do not show any overdrainage.

Treatment of subdural hematomas in infants

has a long and storied history. In Donald D. Matson’s classic text, there was an extensive discussion of this topic that included descriptions of the invasive procedures needed to make this diagnosis at a time when few imaging data were available; an unforgettable illustration from the text was a photograph showing tubes draining subdural fluid, which was tapped over time at the bedside to follow the progression of the SDH’s content. It is now understood that removing the xanthochromic fluid through punctures, drains, or subduroperitoneal shunts can eliminate subdural fluid collections. Most practitioners consider placement of a shunt as the last resort of many treatment options, because the placement of a shunt generally implies that the condition’s treatment will be lifelong. However, in their article in this issue of the Journal of Neurosurgery: Pediatrics, Kurschel and colleagues suggest that there is a very high likelihood of success in treating subdural fluid collections with the placement of a unilateral, valveless subduroperitoneal shunt, and they further indicate that such systems can be safely removed after the fluid collections have been evacuated. Because many of the concerns about treating subdural collections during infancy through shunts result from comparison with the use of ventriculoperitoneal shunts for hydrocephalus, a few differences should be stressed. The most important is that the treatment of subdural collections and the treatment of hydrocephalus have vastly different end points: elimination of the subdurals in the former and control of the hydrocephalus in the latter. This difference may be the reason that using a valveless shunt system works so well in the hands of the authors: when the fluid collection is completely gone, flow stops because there is no longer any fluid to flow through the system, and one hopes that there is permanent occlusion of the tubing. Thus, the authors of this study systematically removed virtually all of the catheters, a maneuver tolerated by their patients without problems. The most important point of this paper is that in this particular group of patients, removal of the shunt system can be done apparently with impunity. The protocol recommended for these patients, which does not distinguish between fluid collections following nonaccidental trauma and those collections from other causes, appears to be a reasonable course for the treatment of children with subdural fluid collections. We have had personal experience with patients who have undergone subdural fluid shunt treatment in the past who developed late symptoms, indicating that they were dependent on their subdural shunts; it is to be hoped that early removal of these shunts, as suggested by the authors of the present study, will reduce the likelihood of this occurrence.

The use of ventriculoperitoneal shunts for uncontrollable intracranial hypertension without ventriculomegally secondary to HIV-associated cryptococcal meningitis

Background The risks associated with implanting a cerebrospinal fluid (CSF) shunt in immunocompromised patients with ongoing CSF infection have historically discouraged surgeons from implanting CSF shunts in patients with HIV and cryptococcal meningitis. However, this patient population often requires frequent lumbar punctures to manage elevated intracranial pressure (ICP) secondary to cryptococcal infection. To date, only 7 cases of ventriculoperitoneal (VP) shunting for the treatment of intracranial hypertension in patients with HIV-associated cryptococcal meningitis have been reported. Few of these reports have included outcomes more than 3 months postsurgery. It remains unclear if VP shunts are an effective long-term treatment of intracranial hypertension in this patient population. Case Descriptions Two patients with HIV/AIDS (CD4 counts of 8 and 81 cells/mm 3) presented with altered mental status, visual changes, florid cryptococcal meningitis, and elevated ICP (>500 mm CSF) without evidence of hydrocephalus on computed tomography scan. Both patients experienced rapid reversal of symptoms with external lumbar CSF drainage, and remained lumbar drain-dependent after 2 weeks of amphotericin B and flucytosine therapy. Despite evidence of unresolved cryptococcal meningitis, each patient underwent implantation of a VP shunt without complication and was discharged on lifetime fluconazole therapy. They remained asymptomatic at 12 and 16 months after surgery without evidence of shunt infection or malfunction. Conclusion Patients with intracranial hypertension and HIV-associated cryptococcal meningitis who cannot tolerate cessation of external lumbar CSF drainage or frequent lumbar punctures may be considered for VP shunt placement despite severe immunosuppression and persistent CSF cryptococcal infection.

Shunt surgery for hydrocephalus complicating cryptococcal meningitis in human immunodeficiency virus-negative patients.

From 1988 through 2001, 27 patients with cryptococcal meningitis who had hydrocephalus were identified and were treated by placement of ventriculoperitoneal (VP) shunts. To assess the predictive value of the response to VP shunts in terms of outcome in these patients, univariate analysis for variables was performed. Poor outcome was associated with a Glasgow Coma Scale score of <or=8 (P<.001) and duration of altered consciousness of >48 h (P=.02). Use of VP shunts did not result in a good response or outcome in comatose patients. Thus, any delay in the diagnosis or treatment of patients with hydrocephalus could cause a deterioration of consciousness and is associated with poor outcome.

Experimental negative intraventricular pressures

Negative intracranial pressures are known to occur normally in man and animals in the upright position [3, 71. Pathological conditions associated with increased intracranial pressure may alter this, but there is still a decrease in intracranial pressure with elevation of the head. Attention has recently been drawn to the fact that CSF shunt systems may cause negative intracranial pressure significantly greater than that which occurs normally [5, 8, 91. We have documented that this can occur in animals. It is often assumed that the intraventricular pressure in a shunted patient is maintained at or near the closing pressure of the valve used in the system [2]. Other hydrostatic factors such as position of the patient and particularly the length of tubing from the cerebral ventricles to the heart, pleural cavity, or peritoneal cavity have been ignored. With the increasing use of ventriculo-peritoneal shunts with long distal tubes these factors require more consideration. We initially developed an

Clinical Outcome of Posterior Fossa Tumor Surgery Without Preoperative Ventriculo-peritoneal Shunt

The aim of the study was to assess the clinical outcome of surgically treated patients with posterior fossa tumor with hydrocephalus with symptoms and sings of raised intracranial pressure without pre-operative ventriculo-peritoneal shunt by comparing two groups (one group-with pre-operative ventriculo-peritoneal shunt and other group-without preoperative ventriculo-peritoneal shunt) in respect to complications, duration of hospital stay and final outcome at 1 month post-operative follow up. This clinical study was carried out at the department of neurosurgery, BSMMU from November 2008 to April 2010 on patients with posterior fossa tumor with hydrocephalus with symptoms and signs of raised intracranial pressure (ICP) who underwent surgery without preoperative ventriculo-peritoneal shunt. A total of 32 patients were included in this study. Patients were divided into two groups, control group (group-A) underwent ventriculoperitoneal shunt prior to tumor surgery and experimental group (group-B) were not treated with ventriculo-peritoneal shunt prior to tumor surgery. Both groups were followed up during hospital stay and after 1 month of tumor resection. Clinical studies include analysis of the following parameters: i) duration of hospital stay, ii) post-operative complications include cerebrospinal fluid leakage, pseudomeningocele, seizure, meningitis, and shunt blockage and, iii) final outcome at 1 month follow up in modified karnofsky performance scale. We also observed whether or not, use of ventriculo-peritoneal shunt to drain cerebrospinal fluid was useful and safe. The mean duration of hospital stay were 95.1±12.6 days with ranged from 70 to 120 days and 71.5±12.6 days ranged from 36 to 88 days in group-A and group-B respectively. The majority of the patients had no complications in both group, which were 12(70.6%) and 9 (60.0%) in group A and group B respectively. Final outcome at 1 month follow up in modified karnofsky performance scale in both groups were similar. DOI: http://dx.doi.org/10.3329/bmj.v40i1.9963 BMJ 2011; 40(1): 43-47