Ventriculo-peritoneal Shunt In Children Research Articles

Frequency of Complications after Paediatric Ventriculoperitoneal Shunt Surgery for Management of Hydrocephalus: An Observational Cohort Study

Objectives: To determine the frequency of complications after paediatric ventriculoperitoneal shunt surgery for management of hydrocephalus.
 Materials and Methods: An Observational Cohort Study was conducted from 19th March, 2020 to 18th September, 2021 at Pakistan Institute of Medical Sciences, Islamabad, Pakistan. Total 150 patients of both genders, aged between 1-18 years diagnosed with hydrocephalus were selected. Shunted patients operated for other pathologies of brain and spine and those with more than 3 shunt revisions were excluded. Based on the clinical findings and investigations, a final diagnosis was made and the treatment in individual cases was planned accordingly. Post-operatively all the patients were followed up till 6 months and any complication which occurred was documented.
 Results: Age range in this study was from 1 to 18 years with mean age of 7.50 ± 4.22 years. Majority of the patients 74.0% were between 1 to 10 years of age. Out of these 150 patients, 85 (56.67%) were males and 65 (43.33%) were females with male to female ratio of 1.3:1. Shunt blockade was seen in 36 (24.0%), Shunt malfunction in 21 (14.0%), Shunt infection in 48 (32.0%) and Shunt migration in 23 (15.33%) patients.
 Conclusion: This study concluded that ventriculoperitoneal shunt in children with hydrocephalus is not free of complications and should be monitored and managed properly to reduce the complications.

Ventriculopleural Shunt Following Failed Ventriculoperitoneal Shunt in Children: Two Case Reports

Abstract There have been no reports of ventriculopleural (VPL) shunt in children younger than four years of age in the last 24 years. The pleural space is an alternative to the peritoneum for shunting cerebrospinal fluid (CSF) in cases where the latter cannot be used due to infection or other complications. Though there have been case series published reporting the use of VPL shunts, the anesthetic management has not been described in detail. We describe the management of two pediatric patients aged three and six years old who successfully underwent VPL shunt after failure of ventriculoperitoneal (VP) shunt.

Thirty days complications of pediatric hydrocephalus following ventriculoperitoneal shunt surgery

Background: Ventriculoperitoneal shunt (VPS) is one of the commonest procedures in neurosurgical practice for the treatment of hydrocephalus (HCP) in pediatrics, especially in developing countries. Despite being widely used, VPS is still plagued with several complications, so needed repeated interventions. Thereby increase hospital stay, morbidity, and mortality. The majority of the complications were observed in the early postoperative period but over time, the rate of complications decreases. So we conducted this study to identify the complications within 30 days following VPS in children. Materials and Methods: This prospective interventional study was conducted in the Department of Neurosurgery, BSMMU, between January 2019 and January 2020. Children aged 1 month to 5 years, who underwent VPS surgery for the first time were included in this study. Following VPS operation, patients were given regular follow-up for one month, either through the Telephone or asked to visit the outpatients on the specified days. During follow up all patients were evaluated for shunt-related complications. Then the data were analyzed using the SPSS version 26. Results are presented in the form of tables. Results: We evaluated a total of 120 patients, during the study period, there were 75 (62.5%) males and 45 (37.5%) females with a male to female ratio approaching 1.6:1. Patients aged from 1 month to 5 years (60 months). The indications of VPs surgery were: congenital hydrocephalus in 70 (58.3%), post-infectious hydrocephalus in 15 (12.5%), hydrocephalus due to tumor in 30 (25%), and post-traumatic hydrocephalus in five (4.16%) patients. During the follow-up, complications were encountered in 30 patients (25%). Complications observed between day 1 and day 30 during follow-up were shunt malfunction (blockage, cranial or caudal migration, misplacement) 8(6.66%), shunt infections 10 (8.33%), CSF leakage 3(2.5%),ileus 5 (4.16),convulsion one(0.83%),gut perforation one (0.83%) and abdominal complications 2 ( 1.6%) among 120 patients. Conclusion: VP surgery is very porn to complications and in our study, almost every fourth case of VPS arises complications. Shunt malfunction due to blockage, infections, and abdominal wound-related complications are common earlier in pediatric patients with hydrocephalus.

Clinical characteristics of slit ventricle syndrome after ventriculoperitoneal shunt in children

目的 探讨发生于脑室-腹腔分流术后裂隙脑室综合征(slit ventricle syndrome，SVS)的临床特征，提高儿科医生对SVS的认识。 方法 采用回顾性分析的方法对SVS患儿临床资料进行分析。 结果 7例患儿中原发病分别为先天性脑积水3例，先天性颞极蛛网膜囊肿1例，脑出血1例，颅内感染2例。手术时间为生后3个月～4岁。手术至诊断SVS时间为1.3～11.5年，所有患儿均出现不同程度的头痛，初期多是间断性头痛，严重时出现剧烈头痛伴呕吐，甚至抽搐、视力障碍。 结论 对于进行脑室-腹腔分流术后或者蛛网膜囊肿切除术后患儿出现不明原因的头痛、呕吐时应想到有SVS的可能性。

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.

Diffusion tensor imaging detects early brain microstructure changes before and after ventriculoperitoneal shunt in children with high intracranial pressure hydrocephalus.

To explore the use of diffusion tensor imaging (DTI) parameters in the quantitative assessment of early brain microstructure changes before and after ventriculoperitoneal shunt in children with high intracranial pressure hydrocephalus.Ten patients with communicating hydrocephalus (age: 2–36 months) and 14 age-/gender-matched controls (age: 2–36 months) were enrolled in this study. All patients underwent the ventriculoperitoneal shunt procedure. The imaging data were collected before and 3 months after the operation. Regions of interests (ROIs) included the white matter near the frontal horn of the lateral ventricles (FHLV), the occipital horn of the lateral ventricles (OHLV), occipital subcortical (OS) area, frontal subcortical (FS) area, and thalamus. Fractional anisotropies (FA) and apparent diffusion coefficients (ADC) of the ROIs before and after ventriculoperitoneal shunt were compared between the patients and the controls.Three months after surgery, the patients recovered from the surgery with ameliorated intracranial pressure and slight improvement of clinical intelligence scale and motor scale. Before ventriculoperitoneal shunt, the FA values (except the right FHLV) were significantly decreased and the ADC values were significantly increased in the patients with hydrocephalus, compared with the controls. After the ventriculoperitoneal shunt, the FA values in the FHLV and OHLV of the patients were similar to the controls, but the FA values in other ROIs were still significantly lower than controls. The ADC values in the FS and OS white matter areas of the patients were similar to the controls; however, the ADC values in other ROIs were still significantly higher in patients.The increase of FA and the reduction in ADC in the ROIs preceded the clinical function improvement in patients with high intracranial pressure hydrocephalus and reflected the early changes in brain tissue microstructure, such as the compression of the white matter areas in the ROIs.

Radionuclide Shuntography for the Evaluation of Ventriculo-Peritoneal Shunt in Children with Hydrocephalus

Background: Radionuclide shuntography is a safe, simple and non-invasive functional imaging technique for determining ventriculo-peritoneal (V-P) shunts tube patency with minimal radiation exposure. This is particularly useful in children with hydrocephalus in whom V-P shunt is inserted to divert CSF drainage. V-P shunts are, in many cases, permanent treatment option for children with hydrocephalus and radionuclide shuntography is becoming a very popular technique because of the increasing numbers and survival of children with shunt-treated hydrocephalus. Objective: The aim of this study is to document the usefulness of shuntography in the evaluation of V-P shunt in patients with hydrocephalus. Materials and Methods: All shuntograms performed in our institution from 2008 to 2015 were included in this study. Radionuclide shuntography was performed with Tc-99m DPTA injected into the shunt reservoir and images acquired using a dual headed MEDISO camera. A normal shuntogram is considered as free flow of radiotracer (Tc-99m DTPA) from site of injection to the distal end of shunt tube and spillage into the peritoneum. Results: A total of 56 children were studied comprising of 32 males and 24 females with age ranges of 5month to 11years. Different patterns of results were found, normal functioning shunt tube, partial block shunt tube due to infection or inflammatory debris and total blocked shunt tube due to mechanical defects. Conclusion: About 52% of our patients had partial blockage of their shunt tube. Patients who are diagnosed with a partial tube blockage will require only flushing of the tube and antibiotics treatment, while mechanically blocked tube will require shunt revision. This distinction is critical considering the cost of replacement of V-P shunt tube and the manpower time for surgery. There was no mortality or morbidity associated with radionuclide shuntography in our patients.

The efficacy of silver-embedded polypropylene-grafted polyethylene glycol-coated ventricular catheters on prevention of shunt catheter infection in rats

Catheter-related infection is a major complication of ventriculoperitoneal shunt in children. The aim of this study is to determine inflammatory response and the efficacy of polypropylene-grafted polyethylene glycol (PP-g-PEG) copolymer and silver nanoparticle-embedded PP-g-PEG (Ag-PP-g-PEG) polymer-coated ventricular catheters on the prevention of catheter-related infections on a new experimental model of ventriculoperitoneal shunt in rats. Thirty six Wistar albino rats were divided into six groups: group 1, unprocessed sterile silicone catheter-embedded group; group 2, sterile PP-g-PEG-coated catheter group; group 3, sterile Ag-PP-g-PEG-coated catheter group; group 4, infected unprocessed catheter group; group 5, infected PP-g-PEG-coated catheter group; and group 6, infected Ag-PP-g-PEG-coated catheter group, respectively. In all groups, 1-cm piece of designated catheters were placed into the cisterna magna. In groups 4, 5, and 6, all rats were infected with 0.2 mL of 10 × 10(6) colony forming units (CFU)/mL Staphylococcus epidermidis colonies before the catheters were placed. Thirty days after implantation, bacterial colonization in cerebrospinal fluid and on catheter pieces with inflammatory reaction in the brain parenchyma was analyzed quantitatively. Sterile and infected Ag-PP-g-PEG-covered groups revealed significantly lower bacteria colony count on the catheter surface (ANOVA, 0 ± 0, p < 0.001; 1.08 ± 0.18, p < 0.05, respectively). There was moderate inflammatory response in the parenchyma in group 4, but in groups 5 and 6, it was similar to that of the sterile group (ANOVA, 16.33 ± 3.02, p < 0.001; 4.00 ± 0.68, p < 0.001, respectively). The PP-g-PEG, especially Ag-PP-g-PEG polymer-coated ventricular catheters are more effective in preventing the catheter-related infection and created the least inflammatory reaction in the periventricular parenchyma.

Laparoscopic-Assisted Placement of Ventriculo-Peritoneal Shunt Tips in Children with Multiple Previous Open Abdominal Ventriculo-Peritoneal Shunt Surgeries

Placing a ventriculo-peritoneal shunt in children with hydrocephalus is the standard of care. Many of these children will require revision of this portion of the shunt for a variety of reasons. Previously, it was thought that in a child with multiple previous ventriculo-peritoneal shunt (VPS) revisions, laparoscopy was contraindicated. This study aims to show that laparoscopy can be used safely and effectively in children with multiple previous ventriculo-peritoneal shunt surgeries. Laparoscopically assisted placement of the peritoneal portion of the ventriculo-peritoneal shunt in children with multiple previous VPS revisions was performed in 8 consecutive children (4 female) with ages ranging from 7 months to 18 years between May 2003 and September 2007. All eight children had undergone more than two previous VPS operations. All shunts were placed in areas free of adhesions and flow was observed under direct visualization. All of the procedures were successful; none needed conversion to the standard mini-laparotomy approach. No obvious or occult injury to the abdominal components was noted during hospitalization or during follow-up. Six of 8 patients required lysis of adhesions at the time of the revision. Average length of hospital stay was 2.6 days and no revisions of the abdominal portion of the VPS have been required by any of the 8 patients after laparoscopic revision. Previously unknown complications of shunt surgery were corrected in 1 of 8 children. Laparoscopic placement of the peritoneal portion of a ventriculo-peritoneal shunt can be done safely and effectively in children with multiple previous VPS revisions due to improved visualization and placement of the shunt tip in a virgin area of the abdomen. Additionally, any known or unknown complications from previous VPS surgeries can be corrected with the laparoscopic approach. When combined with the reduction in pain, shorter hospital stay, and fewer immediate and future complications, this is the procedure of choice for patients requiring revision VPS surgeries in our hospital.

小児の髄液短絡術に伴う腹腔内髄液仮性嚢胞 : 12症例における検討

小児の髄液短絡術に伴う腹腔内髄液仮性嚢胞 : 12症例における検討

Abdominal Cerebrospinal Fluid Pseudocyst: A Complication of Ventriculoperitoneal Shunt in Children

The present paper is a retrospective analysis of 27 consecutive patients, treated for abdominal cerebrospinal fluid (CSF) pseudocyst at the Children’s Memorial Hospital in the years 1991–1996. This series is compared to the previous experience from our institution. Treatment consisted of the removal of the ventriculoperitoneal (VP) shunt and placement of an external ventricular drain. Antibiotics were administered intravenously for 10 days. The cysts were aspirated intraoperatively in 9 patients and postoperatively with ultrasound guidance in 3 patients, while they resolved spontaneously in 15 others. In 21 of 27 cases (78%), the shunt could be reinserted into the abdomen in a new location. Four patients had a ventriculopleural shunt, and in 2 patients, a ventriculoatrial shunt was inserted. Forty-four percent of the patients had a positive culture on presentation. The positive culture rate was 77% for those 4 years old and younger and only 28% for those aged 5 and above (p = 0.03). We conclude that abdominal CSF pseudocysts are resolved by externalizing the shunt. A VP shunt can be safely reinserted in the majority of the patients. Infection, while an important factor, is not likely to account for all cases of pseudocyst.

Cerebral blood flow after ventriculoperitoneal shunt in children with hydrocephalus.

Fourteen hydrocephalic children were studied who were between the ages of 6 months and 14 years. Regional cerebral blood flow (rCBF) was measured by the 133Xe intravenous injection method after ventriculoperitoneal shunting. There was a negative correlation between slow flow and preoperative ventricular size (r = -0.718, P < 0.02), but there was no correlation between fast flow and preoperative ventricular size. There was also no correlation between rCBF and postoperative ventricular size. Postoperative IQ or development quotient showed a positive correlation with slow flow (r = 0.813, P < 0.01), but not with fast flow. It is suggested that in hydrocephalic children there is impairment of white-matter communicating fibres and secondary reduction in higher intellectual activity.

Abdominal complications of ventriculo-peritoneal shunt in children: S. Lortat-Jacob, A. Pierre-Khan, D. Renier, et al. Chir Pédiatr 25:17–21, (January–February), 1984

Abdominal complications of ventriculo-peritoneal shunt in children: S. Lortat-Jacob, A. Pierre-Khan, D. Renier, et al. Chir Pédiatr 25:17–21, (January–February), 1984