Ventriculoperitoneal Shunts In Children Research Articles

Abdominal pseudocysts – A cause of peripheral dysfunction in ventriculoperitoneal shunts in children

Abdominal pseudocysts – A cause of peripheral dysfunction in ventriculoperitoneal shunts in children

Transvaginal Migration of Ventriculoperitoneal Shunts in Children: Review of Literature.

Ventriculo-peritoneal shunt placement is the most commonly performed procedure for the treatment of hydrocephalus. The complication of migration of the distal ventriculo-peritoneal shunt is one of the many complications that occur after ventriculo-peritoneal shunt placement. The migration of the ventriculo-peritoneal shunt through the vagina is infrequently reported in children. The aim of this review is to help all the providers caring for children with ventriculo-peritoneal shunts to identify issues early when encountered with this complication and thus limit morbidity and mortality. We reviewed all cases of migration of ventriculo-peritoneal shunt through the vagina in children less than 18 years of age that were published in the literature using PubMed, Google Scholar, Web of Science, and Cochrane Library. A total of 11 articles met the eligibility criteria and were included in this review among the 93 articles obtained with title and abstract screening. Previous non-shunt-related abdominal operations and shunt revisions are consistent risk factors in all cases. We did not recognize specific approaches to catheter placement or management that could have prevented this complication. Ventriculitis necessitating shunt removal and therapies requiring additional procedures and prolonged hospitalization are the major consequences identified. Awareness of this unusual complication is very important among health care providers such as emergency care health providers who are likely to be the first to encounter these children on initial presentation.

Post-Operative Complications of Ventriculoperitoneal Shunts in Children at the Children’s Hospital $ The Institute of Child Health Lahore

Post-Operative Complications of Ventriculoperitoneal Shunts in Children at the Children’s Hospital $ The Institute of Child Health Lahore

Complications of Ventriculoperitoneal Shunts in Children with Pediatric Hydrocephalus a Local Study at Benha University Hospitals

Ventriculoperitoneal shunting is the main way used for extra-thecal cerebrospinal fluid (CSF) diversion. Despite being the main corner stone of treating different types of hydrocephalus, VP shunts has unfortunately a lot of complications making surgeries to treat these complications much more than initial shunt insertions.Methods:It is a clinical retrospective observational study that was conducted on 221 patients wth congenital hydrocephalus of both genders with age ranging from 0 to 18 yrs old who came with symptoms and signs of shunt complications and were primarily shunted at Benha university hospital between 2016 and 2019. A complete clinical assessment was done, history taking, a final diagnosis was made, and a treatment of individual patients was planned accordingly. Patients were followed up till the end of the study post-operatively. Data was analyzed using the SPSS (version 16.0). VP shunt was inserted for 221 patients. 113 (51.1%) patients had various forms of complications. Obstructive complications accounts for the most common complications as they happened in 48 (42.5%) of complicated patients followed by infective complications as they appeared in 27 (24%) patients.Conclusions: Despite .great revolution in the field of neurosurgery in the past 100 years and sincere efforts from neurosurgeons worldwide , shunt complications still common among shunted patients.Background Hydrocephalus is regarded as an imbalance in the formation and absorption of CSF to a sufficient magnitude producing accumulation of CSF fluid with in ventricular system of the brain leading to an elevation of intracranial pressure. Compensatory adjustments especially in very young subjects may occur that may reduce prevailing CSF pressure to normal range on count of functioning brain tissue [1]. Hydrocephalus is the second most common congenital brain malforma-tion [2].Congenital hydrocephalus is type of hydrocephalus that is present or its underlying cause at birth. majority of cases are attributed to aqueductal stenosis , chiarri malformation , dandy walker malformation ,arachnoid cyst. approximately 55% of all cases of congenital hydrocephalus are due to Primary aqueductal stenosis whereas aqueductal stenosis secondary to neoplasm, infection, or hemorrhage accounts for another 5% [4]. Till now , the standard treatment of hydrocephalus is ventriculoperitoneal shunt. The technique of using the peritoneal cavity for CSF absorption in ventriculoperitoneal shunting (VPS) was developed by Kausch in 1908 [3]. Al- though VPS insertion is the most common neurosurgical Procedure done worldwide, complication rates in Children are high ranging from 10% to 100% [11]. The advent of endoscopic third ventriculostomy has gained popularity due to the high complication and failure rates of ventriculoperitoneal shunt [12]. VP shunts are prone to a lot of complications such as mechanical blockage, shunt infection, shunt migration, and various abdominal complications[13].

Laparoscopic insertion and revision of ventriculo-peritoneal shunts in children

Ventriculoperitoneal (VP) shunt is a common procedure used to drain cerebrospinal fluid to treat hydrocephalus. Advances in laparoscopy tools and techniques made it possible to perform this procedure laparoscopically assisted. Complications of this procedure are also amenable to laparoscopic correction. This study outlines the safety and feasibility of laparoscopy in performing the procedure and management of its complications. A retrospective file review for all cases underwent laparoscopic-assisted VP shunt or laparoscopic management of one of its complications in the period 2015–2019. Laparoscopic-assisted procedure was done either by 3-port technique or a peritoneocentesis needle technique. Management of complications was done according to its nature. Over 4 years, we performed 36 laparoscopic-assisted VP shunt placement and 17 laparoscopic interventions for abdominal complications related to VP shunts. There were no intraoperative or postoperative complications related to the laparoscopic technique. Conversion to conventional laparotomy was done in 3 patients presented with hugely infected CSF pseudocysts with amalgamated intestine with the wall of the cyst. Laparoscopic-assisted VP shunt placement and revisions in children are feasible and safe. No special tools are required for the procedure.

Trend of Death in Pediatric Ventriculo-Peritoneal Shunts in the United States

Background: Ventriculoperitoneal shunts (VPS) have been used to treat hydrocephalus for many years. This procedure has saved many lives, but it does not come without its complications. Considering the invasiveness of the procedure, we sought to investigate the mortality rate of VPS in children in the USA. Methods: This retrospective cohort study used the Nationwide Inpatient Sample database to examine patients from the ages of 0 - 17 years who underwent the procedures involving the insertion, replacement, or removal of VPS from 1997 to 2012. Z-test was used to analyze the statistical significance. Results: During the study period, we recorded a total number of 165,484 cases of VPS with 54.5% occurring in males. The mean age was 5.25 years old, and the average mortality rate was 1.03%. The annual number of patients receiving VPS at all institutions during the study period decreased significantly from 13,075 in 1997 to 8,499 in 2012 (P = 0.001). The rate of patients receiving VPS per 100,000 discharges at all institutions during the study period also decreased significantly from 18.4 in 1997 to 11.5 in 2012 (P = 0.0001). The number of in-hospital deaths significantly decreased from 150 in 1997 to 50 in 2012 (P = 0.001), and the main decrease in the mortality happened after 2009 (P = 0.001). Conclusions: Utilization of pediatric VPS decreased in the USA between 1997 and 2012, and the number of in-hospital deaths significantly decreased as well. This may be related to better healthcare services in recent years, especially with more emphasis on the inpatient quality indicators (IQIs). Future research should determine the cause of the significant decrease and use the information to continue bringing the mortality rate down. J Neurol Res. 2020;10(3):69-72 doi: https://doi.org/10.14740/jnr573

A Seven-year Study on the Effects of Intravenous Antibiotic Therapy on Infection of Ventriculoperitoneal Shunts in Children.

Infection is one of the most common complications of ventriculoperitoneal (VP) shunts. Its optimal management is controversial. We aimed to report current practice within a large pediatric neurosurgical center. We retrospectively studied a cohort of children <15 years with VP shunt infection, who underwent treatment from March 2011 to March 2018 in the main referral children hospital in Isfahan, Iran. Patients with distal shunt infection or associated wound infection were not included. The initial protocol was empiric intravenous antibiotic therapy and repeated evaluation of cerebrospinal fluid (CSF) analysis and culture. After obtaining the culture results, antibiotic regimen was adjusted according to the sensitivity results. Response to protocol was defined as negative culture results after 72 hours of appropriate antibiotic, which persisted at least for 1 month after discontinuation of therapy. In patients who failed to respond to protocol, the shunts were replaced. Totally, 148 cases with mean (SD) age of 21.2 (30.1) months included to the study. Of which, 56.1% were boys and 68.2% had responded to the protocol. This response was significantly prominent in patients who infected with Gram-negative bacteria (82.9%), especially with Acinetobacter spp. (100%) and Pseudomonas aeruginosa (100%). The response was significantly higher in patients with CSF glucose of greater than 40 mg/dl (83% versus 58.1%, respectively, P = 0.004). We found that using only intravenous antibiotics is sufficiently enough for treating many children with VP shunt infections, especially in those infected by Gram-negative organisms and CSF glucose level of greater than 40 mg/dl.

Trend of Death in Pediatric Ventriculoperitoneal Shunts in the USA

Background: Ventriculoperitoneal shunts (VPS) have been used to treat hydrocephalus for many years. This procedure has saved many lives, but it does not come without its complications. Considering the invasiveness of the procedure, we sought to investigate the mortality rate of VPS in children in the USA. Methods: This retrospective cohort study used the Nationwide Inpatient Sample database to examine patients from the ages of 0 - 17 years who underwent the procedures involving the insertion, replacement, or removal of VPS from 1997 to 2012. Z-test was used to analyze the statistical significance. Results: During the study period, we recorded a total number of 165,484 cases of VPS with 54.5% occurring in males. The mean age was 5.25 years old, and the average mortality rate was 1.03%. The annual number of patients receiving VPS at all institutions during the study period decreased significantly from 13,075 in 1997 to 8,499 in 2012 (P = 0.001). The rate of patients receiving VPS per 100,000 discharges at all institutions during the study period also decreased significantly from 18.4 in 1997 to 11.5 in 2012 (P = 0.0001). The number of in-hospital deaths significantly decreased from 150 in 1997 to 50 in 2012 (P = 0.001), and the main decrease in the mortality happened after 2009 (P = 0.001). Conclusions: Utilization of pediatric VPS decreased in the USA between 1997 and 2012, and the number of in-hospital deaths significantly decreased as well. This may be related to better healthcare services in recent years, especially with more emphasis on the inpatient quality indicators (IQIs). Future research should determine the cause of the significant decrease and use the information to continue bringing the mortality rate down. J Neurol Res. 2020;10(3):69-72 doi: https://doi.org/10.14740/jnr573

One year failure rate for de-novo ventriculo-peritoneal shunts in children from a small volume paediatric neurosurgical unit

It is the belief of some that results of shunt surgery for the treatment of hydrocephalus in children are improved if the surgery is performed in high-volume centres. Currently in the UK paediatric neurosurgery is undergoing a service review. As part of this review a set of standards of care are being drafted which state that 1-year failure rates and infection rates for de-novo ventriculo-peritoneal shunts in children should be less than 40% and 10%, respectively. Our de-novo shunt infection rate (4.3%) and our 1-year failure rate (28.6%) are well within the standards set by this process and comparable to published literature from much higher volume centres.

Abdominal Complications of Ventriculoperitoneal Shunts in Children

Ventricular peritoneal cerebrospinal fluid shunting has become a common pediatric neurosurgical procedure over the last 40 years. While invaluable for these patients, shunts are prone to complications, especially in children. Abdominal complications are often secondary to infection and its complications, and may be difficult to recognize in these medically complex children. Imaging is often required, but the findings may be subtle and require an appreciation of the spectrum of possible abnormalities. This article reviews the imaging findings present with abdominal shunt complications.

Infections following ventriculoperitoneal shunts in children and teenages

The management of hydrocephalus by means of aventriculoperitoneal shunt (VPS) has, as a major threat,s u rgical infections. Factors, such as cause of hydro-cephalus, age below six months, shunt primary insert i o n ,trainaing curve of surgeons, conditions of antisepsisand length of the pro c e d u re contribute to the occurre n c eof infectious complications. The study aimed at determining the incidence, cause,site of ocurrence and clinical and laboratory manifesta-tions of infections in the children and teenagens whounderwent VPS in Hospital Gov. Joao Alves, Aracaju-SE. Fifteen patients were studied prospectively fro mJanuary 2003 to October 2004. Hospital records wereanalised and data were obtained during hospital stayand after discharge. The results were analised throughYates Chi-square, Fisher’s exact test, relative risk and oddsratio. A confidence interval of 95% was used. All patientsunderwent VPS because of hipertensive hydrocephalusand subsequent infection rate per pro c e d u re was 27.6%.Infection rates according to surgical risk index were25.7% for risk 0 and 30.4% for risk 1/2 (NNISS-CDC).S u rgical site infection (deep and superficial) was themajor complication (87.5%) with early appearance (mean27.6 days). Fever was the most frequent sign in 13 of 16cases. Infection related mortaliy rate was 10% (5/50).However, there was no statistical significance for causeof hydrocephalus (p=0.858), type of pro c e d u re (p=0.330),age at diagnosis (p=0.926), pre-operative length of stay(p=0.172), duration of pro c e d u re (p=0.534, RR=1.09,IC95% [0.6-2.0]), antibiotic prophylaxis (p=0.567), pre-vious use of CNS catheter (p=0.361) and risk index (0, 1,

One-trocar laparoscopy: a valid procedure to treat abdominal complications in children with peritoneal shunt for hydrocephalus.

The aim of this paper is to show the efficacy of laparoscopy using only one umbilical trocar to treat abdominal complications of hydrocephalic children with ventriculoperitoneal shunts (VPS). In a 15-year period, 14 laparoscopies were performed on as many children with VPS complications: in the last 4 patients only one trocar was used to solve the complications, and this subgroup will be the object of the present study. Concerning the indication for surgery, the patients presented one catheter lost in the abdominal cavity; one cerebrospinal fluid pseudocysts; one bowel obstruction; and one malfunctioning peritoneal limbs of the catheter. We used the one-trocar laparoscopic approach in all the 4 patients, and the 10-mm trocar was always introduced through the umbilical orifice in open laparoscopy. The laparoscopic technique was curative in all four cases and permitted the solution of the complication. One-trocar laparoscopic surgery can be considered as the ideal procedure in case of abdominal complications of VPS in children with hydrocephalus.

SHUNT INFECTION AND MALFUNCTION AFTER AUGMENTATION CYSTOPLASTY

Maintenance of a sterile intraperitoneal environment is critical in patients with ventriculoperitoneal shunts. Recent series have reported a broad discrepancy in the rate of shunt infection (0% to 20%) following augmentation cystoplasty. The need for distal shunt revision has not been well defined. We report the incidence of shunt infection and revision at our institution after bladder augmentation. We retrospectively reviewed the records of all patients with myelodysplasia and a ventriculoperitoneal shunt who underwent augmentation cystoplasty since August 1990. All patients included in the study had a minimum of 12 months of followup. A total of 55 patients with a ventriculoperitoneal shunt secondary to myelodysplasia required augmentation cystoplasty for management of a neuropathic bladder. Standard perioperative intravenous and oral antibiotic preparation, mechanical bowel preparation and intraoperative shunt isolation were used. Mean postoperative followup was 60.4 months (range 12 to 111). One patient presented with an extruded peritoneal shunt tip and positive cultures from cerebrospinal fluid and urine. Bladder perforation occurred in 2 patients and the shunt was empirically externalized. Revision was required for 5 (9%) distal shunt obstructions, including 1 cerebrospinal fluid pseudocyst. The incidence of shunt infection after augmentation cystoplasty is low (less than 2% in this large series), and presence of a ventriculoperitoneal shunt should not preclude bladder augmentation. Meticulous perioperative and intraoperative preparation contributes to the low rate of adverse events. Although the rate of distal revision after augmentation is significant, it does not exceed the reported distal failure rate for ventriculoperitoneal shunts in children without a history of urological surgery.

Shunt infection and malfunction after augmentation cystoplasty.

Maintenance of a sterile intraperitoneal environment is critical in patients with ventriculoperitoneal shunts. Recent series have reported a broad discrepancy in the rate of shunt infection (0% to 20%) following augmentation cystoplasty. The need for distal shunt revision has not been well defined. We report the incidence of shunt infection and revision at our institution after bladder augmentation. We retrospectively reviewed the records of all patients with myelodysplasia and a ventriculoperitoneal shunt who underwent augmentation cystoplasty since August 1990. All patients included in the study had a minimum of 12 months of followup. A total of 55 patients with a ventriculoperitoneal shunt secondary to myelodysplasia required augmentation cystoplasty for management of a neuropathic bladder. Standard perioperative intravenous and oral antibiotic preparation, mechanical bowel preparation and intraoperative shunt isolation were used. Mean postoperative followup was 60.4 months (range 12 to 111). One patient presented with an extruded peritoneal shunt tip and positive cultures from cerebrospinal fluid and urine. Bladder perforation occurred in 2 patients and the shunt was empirically externalized. Revision was required for 5 (9%) distal shunt obstructions, including 1 cerebrospinal fluid pseudocyst. The incidence of shunt infection after augmentation cystoplasty is low (less than 2% in this large series), and presence of a ventriculoperitoneal shunt should not preclude bladder augmentation. Meticulous perioperative and intraoperative preparation contributes to the low rate of adverse events. Although the rate of distal revision after augmentation is significant, it does not exceed the reported distal failure rate for ventriculoperitoneal shunts in children without a history of urological surgery.

Ventriculo-Peritoneal Shunts in Children Reveal the Natural History of Closure of the Processus Vaginalis

Abstract Purpose: Little information is known about the natural history of closure of the processus vaginalis. The authors studied children who had ventriculoperitoneal shunts to determine the natural history of closure of the processus vaginalis and to better understand the role of intraabdominal pressure in the etiology of congenital inguinal hernia. Materials and Methods: A retrospective review of all children undergoing insertion of ventriculoperitoneal shunts between 1985 and 1995 at the Royal Children's Hospital was undertaken. In each case, the sex, the cause of hydrocephalus, the age at insertion of the shunt, and the subsequent development of an inguinal hernia or hydrocele was recorded. Results: There were 430 children in the study. An inguinal hernia developed in 15% of children after insertion of a ventriculoperitoneal shunt, and a hydrocele developed in an additional 6% of boys. Inguinal hernias were bilateral in 47% of boys and 27% of girls. The incidence of subsequent development of an inguinal hernia or hydrocele was closely related to the age of insertion of the ventriculoperitoneal shunt, being 30% during the last 8 weeks of gestation and the first few months of life, then falling quite sharply to reach about 10% at 1 year. Conclusions: The high occurrence of inguinal hernias and hydroceles after ventriculoperitoneal shunt insertion supports the role of raised intraabdominal pressure in the etiology of these conditions. It appears that raised intraabdominal pressure is associated with an increased incidence of clinical hernias, but not with increased incidence of patency of the processus vaginalis. The development of an inguinal hernia or hydrocele after inserton of a ventriculoperitoneal shunt can be used as an indirect marker of patency of the processus vaginalis at the time of insertion of the shunt. From this, we propose that the processus vaginalis remains patent in at least 30% of children in the first few months of life, after which time the patency rate appears to fall off quite sharply.

Ventriculo-Peritoneal Shunts in Children Reveal the Natural History of Closure of the Processus Vaginalis

Ventriculo-Peritoneal Shunts in Children Reveal the Natural History of Closure of the Processus Vaginalis

The use of laparoscopy in the diagnosis and treatment of abdominal complications of ventriculo-peritoneal shunts in children: C. Esposito, A. Porreca, M. Gangemi, et al. Pediatr Surg Int 13:352–354, (July), 1998

The use of laparoscopy in the diagnosis and treatment of abdominal complications of ventriculo-peritoneal shunts in children: C. Esposito, A. Porreca, M. Gangemi, et al. Pediatr Surg Int 13:352–354, (July), 1998

The use of laparoscopy in the diagnosis and treatment of abdominal complications of ventriculo-peritoneal shunts in children.

Ventriculo-peritoneal shunts (VPS) are the most frequent operative procedures used to treat hydrocephalic children. Abdominal complications of VPS are now a rare event; however, their frequency varies from 5% to 47% according to reports. Anything that causes an obstruction or impediment of the VP derivation system will lead to intracranial hypertension, which requires immediate surgery. From 1985 to 1995 at the Division of Pediatric Surgery of the Federico II University of Naples, ten laparoscopies were performed in ten children with VPS complications. Cerebrospinal fluid pseudocysts were found in four infants. There was one case of abdominal wall perforation by the tip of the catheter at the umbilical level, two bowel obstructions, and one catheter was lost in the abdominal cavity. Finally, two children had malfunctioning of the peritoneal limb of the catheter. The laparoscopic technique was curative in all ten cases, thus avoiding a conventional laparotomy and the consequent risk of adhesions, which could cause further complications.

Ventriculo-peritoneal shunts in children reveal the natural history of closure of the processus vaginalis

Purpose: Little information is known about the natural history of closure of the processus vaginalis. The authors studied children who had ventriculoperitoneal shunts to determine the natural history of closure of the processus vaginalis and to better understand the role of intraabdominal pressure in the etiology of congenital inguinal hernia. Materials and Methods: A retrospective review of all children undergoing insertion of ventriculoperitoneal shunts between 1985 and 1995 at the Royal Children's Hospital was undertaken. In each case, the sex, the cause of hydrocephalus, the age at insertion of the shunt, and the subsequent development of an inguinal hernia or hydrocele was recorded. Results: There were 430 children in the study. An inguinal hernia developed in 15% of children after insertion of a ventriculoperitoneal shunt, and a hydrocele developed in an additional 6% of boys. Inguinal hernias were bilateral in 47% of boys and 27% of girls. The incidence of subsequent development of an inguinal hernia or hydrocele was closely related to the age of insertion of the ventriculoperitoneal shunt, being 30% during the last 8 weeks of gestation and the first few months of life, then falling quite sharply to reach about 10% at 1 year. Conclusions: The high occurrence of inguinal hernias and hydroceles after ventriculoperitoneal shunt insertion supports the role of raised intraabdominal pressure in the etiology of these conditions. It appears that raised intraabdominal pressure is associated with an increased incidence of clinical hernias, but not with increased incidence of patency of the processus vaginalis. The development of an inguinal hernia or hydrocele after inserton of a ventriculoperitoneal shunt can be used as an indirect marker of patency of the processus vaginalis at the time of insertion of the shunt. From this, we propose that the processus vaginalis remains patent in at least 30% of children in the first few months of life, after which time the patency rate appears to fall off quite sharply.

The use of peritoneoscopy in the diagnosis and treatment of complications of ventriculoperitoneal shunts in children

Abdominal complications of ventriculoperitoneal shunts used for hydrocephalus have been diagnosed and treated by peritoneoscopy in six instances. In four children, lost catheters were retrieved, and in two cases malfunction was treated. This technique was curative in each instance, thus avoiding total shunt replacement and formal laparotomy.