Ventriculoperitoneal Shunt Research Articles

Parkinsonism in a young adult after ventriculoperitoneal shunt procedure for tri ventricular obstructive hydrocephalus – A case report

Parkinsonism in a young adult after ventriculoperitoneal shunt procedure for tri ventricular obstructive hydrocephalus – A case report

The Effects of Using Modern Technologies in the Neurorehabilitation Process of a Patient after Traumatic Brain Injury – A Case Study

This study presents an analysis of the case of a 44-year-old male patient who experienced a traumatic brain injury, resulting in spastic quadriplegia, meningitis, right-sided craniotomy, ventriculoperitoneal shunt placement, and right hip arthroplasty. Data was collected over a four-year comprehensive therapy process involving treatment periods, during which the patient was under the care of an interdisciplinary team and participated in an individualized rehabilitation program, consisting of 3-4 hours of physical therapy daily for 5-6 days per week. The material included results from functional tests, muscle tone assessments, and balance evaluations. Numerical data from robotic gait therapy devices were also considered. With the consent of the patient and his family, the therapy process was documented via video recordings and photographs, which were then used for a retrospective visual analysis of recorded material at various stages of rehabilitation. For this purpose, the ShapeCare.Fizjo device was used, along with Blaze Pose software, based on a moving person’s skeletal detection model. The results indicated that comprehensive therapy using innovative tools such as C-eye, ReoGo, ReoAmbulator, and LeviActive system improved the patient’s balance and motor skills, as well as facilitated the gait re-education process. The use of modern technologies in neurorehabilitation not only optimizes therapeutic outcomes but also reduces the risk of musculoskeletal strain for the therapist during their professional work.

The Ventriculoperitoneal Shunt Complication Rate in Baghdad Medical City from 2019 to 2022.

Due to the substantial lack of data from Iraq on ventriculoperitoneal shunt (VPS) complications, this study aims to examine the various types of complications after VPS surgery in Baghdad Medical City. The retrospective cohort study analyzed VP shunt procedures at Baghdad Medical City from 2019 to 2022. The overall complication rate, including infection and shunt malfunction, was determined from patient records. Data were analyzed using descriptive statistics and Kaplan-Meier survival analysis. Ethical approval was obtained from the IRB, with consent waived due to the study's retrospective nature. The findings highlight the need for improved management to reduce complication rates in VP shunt procedures. The study involved 113 participants with an average age of 2.62 years (±3.4). The most common indications for VPS placement are congenital hydrocephalus (40%) and post-infectious hydrocephalus (30%). The most common complications of post-VPS surgery are VP obstruction (54%) and post-surgical infections (44%). There were no significant differences in the incidence of post-operative complications across different age groups. Our study showed the significant complication rate associated with VPS surgeries for hydrocephalus, particularly VPS infections and obstruction. There were no significant age-related differences in VPS complication rates across age groups.

Laparoscopic-Assisted Peritoneal Access in Ventriculoperitoneal Shunt Placement: Systematic Review and Meta-Analysis.

The most common treatment of hydrocephalus is ventriculoperitoneal (VP) shunting. Peritoneal access is commonly conducted through an open laparotomy, but laparoscopic peritoneal access is gaining popularity. Many studies have reported the benefits of minimally invasive laparoscopic peritoneal access, but there is no consensus on its use. We conducted a systematic review and meta-analysis to compare open laparotomy vs laparoscopic peritoneal access in VP shunting. A systematic search was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines using 3 databases. Twelve studies included only adults, 3 included only pediatric patients, and 3 included both adults and pediatric patients. Compared with open laparotomy, laparoscopic peritoneal access was associated with a reduction in distal shunt failure (6.1% vs 2.2%, P = .01), operative time (69.4 vs 56.3 minutes, P < .001), and length of stay (LOS) (9.6 vs 7.3 days, P < .001). There were no differences in proximal shunt failure, total shunt failure, intraoperative complications, or infection rate. In the pediatric population, laparoscopic access was associated with a reduced LOS (7.8 vs 5.9 days, P < .001). Heterogeneity was high but explained by the varying study populations and techniques. Laparoscopic peritoneal access for VP shunt insertion is associated with improved outcomes, including reduced distal shunt failure, reduced operative time, and reduced hospital LOS, when compared with open laparotomy and should be considered for shunt insertion. Additional studies are necessary to further determine the benefit of laparoscopic access, especially in the pediatric population.

Racemose neurocysticercosis of the basal arachnoid cisterns: illustrative case.

Neurocysticercosis is a parasitic infection of the central nervous system caused by the helminth Taenia solium. Racemose neurocysticercosis is a rare form of the disease that specifically involves cerebrospinal fluid-filled spaces in the brain and carries a high rate of complications and mortality. This report describes the case of a 37-year-old man who developed headaches and nausea, which were found to be secondary to racemose neurocysticercosis. He ultimately required an endoscopic third ventriculostomy, which provided transient symptom relief. In the weeks following the procedure, his symptoms returned, at which point a recommendation to proceed with a ventriculoperitoneal shunt was made. The presentation of racemose neurocysticercosis is wide-ranging and often nonspecific. Patients who respond well to initial surgical management with endoscopic third ventriculostomy can still require more durable measures, such as a ventriculoperitoneal shunt, in the following months. https://thejns.org/doi/10.3171/CASE24489.

ENDOSCOPIC THIRD VENTRICULOSTOMY VS VENTRICULOPERITONEAL SHUNT IN OBSTRUCTIVE HYDROCEPHALUS IN TERMS OF POST-OPERATIVE COMPLICATIONS

: Obstructive Hydrocephalus is a condition characterized by increased cerebrospinal fluid (CSF) volume within the brain's ventricular system, leading to clinical deterioration and disability. Without treatment, it can be fatal. Two primary treatment modalities are Ventriculoperitoneal Shunting (VPS) and Endoscopic Third Ventriculostomy (ETV), with ongoing debate over the superiority of one approach over the other. Objective: To compare the complications associated with Ventriculoperitoneal Shunting (VPS) and Endoscopic Third Ventriculostomy (ETV) in patients with obstructive hydrocephalus. Methods: A randomized controlled trial was conducted at a tertiary care hospital from April 15, 2024, to September 15, 2024. A total of 100 patients diagnosed with obstructive hydrocephalus were randomly allocated into two groups: 50 patients received VPS treatment, and 50 received ETV. Complications, including surgical site infection, seizures, hematoma, and CSF leakage, were recorded and analyzed. Results: Complications were observed in 36% (n=18) of patients in the VPS group compared to 16% (n=8) in the ETV group, with a statistically significant difference (p=0.023). Surgical site infections occurred in 8% (n=4) of VPS patients, while no infections were reported in the ETV group. Seizures were significantly more common in the VPS group, affecting 26% (n=13) compared to 8% (n=4) in the ETV group (p=0.017). Hematoma formation was observed in 4% (n=2) of VPS patients and 6% (n=3) of ETV patients. CSF leakage occurred in 4% (n=2) of VPS patients and 2% (n=1) of ETV patients. Conclusion: Endoscopic Third Ventriculostomy (ETV) demonstrated a significantly lower complication rate compared to Ventriculoperitoneal Shunting (VPS) in the management of obstructive hydrocephalus. These findings support ETV as a safer alternative with fewer associated complications.

Adult-onset neuronal ceroid lipofuscinosis misdiagnosed as autoimmune encephalitis and normal-pressure hydrocephalus: A 10-year case report and case-based review.

Neuronal ceroid lipofuscinoses (NCLs) are rare, fatal, inherited neurodegenerative disorders characterized by myoclonic epilepsy, cognitive decline, brain atrophy, and retinopathy. The pathogenesis and clinical manifestations of NCL are not well understood and frequently result in misdiagnosis and overtreatment. The aim of this case report and review is to improve our understanding of the clinical features and management of NCL. A 36-year-old woman initially presented with refractory epilepsy. Initially diagnosed with autoimmune encephalitis, the patient was later diagnosed with normal-pressure hydrocephalus. A definitive diagnosis of adult-onset neuronal ceroid lipofuscinosis (ANCL) was established after 10 years of observation, utilizing biopsy and genetic testing. High-dose intravenous immunoglobulin and methylprednisolone were administered, along with the insertion of a ventriculoperitoneal shunt. Despite various treatments, the patient's condition did not improve. ANCL typically presents with the clinical triad of refractory seizures, progressive cognitive decline, and movement disorders. Neuroimaging often reveals progressive brain atrophy on magnetic resonance imaging, while electroencephalograms frequently show epileptiform discharges. The prognosis is generally poor. Improved understanding of ANCL from both clinical and radiological perspectives, coupled with early consideration of differential diagnoses, could minimize unnecessary interventions and optimize patient care.

Variability in treatment of postoperative pain in children with severe neurologic impairment.

Treatment of postoperative pain for children with severe neurologic impairment (SNI) is challenging. We describe the type, number of classes, and duration of postoperative pain medications for procedures common among children with SNI, as well as the variability across children's hospitals in pain management with an emphasis on opioid prescribing. This retrospective cohort study included children with SNI ages 0-21 years old who underwent common procedures between January 1, 2019 and December 31, 2019 within 49 children's hospitals in the Pediatric Health Information System. We defined SNI using previously described high-intensity neurologic impairment diagnosis codes and identified six common procedures which included fracture treatment, tracheostomy, spinal fusion, ventriculoperitoneal shunt placement (VP shunt), colostomy, or heart valve repair. Medication classes included benzodiazepines, opioids, and other nonopioid pain medications. Acetaminophen and nonsteroidal anti-inflammatory drugs were excluded from analysis. All findings were summarized using bivariate statistics. A total of 7184 children with SNI underwent a procedure of interest. The median number of classes of pain medications administered varied by procedure (e.g., VP shunt: 0 (interquartile range [IQR] 0-1); tracheostomy: 3 (IQR 2-4)). Across all procedures, opioids and benzodiazepines were the most commonly prescribed pain medications (48.8% and 38.7%, respectively). We observed significant variability in the percentage of postoperative days with opioids across hospitals by procedure (all p < .001). There is substantial variability in the postoperative delivery of pain medications for children with SNI. A standardized approach may decrease the variability in postoperative pain control and enhance care for children with SNI.

The Development of Postoperative Hydrocephalus following Midline Posterior Cranial Fossa Tumors with Hydrocephalus Surgery with Preoperative Ventriculoperitoneal (V-P) shunt in Pediatric Patients

Background: Posterior cranial fossa tumors are the most common tumors in children and constitute about two-thirds of pediatric brain tumors. Such pediatric patient presents with symptoms and signs of raised intracranial pressure. All pediatric patients were diagnosed with midline posterior cranial fossa tumors with hydrocephalus. The ventriculoperitoneal shunt was done before definitive surgery for all patients. Definitive surgery was done later on. These patients were followed up to the 7th postoperative day following definitive surgery. We assessed the development of postoperative hydrocephalus. Objectives: The objective of the study was to assess the development of postoperative hydrocephalus of midline posterior cranial fossa tumors with hydrocephalus after definitive surgery following ventriculoperitoneal (V-P) shunt in pediatric patients. Methods: This cross-sectional experimental study was conducted in the Department of Neurosurgery, Bangabandhu Sheikh Mujib Medical University, and the Department of Pediatrics Neurosurgery, National Institute of Neurosciences &amp; Hospital, Dhaka from March 2018 to September 2019. A total of 43 pediatric patients were included in this study. All pediatric patients were diagnosed with midline posterior cranial fossa tumors with hydrocephalus. The ventriculoperitoneal shunt was done before definitive surgery. Later on, definitive surgery was performed. Follow-up of these patients was done up to the 7th postoperative day. The development of postoperative hydrocephalus was observed. Data were processed and then analyzed. Demographic data were expressed in numbers and percentages. The development of postoperative hydrocephalus was expressed in number and percentage. Logistic regression was done to predict the relationship between the dependent variable (development of hydrocephalus) and independent variables (age, sex, and the extent of tumor removal). The odds ratio (OR) was calculated by using the Chi-square test. The chi-square test gave a Wald statistic by observing at the 95% CI of the odds ratio. Statistical significance was set to p-value &lt;0.05. Results: A total of 43 pediatric patients were included in the study from March 2018 to September 2019. In the study, the maximum patients were in the age group 11-15 years. The mean age of the patients was 8.25 years ± 4.14. The male-to-female ratio was 1.26:1. The study showed preoperative clinical features which includes headache 40 (93%), vomiting 37 (86%), visual disturbance 24 (55.8%), altered level of consciousness 3 (7.0%), gait disturbance 30 (69.8%), swallowing disturbance 9 (20.9%), papilledema 38 (88.4%), lower cranial nerves palsy 8 (18.6%). Among them, 25 patients developed postoperative complications after definitive surgery. Development of postoperative hydrocephalus was found in 2 (4.65%) patients. Logistic regression was found to be statistically non-significant in this study. Conclusion: The development of postoperative hydrocephalus of midline posterior cranial fossa tumors with hydrocephalus after definitive surgery following ventriculoperitoneal (V-P) shunt in pediatric patients was not the major complication among others. Bang. J Neurosurgery 2024; 13(2): 86-95

Assessing Neurosurgery Training: Accreditation Council for Graduate Medical Education Case Minimums Versus Surgical Autonomy.

The Accreditation Council for Graduate Medical Education (ACGME) requires neurosurgery residents to reach a set number of cases in specified procedure types (case minimums) before graduation and mandates completion of Milestones. We used the Surgical Autonomy Program, a validated method of autonomy-based resident evaluation, to determine the number of cases it took for residents to become competent and compared these with the ACGME case minimums. We collected data from neurosurgery residents at Duke University on 7 procedures (tumor craniotomy, trauma craniotomy, ventriculoperitoneal shunt, anterior cervical discectomy and fusion (ACDF), posterior cervical fusion (PCF), discectomy/laminectomy, and posterior thoracolumbar spinal fusion [PSF]). We defined competency as being graded at the highest autonomy level in the Surgical Autonomy Program by attending neurosurgeons for the first and second time and determined the case volume on the ACGME case log when these were achieved. These results were analyzed with summary statistics. The median case volume among residents (N = 4-8) for the first and second competency rating (and ACGME minimum) for each procedure type was found to be: tumor: 44.5 and 64.5 (min. 60), trauma: 21 and 30 (min. 60), ventriculoperitoneal shunt: 11.3 and 13 (min. 20), ACDF: 30 and 32.5 (min. 20), PCF: 24 and 40 (min. 30), discectomy/laminectomy: 28 and 36 (min. 30), and PSF: 51 and 54 (min. 30). We found variation in the case numbers to reach competency and that for some procedures (tumor, ACDF, PCF, discectomy/laminectomy, and PSF), most residents required more cases than the ACGME case minimums to achieve competency. The ACGME case minimums may not accurately reflect the number of cases required for neurosurgical residents to reach competency. To promote trainee-centered education, individualized, competency-based evaluation systems may be better determining readiness for graduation, including a system that builds off the established ACGME Milestones.

Short- and Long-Term Outcomes of Prenatally Identified Congenital Aqueductal Stenosis by Fetal MRI.

Providing accurate prenatal prognostication for expectant parents is challenging due to limited literature on factors impacting outcomes in children with congenital aqueductal stenosis (CAS). This study stratified CAS patients into isolated or complex categories (presence of additional intra- or extra-cranial anomalies or genetic syndromes) and evaluated both short- and long-term outcomes. Additionally, the role of ventricular rupture was assessed. This was a single center retrospective-cohort study of CAS patients who underwent fetal MRI over a 10-year period. Of 140 patients with CAS, 107 (76%) were complex and 33 (24%) were isolated. There were no differences in the size of ventricular enlargement or incidence of ventricular rupture between the two groups. 14 pregnancies were terminated, 9 experienced fetal demise/stillbirth, and there were 21 post-natal deaths. Outcomes at the time of hospital discharge were available for 86 patients and long-term follow-up data for 64. CSF diversion (via ventriculoperitoneal shunt) was performed in 95% of complex and 71% of isolated CAS patients. Acutely, no differences were noted in seizures (complex: 10%; isolated: 18%) or respiratory support but there was an increased risk for feeding support. Risks for non-ambulatory status (complex: 32% vs. isolated: 0%), epilepsy (complex: 56% vs. isolated: 19%) and long-term gastrostomy tube assisted feeding (complex: 25.5% vs. isolated: 0%) were significantly greater with complex CAS. The presence of rupture did not impact clinical outcome. Poor clinical outcome was associated with complex CAS. Ventricular rupture alone did not portend a poor outcome. Prenatal counseling can tailor prognostication by CAS type.

The economic burden of ventriculoperitoneal shunt insertion and its complications: findings from a cohort in the Philippines.

Ventriculoperitoneal shunt (VPS) insertion is the gold standard treatment for congenital hydrocephalus, but there is little data about the cost of this procedure in developing countries. We aimed to determine the in-hospitalization cost of initial VPS insertion and its complications (malfunction and infection) and identify predictors of increased cost. We performed a retrospective cohort study by reviewing the medical and financial records of pediatric patients with congenital hydrocephalus and underwent shunt surgery at our institution between 2015 and 2019. We also performed multivariable linear regression analysis to determine clinical characteristics that were predictive of cost. A total of 230 cerebrospinal fluid diversion procedures were performed on 125 patients. The mean age during index VPS insertion was 9.8months (range: 7days-8years). Over a median follow-up of 222days, 15 patients (12%) developed shunt malfunction while 25 (20%) had a shunt infection. The mean in-hospitalization cost for all patients was PHP 94,573.50 (USD 1815). The predictors of higher cost included shunt infection (p < 0.001), shunt malfunction (p < 0.001), pneumonia (p = 0.006), sepsis (p = 0.004), and length of hospital stay (p = 0.005). Patients complicated by shunt infection had a higher mean cost (PHP 282,631.60; USD 5425) than uncomplicated patients (PHP 40,587.20 or USD 779; p < 0.001) and patients who had shunt malfunction (PHP 87,065.70 or USD 1671; p < 0.001). The study provided current data on the in-hospitalization cost of VPS insertion in a public tertiary hospital in a developing country. Shunt infection, malfunction, pneumonia, sepsis, and length of hospital stay were significant predictors of cost.

Utility of routine postoperative imaging in adults undergoing primary ventriculoperitoneal shunts.

There is currently no consensus on the usefulness of postoperative imaging after ventriculoperitoneal (VP) shunt insertion in adults. The aim of this study was to investigate the utility of routine postoperative imaging (CT head scans and radiographs) following primary VP shunt insertion in a general adult population treated at a tertiary neurosurgical centre. Patients undergoing primary VP shunt insertion between 2017-2021 were included. Actions taken based on routine postoperative imaging and need for subsequent shunt revision were recorded. 236 patients were included. The median age was 63years (range 17-90). There was a slight female preponderance (121/236, 51.3%). The median follow-up was 38.5months (3.1 - 60.5months). Acute intervention was employed in 9 patients (3.9%) on the basis of routine postoperative CT head scan. Routine postoperative radiographs did not result in reoperation. Around a quarter (28.8%) of patients had a shunt revision, most of whom underwent urgent primary shunt insertions. Postoperative ventricular catheter characteristics (position of shunt tip, tip relation to septum pellucidum, and intraventricular catheter distance) were not predictive of shunt revision. Surgical urgency (emergency vs. elective procedures) was associated with long-term shunt revision (OR = 2.80, 95% CI 1.42 - 5.53, p = 0.003). Routine postoperative imaging rarely led to reoperation in adult patients undergoing primary VP shunt insertion. Patients undergoing emergency shunt insertions were at the highest risk for requiring revision.

Experience from a Fast-Track Multidisciplinary Clinic Integrating Movement Disorders Neurologists in Normal Pressure Hydrocephalus Evaluation.

In this prospective observational cohort study, we provide preliminary findings from a same-day multidisciplinary fast-tracked normal pressure hydrocephalus (NPH) clinic; incorporating the expertise of movement disorders neurologists, emphasizing the clinical characteristics, consensus classification, and management of patients referred for suspected NPH. We evaluated 111 patients (male/female: 67/44) from April 2022 to May 2023. Based on the multidisciplinary team consensus, 52 (46.8%) were classified as "probable" idiopathic NPH (iNPH), 14 (12.6%) as "possible" NPH, 42 (37.8%) as "unlikely" NPH, and three (2.7%) as secondary NPH. While parkinsonian syndromes were recognized in 19.2% of "probable" iNPH patients (vs. 7.1% in "possible" and 26.2% in "unlikely" NPH), no significant group differences were noted in the scores of the UPDRS-III scale. Degenerative spine pathologies were prevalent across all NPH categories, affecting at least 50% of patients. In the "probable" iNPH group, 78.8% received programmable ventriculoperitoneal shunts, with clinical improvement identified in 87.8% at 12-month follow-up. Our findings underscore the high prevalence of overlapping and competing movement and spinal disorders in patients with suspected NPH. Further, our novel approach, incorporating movement disorder neurologists in NPH multidisciplinary evaluation, improved diagnostic precision and streamlined personalized plans, including further neurological workups, necessary spinal interventions, and medical management or rehabilitation.

Evaluation of ventriculoperitoneal shunt infections and risk factors in children.

To evaluate the demographic, clinical, diagnostic, and treatment data of pediatric patients with ventriculoperitoneal shunt infection and risk factors for ventriculoperitoneal shunt infection and recurrence of ventriculoperitoneal shunt infection. Patients aged 0-18 years who were diagnosed with ventriculoperitoneal shunt infection at CukurovaUniversity Faculty of Medicine Hospital between 2016 and 2021 were included in the study. Demographic, clinical, laboratory, and treatment data of the patients were evaluated retrospectively. Risk factors for the development and recurrence of ventriculoperitoneal shunt infection were evaluated. Patients who underwent ventriculoperitoneal shunt but did not develop any shunt infection were selected as the control group. Eighty-five patients with a diagnosis of ventriculoperitoneal shunt infection were included in the study. Fever (58.8%), anorexia (58.8%), vomiting (56.5%), and altered consciousness (54.1%) were the most common complaints at admission. The control group consisted of 48 patients. The number of shunt revisions was statistically significantly higher in the group that developed ventriculoperitoneal shunt infection compared to the control group (p < 0.001). In patients with ventriculoperitoneal shunt infection, C-reactive protein and cerebrospinal fluid protein values before shunt insertion were found to be statistically significantly higher than the control group (p < 0.001). Ventriculoperitoneal shunt infection occurs most frequently in the first months after shunt application. Therefore, it is extremely important to prevent colonization and contamination during surgery in preventing the development of ventriculoperitoneal shunt infection. In the present study, cerebrospinal fluid protein elevation and C-reactive protein elevation before shunt application were found to be significant in terms of the development and recurrence of ventriculoperitoneal shunt infection.

Non-invasive diagnosis of ventriculoperitoneal shunt malfunction: Advancing hydrocephalus care with SMI ultrasound and AI.

Non-invasive diagnosis of ventriculoperitoneal shunt malfunction: Advancing hydrocephalus care with SMI ultrasound and AI.

Ascites production and prognosis after ventriculoperitoneal shunt for diffuse midline gliomas in children: A case series.

DMG is a highly invasive and lethal type of brain tumor. As these tumors progress, they often compromise the CSF circulation, leading to hydrocephalus. Ventriculoperitoneal shunt (VPS) is commonly employed to manage hydrocephalus; however, the complication of VPS-induced ascites, particularly in the presence of tumor cells, is a significant concern that merits attention. This case series details 3 pediatric patients diagnosed with brainstem DMG harboring the H3 K27M mutation. Each developed hydrocephalus underwent VPS insertion. Post-operatively, all patients developed carcinomatous ascites with tumor cells detected within the ascitic fluid. All 3 patients were diagnosed with intra-abdominal metastasis of DMG H3K27M mutant cancer cells, each presenting with distinct complications. Initially, the patients' primary head tumors responded to treatment, and their hydrocephalus resolved. However, some time after discharge, each patient developed malignant ascites and received palliative chemotherapy to control symptoms and improve quality of life. Despite the interventions, all 3 patients died within 1 month of developing malignant ascites, with central respiratory failure being the direct cause of death. These cases underscore the importance of continuous monitoring of both the CSF and ascitic fluid in patients with gliomas. Regular assessments of biochemical composition, cytology, and other diagnostic tests are crucial for early detection of disease progression. This proactive approach facilitates timely clinical judgment and intervention, potentially improving patient outcomes.

PDOC-14 CASE SERIES ON THE MANAGEMENT OF POSTERIOR CRANIAL FOSSA TUMORS AND CHALLENGES ENCOUNTERED IN A LOW RESOURCE SETTING: ZIMBABWE

Abstract OBJECTIVES To investigate the management and challenges encountered in caring for patients with posterior cranial fossa tumors in Zimbabwean government central hospitals and their outcomes. METHODS Clinical and surgical records of six paediatric patients diagnosed with posterior cranial fossa tumors and managed at Parirenyatwa group of hospitals and Sally Mugabe Central Hospital over the past 8months were accessed from the hospital archives and utilized to fill in a previously created assessment tool. RESULTS Six cases of posterior fossa tumors were analysed. The ages ranged from 2 to 12 years, with a female-to-male ratio of 2:1. None of the patients underwent standard emergency posterior fossa tumor excision. All of the patients initially had a ventriculoperitoneal shunt inserted for active hydrocephalus due to the unavailability of theatre time, surgical sundries, ICU beds, and blood products. A single patient deceased after developing a complication of upward herniation whilst four patients proceeded to have uneventful excisions of posterior fossa tumors. For the cases that had surgical tumor excision, an average waiting period of 2 weeks was observed between ventriculoperitoneal shunting and surgical excision. One patient was lost to follow-up after shunting. CONCLUSION There are delays in emergency neuro-oncological service delivery in Zimbabwe leading to delayed excision of posterior fossa tumors. These delays have been bridged by CSF diversion through the placement of ventriculoperitoneal shunts while awaiting definitive surgery. Despite these challenges and delays, the outcomes are generally satisfactory.

Tethered cord prevalence among patients with prenatal or postnatal myelomeningocele repair.

Myelomeningocele (MMC) is a severe form of spina bifida characterized by spinal cord extrusion into a cerebrospinal fluid (CSF) filled sac which may lead to lifelong disability. Repair of these lesions have classically occurred shortly after birth, but more recently, prenatal myelomeningocele repair techniques have been elucidated. This study aimed to investigate the outcome of surgery, particularly with subsequent spinal cord tethering, in patients with prenatal myelomeningocele closure and those with postnatal repair surgery. In this retrospective study which assessed patients from April 2002 to April 2020, the data of 18 total patients with MMC were reviewed. Nine patients from each group were included, closed prenatally or postnatally, respectively. Demographic information including age and sex, birth week, infant comorbidities, presence of dermoid or lipoma, cutaneous stigmata, total number and timing of detethering procedures, presence of Chiari malformation, and need for VPS was obtained. Eighteen patients including nine infants closed prenatally and nine infants with myelomeningoceles closed postnatally were reviewed. The mean age was 4 ± 3years and 6.22 ± 2.4 in prenatal and postnatal retrospectively. There was a significant relationship between the number of detethering procedures (p-value = 0.03) and the need for a ventriculoperitoneal shunt (VPS) (p-value = 0.01) between the groups, with the prenatal closure group having lower rates of each. There was no significant difference between the groups in regard to the mean age at the detethering procedure (p = 0.4), sex (p = 0.09), birth week (p = 0.8), comorbidities (p = 0.8), presence of intraspinal dermoid or lipoma (p = 0.09), presence of cutaneous stigma (p = 0.08), Chiari (p = 0.6), fatty filum (p = 0.08), syrinx (p = 0.4), bone anomaly (p = 0.4), and spina bifida neurological scale (p = 0.66). There was a significant relationship between the two groups in terms of the number of detethering procedures, and the need for VPS. Our data represents a possible difference in the need for detethering surgeries and ventriculoperitoneal shunt placements between patients with prenatal and postnatal myelomeningocele closures.

Endoscopic Ventriculocisternostomy with Stent Placement for Trapped Temporal Horn

Trapped temporal horn (TTH) is a subtype of focal obstructive hydrocephalus. Although a ventriculoperitoneal shunt (VPS) is a traditional treatment approach, it poses risks of shunt failure and infection. The emergence of neuroendoscopy has led to an increased interest in ventriculocisternostomy as an alternative. This study aimed to evaluate the efficacy and safety of endoscopic ventriculocisternostomy with stent placement (EVSP) for TTH. We collected data of TTH cases treated with EVSP at our institutions between September 2013 and September 2021 and evaluated baseline characteristics and outcomes. A ventricular stoma was created at the medial wall of the abnormally enlarged temporal horn using a neuroendoscope, and a ventricular stent tube with multiple side holes was placed through the stoma to maintain patency. The study included 10 patients (4 women and 6 men) with a mean age of 56.7±19.7 years. The average follow-up period was 35.0 months (range, 1-96 months). The underlying pathologies were postoperative scarring (5 cases), intraventricular tumor (3 cases), and extraventricular tumor (2 cases). There were no procedural complications; however, one patient experienced recurrence and underwent additional cisternostomy. All patients exhibited partial or complete resolution of the preoperative symptoms and demonstrated shrinkage of the trapped ventricle, with a mean reduction rate of 84.5%±14.9%. EVSP is a safe and feasible option for the treatment of TTH and is a viable alternative to VPS.