VP Shunt Insertion Research Articles

Relationship between preoperative nutritional status assessed using anthropometric measures and postoperative complications in pediatric surgical patients.

To determine the relationship between preoperative nutritional status assessed using anthropometric measures and postoperative complications in pediatric surgical patients. This prospective observational cohort study included 650 patients from 6months to 18years undergoing elective surgery at our institution. Elective surgery included procedures such as herniotomy, orchidopexy, urethroplasty, cystoscopy, PUV fulguration, pyeloplasty, ureteric reimplantation, stoma formation/closure, anorectoplasty, pull-through, choledochal cyst excision and repair, VP shunt insertion, lipomyelomeningocele repair, diastematomyelia excision and repair, and cyst excision. Nutritional status was standardized using Z scores for weight, length, and BMI. Patients were monitored for a month following surgery to detect any complications, and they were classified into five grades using the Clavien-Dindo classification. The duration of hospital stays and readmission within 30days following discharge were secondary outcomes. There were 627 patients of both sexes involved in the study: 350 patients aged 6months to 5years (Group A), while 277 were aged between 5 and 18years (Group B). Wasting status was 47.71% in Group A and 41.52% in Group B. In Group A, 40% of patients were stunted, while 83.75% were in Group B. Group A had 57.14% underweight patients. The complication rate was 39.14% in Group A and 38.99% in Group B. The incidence of postoperative complications was not significantly different in malnourished patients. The patients with prolonged duration of surgery (> 2h) developed more complications in both groups (Group A-67.2%, Group B-82.6%; p < 0.0001). In addition, the patients who experienced complications had lengthier hospital stays (p < 0.001 in both groups) and increased readmission rates (p = 0.016 in Group A and p = 0.008 in Group B). In our study, half of the patients in Group A and nearly two-third in Group B were malnourished. The preoperative poor nutritional status based on anthropometric parameters is not associated with increased postoperative complications. Randomized control trials linking preoperative malnutrition based on anthropometric measures and clinical outcomes in pediatric surgery patients are necessary to provide more robust information on this subject.

Influence of distal insertion technique, valve selection, and patient demographics on shunt survival in ventriculoperitoneal shunt insertion: A retrospective analysis of an Australian case series

BackgroundVentriculoperitoneal (VP) shunt insertion is a means of diverting cerebrospinal fluid (CSF) for management of hydrocephalus. Revision rates, operating time, and length of stay (LOS) following laparoscopic insertion of the distal catheter have been mixed. There are limited data on the role of adhesiolysis during VP shunt insertion. Valve characteristics have also been shown to influence patient outcomes. There is a paucity of Australian data reporting on the effect of these variables on shunt outcomes. We aimed to study patient demographics, indications, and surgical and instrument variables in the Australian context. MethodsWe performed a retrospective, multi-surgeon, single-centre analysis of VP shunts inserted in adults via an open or laparoscopic technique. Data on patient demographics and surgery characteristics were collected from the hospital medical records and the Australasian Shunt Registry. The primary outcome was shunt revision rate and secondary outcomes were postoperative complications, operating time and LOS, and shunt survivability. ResultsFifty-six participants were eligible for analysis. The overall revision rate was 14.3 %, which was lower than the national average. The distal catheter revision rate was 0 %. Laparoscopic insertion of the distal catheter was shown to significantly reduce operating time (70.4 min in the open group and 50.7 min in the laparoscopic group, p < 0.001). This was demonstrated across different aetiologies, and when controlling for age and valve-type (p < 0.05). The revision rate of non-programmable was higher than programmable valves (42.9 % versus 2.9 %, respectively). There were no differences between previous abdominal surgery, LOS, complication, or revision rate between open and laparoscopic insertion. VP shunt survivability was greater in the laparoscopic group (90-day shunt survival of 96.7 % and 92 % in the laparoscopy and open groups, respectively; p > 0.05). We did not find any significant difference in operating time or length of stay for age, sex, or previous abdominal surgery, even when accounting for surgical technique. Indication and shunt survivability varied widely between age groups. The use of laparoscopic insertion increased over time, though surgeons did not crossover techniques. ConclusionsThe overall distal revision rate of VP shunts is low. Laparoscopic insertion of the distal catheter reduces operating time and may improve shunt survivability. Larger studies are needed to confirm differences in shunt survivability in open versus laparoscopic distal catheter insertion, between age groups, clinical indications, and valve type on patient outcomes.

Is endoscopic third ventriculostomy a viable treatment option for normal pressure hydrocephalus? A systematic review.

Endoscopic third ventriculostomy (ETV) is considered an alternative treatment for hydrocephalus and has become a standard of care for obstructive hydrocephalus. Recent studies have also explored its role in normal pressure hydrocephalus (NPH). We conducted a systematic review aiming to assess the outcomes of this minimally invasive endoscopic technique as a viable treatment option for NPH. A systematic literature search was performed using PubMed and Scopus databases, using iterations of search terms "Endoscopic third ventriculostomy," "Idiopathic normal pressure hydrocephalus," and "Normal pressure hydrocephalus." To be eligible for inclusion in the review, articles had to report the usage of ETV as a primary treatment modality for NPH, report its outcomes, and be published in the English language. Out of the 13 studies selected for qualitative synthesis, nine supported the use of ETV for NPH as an effective treatment option with improvement in the preoperative symptoms. Two studies favored shunt over ETV, stating that quality of life is better with VP shunt insertion. One study reported that ETV has higher perioperative mortality rates that outweigh its benefits. One study reported it to be an ineffective surgical option. The current review of evidence does not support the use of ETV for the treatment of NPH, except perhaps in a small subset of patients. These patients have a shorter duration of symptoms and a better preoperative neurological status. The lumbar infusion test and ventricular infusion test are modalities useful for selecting these candidates.

Ventriculoperitoneal shunt infection rate and other associated complications of VP shunt insertion in Abuja, Nigeria

BackgroundComplications associated with ventriculoperitoneal shunt insertion constitute a significant cause of morbidity and mortality among hydrocephalus patients. Despite this, VP shunt placement has remained the mainstay of treatment for hydrocephalus. The aim of this study is to evaluate the complications of VP shunt surgery in our environment and to identify the risk factors associated with it. MethodologyPatients who had VP shunt surgery over a period of two years (Jan 2015–December 2016) were evaluated retrospectively by reviewing their hospital records. The patients’ demography, aetiology and clinical presentation of the hydrocephalus, and complications were analysed using SPSS version 26.0. Results were presented in tables and figures. ResultsA total of 69 patients who had VP shunt over the study period had complete medical records available for review. Their age ranged between 2days and 68years with a male to female ratio of 1.8:1. Overall complication rate was 30.4%. Shunt malfunction (11.5%) and shunt infection (7.2%) were the commonest complications recorded. Late presentation was the most important risk factor for shunt complications. ConclusionThe rate of shunt complications seen in this study compares fairly with studies in other parts of the world.

Scrotal Migration of The Distal End of The Ventriculoperitoneal Shunt: Is There a Role for Early Closure of Patent Processus Vaginalis in The Pediatric Population?

Background: Ventriculoperitoneal shunt (VP) insertion is one of the surgical treatments for patients with hydrocephalus. Infection, malfunction, catheter migration, hernia development, equipment failure, CSF subcutaneous collection and peritoneal pseudocyst formation are considered to be the main complications of this procedure. Case Description: A 6-months-old boy known to have congenital aqueductal stenosis with VP shunt insertion at the age of 1 month, presented with scrotal swelling and generalized hypotonia. He was found to have catheter migration into the scrotum. Conclusion: Scrotal migration of the distal end of the ventriculoperitoneal shunt is a rare but threatening complication that can present with either signs of hydrocephalus or scrotal swelling or hydrocele. Accordingly, we recommend performing a scrotal exam with an ultrasound early upon evaluation of any infant presenting with scrotal swelling or hydrocele after VP shunt insertion. There haven’t been clear recommendations in the literature concerning closure of patent processus vaginalis upon placing a VP shunt in patients below the age of 3 months. Thus, we question whether early closure could help reduce the complications of catheter migration in infants.

Gamma Knife Radiosurgery for Third Ventricular Colloid Cysts: A Retrospective Study

Introduction: Colloid cysts often occur in the third ventricle, and they are considered benign, slowly growing lesions. They commonly present with symptoms of intracranial hypertension and rarely sudden death due to acute hydrocephalus. The management options include cerebrospinal fluid diversion procedure by shunt, endoscopic or transcranial surgical excision, and stereotactic aspiration. Complications associated with excisional procedures make them undesirable to some patients. Stereotactic radiosurgery has emerged as a noninvasive less risky treatment option. To date, there is no clinical series in the literature reporting on this treatment modality. The aim of the study was to determine the efficacy and safety of gamma knife (GK) radiosurgery in the treatment of third ventricular colloid cysts. Methods: This is a retrospective study involving 13 patients with third ventricular colloid cysts who underwent GK radiosurgery. GK radiosurgery was used as a primary treatment in all the patients. The median prescription dose was 12 Gy (11–12 Gy). The cyst volumes ranged from 0.2 to 10 cc (median 1.6 cc). Results: The median follow-up was 50 months (18–108 months). Cyst control was achieved in 100% of the patients. Complete or partial response was observed in 12 patients (92%). Eight patients (62%) had hydrocephalus on imaging at the initial diagnosis. Seven of these patients had VP shunt insertion before GK. One patient required shunt insertion after GK. Conclusion: GK for third ventricular colloid cysts is a promising treatment, regarding its efficacy and safety, to be added to other treatment options. A longer follow-up is required to confirm long-term control.

Scrotal migration of the distal end of the ventriculoperitoneal shunt: Is there a role for early closure of patent processus vaginalis in the pediatric population?

Background: Ventriculoperitoneal shunt (VP) insertion is one of the surgical treatments for patients with hydrocephalus. Infection, malfunction, catheter migration, hernia development, equipment failure, CSF subcutaneous collection and peritoneal pseudo cyst formation are considered to be the main complications of this procedure. Case description: A 6-months-old boy known to have congenital aqueductal stenosis with VP shunt insertion at the age of 1 month, presented with scrotal swelling and generalized hypotonia. He was found to have catheter migration into the scrotum. Conclusion: Scrotal migration of the distal end of the ventriculoperitoneal shunt is a rare but threatening complication that can present with either signs of hydrocephalus or scrotal swelling or hydrocele. Accordingly, we recommend performing a scrotal exam with an ultrasound early upon evaluation of any infant presenting with scrotal swelling or hydrocele after VP shunt insertion. There hasn’t been clear recommendations in the literature concerning closure of patent processus vaginalis upon placing a VP shunt in patients below the age of 3 months. Thus, we question whether early closure could help reduce the complications of catheter migration in infants.

Intracardiac migration of distal catheter—a rare complication of VP shunt insertion: case report and literature review

Intracardiac migration is a rare complication of ventriculoperitoneal shunt insertion. Only 15 cases have been reported, 7 of which were paediatric cases, treated with techniques including interventional radiography, open thoracotomies and direct extraction through the initial shunt incision. The authors report the youngest case of intracardiac shunt migration complicated by significant coiling and knotting within the cardiac chambers and pulmonary vasculature. Migration likely began when the SVC was pierced during initial shunt placement and progressed due to negative intrathoracic pressure. Extrusion was achieved combining thoracoscopic endoscopy, interventional fluoroscopy screening and a posterolateral neck incision with uncoiling of the shunt via a Seldinger guide wire. This offered a minimally invasive solution with rapid post-operative recovery.

111 Normal Pressure Hydrocephalus—a disease made for frailty clinics

Abstract Background NPH is one of the few reversible causes of dementia and gait disturbance. Multidisciplinary assessment is vital for diagnosis. CT findings are variable but scoring systems are available. Trial of high volume CSF drainage can be technically difficult in this population and even if there is measurable improvement after CSF drainage, referral for VP shunting can take months to years. Methods We present a Case Series of 10 cases of Probable NPH presenting to RFIT (Roscommon Frailty Intervention Team) over a 1 year period. Diagnosis was based on ‘Radscale’ CT Brain criteria (1) (used to differentiate from ventriculomegaly ex-vacuo) with presenting Gait and Cognitive deficits and positive response to high volume CSF drainage. Pre- and post-LP (up to 40 mL CSF drained) Gait and Cognitive findings are presented. Results Ten patients were diagnosed as having probable NPH using the Imperial College London diagnostic pathway. Three patients were deemed not to be fit for VP shunt. One elected to have a trail of CSF drainage for diagnostic reasons. Seven patients had high volume CSF drainage. Five patients showed improvement of &amp;gt;15% in timed up and go. Two patients showed no improvement post-LP. Five patients were referred for VP shunt. Three patients have had shunts inserted and have improved. Two still await VP shunt insertion. Conclusion 10 cases of probable NPH were diagnosed by the RFIT team in 1 year. We feel that as one of the very few reversible causes of progressive cognitive impairment and gait disturbance it is imperative that NPH be diagnosed as early and as definitively as possible. We highlight the utility of the Radscale CT Brain scoring system as an initial diagnostic prompt. We feel that this can be used by non-radiologist doctors, Frailty CNS or ANP, Physiotherapists in order to prompt teams to consider NPH in the differential diagnosis of Gait and cognitive abnormalities.

Ultrasonographic Estimation of Ventricular Volume in Infants Born Preterm with Posthemorrhagic Ventricular Dilatation: A Nested Substudy of the Randomized Controlled Early Versus Late Ventricular Intervention Study (ELVIS) Trial

To study the potential role of ventricular volume (VV) estimation in the management of posthemorrhagic ventricular dilatation related to the need for ventriculoperitoneal (VP)-shunt insertion and 2-year neurodevelopmental outcome in infants born preterm. We included 59 patients from the Early vs Late Ventricular Intervention Study from 4 participating centers. VV was manually segmented in 209 3-dimensional ultrasound scans and estimated from 2-dimensional ultrasound linear measurements in a total of 1226 ultrasounds. We studied the association of both linear measurements and VV to the need for VP shunt and 2-year neurodevelopmental outcome in the overall cohort and in the 29 infants who needed insertion of a reservoir. We used general estimating equations to account for repeated measures per individual. Maximum pre-reservoir VV (β coefficient=0.185, P=.0001) and gestational age at birth (β =-0.338; P=.0001) were related to the need for VP shunt. The estimated optimal single VV measurement cut point of 17cm3 correctly classified 79.31% with an area under the curve of 0.76 (CI 95% 0.74-0.79). Maximum VV (β=0.027; P=.012) together with VP shunt insertion (β =3.773; P=.007) and gestational age (β =-0.273; P=.0001) were related to cognitive outcome at 2years. Maximum ventricular index and anterior horn width before reservoir insertion were independently associated with the need of VP shunt and the proposed threshold groups in the Early vs Late Ventricular Intervention Study trial were associated with long-term outcome. Pre-reservoir VV measurements were associated with the need for VP-shunt insertion and 2-year cognitive outcome among infants born preterm with posthemorrhagic ventricular dilatation. ISRCTN43171322.

Outcomes Of Patients With Chronic Secondary Hydrocephalus Undergoing VP Shunt Insertion At A UK Tertiary Neurosurgical Centre

Outcomes Of Patients With Chronic Secondary Hydrocephalus Undergoing VP Shunt Insertion At A UK Tertiary Neurosurgical Centre

Peritoneal Shunt Extraction in Children Using Laparoscopy: A Case Report

Laparoscopy is one way to perform various simple procedures or surgeries in the abdominal cavity. Laparoscopy can be useful in the management of ventriculo-peritoneal shunt (VP Shunt) fractures. The peritoneal component of the shunt remaining in the abdominal cavity can be removed using laparoscopy. A pediatric patient with hydrocephalus with a history of VP Shunt insertion 5 years ago, came with complaints of weakness, vomiting and difficulty eating. Physical examination revealed the presence of edema in the chamber area. A CT scan of the head and plain abdominal radiographs were performed. The diagnosis was made as a shunt fracture, with the peritoneal component of the shunt remaining in the abdominal cavity. The patient received treatment in the form of a revised VP shunt and peritoneal shunt extraction using standard laparoscopy which is commonly used for adult patients. The patient's condition improved after the procedure. Peritoneal shunt extraction in cases of VP shunt fracture can be safely performed using laparoscopy. If there are limited tools, this procedure can still be performed on children using standard laparoscopy which is usually used for adult patients. Authors report this case due to no previous report in Mojokerto area were known.

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

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

HGG-53. "Profile of High Grade Gliomas and Diffuse Intrinsic Pontine Gliomas in Greek Pediatric Patients: an 8-year Single Institution's experience"

BACKGROUND/OBJECTIVES: Aggressive clinical and biological behavior, high morbidity and mortality are the main characteristics of pediatric high-grade-gliomas (HGG). Our aim was to study patients (pts) with ΗGG or diffuse-intrinsic-pontine-glioma (DIPG), diagnosed in the largest pediatric neurooncology Center in Greece. DESIGN-METHODS: We performed a retrospective-review of newly-diagnosed pts with HGG or DIPG during 2014-2021. Gender, age, location, resectability, type of surgery, histological and molecular characteristics, management and outcome were analyzed. RESULTS: During the study-period, 38pts (18females), median age:9.35y(range:3days-16.9y), were diagnosed in our center. The most common tumor-location were pons (17/38 pts) and parietal lobe (11/38 pts). DIPG based on imaging-studies was diagnosed in 16pts. Surgical approach was performed in 32pts (VP-shunt insertion:8, biopsy:12, partial resection:6, subtotal: 6). In 23pts(5 brainstem-tumors) a histological-diagnosis was feasible. Astrocytoma grIV was found in 60.8% and grΙΙΙ in 26.1%(14 and 6 respectively). Of notice, 3 additional pts with histological findings of low-grade(2grII and 1gr1), were upgraded in grIV after molecular-studies and DNA-methylation analysis. Furthermore, 17.3% of the pts (4/23, 3 located in the midline) carried a Η3Κ27Μ-mutation (diffuse midline glioma, DMG), 17.3% a Η3F3A-mutation and 8.6% showed ΕGFR-overexpression. All patients>3years of age were treated upfront according to HIT-HGG2013 with radiotherapy-temozolomide (29/32pts). In 5DIPG pts, reirradiation after disease-progression resulted in temporary symptomatic improvement. HGG-pts upon progression were treated with bevacizumab-irinotecan. Of the 38pts, 6pts elected to receive treatment in other countries. Overall-survival was 75.1%,15.1% and 3.7% at 1,2 and 3 years post-diagnosis respectively. Patients with DIPG/ DMG and non-midline HGG had a median overall-survival of 1.10 years and1.34 years, respectively. CONCLUSIONS: The experience of our unit concurs with worldwide published series and shows that pediatric HGG and DIPG have a dismal prognosis. Re-irradiation may offer short survival prolongation. ASKNOWLEDGEMENTS: Authors asknowledge the contribution of KiTZ-Heidelberg in molecular diagnostics through collaboration with ACCC.

Ventriculoperitoneal Shunt Infection: A Study about Age as a Risk Factor in Hydrocephalus Pediatrics

BACKGROUND: Shunt infection is one of the dreaded and serious complications following ventriculoperitoneal shunt (VP shunt) insertion, especially in a pediatric population. Numerous risk factors have been identified, particularly in developing countries, indicating that age may play an essential element in the pathogenesis of shunt infection, typically in patients &lt;1-year-old. However, a few research demonstrate the inverse result. AIM: The purpose of this was to determine the relationship between age and shunt infection so that it can be taken into consideration when performing VP shunt insertion. METHODS: From January 2017 to December 2019, 98 pediatric patients with hydrocephalus who underwent VP shunt insertion were retrospectively reviewed to determine the relationship between age and shunt infection. We evaluated the microbiology results and management of shunt infection in patients with shunt infection. RESULTS: Fifteen (15.15%) of 98 patients developed shunt infection. Patients aged &gt;3–6 months had a significantly increased risk of shunt infection (p = 0.04; RR = 4.15; CI 95% = 1.19–14.45). Staphylococcus aureus was the most frequently encountered pathogen in pediatric patients with shunt infection (53.3%), and the most common management for shunt infection was complete removal of the shunt and systemic antibiotics followed by re-insertion of the shunt after the cerebrospinal fluid was sterile (46.6%). CONCLUSION: We conclude that age, especially those aged &gt;3–6 months, has a significantly higher risk of shunt infection in pediatric patients.

809. Evaluation of Antimicrobial Prophylaxis Prescribing in Post-operative Neurosurgical Procedures

BackgroundDue to lack of relevant clinical data or guidelines, duration of post-operative prophylactic antimicrobial therapy for neurosurgical procedures at the Kaiser Permanente Northern California (KPNC) hospitals has varied among patients and is largely based on the clinical judgment of surgeons. Non-standardized perioperative microbial prophylaxis practice has been associated with excessive antimicrobial therapy, increased risk of drug resistance, institutional cost, and adverse drug effects. This study aims to evaluate differences in prescribing practices of post-operative prophylactic antibiotics among neurosurgeons and to observe the incidence of surgical site infections and adverse drug events caused by antimicrobial prophylaxis that are associated with varying durations of post-procedure prophylaxis.MethodsA retrospective, observational study of health plan members of KPNC who underwent neurosurgical procedures from 01/01/2011 to 12/31/2019. Prophylactic antimicrobial therapy and duration was identified from medication dispensing and administration records. The study analyzed rates of surgical site infection, post-surgical wound drainage, 60-day mortality, and adverse drug events within 60 days of surgery.ResultsThe cohort consisted of 491 patients. 140 received antibiotics for >24 hours and 351 received antibiotics for ≤24 hours. The most common procedures analyzed in our patient population were VP shunt insertion (70.7%) and craniotomy subdural hematoma evacuation (17.9%). There were more surgical site infections in those who received antibiotics >24 hours (4.3% vs 1.4%, p value= 0.05). Univariate logistic regression model showed receiving antibiotics for ≤ 24 hours significantly decreased chance of composite drug event (odds ratio 0.345, 95% CI 0.172-0.691, p value= 0.003).ConclusionThis study demonstrated that antimicrobial prophylaxis for neurosurgical procedures ≤24 hours decreases risk of adverse drug events. The study provides further evidence to support the development of a standardized protocol that recommends short duration of antibiotic prophylaxis for neurosurgical procedures at KPNC.Poster Disclosures All Authors: No reported disclosures

Hydrocephalus Surgery in Touba City (Senegal): 0% infection Preliminary study about 20 cases

Introduction: Infection is the most common complication encountered after ventriculoperitoneal shunt. The AIMS of this study is to evaluate the effectiveness of antibiotic therapy with protocol in the prevention of post-operative infections after ventriculoperitoneal shunt in our city. Patients and methods: We retrospectively study 20 hydrocephalus cases in one year. They were operated through the classic VP Shunt insertion technique and with the protocol adopted for shunt implantation. They received antibiotic therapy for ten days. Results: In one year we operated 95 patients,20 (21%) cases were hydrocephalus. There were 7 males et 13 females (ratio:0,53) . The age of patients ranged from 15 days to 12 years and the average age was 13,5 months. The average consultation time was 5,6 weeks. Clinically the most common sign were anterior fontanelle tense (100%) , macrocrania (60%) ,vomiting (80%) and sunset eye sign (80%) . Brain CT-scan was performed in all patient,66% of patients had Transfontanelle Ultrasonography and anyone hadn’t performed MRI. All cases underwent surgical treatment. only ventriculoperitoneal shunt was performed and the standard technique protocol to minimize infection was done during surgery. All of them received ceftriaxone 100mg/kg/day for five days then oral relay by thiamphenicol 50mg/Kg/day for five days. The follow up was good no infection was found (0%). Conclusion: Establishing an aseptic protocol for the shunt is essential to reduce the rate of postoperative infections. This result becomes better when we make a combination of antibiotic therapy and protocol. We can achieve infection rates to zero or less than 1% in case of association

P.207 Reducing the risks of proximal and distal shunt failure in adult hydrocephalus: A Shunt Outcomes Quality Improvement (ShOut-QI) Study

Background: Ventriculoperitoneal (VP) shunt failures in adult patients are common and subject patients to multiple surgeries and a decreased quality of life. A prospective cohort Shunt Outcomes Quality Improvement (ShOut-QI) initiative was implemented to reduce shunt failure incidence through neuronavigation-assisted proximal catheter insertion and laparoscopy-guided distal catheter anchoring over the liver dome to drain CSF away from the omentum. Methods: “Pre-ShOut” and “Post-ShOut” groups of patients included those with and without neuronavigation/laparoscopy, respectively for insertion of a new VP shunt. The primary outcome was shunt failure which was defined as any return to surgery for shunt revision as determined with a standardized clinical and radiology follow-up protocol. Results: 244 patients (97 Pre-ShOut, 147 Post-ShOut), mean age 73 years, were enrolled over a 7-year interval and observed for a mean duration of 4 years after shunt insertion. Neuronavigation improved proximal catheter placement accuracy by 20% (p&lt;.001), and shunt failure occurred in 57% vs 23% in the Pre-ShOut and Post-ShOut groups, respectively (p=.008), representing a 53% relative risk reduction in the incidence of shunt failure. Conclusions: Adult shunt failure incidence may be significantly reduced by improving the accuracy of proximal catheter placement with neuronavigation and reducing the risk of distal catheter failure with laparoscopic-guided placement.

Ventriculoperitoneal Shunt versus Endoscopic Third Ventriculostomy in the treatment of Obstructive Hydrocephalus in Pediatric Midline Posterior Fossa tumors

Abstract Background Treatment of secondary hydrocephalus due to posterior fossa tumors in these children is still a matter of controversy, although preoperative ventriculo-peritoneal shunt (VP shunt) insertion before tumor excision is widely accepted among neurosurgeons but many attempts are rising to minimize permanent VP shunt insertion and associated complications and introducing third endoscopic ventriculostomy (ETV) as one of the options of 2ry hydrocephalus. Objectives Comparing the post-operative clinical success with resolution of the manifestations and post-operative complications between endoscopic third ventriculostomy and ventriculoperitoneal shunt as different modes of CSF diversion in children with 2ry hydrocephalus due to midline posterior fossa tumors. Methods The following electronic databases were searched from June 2009 to june2019: PubMed, Google scholar search engine. Cochrane database of systematic reviews, EMBASE and science Direct, using the keywords ―hydrocephalus; posterior fossa tumors; pediatrics; ventriculoperitoneal shunt; endoscopic third ventriculostomy‖. Studies were eligible if they contain the target keywords in title or abstract, addressing the Pediatric age group with 2ry hydrocephalus due to de novo posterior fossa tumor manifested by signs of increase the intra cranial tension including persistent headache and vomiting, blurred vision, 6th nerve palsy, papilledema in fundus examination, acute DCL and 2ry hydrocephalus confirmed by brain imaging. Exclusion criteria included studies including age group below 1yr or above 18 yr, or patients with recurrent post fossa tumors and operated before or patients presented by failed previously attempt of CSF diversion. Results: A total of 1255 citations were screened for eligibility,6 studies were included in our systematic review discussing, comparing and evaluating the durability of ETV versus VP shunt in treatment the 2ry hydrocephalusdue to pediatric posterior fossa tumor.. Overall study population reached 474 patients. the overall clinical findings at presentation and postoperative outcomes regarding the clinical findings improvement, radiological improvement and postoperative complications between ETV and VP shunt are compared and showing that ETV should be considered as an alternative procedure to VP shunt in controlling severe hydrocephalus related to posterior fossa tumors to relieve symptoms quickly during the preoperative period when patients should wait for their definite tumor excision. Conclusion The shorter duration of surgery, the lower incidence of morbidity, the absence of mortality, the lower incidence of procedure failure of endoscopic third ventriculostomy as compared to ventriculoperitoneal shunt, and the significant advantage of not becoming shunt dependent make endoscopic third ventriculostomy to be recommended as the first choice in the treatment of pediatric patients with marked obstructive hydrocephalus due to posterior fossa tumors. It is a preliminary, simple, safe, effective, physiological, minimally invasive procedure for the relief of elevated intracranial pressure before direct tumor removal.

Hydrocephalus and occipital encephaloceles: presentation of a series and review of the literature.

Encephaloceles are rare congenital malformations of the central nervous system in which brain tissue is extruded from a defect in the skull. Hydrocephalus can occur in 60 to 90% of patients with posterior encephaloceles when compared to other types of this malformation. This article aims to present a series of posterior encephaloceles and its association with hydrocephalus as well as promote a review of the pertinent literature. A retrospective study of our series based on hospital charts of 50 patients with posterior encephaloceles was performed. Data on sex, location of encephalocele, presence of associated malformations, presence of neural tissue within the malformation, presence of hydrocephalus and microcephaly were recorded. There were 29 females and 21 males. There were 25 (50%) supratorcular, 8 (16%) torcular, and 17 (34%) infratorcular lesions. Mean age of encephalocele primary repair was 8days (range 2-120days). Hydrocephalus was diagnosed in 25 (50%) of the cases. Ventriculoperitoneal shunt was inserted in 24 patients. The mean age at VP shunt insertion was 1.3months (range 0.3-9months). Endoscopic third ventriculostomy was successfully performed in one patient. Dandy-Walker malformation and ventriculomegaly prior to encephalocele surgical correction were positively associated with hydrocephalus (p values 0.05 and 0.01, respectively). Chiari III malformation was found in 2 cases, both requiring CSF shunt for treatment of hydrocephalus and are stable in follow-up. Microcephaly was present in 9 cases. The known mortality rate was 8%. Hydrocephalus is common in patients with posterior encephaloceles, being more frequent in the supratorcular type, especially when associated to Dandy-Walker, Chiari III malformation, and pre-existing ventriculomegaly. The severity of giant encephaloceles, when associated to torcular types and microcephaly, is a limiting factor for development of hydrocephalus, due both to the rapid evolution of natural history and the structural changes in microcephaly.