Transient Episode of Alice in Wonderland Syndrome After Ventriculoatrial Shunt Revision

Abstract OBJECTIVE Shunt patency studies are performed to determine whether shunt revision surgery is needed in malfunctioned ventriculoperitoneal shunt. The aim of our study was to develop a simple diagnostic algorithm in the diagnostic workup and identify factors associated with improvement after revision surgery. METHODS A retrospective review of patients with confirmed shunt obstruction who underwent a revision surgery and were followed for 6 to 12 months was performed. A simpler algorithm to identify shunt obstruction was created and compared with the 4-variable algorithm. RESULTS Of the 63 patients in whom shunt obstruction was suspected, 39 were diagnosed with complete or partial obstruction. Thirty-seven patients underwent shunt revision surgery that included removal of shunt (n = 2), conversion to a ventriculoatrial shunt (n = 8), and relocation of the distal end of the catheter into a different part of the peritoneal cavity (n = 27). Improvements were seen in 63.3% (n = 19) of patients evaluated at 6 months and 63.6% (n = 14) of patients evaluated at 12 months. The positive predictive value of the study was 80%. A simpler 1-variable algorithm using T1/2 (half-time) could correctly classify 86.9% of patients with shunt obstruction, compared with a 4-variable algorithm that correctly classified 80% of patients. CONCLUSION Shunt patency studies are very useful for evaluation of shunt patency. Their results can be interpreted using a single-variable (T1/2) algorithm. Patients most likely to respond to a revision surgery are those who had a good response to original placement of a ventriculoperitoneal shunt.

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Simple Removal of Ventriculoatrial Shunt and Simultaneous Ventriculoperitoneal Shunt Revision: Short Communication

Indian Journal of Neurosurgery ◽

10.1055/s-0041-1730131 ◽

2021 ◽

Author(s):

Ryo Oike ◽

Yasuaki Inoue ◽

Kazuhito Matsuzawa

Keyword(s):

Ventriculoperitoneal Shunt ◽

Cardiac Tissue ◽

Surgical Techniques ◽

Normal Pressure ◽

Shunt Revision ◽

Cardiac Complications ◽

Ventriculoatrial Shunt ◽

Usual Procedure ◽

Alternative Treatment Option ◽

Specialized Equipment

Abstract Background Ventriculoatrial shunt (VAS) is a common alternative treatment option for hydrocephalus in patients with ventriculoperitoneal shunt (VPS) failure. Most previous reports on VAS discuss the atrial-related complications and none focus on simple removal (i.e., without specialized equipment). We report a case of simple VAS removal and simultaneous VPS revision, with no obvious shunt-related cardiac complications. Case presentation The patient was an 87-year-old female who had received a VAS for idiopathic normal pressure hydrocephalus 6 years prior. She developed a right thalamic hemorrhage with intraventricular hemorrhage and was admitted to our hospital. She had a recurrence of the hydrocephalus and was diagnosed with shunt malfunction, due to simple obstruction without obvious shunt-related cardiac complications. The VAS was simply and safely removed, and a VPS was simultaneously placed, as per the usual procedure in our institution. She remains well with no evidence of complications on postoperative day 10. Discussion Since VAS is mostly used in pediatric cases that are difficult to treat with VPS, the duration of time elapsed allows VAS catheters to form strong adhesions with the surrounding cardiac tissue. Therefore, the simple removal of VAS is usually not straightforward. Conclusion If the follow-up period is short and there are no specific cardiac complications at the time of replacement, VAS can be safely removed and VPS can be spontaneously placed, without any specialized surgical techniques or equipment.

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Intraventricular and Intravenous Tobramycin with Ceftazidime for Ventriculitis Secondary to Pseudomonas aeruginosa

The Journal of Pediatric Pharmacology and Therapeutics ◽

10.5863/1551-6776-8.2.138 ◽

2003 ◽

Vol 8 (2) ◽

pp. 138-143

Author(s):

Priscilla Masvosva ◽

Steven C. Buckingham ◽

Stephanie Einhaus ◽

Stephanie J. Phelps

Keyword(s):

Staphylococcus Epidermidis ◽

Bacterial Infections ◽

Major Complication ◽

Shunt Revision ◽

Drug Selection ◽

Intellectual Impairment ◽

Ventriculoatrial Shunt ◽

Gram Negative ◽

Patient At Risk ◽

And Staphylococcus Aureus

The preferred method for shunting cerebrospinal fluid in the ventricles is via a ventriculoperitoneal or ventriculoatrial shunt. Unfortunately, infection is a major complication of shunt surgery, which places the patient at risk of intellectual impairment and death. Although the most common causative pathogens are Staphylococcus epidermidis and Staphylococcus aureus, gram-negative bacterial infections have increased over the last three decades. Treatment of Pseudomonas ventriculitis is highly variable, because there are few guidelines for drug selection, administration, and monitoring. We report a case of post-shunt revision Pseudomonas meningitis/ ventriculitis that was successfully treated by the intraventricular adminstration tobramycin in conjunction with intravenous tobramycin and ceftazidime.

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