Neurosurgical Aspects of Cerebral Cryptococcosis

Neurosurgery ◽  
1989 ◽  
Vol 25 (1) ◽  
pp. 44-48 ◽  
Author(s):  
Kwan-Hon Chan ◽  
Kirpal S. Mann ◽  
Chung P. Yue
Keyword(s):  
Intracranial Pressure ◽  
Ventriculoperitoneal Shunt ◽  
Original Work ◽  
External Ventricular Drainage ◽  
Subdural Effusion ◽  
Cystic Lesions ◽  
Raised Intracranial Pressure ◽  
Ventricular Drainage ◽  
Impaired Consciousness ◽  
High Incidence

Abstract Eleven patients with raised intracranial pressure caused by cerebral cryptococcosis developed complications requiring neurosurgical operations. Two patients were fully conscious on admission, and 9 had impaired consciousness, four of whom were comatose. Seven patients were found to have hydrocephalus only. Two patients had cerebral edema initially, and 2 had cystic lesions. One of the latter developed subdural effusion. All patients eventually developed progressive hydrocephalus requiring placement of a ventriculoperitoneal shunt. Four patients were initially treated by external ventricular drainage. When external ventricular drainage was used initially, there were no associated complications; however, there was a high incidence of complications (4 of 7 patients) when a ventriculoperitoneal shunt was placed as the initial treatment. Of the 11 patients, 10 (91%) survived; of these 9 (82%) made an excellent recovery and 7 (64%) returned to their original work. The patient who died had been receiving steroid therapy for hypopituitarism.

scholarly journals Intracranial Pressure during External Ventricular Drainage Weaning Is an Outcome Predictor of Traumatic Brain Injury

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Jia-cheng Gu ◽  
Hong Wu ◽  
Xing-zhao Chen ◽  
Jun-feng Feng ◽  
Guo-yi Gao ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Intracranial Pressure ◽  
External Ventricular Drainage ◽  
Unfavorable Outcome ◽  
Ventricular Drainage ◽  
Outcome Group ◽  
Significant Difference ◽  
The Mean ◽  
The Relationship

External ventricular drainage (EVD) is widely used in patients with a traumatic brain injury (TBI). However, the EVD weaning trial protocol varies and insufficient studies focus on the intracranial pressure (ICP) during the weaning trial. We aimed to establish the relationship between ICP during an EVD weaning trial and the outcomes of TBI. We enrolled 37 patients with a TBI with an EVD from July 2018 to September 2019. Among them, 26 were allocated to the favorable outcome group and 11 to the unfavorable outcome group (death, post-traumatic hydrocephalus, persistent vegetative state, and severe disability). Groups were well matched for sex, pupil reactivity, admission Glasgow Coma Scale score, Marshall computed tomography score, modified Fisher score, intraventricular hemorrhage, EVD days, cerebrospinal fluid output before the weaning trial, and the complications. Before and during the weaning trial, we recorded the ICP at 1-hour intervals to calculate the mean ICP, delta ICP, and ICP burden, which was defined as the area under the ICP curve. There were significant between-group differences in the age, surgery types, and intensive care unit days (p=0.045, p=0.028, and p=0.004, respectively). During the weaning trial, 28 (75.7%) patients had an increased ICP. Although there was no significant difference in the mean ICP before and during the weaning trial, the delta ICP was higher in the unfavorable outcome group (p=0.001). Moreover, patients who experienced death and hydrocephalus had a higher ICP burden, which was above 20 mmHg (p=0.016). Receiver operating characteristic analyses demonstrated the predictive ability of these variables (area under the curve AUC=0.818 [p=0.002] for delta ICP and AUC=0.758 [p=0.038] for ICP burden>20 mmHg). ICP elevation is common during EVD weaning trials in patients with TBI. ICP-related parameters, including delta ICP and ICP burden, are significant outcome predictors. There is a need for larger prospective studies to further explore the relationship between ICP during EVD weaning trials and TBI outcomes.

Intracranial Pressure Monitoring and External Ventricular Drainage

2019 ◽  
pp. 899-902
Author(s):  
Maya A. Babu ◽  
John L. D. Atkinson
Keyword(s):  
Intracranial Pressure ◽  
Surgical Therapy ◽  
Strain Gauge ◽  
Clinical Status ◽  
External Ventricular Drainage ◽  
Ventricular Drainage ◽  
Pressure Monitoring ◽  
Neurologic Outcomes ◽  
Outcomes Management ◽  
Increased Icp

Several studies have shown that increased ICP has been associated with poor neurologic outcomes. Management of elevated ICP can improve neurologic outcomes and influence medical and surgical therapy, and accurate recording of ICP is helpful in assessing a patient’s clinical status. Currently, the 2 most common forms of monitoring ICP involve 1) placement of a fiberoptic or strain gauge intraparenchymal monitor or 2) placement of a ventricular drain.

scholarly journals Epidemiological Profile Of Children With External Ventricular Drainage

10.3823/2317 ◽  
2017 ◽  
Vol 10 ◽  
Author(s):  
Alane Barreto de Almeida Leôncio ◽  
Thaís Grilo Moreira Xavier ◽  
Saionara Lenarda Oliveira Dantas ◽  
Cibério Ladim Macêdo ◽  
Andrea Valente Braga ◽  
...  
Keyword(s):  
Causes Of Death ◽  
Death Certificate ◽  
Descriptive Study ◽  
External Ventricular Drainage ◽  
Ventricular Drainage ◽  
Pediatric Hospital ◽  
Chi Square ◽  
High Incidence ◽  
Chi Square Test ◽  
Epidemiological Profile

Objective: tracing the epidemiological profile, focused on infectious aspects, of children undergoing insertion of external ventricular drainage valve for the treatment of hydrocephalus. Method: A retrospective, documentary and descriptive study of clinical and epidemiological approach with a quantitative analysis of the findings. The sample consisted of 53 children in a pediatric hospital of reference in the state of Paraiba in the period July 2009 to December 2014. For data analysis, non-parametric tests were used, and the chi-square test and Fisher test performed according to the statement. Results: Among the 53 children who participated in our study, 49.1% (26) died. According to the causes found on the death certificate, 69.2% of the causes of death described relation to infection. Conclusion: the high rates of CNS infections and other acquired infections, resulting in the deaths of children who underwent insertion of EVD valve, they are the result of a set of facts involving the care of a multidisciplinary team. The high incidence presented in the shunt study showed that changes and system remaining in the patient to a risk factor for infection.

Comparison of transorbital ultrasound measurements to predict intracranial pressure in brain-injured patients requiring external ventricular drainage

2021 ◽  
pp. 1-7
Author(s):  
Jin Young Youm ◽  
Jae Hoon Lee ◽  
Hyun Seok Park
Keyword(s):  
Intracranial Pressure ◽  
Dura Mater ◽  
Doppler Ultrasonography ◽  
External Ventricular Drainage ◽  
Repeated Measurements ◽  
Transverse Diameter ◽  
Ventricular Drainage ◽  
Brain Injured ◽  
Injured Patients ◽  
Increased Icp

OBJECTIVE The optic nerve sheath diameter (ONSD) excluding the dura mater (ONSDE; i.e., the subarachnoid diameter) and the ONSD including the dura mater (ONSDI) have been used differently in studies, but the predictive ability of these two different measurements of the ONSD as measured by invasive intracranial pressure (ICP) monitoring has never been compared. Additionally, studies on the prediction of ICP using central retinal artery (CRA) Doppler ultrasonography are scarce. The authors aimed to determine how the two different ONSD measurements, the ONSD/eyeball transverse diameter (ETD) ratio, and transorbital Doppler ultrasonography parameters are associated with ICP via external ventricular drainage (EVD). METHODS This prospective observational study included 50 patients with brain injury who underwent EVD between August 2019 and September 2020. The mean of three repeated measurements of the ONSDI and ONSDE was calculated to reduce artifact and off-axis measurements. ETD, an immutable value, was measured from the initial brain CT with a clear outline of the eyeball. Simultaneously, flow velocities in the CRA and posterior ciliary artery (PCA) were compared with the ICP. RESULTS The ONSDE, ONSDI, and ONSD/ETD ratio were significantly associated with ICP (p = 0.005, p < 0.001, and p < 0.001, respectively). The ONSD/ETD ratio showed the highest predictive power of increased ICP (area under the curve [AUC] 0.897). The ONSDI was correlated more with the ICP than was the ONSDE (AUC 0.855 vs 0.783). None of the Doppler ultrasonography parameters in the CRA and PCA were associated with ICP. CONCLUSIONS The ONSD/ETD ratio is a better predictor of increased ICP compared with the ONSDI or ONSDE in brain-injured patients with nonsevere ICP. The ONSDI may be more available for predicting the ICP than the ONSDE.

scholarly journals Hemorrhage Rates Associated with Two Methods of Ventriculostomy: External Ventricular Drainage vs. Ventriculoperitoneal Shunt Procedure

2014 ◽  
Vol 54 (7) ◽  
pp. 545-551 ◽  
Author(s):  
Jun Kyeung KO ◽  
Seung Heon CHA ◽  
Byung Kwan CHOI ◽  
Jae Il LEE ◽  
Eun Young YUN ◽  
...  
Keyword(s):  
Ventriculoperitoneal Shunt ◽  
External Ventricular Drainage ◽  
Ventricular Drainage ◽  
Shunt Procedure

scholarly journals Ventriculoperitoneal Shunt Disconnection, Shunt Migration, and Silent Bowel Perforation in a 10-Year-Old Boy

2019 ◽  
Vol 10 (02) ◽  
pp. 342-345
Author(s):  
Rajendra Kumar Ghritlaharey
Keyword(s):  
Intracranial Pressure ◽  
Ventriculoperitoneal Shunt ◽  
Rare Case ◽  
Bowel Perforation ◽  
Postoperative Recovery ◽  
Raised Intracranial Pressure ◽  
Peritoneal Catheter ◽  
Tubercular Meningitis ◽  
Fecal Matter ◽  
Shunt Migration

ABSTRACTA 10-year-old boy was admitted with chest wall infection around the implanted ventriculoperitoneal shunt (VPS) catheter of 5 days. He had received a right-sided, medium pressure, whole-length VPS for hydrocephalus, following tubercular meningitis at the age of 3 years. Seven years, 9 months following VPS implantation, he was admitted with shunt tract infection at the chest area for 5 days. He had neither fever nor features of meningitis, raised intracranial pressure, or peritonitis. His clinical examination and radiological investigations revealed that the VPS catheter was disconnected at the cranial site, and it was migrated downward up to the upper chest. He was managed well with the removal of the entire VPS catheter. The removed peritoneal catheter along with the shunt chamber was loaded with fecal matter and was presumed that the peritoneal catheter was within the colon. His postoperative recovery was excellent. This is a rare case of VPS catheter disconnection, shunt migration, and silent bowel perforation by peritoneal catheter, and all the above-mentioned complications were detected in a child at the same time and were managed well with the removal of the entire VPS catheter.

scholarly journals Ossified Occipital Pseudomeningocele following Ventriculoperitoneal Shunt Malfunction

2019 ◽  
Vol 10 (03) ◽  
pp. 542-544
Author(s):  
Anusha S. Bhatt ◽  
Ajit M. Mishra ◽  
Radhika Mhatre ◽  
Bevinahalli N. Nandeesh
Keyword(s):  
Computed Tomography ◽  
Intracranial Pressure ◽  
Treatment Option ◽  
Ventriculoperitoneal Shunt ◽  
Aqueductal Stenosis ◽  
Shunt Malfunction ◽  
Rare Entity ◽  
Raised Intracranial Pressure ◽  
Rare Occurrence ◽  
Vp Shunt

AbstractOssification of pseudomeningocele is a rare occurrence and is one of the rare complications of ventriculoperitoneal (VP) shunt malfunction. We report a case of 12-year-old boy who came with features of raised intracranial pressure following shunt malfunction which was placed as a treatment to the aqueductal stenosis. Computed tomography showed ventriculomegaly and hypodense collection in the occiput with posterior rim of calcification. The findings were confirmed on histopathology. Although ossified pseudomeningocele is a rare entity following VP shunt placement, it should be suspected if patients present with aggravated symptoms, especially if there is shunt malfunction as the treatment option varies with the presence or absence of resultant symptoms and ossification.

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