INTRA-ABDOMINAL VASCULAR INJURY DURING TROCAR-ASSISTED VENTRICULOPERITONEAL SHUNTING

ABSTRACT OBJECTIVE Laparoscopic trocar injury is a relatively well-described complication of cholecystectomies and gynecological procedures. However, this type of injury has not been reported in association with adult neurological surgery. To increase awareness of this very serious risk, we report a case of intra-abdominal vascular injury during a shunt procedure involved with a common neurosurgical procedure. CLINICAL PRESENTATION A 76-year-old man with no previous abdominal surgical history presented with probable normal pressure hydrocephalus. INTERVENTION After an appropriate preoperative workup confirming probable normal pressure hydrocephalus, the patient consented to placement of a ventriculoperitoneal shunt with a programmable valve. During placement of the distal catheter using an abdominal trocar, the aorta was punctured inadvertently, necessitating emergency laparotomy for vascular repair. CONCLUSION An abdominal trocar should be used with caution in ventriculoperitoneal shunt surgery. Even with meticulous technique, vascular injury can occur with any trocar-based abdominal procedure. The neurosurgeon who uses this technique must be prepared to initiate emergent vascular access and repair, with a vascular surgery team available should such an injury occur. Alternatively, open placement of peritoneal catheters avoids blind peritoneal instrumentation and is an effective method for minimizing potentially catastrophic vascular injuries.

Download Full-text

Ventriculoperitoneal Shunting of Idiopathic Normal Pressure Hydrocephalus Increases Midbrain Size: A Potential Mechanism for Gait Improvement

Neurosurgery ◽

10.1227/01.neu.0000232655.78335.d5 ◽

2006 ◽

Vol 59 (4) ◽

pp. 847-851 ◽

Cited By ~ 22

Author(s):

J Mocco ◽

Matthew I. Tomey ◽

Ricardo J. Komotar ◽

William J. Mack ◽

Steven J. Frucht ◽

...

Keyword(s):

Normal Pressure Hydrocephalus ◽

Ventriculoperitoneal Shunt ◽

Medical Center ◽

Normal Pressure ◽

Idiopathic Normal Pressure Hydrocephalus ◽

Cross Sectional ◽

Mean Values ◽

Shunt Placement ◽

Ventriculoperitoneal Shunting ◽

The Mean

Abstract OBJECTIVE: Idiopathic normal pressure hydrocephalus (INPH) is characterized by a classic clinical triad of symptoms, including dementia, urinary incontinence, and gait disturbance. Recent work has demonstrated that the maximal midbrain anteroposterior (AP) diameter is significantly smaller in patients with INPH than in healthy, age-matched controls. The current study was undertaken to determine the effect of ventriculoperitoneal shunt placement on midbrain dimensions in INPH patients. METHODS: Twelve consecutive INPH patients undergoing ventriculoperitoneal shunt placement with pre- and postoperative computed tomographic scans at the Columbia University Medical Center were enrolled. Each patient's pre- and postoperative maximum AP and left-to-right diameters of the midbrain at the pontomesencephalic junction were independently measured in a blinded fashion by two of the authors. The average value of each dimension was computed by calculating the mean values of the measurements of the two observers. RESULTS: Both the mean AP diameter (preoperative mean, 2.06 ± 0.04 cm; postoperative mean, 2.27 ± 0.05; P = 0.0007) and left-to-right diameter (preoperative mean, 2.80 ± 0.07; postoperative mean, 3.03 ± 0.08; P = 0.0029) increased from pre- to postoperative imaging. The approximate cross-sectional area determined as the product of AP and left-to-right diameters also increased from pre- to postoperative images (preoperative mean, 5.79 ± 0.22 cm2; postoperative mean, 6.90 ± 0.25 cm2; P = 0.00049). CONCLUSION: This study provides supportive evidence that midbrain cytoarchitecture may play a role in the pathophysiology and post-ventriculoperitoneal shunt gait improvement of INPH patients.

Download Full-text

Uncommon complications of ventriculoperitoneal shunt surgery: review of four cases and literature review

Egyptian Journal of Neurosurgery ◽

10.1186/s41984-019-0071-6 ◽

2020 ◽

Vol 35 (1) ◽

Author(s):

Aliyu Muhammad Koko ◽

Nasiru Jinjiri Ismail ◽

Ali Lasseini ◽

Sahabi M. Saddiku

Keyword(s):

Cerebrospinal Fluid ◽

Ventriculoperitoneal Shunt ◽

Abdominal Wound ◽

Distal Catheter ◽

Excellent Outcome ◽

Post Surgery ◽

First Case ◽

Ventriculoperitoneal Shunting ◽

Shunt Procedure

Abstract Background Ventriculoperitoneal shunt is one of the most popular cerebrospinal fluid diversion procedures worldwide. Complications are common, but uncommon complications are rarely reported in the literature making a standardized guideline on management of unusual complications unavailable. We report this series of uncommon complications managed in our centre to share our experience and contribute to the pool of literature on the management of these weird complications of ventriculoperitoneal shunting. Case presentation The first case was a 10-year-old girl who presented with headache, early morning vomiting and itching over the tract of the shunt in the neck. She has had ventriculoperitoneal shunt and excision and repair of encephalocele at the age of 3 months in our facility. On physical examination, she was conscious with a Glasgow coma score of 15, and shunt valve was hardened. She had removal of the shunt with intraoperative finding of calcified shunt tubing and the valve, and also cerebrospinal fluid was under high pressure that warranted re-insertion of another medium pressure shunt. She remained stable at last follow-up 3 months post-surgery. We managed two cases of shunt extrusion via the anus (a 1-year-old female infant and 9-year-old boy). None of the patients presented with evidence of peritonitis or shunt tract infection. The extruded shunts were removed under aseptic technique, and both patients had ventriculoperitoneal shunt re-inserted because of progression of hydrocephalus. They remained stable at last follow-up visits 6 months after surgery. The fourth case was a 9-month-old infant that presented with shunt extrusion via the abdominal wound site 3 weeks after ventriculoperitoneal shunt procedure. The child developed an abscess at the abdominal wound that ruptures spontaneously with extrusion of distal catheter, had no features of peritonitis and had shunt removed and re-inserted after 3 months. The child has remained stable. Conclusion Although ventriculoperitoneal shunt calcification and extrusion are rare, they do occur. None of our patients had peritonitis. Shunt removal and subsequent reinsertion in the presence of raised intracranial pressure from hydrocephalus confirms an excellent outcome.

Download Full-text

Role of Endoscopic Third Ventriculostomy and Ventriculoperitoneal Shunt in Idiopathic Normal Pressure Hydrocephalus

Neurosurgery ◽

10.1227/neu.0b013e318285b37c ◽

2013 ◽

Vol 72 (5) ◽

pp. 845-854 ◽

Cited By ~ 37

Author(s):

Fernando Campos Gomes Pinto ◽

Felippe Saad ◽

Matheus Fernandes de Oliveira ◽

Renan Muralho Pereira ◽

Fernanda Letkaske de Miranda ◽

...

Keyword(s):

Normal Pressure Hydrocephalus ◽

Ventriculoperitoneal Shunt ◽

Endoscopic Third Ventriculostomy ◽

Normal Pressure ◽

Functional Independence ◽

Idiopathic Normal Pressure Hydrocephalus ◽

Third Ventriculostomy ◽

Timed Up And Go ◽

Programmable Valve ◽

Significant Difference

Abstract BACKGROUND: Currently, the most common treatment for idiopathic normal pressure hydrocephalus (INPH) is a ventriculoperitoneal shunt (VPS), generally with programmable valve implantation. Endoscopic third ventriculostomy (ETV) is another treatment option, and it does not require prosthesis implantation. OBJECTIVE: To compare the functional neurological outcome in patients after 12 months of treatment with INPH by using 2 different techniques: ETV or VPS. METHODS: Randomized, parallel, open-label trial involving the study of 42 patients with INPH and a positive response to the tap test, from January 2009 to January 2012. ETV was performed with a rigid endoscope with a 30° lens (Minop, Aesculap), and VPS was performed with a fixed-pressure valve (PS Medical, Medtronic). The outcome was assessed 12 months after surgery. The neurological function outcomes were based on the results of 6 clinical scales: mini-mental, Berg balance, dynamic gait index, functional independence measure, timed up and go, and normal pressure hydrocephalus. RESULTS: There was a statistically significant difference between the 2 groups after 12 months of follow-ups, and the VPS group showed better improvement results (ETV = 50%, VPS = 76.9%). CONCLUSION: Compared with ETV, VPS is a superior method because it had better functional neurological outcomes 12 months after surgery.

Download Full-text

Secondary Normal-Pressure Hydrocephalus in Rheumatoid Meningitis

Case Reports in Neurology ◽

10.1159/000514728 ◽

2021 ◽

pp. 434-440

Author(s):

Micaela Owens ◽

Na Tosha Gatson ◽

Gino Mongelluzzo ◽

Oded Goren ◽

Eric Newman ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Normal Pressure Hydrocephalus ◽

Immune Suppression ◽

Normal Pressure ◽

The Elderly ◽

Common Cause ◽

Gait Abnormality ◽

Ventriculoperitoneal Shunting ◽

Patient Reported ◽

Rheumatoid Meningitis

Normal-pressure hydrocephalus (NPH) is a common cause of gait apraxia, cognitive impairment, and urinary incontinence in the elderly. It is usually a primary idiopathic disorder but can be secondary. We present a case of secondary NPH due to biopsy-confirmed rheumatoid meningitis initially refractory to intravenous (IV) immunotherapy. Our patient reported an excellent response right after shunting. Her gait remains normal one and a half years later. We searched PubMed for similar cases of rheumatoid meningitis with gait abnormality for additional clinicopathologic discussion. The patient’s movement disorder initially improved with steroid taper. However, she developed progressive symptoms, later on, refractory to IV solumedrol and rituximab. She underwent ventriculoperitoneal shunting (VPS) and reported an outstanding outcome. This is the first reported biopsy-confirmed case of rheumatoid meningitis causing NPH to undergo shunting for immediate improvement. Previous cases of rheumatoid meningitis-associated Parkinsonism have improved with steroid induction. Although our patient’s rheumatoid arthritis is now controlled, her case illustrates that NPH in autoinflammatory conditions may not recover with immune suppression alone. VPS is an option for a faster response in secondary NPH due to rheumatoid meningitis or other inflammatory disorders with progressive symptoms despite standard induction therapy.

Download Full-text

Ventriculoperitoneal shunt in treating of idiopathic normal pressure hydrocephalus—single-center study

Acta Neurochirurgica ◽

10.1007/s00701-019-04135-5 ◽

2019 ◽

Vol 162 (1) ◽

pp. 1-7

Author(s):

David Krahulik ◽

Miroslav Vaverka ◽

Lumir Hrabalek ◽

Martin Hampl ◽

Matej Halaj ◽

...

Keyword(s):

Normal Pressure Hydrocephalus ◽

Ventriculoperitoneal Shunt ◽

Normal Pressure ◽

Idiopathic Normal Pressure Hydrocephalus ◽

Single Center ◽

Single Center Study ◽

Center Study

Download Full-text

Treatment of ventriculoperitoneal shunt dysfunction during rehabilitation therapy in patients with normal pressure hydrocephalus

Neurorehabilitation ◽

10.3233/nre-1999-12307 ◽

1999 ◽

Vol 12 (3) ◽

pp. 205-210 ◽

Cited By ~ 1

Author(s):

Hikaru Muramatsu ◽

Masahiro Matsumoto ◽

Toshiro Shimura ◽

Yoji Node ◽

Akira Teramoto

Keyword(s):

Normal Pressure Hydrocephalus ◽

Ventriculoperitoneal Shunt ◽

Normal Pressure ◽

Rehabilitation Therapy ◽

Shunt Dysfunction

Download Full-text

Ventriculoperitoneal Shunt Outcomes of Normal Pressure Hydrocephalus: A Case Series of 116 Patients

Cureus ◽

10.7759/cureus.4170 ◽

2019 ◽

Author(s):

Eva M Wu ◽

Tarek Y Ahmadieh ◽

Benjamin Kafka ◽

James Caruso ◽

Salah G Aoun ◽

...

Keyword(s):

Normal Pressure Hydrocephalus ◽

Ventriculoperitoneal Shunt ◽

Case Series ◽

Normal Pressure

Download Full-text

Decreases in Ventricular Volume Correlate with Decreases in Ventricular Pressure in Idiopathic Normal Pressure Hydrocephalus Patients Who Experienced Clinical Improvement after Implantation with Adjustable Valve Shunts

Neurosurgery ◽

10.1227/01.neu.0000134385.23401.01 ◽

2004 ◽

Vol 55 (3) ◽

pp. 582-593 ◽

Cited By ~ 10

Author(s):

Kathleen A. McConnell ◽

Kelly H. Zou ◽

Alexandra V. Chabrerie ◽

Nancy Olsen Bailey ◽

Peter McL. Black

Keyword(s):

Correlation Coefficient ◽

Clinical Improvement ◽

Normal Pressure Hydrocephalus ◽

Normal Pressure ◽

Ventricular Volume ◽

Idiopathic Normal Pressure Hydrocephalus ◽

Adjustable Valve ◽

Programmable Valve ◽

Valve Pressure ◽

Over Time

Abstract OBJECTIVE: This retrospective study examined whether changes in ventricular volume correspond with changes in adjustable valve pressure settings in a cohort of patients who received shunts to treat idiopathic normal pressure hydrocephalus. We also examined whether these pressure–volume curves and other patient variables would co-occur with a positive clinical response to shunting. METHODS: We selected 51 patients diagnosed with idiopathic normal pressure hydrocephalus who had undergone implantation of a Codman Hakim programmable valve (Medos S.A., Le Locle, Switzerland). Clinical data were gathered from the patients' records and clinical notes by an investigator blinded to patients' ventricular volumes. Ventricular volume was measured using 3D Slicer, an image analysis and interactive visualization software package developed and maintained at the Surgical Planning Laboratory at Brigham and Women's Hospital. RESULTS: Eighty-six percent of patients with gait disturbance at presentation showed improvement of this symptom, 70% experienced improvement in incontinence, and 69% experienced improvement in dementia. For the group showing 100% clinical improvement, the correlation coefficient of average changes in valve pressure over time (ΔP/ΔT) and average changes in ventricular volume over time (ΔV/ΔT) were high at 0.843 (P < 0.05). For the group experiencing no or only partial improvement, the correlation coefficient was 0.257 (P = 0.32), indicating no correlation between average ΔV/ΔT and average ΔP/ΔT for each patient. CONCLUSION: This was a carefully analyzed modeling study of idiopathic normal pressure hydrocephalus treatment made possible only by adjustable valve technology. With careful volumetric analysis, we found that changes in ventricular volume correlated with adjustments in valve pressure settings for those patients who improved clinically after shunting. This suggests that positive clinical responders retained parenchymal elasticity, emphasizing the importance of dynamic changes in this cohort.

Download Full-text