scholarly journals Cerebrospinal fluid drainage options for posthemorrhagic hydrocephalus in premature neonates

2017 ◽  
Vol 75 (7) ◽  
pp. 433-438 ◽  
Author(s):  
José Roberto Tude Melo ◽  
Rosane Klein Passos ◽  
Marcelo Liberato Coelho Mendes de Carvalho
Keyword(s):  
Cerebrospinal Fluid ◽  
Birth Weight ◽  
Ventriculoperitoneal Shunt ◽  
Case Series ◽  
Posthemorrhagic Hydrocephalus ◽  
Premature Neonates ◽  
Cerebrospinal Fluid Diversion ◽  
Csf Drainage ◽  
Csf Diversion ◽  
Preterm Newborns

ABSTRACT Objective The literature describes various cerebrospinal fluid (CSF) drainage techniques to alleviate posthemorrhagic hydrocephalus in preterm newborns; however, consensus has not been reached. The scope of this study was describing a case series of premature neonates with posthemorrhagic hydrocephalus and assessing the outcomes of different approaches used for CSF diversion. Methods A consecutive review of the medical records of neonates with posthemorrhagic hydrocephalus treated with CSF drainage was conducted. Results Forty premature neonates were included. Serial lumbar puncture, ventriculosubgaleal shunt, and ventriculoperitoneal shunt were the treatments of choice in 25%, 37.5% and 37.5% of the cases, respectively. Conclusion Cerebrospinal fluid diversion should be tailored to each case with preference given to temporary CSF drainage in neonates with lower age and lower birth-weight, while the permanent ventriculoperitoneal shunt should be considered in healthier, higher birth-weight neonates born closer to term.

Ventricular reservoirs and ventriculoperitoneal shunts for premature infants with posthemorrhagic hydrocephalus: an institutional experience

2009 ◽  
Vol 3 (2) ◽  
pp. 94-100 ◽  
Author(s):  
Brian Willis ◽  
Vijayakumar Javalkar ◽  
Prasad Vannemreddy ◽  
Gloria Caldito ◽  
Junko Matsuyama ◽  
...  
Keyword(s):  
Birth Weight ◽  
Surgical Treatment ◽  
Premature Infants ◽  
Preterm Neonates ◽  
Posthemorrhagic Hydrocephalus ◽  
Vp Shunt ◽  
Shunt Group ◽  
Institutional Experience ◽  
Csf Diversion ◽  
The Mean

Object The aim of the study was to analyze the outcome of surgical treatment for posthemorrhagic hydrocephalus in premature infants. Methods From 1990 to 2006, 32 premature infants underwent surgical treatment for posthemorrhagic hydrocephalus, and their charts were retrospectively reviewed to analyze the complications and outcome with respect to shunt revisions. Multivariate analysis and time series were used to identify factors that influence the outcome in terms of shunt revisions. Results The mean gestational age was 27 ± 3.3 weeks, and mean birth weight was 1192 ± 660 g. Temporary reservoir placement was performed in 15 patients, while 17 underwent permanent CSF diversion with a ventriculoperitoneal (VP) shunt. In 2 patients, reservoir tapping alone was sufficient to halt the progression of hydrocephalus; 29 patients received VP shunts. The mean follow-up period was 37.3 months. The neonates who received VP shunts first were significantly older (p = 0.02) and heavier (p = 0.04) than those who initially underwent reservoir placement. Shunts were revised in 14 patients; 42% of patients in the reservoir group had their shunts revised, while 53% of infants who had initially received a VP shunt required a revision. The revision rate per patient in the reservoir group was half that in the direct VP shunt group (p = 0.027). No patient in the reservoir group had > 2 revisions. Shunt infections developed in 3 patients (10.3%), and 2 patients in the reservoir group died of nonneurological issues related to prematurity. Conclusions Birth weight and age are useful parameters in decision making. Preterm neonates with low birth weights benefit from initial CSF drainage procedures followed by permanent CSF diversion with respect to the number of shunt revisions.

Potential Risk Factors for Ventriculoperitoneal Shunt Implantation in Paediatric Patients with Posthemorrhagic Hydrocephalus of Prematurity Treated with Subcutaneous Reservoir: An Institutional Experience

2021 ◽  
Author(s):  
Adam K. Bębenek ◽  
Stanisław Kwiatkowski ◽  
Olga Milczarek
Keyword(s):  
Risk Factors ◽  
Birth Weight ◽  
Ventriculoperitoneal Shunt ◽  
Gestational Age ◽  
Potential Risk ◽  
Statistical Significance ◽  
Skin Lesions ◽  
Ventricular Catheter ◽  
Posthemorrhagic Hydrocephalus ◽  
Medical Health Care

Abstract Background Posthemorrhagic hydrocephalus of prematurity (PHHP) is a result of intraventricular hemorrhage (IVH). IVH occurs in 6 to 23% of the preterms in countries with advanced medical health care. Most of these patients will eventually require the use of ventriculoperitoneal shunt (VPS). The purpose of this study is to assess the risk factors of VPS implantation in patients with PHHP who have been treated with ventricular catheter with subcutaneous reservoir (VCSR). Methods The retrospective study was conducted evaluating 35 premature patients who suffered from severe IVH. Their mean gestational age was 28 weeks. The assessment included antenatal factors such as gestational age, birth weight, and intrauterine and perinatal infection. Postparturient period factors such as the IVH grade, time between diagnosis, and VCSR implantation and body weight on VCSR implantation were also considered in the study. Postprocedural complications, such as bacterial cerebrospinal fluid (CSF) infection, sepsis, and skin lesions, were evaluated. Data were calculated with R program, version 4.04. Results From among 35 evaluated patients, 23 (65.71%) required a VPS. Median of birth weight was 1,190 g. Infections were observed in 11 (31.43%) cases. Mean time between IVH diagnosis and VCSR implantation was 2.6 weeks. Postprocedural complications occurred in 19 (54.29%) patients. None of the evaluated factors has proven its statistical significance (p > 0.05) for being a potential risk factor for VPS implantation. Conclusion External factors seem to not affect the necessity of VPS implantation in patients after the severe IVH. Ostensibly, there seems to be no difference between the grades III and the IV of Papile's IVH scale regarding VPS implantation necessity.

scholarly journals Complications of Cerebrospinal Fluid Diversion (Shunt) Catheters: A Pictorial Essay

2017 ◽  
Vol 07 (01) ◽  
pp. 058-076
Author(s):  
M. Rahalkar
Keyword(s):  
Cerebrospinal Fluid ◽  
Ventriculoperitoneal Shunt ◽  
Related Literature ◽  
Cerebrospinal Fluid Diversion ◽  
Abdominal Organs ◽  
Pictorial Essay ◽  
Fluid Collections ◽  
And Function

AbstractVentriculoperitoneal shunt catheters are very commonly used for hydrocephalus of varying etiologies in infancy to childhood to bypass the obstruction. Few people are aware of their complications, such as infection, obstruction, malfunctioning, displacements, fluid collections, disconnections, and entry into various intra-abdominal organs. These complications and related literature and images are presented in this essay. In some cases, a radiologist can be of use to a neurosurgeon to alert what complication a given catheter has produced. The objectives are (1) to describe the types and functioning of cerebrospinal fluid diversion shunt catheters, (2) to know what can go wrong with the position and function of these catheters, and (3) to understand the specific or syndromic states of complication.

Vision Deterioration and Hydrocephalus: Rare Presentations of Vestibular Schwannoma and Evolution of Management

2021 ◽  
Author(s):  
Marte van Keulen ◽  
Jonathan Pace ◽  
Christopher J. Burant ◽  
David L. Penn ◽  
Betsy Wilson ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Surgical Resection ◽  
Vestibular Schwannoma ◽  
Clinical Evidence ◽  
Tumor Resection ◽  
Case Series ◽  
Rare Presentation ◽  
Visual Symptoms ◽  
Younger Age ◽  
Csf Diversion

Abstract Introduction The incidence of vestibular schwannoma is reported as 12 to 54 new cases per million per year, increasing over time. These patients usually present with unilateral sensorineural hearing loss, tinnitus, or vertigo. Rarely, these patients present with symptoms of hydrocephalus or vision changes. Objective The study aimed to evaluate the surgical management of vestibular schwannoma at a single institution and to identify factors that may contribute to hydrocephalus, papilledema, and the need for pre-resection diversion of cerebrospinal fluid. Patients and Methods A retrospective review examining the data of 203 patients with vestibular schwannoma managed with surgical resection from May 2008 to May 2020. We stratified patients into five different groups to analyze: tumors with a diameter of ≥40 mm, clinical evidence of hydrocephalus, and of papilledema, and patients who underwent pre-resection cerebrospinal fluid (CSF) diversion. Results From May 2008 to May 2020, 203 patients were treated with surgical resection. Patients with tumors ≥40 mm were more likely to present with visual symptoms (p < 0.001). Presentation with hydrocephalus was associated with larger tumor size (p < 0.001) as well as concomitant visual symptoms and papilledema (p < 0.001). Patients with visual symptoms presented at a younger age (p = 0.002) and with larger tumors (p < 0.001). Conclusion This case series highlights the rare presentation of vision changes and hydrocephalus in patients with vestibular schwannoma. We recommend urgent CSF diversion for patients with visual symptoms and hydrocephalus, followed by definitive resection. Further, vision may still deteriorate even after CSF diversion and tumor resection.

scholarly journals Subdural Effusions with Hydrocephalus after Severe Head Injury: Successful Treatment with Ventriculoperitoneal Shunt Placement: Report of 3 Adult Cases

2010 ◽  
Vol 2010 ◽  
pp. 1-7 ◽  
Author(s):  
N. Tzerakis ◽  
G. Orphanides ◽  
E. Antoniou ◽  
P. J. Sioutos ◽  
S. Lafazanos ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Head Injury ◽  
Ventriculoperitoneal Shunt ◽  
Severe Head Injury ◽  
Accurate Diagnosis ◽  
Subdural Effusion ◽  
Midline Shift ◽  
Subdural Collection ◽  
Csf Diversion ◽  
Subdural Effusions

Background. Subdural collections of cerebrospinal fluid (CSF) with associated hydrocephalus have been described by several different and sometimes inaccurate terms. It has been proposed that a subdural effusion with hydrocephalus (SDEH) can be treated effectively with a ventriculoperitoneal shunt (V-P shunt). In this study, we present our experience treating patients with SDEH without directly treating the subdural collection.Methods. We treated three patients with subdural effusions and hydrocephalus as a result of a head injury. All the patients were treated with a V-P shunt despite the fact that there was an extra-axial CSF collection with midline shift.Results. In all of the patients, the subdural effusions subsided and the ventricular dilatation improved in the postoperative period. The final clinical outcome remains difficult to predict and depends not only on the successful CSF diversion but also on the primary and secondary brain insult.Conclusion. Subdural effusions with hydrocephalus can be safely and effectively treated with V-P shunting, without directly treating the subdural effusion which subsides along with the treatment of hydrocephalus. However, it is extremely important to make an accurate diagnosis of an SDEH and differentiate this condition from other subdural collections which require different management.

External hydrocephalus in adults

1996 ◽  
Vol 85 (6) ◽  
pp. 1143-1147 ◽  
Author(s):  
érico R. Cardoso ◽  
Romaine Schubert
Keyword(s):  
Cerebrospinal Fluid ◽  
Ventriculoperitoneal Shunt ◽  
Animal Experiments ◽  
Great Resistance ◽  
Posthemorrhagic Hydrocephalus ◽  
Content Type ◽  
External Hydrocephalus ◽  
Csf Shunting ◽  
Fluid Collections ◽  
Fine Print

✓ The authors report three adult patients who developed a symptomatic extraaxial collection of cerebrospinal fluid (CSF) after an intracranial hemorrhage. The fluid shifted from the extraaxial into the ventricular space as the patients' symptoms progressed. The symptoms resolved after placement of a ventriculoperitoneal shunt. External hydrocephalus, which is frequently observed in children, had not yet been described in adults. It is important to differentiate chronic subdural collections from external hydrocephalus, because ventricular CSF shunting increases the former while it is the treatment for the latter. The authors believe that symptomatic extraaxial fluid collections developed in these three adults during the early phase of posthemorrhagic hydrocephalus because the ventricles presented great resistance to distention at the onset of hydrocephalus. Animal experiments have led to the same result.

Trapped Fourth Ventricle Phenomenon Following Aneurysm Rupture of the Posterior Circulation

Neurosurgery ◽  
2011 ◽  
Vol 70 (1) ◽  
pp. 253-258 ◽  
Author(s):  
Manuel Ferreira ◽  
Brian V. Nahed ◽  
Maya A. Babu ◽  
Brian P. Walcott ◽  
Richard G. Ellenbogen ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Fourth Ventricle ◽  
Case Series ◽  
Aneurysm Rupture ◽  
Posterior Circulation ◽  
Shunt System ◽  
Cerebrospinal Fluid Diversion ◽  
Isolated Fourth Ventricle ◽  
Posterior Circulation Aneurysms ◽  
Trapped Fourth Ventricle

Abstract BACKGROUND AND IMPORTANCE Cerebral ventricular noncommunication has been described in the setting of infection and acutely in the setting of intracranial hemorrhage. We describe the first adult case series of individuals who developed delayed isolated fourth ventricles after rupture of intracranial posterior circulation aneurysms and define treatment modality. CLINICAL PRESENTATION A retrospective review was performed of all patients with aneurysms treated at a single institution from 2005 to 2009. Both microsurgical obliteration and endovascular cases were queried. Of 1044 aneurysms treated in this period, 3 patients were identified who required fourth ventricular shunting, for the treatment of the isolated ventricle. All 3 patients underwent microsurgical clip obliteration of their aneurysms and had subsequent frontal approach ventriculoperitoneal cerebrospinal fluid diversion. These patients had no evidence of infection of the cerebrospinal fluid as measured by serial cultures. Subsequently, all 3 patients presented in a delayed fashion with symptoms attributable to a dilated fourth ventricle and syringomyelia or syringobulbia. Either exploration or percutaneous tapping confirmed the function of the supratentorial shunt. These patients then underwent fourth ventriculoperitoneal cerebrospinal fluid diversion by the use of a low-pressure shunt system. The symptoms attributable to the isolated fourth ventricle resolved rapidly in all 3 patients after shunting. This clinical improvement correlated with the fourth ventricular size. CONCLUSION Isolated fourth ventricle, in an adult, is a rare phenomenon associated with intracranial posterior circulation aneurysm rupture treated with microsurgical clip obliteration. Fourth ventriculoperitoneal cerebrospinal fluid diversion is effective at resolving the symptoms attributed to the trapped ventricle and associated syrinx.

Predictors of the need for cerebrospinal fluid diversion in patients with myelomeningocele

2014 ◽  
Vol 14 (2) ◽  
pp. 167-172 ◽  
Author(s):  
Blake C. Phillips ◽  
Michael Gelsomino ◽  
Ambre' L. Pownall ◽  
Eylem Ocal ◽  
Horace J. Spencer ◽  
...  
Keyword(s):  
Ventriculoperitoneal Shunt ◽  
Head Circumference ◽  
Perinatal Period ◽  
Csf Leak ◽  
Shunt Placement ◽  
Head Growth ◽  
Cerebrospinal Fluid Diversion ◽  
Significant Difference ◽  
Radiological Images ◽  
Csf Diversion

Object Many patients with myelomeningocele (MMC) develop hydrocephalus, and most will undergo CSF diversion. The goal of this retrospective study was to determine whether there was a change in the shunt rate over the 7 consecutive years of the study. The authors will also identify the criteria used to determine the need for shunt placement. Methods During a 7-year period, 73 patients underwent MMC closure at Arkansas Children's Hospital. The shunt rate for each year was calculated. Clinical characteristics were evaluated, including apneic and bradycardic spells, CSF leak, level of the MMC, head circumference, and rate of head growth. In addition, radiological images were reviewed, and the frontooccipital horn ratio (FOHR), ventricular index (VI), and thalamooccipital distance (TOD) were calculated. Comparisons were made between those patients who underwent shunt placement and those who did not. Results One patient was excluded due to death in the perinatal period. Of the 72 remaining patients, 54 (75%) underwent placement of a ventriculoperitoneal shunt. This rate did not change significantly over time. Between the cohorts with and without a shunt there was no significant difference in age, sex, or race. There was no significant difference in apneic episodes or bradycardic episodes. There was a statistically significant difference in fontanelle characteristics, head circumference at birth, and rate of head growth. Patients who required CSF diversion had a mean head growth of 0.32 cm/day compared with those who did not receive a shunt (0.13 cm/day; p < 0.05). All radiological parameters were found to be statistically significant. Conclusions In this study, several classic indicators of hydrocephalus in the neonate were not found to be significantly associated with the need for CSF diversion. Fontanelle characteristics, head circumference at birth, and head growth velocity were associated with the need for shunt placement. Imaging information including the VI, TOD, and FOHR are statistically significant measures to evaluate prior to placement of a ventriculoperitoneal shunt. The optimal patient with MMC for CSF diversion will have full to tense fontanelle, increasing head circumference of more than 3 mm/day, and radiological evidence of an elevated VI, TOD, and/or FOHR.

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