scholarly journals ETV in tuberculous meningitis with hydrocephalus and allergic reaction to VP shunt: a case report

2018 ◽  
Vol 7 (1) ◽  
pp. 305
Author(s):  
Rohadi M. Rosyidi ◽  
Bambang Priyanto ◽  
Muhammad Arifin Parenrengi
Keyword(s):  
Allergic Reaction ◽  
Tuberculous Meningitis ◽  
Difficult Problem ◽  
Shunt Revision ◽  
Third Ventriculostomy ◽  
Anatomical Landmarks ◽  
Vp Shunt ◽  
Alternative Choice ◽  
High Level ◽  
Shunt Tubing

Hydrocephalus is one of the most common complications of tuberculous meningitis (TBM) occurring in up to 85% of patients with the disease. The placement of a ventriculoperitoneal (VP) shunt is the most common form of treatment for hydrocephalus in tuberculous meningitis (TBM). Although allergic reactions to the silicone in shunt device are very rare, the authors describe a case of silicone allergy causing multiple VP shunt revisions. Alternative choice is endoscopic third ventriculostomy (ETV), but it is debatable. ETV has variable success in these patients and is generally not advisable in patients in the acute stages of the disease. A 19-year-old woman with hydrocephalus in tuberculous meningitis, who had undergone multiple VP shunt revisions, presented with shunt malfunction caused by allergic reaction of the tissue surrounding the shunt tubing. Laboratory examination demonstrated high level IgE, high level ESR, and PCR-TBC Positive, related to the allergic reaction. Patient with ETV success score of 50. Patients received ETV and release VSS Shunt. ETV has success in these patients. VP Shunts complications remain a difficult problem in neurosurgical clinical practice. The most typical complications are mechanical obstruction and infection. Allergy to the silicone shunt tubing is quite rare. Silicone allergy is an even more rare occurrence because of its high biocompatibility and low biological reactivity. It is a challenge for ETV when TBM has difficulty to recognize anatomical landmarks on this patient. It could also consider in patients who have shunt failure, and might be a better option than shunt revision.

ENDOSCOPIC THIRD VENTRICULOSTOMY (ETV) IS A BETTER ALTERNATIVE FOR VP SHUNT FAILURE IN NON-COMMUNICATING HYDROCEPHALUS

2021 ◽  
pp. 65-67
Author(s):  
Ramesh Tanger ◽  
Dinesh Kumar Barolia ◽  
Arka Chatterjee ◽  
Punit Singh Parihar ◽  
Arun Gupta
Keyword(s):  
Success Rate ◽  
Endoscopic Third Ventriculostomy ◽  
Obstructive Hydrocephalus ◽  
Shunt Revision ◽  
Third Ventriculostomy ◽  
Communicating Hydrocephalus ◽  
Shunt Failure ◽  
Shunt Insertion ◽  
Vp Shunt

CONTEXT: VP Shunt is most commonly used procedure for hydrocephalus but shunt failure is also the common complication in many patients. Endoscopic third ventriculostomy (ETV) is an accepted procedure for the treatment of obstructive hydrocephalus. The aim of our study is to evaluate the success rate AIM AND OBJECTIVE - of ETV in patients of obstructive hydrocephalus formerly treated by ventriculo-peritoneal (VP shunt) shunt. The failure VP shunt was removed before ETV. MATERIALS AND METHOD: This study was conducted between June 2015 and December 2019 in single unit of our department. Twenty one (n=21) patients were enrolled for this study. All patients were admitted with failure of VP shunt. They were known case of non-communicating hydrocephalus previously operated for VP shunt. Six patients were excluded for ETV because CT/MRI show grossly distorted anatomy of ventricles. Endoscopic third ventriculostomy was attempted in 15 patients, but ventriculostomy was done successfully in 10 patients, rests were treated with revision of VP shunt. All patients in this study were radiologically diagnosed RESULTS: case of hydrocephalus due to aqueduct stenosis. They were experienced VP shunt insertion but there were failure of shunt due to any reason. ETV procedures were done successfully in 10 patients. Out of 10 patients one patient needed shunt insertion due ineffective ETV. Shunt revision was done in 11 patients. There was no serious complication during and after ETV procedures. The follow-up period of patients with successful ETV was 6–60 months. This follow-up was uneventful and peaceful for their parents. ETV can be considered as an alternative treatment for the patients w CONCLUSION: ith VP shunt failure with an acceptable success rate of 80%, although long-term follow-up is needed for these patients.

Distal ventriculoperitoneal shunt failure caused by silicone allergy

2005 ◽  
Vol 102 (3) ◽  
pp. 536-539 ◽  
Author(s):  
Namath S. Hussain ◽  
Paul P. Wang ◽  
Carol James ◽  
Benjamin S. Carson ◽  
Anthony M. Avellino
Keyword(s):  
Allergic Reaction ◽  
Allergic Reactions ◽  
Shunt Failure ◽  
Valve Mechanism ◽  
Shunt System ◽  
Content Type ◽  
Vp Shunt ◽  
Shunt Tubing ◽  
Fine Print

✓ The placement of a ventriculoperitoneal (VP) shunt is the most common form of treatment for hydrocephalus. Although allergic reactions to the silicone in shunt hardware are very rare, the authors describe a case of silicone allergy causing multiple ventricular shunt revisions. A 24-year-old man, who had undergone multiple VP shunt revisions, presented with shunt malfunction caused by allergic reaction of the tissues surrounding the shunt tubing. The patient's existing silicone-based shunt was replaced with a new polyurethane system, including the proximal and distal catheters as well as the valve mechanism. Contrary to recommendations in previous studies of silicone shunt allergies, long-term immunosuppression was not initiated. The patient was followed up for more than 8 years without recurrence of an allergic reaction to the shunt. This outcome indicates that replacing the original silicone-based shunt system with a polyurethane-based system alone is sufficient in the treatment of a silicone shunt allergy.

scholarly journals Factors influencing shunt malfunction in patients with tuberculous meningitis

2013 ◽  
Vol 02 (02) ◽  
pp. 175-181 ◽  
Author(s):  
Sudheer Ambekar ◽  
Paritosh Pandey ◽  
Somanna Sampath ◽  
Chandramouli Bangalore ◽  
Devi Indira ◽  
...  
Keyword(s):  
Tuberculous Meningitis ◽  
Serum Sodium ◽  
Protein Concentration ◽  
Normal Serum ◽  
High Rate ◽  
Shunt Malfunction ◽  
Neurological Deficits ◽  
Shunt Revision ◽  
Duration Of Symptoms ◽  
Vp Shunt

Abstract Hydrocephalus secondary to tuberculous meningitis (TBM) is a challenging condition to treat. Though ventriculo-peritoneal (VP) shunt is an accepted modality of treatment for hydrocephalus in TBM, there is a high rate of complications associated with the same. The study was planned to evaluate various factors associated with shunt malfunction in patients undergoing VP shunt surgery for hydrocephalus due to TBM. A retrospective review of all the patients undergoing VP shunt and shunt revision for TBM between 2004 and 2008 was performed. 449 VP shunt surgeries were performed in 432 patients for hydrocephalus due to TBM. Among these 70 shunt revisions were performed in 53 patients. Shunt malfunction rate in our series was 16.2%. High cerebrospinal fluid (CSF) protein concentration (>200 mg/dL) was associated with 5 times increased incidence of shunt malfunction. Patients with hyponatremia (Na+ <130 mEq/dL) prior to surgery had a 3 times increased incidence of shunt malfunction (P < 0.05). Other factors such as duration of symptoms, presence of neurological deficits, Evan’s index, third ventricular diameter, thickness of exudates, presence of infarcts, anemia, CSF cellularity and CSF glucose concentration were not associated with increased incidence of shunt malfunction. Analysis showed that shunt viability was longest in patients with normal serum sodium levels and CSF protein concentration less than 200 mg/dL and shortest in patients with low serum sodium and CSF protein concentration more than 200 mg/dL. Patients with pre-operative hyponatremia and high CSF protein concentration have a higher incidence of shunt malfunction and need to be followed-up closely.

Endoscopic cyst fenestration in the treatment of multiloculated hydrocephalus in children

2008 ◽  
Vol 1 (3) ◽  
pp. 217-222 ◽  
Author(s):  
Nasser M. F. El-Ghandour
Keyword(s):  
Pediatric Neurosurgery ◽  
Difficult Problem ◽  
Magnetic Resonance Images ◽  
Definitive Treatment ◽  
Shunt Revision ◽  
Neonatal Meningitis ◽  
Third Ventriculostomy ◽  
Shunt Insertion ◽  
Multiloculated Hydrocephalus ◽  
Cyst Fenestration

Object The treatment of multiloculated hydrocephalus is a difficult problem in pediatric neurosurgery. Definitive treatment is surgical, yet the approach remains controversial. The author has therefore reviewed his results with endoscopic cyst fenestration (ECF) in the management of this disease. Methods The author presents the largest series to date of 24 patients with multiloculated hydrocephalus who were treated endoscopically. The group included 10 boys and 14 girls with a mean age of 12.5 months. Uniloculated hydrocephalus was not included in this study because it is a different entity that would be better studied separately. Results Neonatal meningitis was the most common cause (in 9 patients), followed by intraventricular hemorrhage (in 6 patients), postoperative gliosis (in 6 patients), and multiple neuroepithelial cysts (in 3 patients). Multiplanar magnetic resonance images made early diagnosis possible and are indicated if the computed tomography scan shows disproportionate hydrocephalus. Surgical treatment included ECF (in 24 patients), endoscopic revision of a malfunctioning preexisting shunt (in 6 patients), placement of a new shunt (in 15 patients), and third ventriculostomy (in 3 patients). The ECF was easily performed in all cases through devascularization of the cyst wall by coagulation to prevent recurrence. The results are encouraging with improvement of hydrocephalus in 18 patients (75%). The need for shunt insertion was avoided in 3 patients (12.5%). Endoscopy reduced shunt revision rate from 2.9 per year before fenestration to 0.2 per year after fenestration. During the overall mean follow-up period (30 months), repeated ECF was necessary in 8 patients (33%). Six (75%) of these 8 patients had already undergone shunt treatment before endoscopy. Endoscopic complications were minimal (2 cerebrospinal fluid leaks and 2 minor arterial hemorrhages), and there were no deaths (0%). Conclusions An ECF procedure is recommended in the treatment of multiloculated hydrocephalus because it is effective, simple, minimally invasive, and associated with low morbidity and mortality rates.

scholarly journals Overshunting-Related Cervical Myelopathy Causing Progressive Gait Disturbance: A Case Report

2021 ◽  
pp. 312-317
Author(s):  
Eva Vister ◽  
Sebastiaan Hammer ◽  
Rudolf W.M. Keunen ◽  
Astrid L. Rijssenbeek ◽  
Niels A. van der Gaag
Keyword(s):  
Cerebrospinal Fluid ◽  
Cervical Myelopathy ◽  
Complete Resolution ◽  
Late Complication ◽  
Gait Disturbance ◽  
Shunt Revision ◽  
Proper Treatment ◽  
Cervical Stenosis ◽  
Vp Shunt ◽  
Associated Symptoms

A complication of ventriculoperitoneal (VP) shunting is overdrainage or overshunting of cerebrospinal fluid, which can cause formation of hygroma but in rare cases also cervical myelopathy at a later stage. In this article, we describe a very late complication of VP shunting. We present a 75-year-old man, previously given a VP shunt at the age of 46, who developed a progressive gait disturbance and ataxia of the limbs after 27 years. MRI showed a cervical stenosis and myelopathy as a result of venous engorgement due to chronic overshunting of the VP shunt. Revision of the VP shunt resulted in complete resolution of his neurological symptoms and the cervical myelopathy. Cervical myelopathy due to chronic overshunting is a rare and potentially very late complication of a VP shunt. Our case underlines the importance of awareness of this complication while proper treatment can reverse the associated symptoms fully.

scholarly journals Hemorrhagic abdominal pseudocyst following ventriculoperitoneal shunt: a case report

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Hong-Cai Wang ◽  
Yi-Lei Tong ◽  
Shi-Wei Li ◽  
Mao-Song Chen ◽  
Bo-Ding Wang ◽  
...  
Keyword(s):  
Fibrous Tissue ◽  
Clinical Signs ◽  
Chronic Subdural Hematoma ◽  
Normal Pressure ◽  
Cystic Mass ◽  
Shunt Revision ◽  
Subdural Effusion ◽  
Palpable Mass ◽  
Vp Shunt ◽  
Abdominal Pseudocyst

Abstract Background Abdominal cerebrospinal fluid (CSF) pseudocyst is an uncommon but important complication of ventriculoperitoneal (VP) shunts. While individual articles have reported many cases of abdominal CSF pseudocyst following VP shunts, no case of a hemorrhagic abdominal pseudocyst after VP shunts has been reported so far. Case presentation This article reports a 68-year-old woman with a 4-month history of progressive abdominal pain and distention. She denied any additional symptoms. A VP shunt was performed 15 years earlier to treat idiopathic normal pressure hydrocephalus and no other abdominal surgery was performed. Physical examination revealed an elastic palpable mass in her right lower abdomen, which was dull to percussion. Abdominal computed tomography (CT) scan indicated a large cystic collection of homogenous iso-density fluid in the right lower abdominal region with clear margins. The distal segment of the peritoneal shunt catheter was located within the cystic mass. Abdominal CSF pseudocyst was highly suspected as a diagnosis. Laparoscopic cyst drainage with removal of the whole cystic mass was performed, 15-cm cyst which found with thick walls and organized chronic hematic content. No responsible vessel for the cyst hemorrhage was identified. No further shunt revision was placed. Histological examination showed that the cyst wall consisted of outer fibrous tissue and inner granulation tissue without epithelial lining, and the cystic content was chronic hematoma. The patient had an uneventful postoperative course and remained asymptomatic for 8-mo follow-up. Conclusion To the best of our knowledge, this is the first report of hemorrhagic onset in the abdominal pseudocyst following VP shunt. Such special condition can accelerate the appearance of clinical signs of the abdominal pseudocyst after VP shunts, and its mechanisms may be similar to the evolution of subdural effusion into chronic subdural hematoma (CSDH).

scholarly journals Effect of electromagnetic-navigated shunt placement on failure rates: a prospective multicenter study

2010 ◽  
Vol 113 (6) ◽  
pp. 1273-1278 ◽  
Author(s):  
Caroline Hayhurst ◽  
Tjemme Beems ◽  
Michael D. Jenkinson ◽  
Patricia Byrne ◽  
Simon Clark ◽  
...  
Keyword(s):  
Revision Rate ◽  
Shunt Revision ◽  
Standard Group ◽  
Fisher Exact Test ◽  
Anatomical Landmarks ◽  
Failure Rates ◽  
Shunt Failure ◽  
Catheter Position ◽  
Optimal Position ◽  
Shunt Placement

Object As many as 40% of shunts fail in the first year, mainly due to proximal obstruction. The role of catheter position on failure rates has not been clearly demonstrated. The authors conducted a prospective cohort study of navigated shunt placement compared with standard blind shunt placement at 3 European centers to assess the effect on shunt failure rates. Methods All adult and pediatric patients undergoing de novo ventriculoperitoneal shunt placement were included (patients with slit ventricles were excluded). The first cohort underwent standard shunt placement using anatomical landmarks. All centers subsequently adopted electromagnetic (EM) navigation for routine shunt placements, forming the second cohort. Catheter position was graded on postoperative CT in both groups using a 3-point scale developed for this study: (1) optimal position free-floating in CSF; (2) touching choroid or ventricular wall; or (3) intraparenchymal. Episodes and type of shunt revision were recorded. Early shunt failure was defined as that occurring within 30 days of surgery. Patients with shunts were followed-up for 12 months in the standard group, for a median of 6 months in the EM-navigated group, or until shunt failure. Results A total of 75 patients were included in the study, 41 with standard shunts and 34 with EM-navigated shunts. Seventy-four percent of navigated shunts were Grade 1 compared with 37% of the standard shunts (p = 0.001, chi-square test). There were no Grade 3 placements in the navigated group, but 8 in the standard group, and 75% of these failed. Early shunt failure occurred in 9 patients in the standard group and in 2 in the navigated group, reducing the early revision rate from 22 to 5.9% (p = 0.048, Fisher exact test). Early shunt failures were due to proximal obstruction in 78% of standard shunts (7 of 9) and in 50% of EM-navigated shunts (1 of 2). Conclusions Noninvasive EM image guidance in shunt surgery reduces poor shunt placement, resulting in a significant decrease in the early shunt revision rate.

Ventriculoperitoneal shunt failure causing myelopathy in a patient with bilateral jugular vein occlusion

2007 ◽  
Vol 6 (1) ◽  
pp. 60-63 ◽  
Author(s):  
William E. Humphries ◽  
Peter M. Grossi ◽  
Linda G. Liethe ◽  
Timothy M. George
Keyword(s):  
Spinal Cord ◽  
Ct Angiography ◽  
Jugular Vein ◽  
Cervical Spinal Cord ◽  
Venous Drainage ◽  
Shunt Revision ◽  
Shunt Failure ◽  
Vp Shunt ◽  
Physiological Importance ◽  
Vein Occlusion

✓The authors describe the case of a 36-year-old woman with bilateral internal jugular vein occlusion, hydrocephalus, and Dandy–Walker variant who presented with myelopathy that was ultimately attributed to ventriculoperitoneal (VP) shunt failure. Computed tomography (CT) angiography of the head and neck revealed epidural venous engorgement within the cervical spine, greater that 50% narrowing of the C2–5 spinal canal, and compression of the cervical spinal cord. After successful shunt revision, postoperative CT angiography revealed decreased venous engorgement as well as decompression of the cervical spinal cord, and the patient’s myelopathy improved. This case represents a fascinating clinical presentation of VP shunt failure, highlighting the physiological importance of the external jugular pathways involved in cerebral venous drainage.

Fluorescein-Enhanced Characterization of Additional Anatomical Landmarks in Cerebral Ventricular Endoscopy

Neurosurgery ◽  
2013 ◽  
Vol 72 (5) ◽  
pp. 855-860 ◽  
Author(s):  
Pierluigi Longatti ◽  
Luca Basaldella ◽  
Francesco Sammartino ◽  
Alessandro Boaro ◽  
Alessandro Fiorindi
Keyword(s):  
Choroid Plexus ◽  
White Light ◽  
Area Postrema ◽  
Functional Anatomy ◽  
Circumventricular Organs ◽  
Third Ventriculostomy ◽  
Cancer Tissue ◽  
Anatomical Landmarks ◽  
Fluorescein Sodium ◽  
Anatomic Landmarks

Abstract BACKGROUND: Fluorescein enhancement to detect retinal disorder or differentiate cancer tissue in situ is a well-defined diagnostic procedure. It is a visible marker of where the blood-brain barrier is absent or disrupted. Little is reported in the contemporary literature on endoscopic fluorescein-enhanced visualization of the circumventricular organs, and the relevance of these structures as additional markers for safe ventricular endoscopic navigation remains an unexplored field. OBJECTIVE: To describe fluorescein sodium–enhanced visualization of circumventricular organs as additional anatomic landmarks during endoscopic ventricular surgery procedures. METHODS: We prospectively administered intravenously 500 mg fluorescein sodium in 12 consecutive endoscopic surgery patients. A flexible endoscope equipped with dual observation modes for both white light and fluorescence was used. During navigation from the lateral to the fourth ventricle, the endoscopic anatomic landmarks were first inspected under white light and then under the fluorescent mode. RESULTS: After a mean of 20 seconds in the fluorescent mode, the fluorescein enhanced visualization of the choroid plexus of the lateral ventricle, median eminence–tuber cinereum complex, organum vasculosum of the lamina terminalis, choroid plexus of the third and fourth ventricles, and area postrema. CONCLUSION: Fluorescein-enhanced visualization is a useful tool for helping neuroendoscopists recognize endoscopic anatomic landmarks. It could be adopted to guide orientation when the surgeon deems an endoscopic procedure unsafe or contraindicated because of unclear or subverted anatomic landmarks. Visualization of the circumventricular organs could add new insight into the functional anatomy of these structures, with possible implications for the site and safety of third ventriculostomy.

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