Complications of CSF Shunts in Pediatrics: Functional Assessment With CSF Shunt Scintigraphy—Performance and Interpretation

2020 ◽  
Vol 215 (6) ◽  
pp. 1474-1489
Author(s):  
Hedieh Khalatbari ◽  
Marguerite T. Parisi
Keyword(s):  
Functional Assessment ◽  
Csf Shunt ◽  
Csf Shunts

Vancomycin and rifampin therapy for Staphylococcus epidermidis meningitis associated with CSF shunts

1981 ◽  
Vol 55 (4) ◽  
pp. 633-636 ◽  
Author(s):  
Myles E. Gombert ◽  
Sheldon H. Landesman ◽  
Michael L. Corrado ◽  
Sherman C. Stein ◽  
Ellen T. Melvin ◽  
...  
Keyword(s):  
Staphylococcus Epidermidis ◽  
Susceptibility Testing ◽  
Csf Shunt ◽  
Csf Shunts ◽  
Methicillin Resistant ◽  
Content Type ◽  
Favorable Clinical Response ◽  
Time Kill ◽  
Fine Print

✓ Three patients with Staphylococcus epidermidis meningitis associated with cerebrospinal fluid (CSF) shunt devices were treated with a combination of intravenous vancomycin and oral rifampin. Two of the isolates were methicillin-resistant. All patients had a favorable clinical response. Time-kill curves showed that the addition of rifampin to vancomycin resulted in enhanced bactericidal activity against all isolates when compared to either antibiotic alone. This finding suggests that the combination of oral rifampin and intravenous vancomycin may be useful in the treatment of methicillin-resistant and recalcitrant methicillin-sensitive S. epidermidis meningitis associated with CSF shunts. In vitro susceptibility testing should be performed.

The necessity of shunt series

2010 ◽  
Vol 6 (5) ◽  
pp. 468-473 ◽  
Author(s):  
Michael Vassilyadi ◽  
Zac L. Tataryn ◽  
Fahad Alkherayf ◽  
Kristin Udjus ◽  
Enrique C. G. Ventureyra
Keyword(s):  
Related Problem ◽  
Shunt Revision ◽  
Csf Shunt ◽  
Csf Shunts ◽  
Shunt Insertion ◽  
Brain Ct ◽  
Ancillary Test ◽  
Ancillary Studies ◽  
Shunt Series

Object This work assessed the value of shunt series in the evaluation of children with CSF shunts, a test that is frequently ordered as part of the assessment of shunt integrity. Methods The medical records of all children who underwent shunt series at Children's Hospital of Eastern Ontario between 1975 and 2007 were reviewed. Ancillary studies that were performed within 2 days of the shunt series (brain CT, MR imaging, ultrasonography, and radionuclide shuntography) were noted, as well as the subsequent requirement for a shunt revision. Shunt series and ancillary studies were categorized as either positive (revealing an observable sign that a shunt-related problem was present, such as shunt discontinuity on the shunt series or enlargement of the ventricles on the brain CT scan) or negative (no clear sign of a shunt-related problem). Shunt series were further grouped into shunt series performed for diagnostic reasons, shunt series performed on a routine basis during follow-up in clinic, and shunt series performed postoperatively. The length of time between shunt insertion and shunt fracture was noted. Statistical analyses were performed, including the derivation of sensitivities and specificities. Results There were 3416 shunt series in 394 patients, of which 3004 were performed with ancillary studies. On average, patients underwent 9 shunt series, with a minimum of 1 and a maximum of 43, during the follow-up period (range 3 weeks to 19 years). A total of 2493 shunt series and ancillary studies (83%) yielded negative results and no surgery was performed. One hundred thirty shunts series were negative with a positive ancillary study (4.3%) and no surgery was required. In 8.7% (261 shunt series negative, ancillary studies positive) shunt revision surgery was necessary. The opposite trend was far less prevalent (17 shunt series positive, ancillary test negative; 0.6%) in which surgery was required. There were 87 patients with 96 shunt fractures (2.8% of shunt series). The average time between shunt insertion and shunt fracture was 7.9 years (range 3 months to 18 years). Shunt series had a sensitivity of 18% and a specificity of 97%. The ancillary studies had a sensitivity of 84% and a specificity of 85%. Conclusions The routine utilization of shunt series in the evaluation of a child with a CSF shunt is not necessary. This study showed that a very small number (0.6%) of shunt series helped in surgical decision making. Shunt series can be performed in selected cases, especially preoperatively in the absence of a baseline study to obtain information necessary for surgical planning.

A flow-regulating device to control differential pressure in CSF shunt systems

1982 ◽  
Vol 57 (4) ◽  
pp. 570-573 ◽  
Author(s):  
Hiroshi Yamada
Keyword(s):  
Experimental Study ◽  
Flow Rate ◽  
Csf Shunt ◽  
Csf Flow ◽  
Csf Shunts ◽  
Shunt System ◽  
Distal Catheter ◽  
Content Type ◽  
Teflon Tube ◽  
Fine Print

✓ A method of regulating flow rate through cerebrospinal fluid (CSF) shunts with the addition of a flow-regulating device (FRD) is reported. The FRD consists of a small-caliber (0.4 mm) Teflon tube placed in the usual connector. This device has the advantage of converting the original shunt valves to valves for higher-resistance flow without replacing the entire distal catheter. An experimental study revealed that this device reduced the CSF flow rate in the shunt system by approximately 30%. The author has found it reliable in 32 patients, without causing CSF obstruction. The device is easily installed and removed.

Cerebrospinal fluid shunt operations without cranial bandaging

2009 ◽  
Vol 3 (6) ◽  
pp. 511-515 ◽  
Author(s):  
Ken R. Winston ◽  
Elizabeth Trinidad ◽  
C. Corbett Wilkinson ◽  
Lori A. McBride
Keyword(s):  
Cerebrospinal Fluid ◽  
Revision Surgery ◽  
Healthcare Workers ◽  
Age Distribution ◽  
Csf Shunt ◽  
Csf Shunts ◽  
Shunt Insertion ◽  
Shunt Implantation ◽  
Clean Contaminated ◽  
Antibiotic Ointment

Object Cranial bandages are commonly applied over scalp incisions immediately after cerebrospinal fluid (CSF) shunt surgery, putatively to prevent complications, particularly infection. These bandages require resources, consume the time of healthcare workers, and incur non-negligible expenses. It is therefore both reasonable and important to examine the efficacy of cranial bandaging. Methods The combined experience of 3 neurosurgeons over 6.75 years with using no cranial bandaging after operations for implantation or revision of CSF shunts is the basis of this report. These data were prospectively accrued and retrospectively analyzed. Results The infection rate was 4.2% (95% CI 3.1–5.6%) for 1064 operations performed without postoperative cranial bandaging after either shunt insertion or revision surgery through clean or clean-contaminated wounds. The age distribution extended from premature infants through adults 77 years of age. Conclusions The results of this investigation support the position that bandaging scalp wounds after CSF shunt implantation or revision surgery adds no benefit beyond the easier, simpler, faster, and cheaper practice of using antibiotic ointment as a dressing without bandaging.

Role of endoscopic third ventriculostomy at infected cerebrospinal fluid shunt removal

2012 ◽  
Vol 9 (3) ◽  
pp. 320-326 ◽  
Author(s):  
Tomohisa Shimizu ◽  
Mark G. Luciano ◽  
Toru Fukuhara
Keyword(s):  
Risk Factors ◽  
Cerebrospinal Fluid ◽  
Endoscopic Third Ventriculostomy ◽  
Shunt Infection ◽  
Secondary Outcome ◽  
Csf Shunt ◽  
Third Ventriculostomy ◽  
Cerebrospinal Fluid Shunt ◽  
Csf Shunts ◽  
Shunt Removal

Object Cerebrospinal fluid shunt infection is distressing, especially in the pediatric population. Usually, infected CSF shunts are removed, and after temporary external CSF drainage, reinsertion of the CSF shunt is necessary. Unfortunately, it is not rare to encounter CSF reinfection after shunt renewal, and furthermore, the reinserted CSF shunt is at a considerable risk of malfunction. Endoscopic third ventriculostomy (ETV) is a potent option in managing CSF shunt infection, although ETV failure may occur more frequently when it is used to remove an infected shunt. The authors retrospectively evaluated CSF reinfection after using ETV during removal of infected CSF shunts; then the longevity of ETV and of successive reinserted ventriculoperitoneal shunts (VPSs) after ETV failure were also examined. Methods Children with shunted hydrocephalus were retrospectively reviewed, and data on their initial CSF shunt infections were extracted. Thirty-six children underwent VPS reinsertion (the VPS group), and 9 underwent ETV after removal of the infected CSF shunt (the ETV group). As the primary outcome, ETV efficacy against CSF reinfection within 6 months was analyzed by comparing the reinfection rates, and the risk factors for CSF reinfection were analyzed by logistic regression. The longevity of the reinserted shunt in the VPS group was calculated using the Kaplan-Meier method, which was compared with ETV longevity as the secondary outcome, and also with the longevity of reinserted VPSs in the ETV group after ETV failure as the tertiary outcome. Results Reinfection of CSF was seen in 27.8% of children in the VPS group. Among 9 children in the ETV group, only 1 (11.1%) had CSF reinfection. However, logistic regression analysis failed to show that performing ETV was a significant factor protecting against CSF reinfection: the significant risk factors were younger age at reinsertion of VPS or ETV (p = 0.037) and a history of shunt revisions (p = 0.011). The longevity of reinserted VPSs in the VPS group was calculated to be 658 ± 166.3 days (mean ± SE). Longevity of ETV was compared in the analysis of the secondary outcome, which was 929.2 ± 511.1 days, and there were no significant differences between these durations. Only 2 ETVs stayed patent, and a VPS was eventually implanted in the other 7 children. The longevity of this reinserted VPS in the ETV group, calculated based on these 7 children, was 2011.1 ± 540.7 days, which was confirmed to be longer than that in the VPS group (p = 0.031). Conclusions Although the protective effect of using ETV during removal of an infected CSF shunt on reinfection is marginal, the ETV longevity can be considered equivalent to that of reinserted VPSs. Even if ETV failure occurs, the reinserted VPS has significantly better longevity than a VPS reinserted without using ETV, and use of ETV during infected CSF shunt removal can be considered a potent alternative or at least an adjunct to VPS reinsertion.

scholarly journals Action of Linezolid or Vancomycin on Biofilms in Ventriculoperitoneal ShuntsIn Vitro

2012 ◽  
Vol 56 (6) ◽  
pp. 2842-2845 ◽  
Author(s):  
Roger Bayston ◽  
Gautham Ullas ◽  
Waheed Ashraf
Keyword(s):  
Staphylococcus Aureus ◽  
Staphylococcus Epidermidis ◽  
Shunt Infection ◽  
Csf Shunt ◽  
Csf Shunts ◽  
Content Type ◽  
Shunt Removal ◽  
Biofilm Development ◽  
Surgical Shunt

ABSTRACTCerebrospinal fluid (CSF) shunts used to treat hydrocephalus have an overall infection rate of about 10% of operations. The commonest causative bacteria areStaphylococcus epidermidis, followed byStaphylococcus aureusand enterococci. Major difficulties are encountered with nonsurgical treatment due to biofilm development in the shunt tubing and inability to achieve sufficiently high CSF drug levels by intravenous administration. Recently, three cases ofS. epidermidisCSF shunt infection have been treated by intravenous linezolid without surgical shunt removal, and we therefore investigated vancomycin and linezolid against biofilms of these bacteriain vitro. A continuous-perfusion model of shunt catheter biofilms was used to establish mature (1-week) biofilms ofStaphylococcus aureus,Staphylococcus epidermidis(both methicillin resistant [MRSA and MRSE]),Enterococcus faecalis, andEnterococcus faecium. They were then “treated” with either vancomycin or linezolid in concentrations achievable in CSF for 14 days. The biofilms were then monitored for 1 week for eradication and for regrowth. Enterococcal biofilms were not eradicated by either vancomycin or linezolid. Staphylococcal biofilms were eradicated by both antibiotics after 2 days and did not regrow. No resistance was seen. Linezolid at concentrations achievable by intravenous or oral administration was able to eradicate biofilms of bothS. epidermidis(MRSE) andS. aureus(MRSA). Neither vancomycin at concentrations achievable by intrathecal administration nor linezolid was able to eradicate enterococcal biofilms. It is hoped that thesein vitroresults will stimulate further clinical trials with linezolid, avoiding surgical shunt removal.

Management of hydrocephalus secondary to posterior fossa tumors

1977 ◽  
Vol 46 (1) ◽  
pp. 52-55 ◽  
Author(s):  
Leland Albright ◽  
Donald H. Reigel
Keyword(s):  
Posterior Fossa ◽  
External Ventricular Drainage ◽  
Csf Shunt ◽  
Safe Procedure ◽  
Tumor Removal ◽  
Posterior Fossa Tumors ◽  
Csf Shunts ◽  
Content Type ◽  
Suboccipital Craniectomy ◽  
Methods Of Treatment

✓ The records of children with hydrocephalus secondary to posterior fossa tumors were reviewed and the methods of treatment compared with their subsequent clinical course. Of 86 patients evaluated, 47 had no treatment for hydrocephalus prior to tumor removal, 12 had external ventricular drainage, and 27 had cerebrospinal fluid (CSF) shunts before suboccipital craniectomy. Children with CSF shunts before tumor removal had significantly better postoperative conditions than the children without shunts (p < 0.01). Operative mortality of children without treatment of hydrocephalus before tumor surgery was 12.8%; it was 3.7% in the children with preexisting shunts. Treatment of hydrocephalus with a CSF shunt prior to suboccipital craniectomy was a safe procedure that significantly lowered the morbidity and mortality of subsequent tumor removal.

Laparoscopic bowel resection in the presence of a lumbo-peritoneal shunt: a rare case

2020 ◽  
Vol 13 (9) ◽  
pp. e233159
Author(s):  
Gregg Neagle ◽  
Emma Bhatti ◽  
Martyn Hawkins ◽  
Chris Rodger
Keyword(s):  
Laparoscopic Surgery ◽  
Rare Case ◽  
Bowel Resection ◽  
Case Reports ◽  
Adverse Outcomes ◽  
Current Evidence ◽  
Csf Shunt ◽  
Csf Shunts ◽  
Laparoscopic Bowel Resection ◽  
Precautionary Measures

The presence of a cerebrospinal fluid (CSF) shunt was previously considered a contra-indication to laparoscopic surgery, however, case reports appeared that describe laparoscopic surgery proceeding with no adverse outcomes in such patients. The majority of these reports relate to laparoscopic cholecystectomy. Here we present what we believe to be only the second report of a patient undergoing laparoscopic bowel resection in the presence of a lumbo-peritoneal shunt. With this case we aim to add to the evidence that more major laparoscopic procedures can be performed safely in the presence of CSF shunts and with a brief review of the current evidence, have suggested appropriate monitoring and precautionary measures for approaching these procedures.

Results of surgical treatment of neurocysticercosis in 69 cases

1986 ◽  
Vol 65 (3) ◽  
pp. 309-315 ◽  
Author(s):  
Benedicto Oscar Colli ◽  
Nelson Martelli ◽  
João Alberto Assirati ◽  
Hélio Rubens Machado ◽  
Sylvio de Vergueiro Forjaz
Keyword(s):  
Posterior Fossa ◽  
Complement Fixation Test ◽  
Shunt Infection ◽  
Shunt Revision ◽  
Csf Shunt ◽  
Increased Intracranial Pressure ◽  
Csf Shunts ◽  
Content Type ◽  
Cerebral Parenchyma

✓ The clinical course of 69 patients with neurocysticercosis who underwent surgery to control increased intracranial pressure (ICP) or cyst removal is analyzed. Increased ICP was caused by hydrocephalus in 63 patients, by cerebral edema in four, and by giant cysts in two. Skull x-ray films showed calcifications in 14% and signs of elevated ICP in 46%. Examination of cerebrospinal fluid (CSF) revealed pleocytosis with eosinophils in 52% of cases and a positive complement fixation test for cysticercosis in 66%. Ventriculography allowed localization of the CSF obstruction and ventricular cysts, and generally differentiated between an obstruction due to cysts and an inflammatory process. Computerized tomography showed cysts in the cerebral parenchyma and ventricular dilatation. Ventricular cysts were best seen when intraventricular metrizamide was used. Intracranial shunting and posterior fossa exploration were less effective in the treatment of hydrocephalus than was ventriculoatrial (VA) or ventriculoperitoneal (VP) shunting, although VA or VP shunting was associated with a high percentage of complications. Quality of survival was good in 87% of the cases in the first 3 postoperative months and in 93% of patients who survived 2 years after surgery. Fortyseven patients (68%) were readmitted one or more times for CSF shunt revision; 14 of them for shunt infection (meningitis). The early operative mortality rate was 1.8% for patients with VA or VP shunt placement and 5.3% for those with posterior fossa exploration. The authors conclude that placement of CSF shunts is indicated in the treatment of hydrocephalus, and cyst removal is indicated only when the cyst exhibits tumor-like behavior. Surgical exploration is also indicated when the diagnosis is uncertain.

scholarly journals Ventricular catheter development: past, present, and future

2016 ◽  
Vol 125 (6) ◽  
pp. 1504-1512 ◽  
Author(s):  
Sofy H. Weisenberg ◽  
Stephanie C. TerMaath ◽  
Chad E. Seaver ◽  
James A. Killeffer
Keyword(s):  
Mechanical Design ◽  
Computational Design ◽  
Csf Shunt ◽  
Ventricular Catheter ◽  
Original Design ◽  
Csf Shunts ◽  
Current Form ◽  
Cerebrospinal Fluid Diversion ◽  
History Of ◽  
Effective Design

Cerebrospinal fluid diversion via ventricular shunting is the prevailing contemporary treatment for hydrocephalus. The CSF shunt appeared in its current form in the 1950s, and modern CSF shunts are the result of 6 decades of significant progress in neurosurgery and biomedical engineering. However, despite revolutionary advances in material science, computational design optimization, manufacturing, and sensors, the ventricular catheter (VC) component of CSF shunts today remains largely unchanged in its functionality and capabilities from its original design, even though VC obstruction remains a primary cause of shunt failure. The objective of this paper is to investigate the history of VCs, including successful and failed alterations in mechanical design and material composition, to better understand the challenges that hinder development of a more effective design.

Sign in / Sign up

Export Citation Format

Share Document