Inguinal Herniation with Glial Implants: Possible Complication of Ventriculoperitoneal Shunting

Abstract BACKGROUND Tumor proximity to the ventricle and ventricular entry (VE) during surgery have both been associated with poorer prognoses; however, the interaction between these two factors is poorly understood. METHODS The UCSF tumor registry was searched for patients with newly diagnosed and recurrent supratentorial glioblastoma who underwent surgical resection with the senior author between 2013 – 2018. Tumor location with respect to the subventricular zone (SVZ), size, VE, and extent of resection were assessed using pre and postoperative imaging. RESULTS In the 200-patient cohort of newly diagnosed and recurrent glioblastoma, 26.5% had VE. Comparing patients with VE to those without VE, there was no difference in postoperative hydrocephalus (1.9% vs. 4.8%, p = 0.36), ventriculoperitoneal shunting (0% vs. 3.4%, p = 0.17), pseudomeningoceles (7.5% vs. 5.4%, p = 0.58), or subdural hematomas (11.3% vs. 3.4%, p = 0.07). Importantly, rates of leptomeningeal disease (7.5% in VE vs. 10.2% w/o VE, p = 0.57) and distant parenchymal recurrence (17.9% in VE vs. 23.1% w/o VE, p = 0.35) were not different between the groups. There was no effect of VE on EOR when controlling for SVZ type. Newly diagnosed patients with tumors contacting the SVZ (Type 1 or 2) had worse survival than patients with tumors that did not contact the SVZ (Type 3 or 4) (1.27 vs 1.84 years, p = 0.014, HR 1.8, CI 1.08 – 3.03), but VE was not associated with worse survival in these patients with high risk SVZ Type 1 and 2 tumors (1.15 vs 1.68 years, p = 0.151, HR 0.59, CI 0.26 – 1.34). DISCUSSION VE was well tolerated with complications being rare events. There was no increase in leptomeningeal spread or distant parenchymal recurrence in patients with VE. Finally, VE did not change survival for patients with tumors contacting the ventricle.

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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.

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Transumbilical single-incision laparoscopically assisted ventriculoperitoneal shunting: a minimal invasive technique

Child s Nervous System ◽

10.1007/s00381-020-05022-6 ◽

2021 ◽

Author(s):

Renzhong Zhu ◽

Jiang He ◽

Hong Yu

Keyword(s):

Single Incision ◽

Minimal Invasive ◽

Invasive Technique ◽

Minimal Invasive Technique ◽

Ventriculoperitoneal Shunting

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Attenuation of the rectus sheath in inguinal herniation

The American Journal of Surgery ◽

10.1016/s0002-9610(70)80178-7 ◽

1970 ◽

Vol 120 (5) ◽

pp. 610-614 ◽

Cited By ~ 60

Author(s):

Raymond C. Read

Keyword(s):

Rectus Sheath ◽

Inguinal Herniation

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Inguinal Herniation of a Transplant Ureter: Rare Cause of Obstructive Uropathy

Urology ◽

10.1016/j.urology.2007.09.054 ◽

2007 ◽

Vol 70 (6) ◽

pp. 1224.e1-1224.e3 ◽

Cited By ~ 24

Author(s):

Michael S. Ingber ◽

Benjamin J. Girdler ◽

Jason F. Moy ◽

Mark J. Frikker ◽

Jay B. Hollander

Keyword(s):

Obstructive Uropathy ◽

Inguinal Herniation

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Antimicrobial-impregnated and -coated shunt catheters for prevention of infections in patients with hydrocephalus: a systematic review and meta-analysis

Journal of Neurosurgery ◽

10.3171/2014.12.jns14908 ◽

2015 ◽

Vol 122 (5) ◽

pp. 1096-1112 ◽

Cited By ~ 54

Author(s):

Athanasios A. Konstantelias ◽

Konstantinos Z. Vardakas ◽

Konstantinos A. Polyzos ◽

Giannoula S. Tansarli ◽

Matthew E. Falagas

Keyword(s):

De Novo ◽

Meta Analysis ◽

Ventricular Drainage ◽

Gram Negative ◽

Ventriculoperitoneal Shunting ◽

Csf Shunting ◽

Statistical Heterogeneity ◽

Catheter Implantation ◽

Prevention Of Infections ◽

Definition Of

OBJECT The aim of this study was to evaluate the effectiveness of antimicrobial-impregnated and -coated shunt catheters (antimicrobial catheters) in reducing the risk of infection in patients undergoing CSF shunting or ventricular drainage. METHODS The PubMed and Scopus databases were searched. Catheter implantation was classified as either shunting (mainly ventriculoperitoneal shunting) or ventricular drainage (mainly external [EVD]). Studies evaluating antibioticimpregnated catheters (AICs), silver-coated catheters (SCCs), and hydrogel-coated catheters (HCCs) were included. A random effects model meta-analysis was performed. RESULTS Thirty-six studies (7 randomized and 29 nonrandomized, 16,796 procedures) were included. The majority of data derive from studies on the effectiveness of AICs, followed by studies on the effectiveness of SCCs. Statistical heterogeneity was observed in several analyses. Antimicrobial shunt catheters (AICs, SCCs) were associated with lower risk for CSF catheter–associated infections than conventional catheters (CCs) (RR 0.44, 95% CI 0.35–0.56). Fewer infections developed in the patients treated with antimicrobial catheters regardless of randomization, number of participating centers, funding, shunting or ventricular drainage, definition of infections, de novo implantation, and rate of infections in the study. There was no difference regarding gram-positive bacteria, all staphylococci, coagulase-negative streptococci, and Staphylococcus aureus, when analyzed separately. On the contrary, the risk for methicillin-resistant S. aureus (MRSA, RR 2.64, 95% CI 1.26–5.51), nonstaphylococcal (RR 1.75, 95% CI 1.22–2.52), and gram-negative bacterial (RR 2.13, 95% CI 1.33–3.43) infections increased with antimicrobial shunt catheters. CONCLUSIONS Based on data mainly from nonrandomized studies, AICs and SCCs reduce the risk for infection in patients undergoing CSF shunting. Future studies should evaluate the higher risk for MRSA and gram-negative infections. Additional trials are needed to investigate the comparative effectiveness of the different types of antimicrobial catheters.

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