scholarly journals A study on Complications of ventriculoperitoneal shunt surgery in Bir Hospital, Kathmandu, Nepal

2012 ◽  
Vol 1 (2) ◽  
pp. 119-122 ◽  
Author(s):  
BG Karmacharya ◽  
P Kumar
Keyword(s):  
Ventriculoperitoneal Shunt ◽  
Shunt Infection ◽  
Shunt Surgery ◽  
Inclusion Criteria ◽  
Medical Sciences ◽  
Referral Centre ◽  
Neurosurgical Procedure ◽  
Ventriculoperitoneal Shunts ◽  
Shunt Procedure ◽  
A Prospective Study

Background: Ventriculoperitoneal shunt is one of the most commonly performed neurosurgical procedure, both on the elective and emergency basis. However this procedure is dreaded because of complications. There is lack of prospective studies on complications of shunt procedure. In this study, the indications for shunt, the types used and complications of ventriculoperitoneal shunts were studied. Methods: This was a prospective study carried out in the national neurosurgical referral centre, Bir hospital, Kathmandu from April 2004 to March 2005. Results: There were 109 ventriculoperitoneal shunt procedures during the study period. Among them 60 consecutive patients who fulfilled the inclusion criteria were enrolled for the study. There were 43 male and 17 female patients, with age ranging from 4 months to 75 years. Fourteen patients (23.3%) developed complications which included shunt block, shunt infection, over drainage and shunt extrusion. Conclusion: About one fourth all patients who underwent ventriculoperitoneal shunt surgery developed complications. Shunt block and infections were the major complications. DOI: http://dx.doi.org/10.3126/njms.v1i2.6612 Nepal Journal of Medical Sciences. 2012;1(2): 119-22

scholarly journals Burr hole site acute extradural hematoma after ventriculoperitoneal shunt surgery: a rare case report and its pathogenesis

2017 ◽  
Vol 31 (3) ◽  
pp. 422-425
Author(s):  
Prajapati Hanuman Prasad ◽  
Singh Deepak Kumar ◽  
Singh Rakesh Kumar ◽  
Ahmed Faran ◽  
Chhabra Anuj
Keyword(s):  
Case Report ◽  
Ventriculoperitoneal Shunt ◽  
Rare Case ◽  
Burr Hole ◽  
Shunt Surgery ◽  
Extradural Hematoma ◽  
Neurosurgical Procedure ◽  
Vp Shunt ◽  
Shunt Procedure ◽  
Rare Case Report

Abstract Ventriculoperitoneal (VP) shunt, a common neurosurgical procedure, has a long list of known complications associated with it. A rare but dangerous complication of VP shunt procedure is extradural hematoma (EDH). It can be diagnosed and managed easily before it turns into a catastrophic complication.

Operative Related Infection Rates for Ventriculoperitoneal Shunt Procedures in a Children's Hospital

1987 ◽  
Vol 8 (2) ◽  
pp. 67-70 ◽  
Author(s):  
Janara J. Younger ◽  
James C.H. Simmons ◽  
Fred F. Barrett
Keyword(s):  
Cerebrospinal Fluid ◽  
Ventriculoperitoneal Shunt ◽  
Shunt Infection ◽  
Infection Risk ◽  
Csf Shunt ◽  
Infection Rates ◽  
Surgical Infection ◽  
Shunt Procedure ◽  
Csf Shunt Infection

AbstractWe determined the operative related cerebrospinal fluid (CSF) shunt infection rates for our institution over a 3-year period (1982 to 1984) using strictly defined numerator and denominator data. The minimum post-operative follow-up period was 12 months. The average surgical infection risk for a CSF shunt procedure at our institution during the study period was 13.3%. Annual infection rates were relatively constant (13.8%, 13.2% and 12.9%), however both quarterly (5.7% to 23.3%) and surgeon-specific (5.7% to 22.8%) rates varied widely. Infection rates calculated by using “traditional” numerator and denominator data were considerably lower (6.5% to 9.2%).Operative related CSF shunt infection rates should be determined by utilizing strictly defined numerator and denominator values in order to allow valid comparisons of published rates.

Ventriculoperitoneal shunt infection with Mycobacterium fortuitum: a rare offending organism

2014 ◽  
Vol 14 (6) ◽  
pp. 704-707 ◽  
Author(s):  
Gilbert Cadena ◽  
Jean Wiedeman ◽  
James E. Boggan
Keyword(s):  
Ventriculoperitoneal Shunt ◽  
Nontuberculous Mycobacteria ◽  
Treatment Strategies ◽  
Shunt Infection ◽  
Mycobacterium Fortuitum ◽  
Shunt Surgery ◽  
Time Of Surgery ◽  
Skin Flora ◽  
Ventriculoperitoneal Shunt Infection

Postsurgical infection is one of the greatest potential morbidities of ventriculoperitoneal shunt surgery. The majority of infections can be linked to contamination with skin flora at the time of surgery, a phenomenon that has been well described. However, there is a paucity of literature regarding infection with nontuberculous mycobacteria. The authors report a case of postoperative ventriculoperitoneal shunt infection with Mycobacterium fortuitum and review the available neurosurgical literature and treatment strategies.

scholarly journals Trimethoprim/Sulfamethoxazole and Moxifloxacin Therapy for a Pediatric Stenotrophomonas Maltophilia Ventriculoperitoneal Shunt Infection

2019 ◽  
Vol 24 (1) ◽  
pp. 61-65
Author(s):  
Eric R. Gregory ◽  
Sam B. Osborne ◽  
Brian M. Gardner ◽  
Robert A. Broughton
Keyword(s):  
Literature Review ◽  
Ventriculoperitoneal Shunt ◽  
Nosocomial Infections ◽  
Stenotrophomonas Maltophilia ◽  
Shunt Infection ◽  
Concomitant Treatment ◽  
Neurosurgical Procedure ◽  
Ventriculoperitoneal Shunt Infection

Stenotrophomonas maltophilia is an increasingly prevalent cause of nosocomial infections. This report describes a 5-month-old male diagnosed with a S maltophilia ventriculoperitoneal shunt infection after a neurosurgical procedure. Intravenous trimethoprim/sulfamethoxazole and moxifloxacin successfully treated the patient. A literature review revealed a scarcity of similar reports, with none using moxifloxacin as an effective concomitant treatment with trimethoprim-sulfamethoxazole.

Patterns in neurosurgical adverse events: cerebrospinal fluid shunt surgery

2012 ◽  
Vol 33 (5) ◽  
pp. E13 ◽  
Author(s):  
Judith M. Wong ◽  
John E. Ziewacz ◽  
Allen L. Ho ◽  
Jaykar R. Panchmatia ◽  
Angela M. Bader ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Adverse Events ◽  
Ventriculoperitoneal Shunt ◽  
Shunt Infection ◽  
Current Evidence ◽  
Csf Shunt ◽  
Complication Rates ◽  
Cerebrospinal Fluid Shunt ◽  
Shunt Surgery ◽  
Programmable Valves

Object As part of a project to devise evidence-based safety interventions for specialty surgery, the authors sought to review current evidence in CSF shunt surgery concerning the frequency of adverse events in practice, their patterns, and the state of knowledge regarding methods for their reduction. This review may also inform future and ongoing efforts for the advancement of neurosurgical quality. Methods The authors performed a PubMed search using search terms “cerebral shunt,” “cerebrospinal fluid shunt,” “CSF shunt,” “ventriculoperitoneal shunt,” “cerebral shunt AND complications,” “cerebrospinal fluid shunt AND complications,” “CSF shunt AND complications,” and “ventriculoperitoneal shunt AND complications.” Only papers that specifically discussed the relevant complication rates were included. Papers were chosen to be included to maximize the range of rates of occurrence for the adverse events reported. Results In this review of the neurosurgery literature, the reported rate of mechanical malfunction ranged from 8% to 64%. The use of programmable valves has increased but remains of unproven benefit even in randomized trials. Infection was the second most common complication, with the rate ranging from 3% to 12% of shunt operations. A meta-analysis that included 17 randomized controlled trials of perioperative antibiotic prophylaxis demonstrated a decrease in shunt infection by half (OR 0.51, 95% CI 0.36–0.73). Similarly, use of detailed protocols including perioperative antibiotics, skin preparation, and limitation of OR personnel and operative time, among other steps, were shown in uncontrolled studies to decrease shunt infection by more than half. Other adverse events included intraabdominal complications, with a reported incidence of 1% to 24%, intracerebral hemorrhage, reported to occur in 4% of cases, and perioperative epilepsy, with a reported association with shunt procedures ranging from 20% to 32%. Potential management strategies are reported but are largely without formal evaluation. Conclusions Surgery for CSF shunt placement or revision is associated with a high complication risk due primarily to mechanical issues and infection. Concerted efforts aimed at large-scale monitoring of neurosurgical complications and consistent quality improvement within these highlighted realms may significantly improve patient outcomes.

scholarly journals Shunt Infection in Adults: A Retrospective Study of 1324 Cases

2021 ◽  
Author(s):  
Bing Qin ◽  
Liansheng Gao ◽  
Chun Wang ◽  
Chenghan Wu ◽  
lin wang
Keyword(s):  
Risk Factors ◽  
Spine Surgery ◽  
Major Complication ◽  
Shunt Infection ◽  
Shunt Operation ◽  
Shunt Surgery ◽  
Shunt Placement ◽  
Intracranial Infection ◽  
Shunt Procedure ◽  
History Of

Abstract Background: Shunt infection (SI) is a serious major complication in the management of hydrocephalus after cerebral fluid shunts. Here we study retrospectively hydrocephalus shunting to evaluate the incidence of SI, including the risk factors and types of infection.Meterial and Methods: 1556 patients (age≥18years) who had undergone shunt surgery from January 2013 to December 2019 at our center were included(6-78 months follow-up period). 1324 cases of them were confirmed as effective cases. Infection rate and risk factors were investigated.Results: We found 79 (6.0%) cases (58 men and 21 women) with SI, of which 72 were ventriculo-peritoneal (VP) shunt and 7 were lumbo-peritoneal (LP) shunt. Risk factors include male gender (p=0.04), patients with a history of intracranial infection (p<0.001) and patients suffered an infection when shunt surgery performed (p=0.008). Surgery type (p=0.80), Glasgow Coma Score (GCS) before shunt procedure (p=0.57) and history of hypertension (p=0.16), diabetes (p=0.44) or cerebral infarction (p=0.29) were not risk factors of SI. Brain or spine surgery performed within 2 years prior to shunt procedure increased rate of SI (p=0.015, SI rate: 7.4%), but not when performed after shunt procedure (p=0.42). Idiopathic hydrocephalus and hydrocephalus caused by trauma, hemorrhage, tumor and other factors showed no significant correlation with SI. Of all SI, 48 (60.8%) and 62 (78.5%) cases were present within 1 and 2 months after shunt surgery, respectively. Only 2.5% (2/79) of SI were found after 1 year since shunt placement. Pathogens were found in 46 cases, and Gram positive cocci were accounted for 50.0% (23/46). Conclusions: Our study suggests that male, history of intracranial infection, patients’ infection status when shunt surgery performed and history of brain or spine surgery performed within 2 years are risk factors of SI. Infections are more likely to present within the first 2 months after shunt placement, only 2.5% shunt infections were found after more than 1 year form shunt operation.

scholarly journals Silver-impregnated, antibiotic-impregnated or non-impregnated ventriculoperitoneal shunts to prevent shunt infection: the BASICS three-arm RCT

2020 ◽  
Vol 24 (17) ◽  
pp. 1-114
Author(s):  
Conor L Mallucci ◽  
Michael D Jenkinson ◽  
Elizabeth J Conroy ◽  
John C Hartley ◽  
Michaela Brown ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Ventriculoperitoneal Shunt ◽  
Technology Assessment ◽  
Primary Outcome ◽  
Health Technology ◽  
Shunt Infection ◽  
Hazard Ratio ◽  
Shunt Failure ◽  
Ventriculoperitoneal Shunts ◽  
Ventriculoperitoneal Shunt Infection

Background Insertion of a ventriculoperitoneal shunt to treat hydrocephalus is one of the most common neurosurgical procedures worldwide. Shunt infection affects up to 15% of patients, resulting in long hospital stays, multiple surgeries and reduced cognition and quality of life. Objectives The aim of this trial was to determine whether or not antibiotic-impregnated ventriculoperitoneal shunts (hereafter referred to as antibiotic shunts) (e.g. impregnated with rifampicin and clindamycin) or silver-impregnated ventriculoperitoneal shunts (hereafter referred to as silver shunts) reduce infection compared with standard ventriculoperitoneal shunts (hereafter referred to as standard shunts). Design This was a three-arm, superiority, multicentre, parallel-group randomised controlled trial. Patients and a central primary outcome review panel, but not surgeons or operating staff, were blinded to the type of ventriculoperitoneal shunt inserted. Setting The trial was set in 21 neurosurgical wards across the UK and the Republic of Ireland. Participants Participants were patients with hydrocephalus of any aetiology who were undergoing insertion of their first ventriculoperitoneal shunt. Interventions Participants were allocated 1 : 1 : 1 by pressure-sealed envelope to receive a standard non-impregnated, silver-impregnated or antibiotic-impregnated ventriculoperitoneal shunt at the time of insertion. Ventriculoperitoneal shunts are medical devices, and were used in accordance with the manufacturer’s instructions for their intended purpose. Main outcome measures The primary outcome was time to ventriculoperitoneal shunt failure due to infection. Secondary outcomes were time to failure for any cause, reason for failure (infection, mechanical), types of ventriculoperitoneal shunt infection, rate of infection after first clean (non-infected) revision and health economics. Outcomes were analysed by intention to treat. Results Between 26 June 2013 and 9 October 2017, 1605 patients from neonate to 91 years of age were randomised to the trial: n = 36 to the standard shunt, n = 538 to the antibiotic shunt and n = 531 to the silver shunt. Patients who did not receive a ventriculoperitoneal shunt (n = 4) or who had an infection at the time of insertion (n = 7) were not assessed for the primary outcome. Infection occurred in 6.0% (n = 32/533) of those who received the standard shunt, in 2.2% (n = 12/535) of those who received the antibiotic shunt and in 5.9% (n = 31/526) of those who received the silver shunt. Compared with the standard shunt, antibiotic shunts were associated with a lower rate of infection (cause-specific hazard ratio 0.38, 97.5% confidence interval 0.18 to 0.80) and a decreased probability of infection (subdistribution hazard ratio 0.38, 97.5% confidence interval 0.18 to 0.80). Silver shunts were not associated with a lower rate of infection than standard shunts (cause-specific hazard ratio 0.99, 97.5% confidence interval 0.56 to 1.74). The ventriculoperitoneal shunt failure rate attributable to any cause was 25.0% overall and did not differ between arms. Antibiotic shunts save £135,753 per infection avoided. There were no serious adverse events. Limitations It was not possible to blind treating neurosurgeons to the ventriculoperitoneal shunt type. The return rate for patient-reported outcomes was low. Limitations to the economic evaluation included failure to obtain Hospital Episode Statistics data from NHS Digital, as per protocol. Reliance on patient-level information and costing systems data mitigated these limitations. Conclusions Antibiotic shunts have a reduced infection rate compared with standard shunts, whereas silver shunts do not. Antibiotic shunts are cost-saving. Future work A sample collection has been established that will enable the study of surrogate markers of ventriculoperitoneal shunt infection in cerebrospinal fluid or blood using molecular techniques. A post hoc analysis to study factors related to shunt failure will be performed as part of a future study. An impact analysis to assess change in practice is planned. Trial registration Current Controlled Trials ISRCTN49474281. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 17. See the NIHR Journals Library website for further project information.

scholarly journals Navigating Brain Lesions Via Craniometric Points of Human Skull. Effectiveness in Targeted Craniotomy

2020 ◽  
Vol 24 (1) ◽  
Author(s):  
SHAMS UD-DIN ◽  
ISHFAQ AHMED
Keyword(s):  
Descriptive Study ◽  
Brain Lesions ◽  
Brain Surgery ◽  
Inclusion Criteria ◽  
Neurosurgical Procedure ◽  
Ventriculoperitoneal Shunts ◽  
Human Skull ◽  
Female Patients ◽  
Minimum Age

Background and Objectives: Navigating brain pathologies via external landmarks helps in guiding neurosurgeon to perform and plan brain surgeries without feeling compromised in their competence, when modern neuronavigation is not available. We assessed the navigating art of human craniometry in brain surgery, in terms of accuracy and safety, of our patients.Materials and Methods: A descriptive study was in Department of Neurosurgery Quaid-e-Azam International Hospital on utilizing the art of Craniometry in navigating brain lesions and to see how effective this art is in the execution of neurosurgical procedures.Results: Total of hundred patients were subjected in our study, who were according to inclusion criteria. Mean age calculated was 44 years with STD ± 6, with minimum age of 8months and maximum age of 83years. There were 61% male, and 39% female patients. Supratentorial lesions were 72%, ventriculoperitoneal shunts 11%,and 17% were infratentorial.In 89 surgeries, we were exactly on the target according to our external skull landmarks, in 4 cases we slightly deviated about 0.3 cm, and in 7 surgeries we encounter some difficulty in navigating lesions.Conclusion: Modern navigating technology is very much helpful in neurosurgery, and this fact is undeniable, but because of resources restrained is not always available. Mastering the art of craniometery of human skull guide neurosurgeons to perform/plan neurosurgical procedure of brain without feeling compromised in theircompetence.

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