Analysis of Factors associated with Revision of Ventriculoperitoneal shunt at National Institute of Neurological and Allied Science, Nepal

2019 ◽  
Vol 4 (2) ◽  
pp. 10-19
Author(s):  
Nikunja Yogi ◽  
Suraj Thulung ◽  
Mayush Bahadur Munakarmi ◽  
Rachana Nakarmi ◽  
Dinesh Nath Gongal
Keyword(s):  
External Ventricular Drain ◽  
Shunt Revision ◽  
Categorical Variables ◽  
Shunt Surgery ◽  
Shunt Insertion ◽  
Vp Shunt ◽  
Factors Associated ◽  
Duration Of Surgery ◽  
Drain Placement ◽  
One Year

Introduction: Ventriculoperitoneal (VP) shunt is the commonest procedure for hydrocephalus. The cases requiring shunt revision is a major obstacle in its management. Various factors have been implicated for failure or revision of shunt like patient’s age, sex, cause of hydrocephalus, duration of surgery. This study aims to analyze the rate of VP shunt revision and various factors associated with it. Methods: In this study, we analyzed 237 cases aged three months to 75 years, of VP shunt from January 2010-December 2014 with at least one year follow up at National Institute of Neurological and Allied Sciences. We evaluated the rate of VP shunt revision and various factors associated with it. The categorical variables were evaluated by chi-square test. Odds ratio was calculated for each factors at 95% CI. Results: There were 54 (22.78%) cases having at least one revision within one year of shunt insertion. The odds of revision of shunt was 6.58 times higher when inserted through frontal approach than occipital approach. The external ventricular drain placement prior to shunt surgery had statistically significant association with shunt revision (p=0.02). There was no difference in patients requiring/not requiring shunt revision when compared in terms of age group, gender, various etiologies and side of shunt insertions. Conclusions: The rate of shunt revision in our study was 22.78% which is comparable to other studies. Frontal approach in VP shunt insertion was associated with increased rate of shunt failure thus requiring revision. Likewise, external ventricular drain placement prior to shunt surgery was associated with increased incidence of revision surgery.

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.

scholarly journals Factors Associated With Ventriculoperitoneal Shunt Placement in Patients With Cryptococcal Meningitis

2019 ◽  
Vol 6 (6) ◽  
Author(s):  
John W Baddley ◽  
George R Thompson ◽  
Kristen O Riley ◽  
Mary K Moore ◽  
Stephen A Moser ◽  
...  
Keyword(s):  
Cryptococcal Meningitis ◽  
Multivariable Analysis ◽  
Solid Organ Transplantation ◽  
Categorical Variables ◽  
Stepwise Logistic Regression ◽  
Fisher Exact Test ◽  
Solid Organ ◽  
Vp Shunt ◽  
Factors Associated ◽  
Shunt Placement

Abstract Objective Increased intracranial pressure (ICP) is an important complication of cryptococcal meningitis (CM) and impacts morbidity and mortality. Factors associated with permanent ventriculoperitoneal (VP) shunt placement are poorly characterized. Method We conducted a retrospective cohort study of patients with CM at the University of Alabama at Birmingham from 1996 through 2015. Characteristics of patients at time of CM diagnosis who did and did not receive a VP shunt were compared with use of the 2-group chi-square test or Fisher exact test for categorical variables and the 2-group t test for continuous variables. Stepwise logistic regression analysis was used to determine predictors of shunt placement. Results Of 422 patients with cryptococcosis, 257 (60.9%) had CM. Mean age was 47.7 years, 71.6% were male, and 44.4% were African American. The most common underlying conditions were HIV (42.4%), solid organ transplantation (29.6%), and corticosteroid use (34.2%). Forty-four (17.1%) received a VP shunt a median of 17 days (range, 1–320 days) post-diagnosis. By multivariable analysis, baseline opening pressure >30 cm H2O (OR, 9.4; 95% CI, 3.0, 28.8; P < .0001), being a normal host (OR, 6.3; 95% CI, 1.5, 26.1; P = .011) and hydrocephalus (OR, 4.9, 95% CI, 1.3, 17.9); P = .017) were associated with increased odds of shunting (Table 2). In contrast, age (OR, 0.96; 95% CI, 0.92, 0.99; P = .037) and male gender (OR, 0.18; 95% CI, 0.06, 0.55; P = .023) were associated with decreased odds of shunting. Conclusions Identification of factors at time of CM diagnosis associated with need for permanent VP shunt placement may allow for earlier, more aggressive treatment and potentially improve outcomes associated with increased ICP from cryptococcal meningitis.

Otogenic tension pneumocephalus complicated by eustachian tube insufflation in a patient with a ventriculoperitoneal shunt

2007 ◽  
Vol 106 (6) ◽  
pp. 1098-1101 ◽  
Author(s):  
Hidemasa Nagai ◽  
Kouzo Moritake
Keyword(s):  
Eustachian Tube ◽  
Valsalva Maneuver ◽  
Csf Shunt ◽  
Tympanic Cavity ◽  
Shunt Surgery ◽  
Shunt Insertion ◽  
Vp Shunt ◽  
Tension Pneumocephalus ◽  
Tegmen Tympani ◽  
Osseous Defects

✓Spontaneous tension pneumocephalus (TPC) related to shunt surgery has sometimes been reported with reference to the Valsalva maneuver and osseous defects of the tegmen tympani. Here, the authors report on a case of TPC complicated by eustachian tube (ET) insufflation and a ventriculoperitoneal (VP) shunt. This 78-year-old man had undergone VP shunt insertion 3 weeks before readmission to the hospital with a diagnosis of TPC, a left temporal porencephalic cyst, and air accumulation and late leakage of cerebrospinal fluid (CSF) into the left tympanic cavity. The TPC was controlled successfully by ligation of the shunt tube. The authors discuss the pathophysiology of this complicated TPC case, which illustrates the risk of ET insufflation in patients undergoing CSF shunt surgery.

scholarly journals Factors associated with external ventricular drain placement accuracy: data from an electronic health record repository

2013 ◽  
Vol 155 (9) ◽  
pp. 1773-1779 ◽  
Author(s):  
Vaibhav Patil ◽  
Ronilda Lacson ◽  
Kirby G. Vosburgh ◽  
Judith M. Wong ◽  
Luciano Prevedello ◽  
...  
Keyword(s):  
Electronic Health Record ◽  
External Ventricular Drain ◽  
Health Record ◽  
Factors Associated ◽  
Placement Accuracy ◽  
Drain Placement ◽  
Electronic Health ◽  
Accuracy Data

scholarly journals Case Report: A case report of dry tap during ventriculostomy

F1000Research ◽  
2015 ◽  
Vol 4 ◽  
pp. 188
Author(s):  
Sunil Munakomi ◽  
Binod Bhattarai
Keyword(s):  
Case Report ◽  
External Ventricular Drain ◽  
Foramen Of Monro ◽  
Shunt Insertion ◽  
Gradual Improvement ◽  
Vp Shunt ◽  
Tension Pneumocephalus ◽  
Frontal Horn ◽  
Increased Risk ◽  
Ventricular Puncture

Pneumocephalus following ventriculoperitoneal (VP) shunt insertion is an exceptionally rare occurrence. We report such an event after attempting ventricular puncture (ventriculostomy) for VP shunt insertion and then discuss the management of the same. Dry tap can lead to multiple attempts for ventriculostomy with the associated added risks of complications, as well as complicating the subsequent management. In addition, there is an increased risk of tension pneumocephalus, seizure and shunt failure due to a blockage by air bubbles. Our patient presented with features of raised intracranial pressure two months following craniotomy and evacuation of traumatic subdural hematoma. External ventricular puncture revealed egress of CSF under pressure. Upon attempting VP shunting for post-traumatic hydrocephalus, we experienced dry tap during ventricular puncture that complicated further management. We placed the proximal shunt in the presumed location of the foramen of Monro of ipsilateral frontal horn of lateral ventricle and did not remove the external ventricular drain. Post-operative CT scan revealed pneumoventriculi as the cause for the dry tap during ventricular puncture. Patient was managed with 100% oxygen. He showed gradual improvement and was later discharged. This case shows that variations in the procedure, including head down positioning, adequate cruciate dural incision prior to cortex puncture, and avoiding excessive egress of CSF can help to prevent such complications.

scholarly journals Indications of ventriculoperitoneal shunt: a prospective study

2017 ◽  
Vol 4 (4) ◽  
pp. 1319
Author(s):  
Ritvik D. Jaykar ◽  
Shrikant P. Patil
Keyword(s):  
Ct Scan ◽  
Tuberculous Meningitis ◽  
Surgical Techniques ◽  
Congenital Hydrocephalus ◽  
Clinical Feature ◽  
Communicating Hydrocephalus ◽  
Shunt Surgery ◽  
Shunt Insertion ◽  
Female Ratio ◽  
Vp Shunt

Background: Shunts have been used to drain the Cerebrospinal fluid into practically every body cavity, organ system and tissue spaces. Scraff has critically reviewed the efficacy of various shunts.  These are of historical interest.  Ventriculo peritoneal and ventriculo cardiac shunts continue to remain the chief surgical techniques in the management of hydrocephalus.Methods: This study included sixty cases where VP shunt insertion surgery was indicated. Chhabra’s medium pressure VP shunt was used in all 60 cases.  32 out of 60 cases were below 2 years (53.3%) .70% of the patients were male and 30% were female. Male to female ratio was 2.3:1. Out of 24 cases of congenital hydrocephalus 16 were due to aqueductal stenosis i.e. 66.6 % of cases. Dandy Walker malformation was found in 2 cases. And in 2 more cases, Arnold Chiari malformation was found. In acquired group 22 cases had tuberculous meningitis, 4 cases were of post meningitis aetiology and 10 cases were of communicating hydrocephalus with history of trauma.Results: In congenital group of patients, most common clinical feature was ‘enlargement of head’ bulging of fontanelle.  In acquired group of patients the common clinical features were headache, vomiting, fever and convulsions. USG cranium and CT scan proved to be highly informative investigations and were done wherever necessary. Out of 36 cases of acquired group the percentage of tuberculous meningitis was 61.6% and communicating hydrocephalus with trauma was about 27%. USG cranium was also used in follow up congenital hydrocephalus to assess the position and functioning of shunt.  Even CT scan was used in adult age group to assess the position of shunt and condition of the brain. All patients of with VP shunt surgery were treated with higher antibiotics preoperatively and postoperatively.Conclusions: Common complications included, shunt infections, shunt obstruction, shunt malposition. Rare complications included shunt migration through anus and shunt ascites. Four patients died after VP shunt surgery, two were operated case of encephalocele with associated congenital anomalies with uremia and other two were with dreaded shunt infection with septicaemia. Ten (16.6%) patients required revision of VP shunt surgery in present study.

scholarly journals Reviewing the prognostic factors in myelomeningocele

2019 ◽  
Vol 47 (4) ◽  
pp. E2 ◽  
Author(s):  
Tatiana Protzenko ◽  
Antônio Bellas ◽  
Marcelo Sampaio Pousa ◽  
Michelle Protzenko ◽  
Juliana Marin Fontes ◽  
...  
Keyword(s):  
Head Circumference ◽  
Primary Repair ◽  
External Ventricular Drain ◽  
Significant Risk ◽  
Morbidity And Mortality ◽  
Shunt Revision ◽  
Wound Complications ◽  
Functional Level ◽  
Shunt Insertion ◽  
Shunt Placement

OBJECTIVEThe goal of this study was to analyze the factors that have an impact on morbidity and mortality in patients with myelomeningocele (MMC).METHODSA retrospective cohort study was conducted to analyze factors associated with MMC that influence the morbidity and mortality of the disease. Data were collected from medical records of children who underwent the primary repair of MMC at the Fernandes Figueira Institute–Oswaldo Cruz Foundation (IFF-Fiocruz) between January 1995 and January 2015, with a minimum follow-up of 1 year. The following variables were analyzed: demographic characteristics (gestational age, sex, and birth weight); clinical features (head circumference at birth, anatomical and functional levels of MMC, hydrocephalus, symptomatic Chiari malformation type II, neurogenic bladder, and urinary tract infection [UTI]); and surgical details such as timing of repair of MMC, age at first shunt placement, shunt surgery modality (elective or emergency), concurrent surgery (correction of MMC and shunt insertion in the same surgical procedure), incidence and cause of shunt dysfunction, use of external ventricular drain, transfontanelle puncture, surgical wound complications prior to shunting, and endoscopic treatment of hydrocephalus.RESULTSA total of 231 patients with MMC were included in the analysis. Patients were followed for periods ranging from 1 to 20 years, with a mean of 6.9 years. The frequency of shunt placement was observed mainly among patients with MMC at the highest spinal levels (p < 0.01). The main causes of morbidity and mortality in patients with MMC were shunt failures, diagnosed in 91 of 193 cases (47.2%) of hydrocephalus, and repeated UTIs, in 129 of 231 cases (55.8%) of MMC; these were the main causes of hospitalization and death. Head circumference ≥ 38 cm at birth was found to be a significant risk factor for shunt revision (p < 0.001; 95% CI 1.092–1.354). Also, the lumbar functional level of MMC was associated with less revision than upper levels (p < 0.014; 95% CI 0.143–0.805). There was a significant association between recurrent UTI and thoracic functional level.CONCLUSIONSMacrocephaly at birth and higher levels of the defect have an impact on worse outcome and, therefore, are a challenge to the daily practice of pediatric neurosurgery.

scholarly journals Reduced ventricular shunt rate in very preterm infants with severe intraventricular hemorrhage: an institutional experience

2012 ◽  
Vol 10 (5) ◽  
pp. 357-364 ◽  
Author(s):  
Nima Alan ◽  
Sunil Manjila ◽  
Nori Minich ◽  
Nancy Bass ◽  
Alan R. Cohen ◽  
...  
Keyword(s):  
Bronchopulmonary Dysplasia ◽  
Gestational Age ◽  
Intraventricular Hemorrhage ◽  
Well Being ◽  
Shunt Revision ◽  
Shunt Insertion ◽  
Vp Shunt ◽  
The Past ◽  
Period 2

Object Although survival for extremely low gestational age newborns (ELGANs) has improved in the past 3 decades, these infants remain prone to complications of prematurity, including intraventricular hemorrhage (IVH). The authors reviewed the outcomes for an entire cohort of ELGANs who suffered severe IVH at their institution during the past 12 years to gain a better understanding of the natural history of IVH and frequency of ventriculoperitoneal (VP) shunt placement in this population. Methods Data from the neonatal ICU (NICU) database, neurosurgery operative log, and medical records were used to identify and follow up all ELGANs who suffered a severe IVH between 1997 and 2008. Trends between Period 1 (1997–2001) and Period 2 (2004–2008) were analyzed using the Pearson chi-square test. Results Between 1997 and 2008, 1335 ELGANs were admitted to the NICU at the authors' institution within 3 days of birth, and 111 (8.3%) of these infants suffered a severe IVH. Survival to 2 years, incidence of severe IVH, neonatal risk factors (gestational age, birth weight, and incidence of necrotizing enterocolitis), ventriculomegaly on cranial ultrasonography, and use of serial lumbar punctures for symptomatic hydrocephalus were all stable. Infants from Period 2 had a significantly lower incidence of bronchopulmonary dysplasia and sepsis than infants from Period 1 (both p < 0.001). All ELGANs with severe IVH and ventriculomegaly underwent long-term follow-up to identify shunt status at late follow-up. Twenty-two ELGANs (20%) with severe IVH required a temporary ventriculosubgaleal (VSG) shunt. Three infants with VSG shunts showed spontaneous hydrocephalus resolution, and 2 infants died of unrelated causes during the neonatal admission. The temporary VSG shunt complication rate was 20% (12% infection and 8% malfunction). Sixteen percent of all ELGANs (18 of 111) with severe IVH eventually required permanent ventricular shunt insertion. Six (35%) of 17 infants with a permanent VP shunt required at least 1 permanent shunt revision during the 1st year. The proportion of ELGANs with severe IVH who required a temporary VSG (35%) or permanent VP shunt (30%) during Period 1 decreased by more than 60% in Period 2 (10% [p = 0.005] and 8.3% [p = 0.009], respectively). Conclusions The authors report for the first time a marked reduction over the past 12 years in the proportion of ELGANs with severe IVH who required surgical intervention for hydrocephalus. Using the NICU database, the authors were able to identify and follow all ELGANs with severe IVH and ventriculomegaly. They speculate that the reduction in ventricular shunt rate results from improved neonatal medical care, including reduced infection, improved bronchopulmonary dysplasia, and postnatal steroid avoidance, which may aid innate repair mechanisms. Multicenter prospective trials and detailed analyses of NICU parameters of neonatal well-being are needed to understand how perinatal factors influence the propensity to require ventricular shunting.

scholarly journals P.207 Reducing the risks of proximal and distal shunt failure in adult hydrocephalus: A Shunt Outcomes Quality Improvement (ShOut-QI) Study

2021 ◽  
Vol 48 (s3) ◽  
pp. S79-S79
Author(s):  
MG Hamilton ◽  
C Ball ◽  
R Holubkov ◽  
G Urbaneja ◽  
A Isaacs
Keyword(s):  
Quality Improvement ◽  
Catheter Placement ◽  
Shunt Revision ◽  
Shunt Failure ◽  
Shunt Insertion ◽  
Distal Catheter ◽  
Vp Shunt ◽  
Catheter Failure ◽  
Placement Accuracy

Background: Ventriculoperitoneal (VP) shunt failures in adult patients are common and subject patients to multiple surgeries and a decreased quality of life. A prospective cohort Shunt Outcomes Quality Improvement (ShOut-QI) initiative was implemented to reduce shunt failure incidence through neuronavigation-assisted proximal catheter insertion and laparoscopy-guided distal catheter anchoring over the liver dome to drain CSF away from the omentum. Methods: “Pre-ShOut” and “Post-ShOut” groups of patients included those with and without neuronavigation/laparoscopy, respectively for insertion of a new VP shunt. The primary outcome was shunt failure which was defined as any return to surgery for shunt revision as determined with a standardized clinical and radiology follow-up protocol. Results: 244 patients (97 Pre-ShOut, 147 Post-ShOut), mean age 73 years, were enrolled over a 7-year interval and observed for a mean duration of 4 years after shunt insertion. Neuronavigation improved proximal catheter placement accuracy by 20% (p<.001), and shunt failure occurred in 57% vs 23% in the Pre-ShOut and Post-ShOut groups, respectively (p=.008), representing a 53% relative risk reduction in the incidence of shunt failure. Conclusions: Adult shunt failure incidence may be significantly reduced by improving the accuracy of proximal catheter placement with neuronavigation and reducing the risk of distal catheter failure with laparoscopic-guided placement.

scholarly journals Case Report: A case report of dry tap during ventriculostomy

F1000Research ◽  
2015 ◽  
Vol 4 ◽  
pp. 188
Author(s):  
Sunil Munakomi ◽  
Binod Bhattarai
Keyword(s):  
Case Report ◽  
External Ventricular Drain ◽  
Foramen Of Monro ◽  
Shunt Insertion ◽  
Gradual Improvement ◽  
Vp Shunt ◽  
Tension Pneumocephalus ◽  
Frontal Horn ◽  
Increased Risk ◽  
Ventricular Puncture

Pneumocephalus following ventriculoperitoneal (VP) shunt insertion is an exceptionally rare occurrence. We report such an event after attempting ventricular puncture (ventriculostomy) for VP shunt insertion and then discuss the management of the same. Dry tap can lead to multiple attempts for ventriculostomy with the associated added risks of complications, as well as complicating the subsequent management. In addition, there is an increased risk of tension pneumocephalus, seizure and shunt failure due to a blockage by air bubbles. Our patient presented with features of raised intracranial pressure two months following craniotomy and evacuation of traumatic subdural hematoma. External ventricular puncture revealed egress of CSF under pressure. Upon attempting VP shunting for post-traumatic hydrocephalus, we experienced dry tap during ventricular puncture that complicated further management. We placed the proximal shunt in the presumed location of the foramen of Monro of ipsilateral frontal horn of lateral ventricle and did not remove the external ventricular drain. Post-operative CT scan revealed pneumoventriculi as the cause for the dry tap during ventricular puncture. Patient was managed with 100% oxygen. He showed gradual improvement and was later discharged. This case shows that variations in the procedure, including head down positioning, adequate cruciate dural incision prior to cortex puncture, and avoiding excessive egress of CSF can help to prevent such complications.

Sign in / Sign up

Export Citation Format

Share Document