Management of sterile abdominal pseudocysts related to ventriculoperitoneal shunts

2020 ◽  
Vol 25 (1) ◽  
pp. 57-61
Author(s):  
Andrew Erwood ◽  
Rima S. Rindler ◽  
Mustafa Motiwala ◽  
Sonia Ajmera ◽  
Brandy Vaughn ◽  
...  
Keyword(s):  
Endoscopic Third Ventriculostomy ◽  
Pleural Cavity ◽  
Surgical Intervention ◽  
Third Ventriculostomy ◽  
Peritoneal Catheter ◽  
Csf Shunts ◽  
Distal Catheter ◽  
Abdominal Pseudocyst ◽  
Common Etiology ◽  
Shunt Removal

OBJECTIVEThere are many known complications associated with CSF shunts. One of the more rare ones is a sterile abdominal pseudocyst due to decreased peritoneal absorption. This study was undertaken to detail the presentation, evaluation, and management of this unusual shunt-related event.METHODSPatients presenting with ventriculoperitoneal shunt (VPS)–related sterile abdominal pseudocysts treated at two institutions between 2013 and 2018 were included. Patients who had undergone abdominal surgery or shunt revisions within a 12-month period preceding presentation were excluded. Information was collected regarding clinical characteristics; hospital course, including surgical intervention(s); and any subsequent complications. Special attention was given to the eventual surgery after pseudocyst resolution, including the use of laparoscopy for peritoneal catheter placement, distal shunt conversion (i.e., in the atrium or pleural cavity), endoscopic third ventriculostomy, or shunt removal. The timing and nature of any subsequent shunt failures were also noted.RESULTSTwenty-eight patients met the study criteria, with a mean age of 10 years. The most common etiology of hydrocephalus was intraventricular hemorrhage of prematurity. All shunts were externalized at presentation. One shunt was removed without subsequent internalization. Distal catheters were re-internalized back into the peritoneal cavity in 11 patients (laparoscopy was used in 8 cases). Fourteen shunts were converted to a ventriculoatrial shunt (VAS), and two to a ventriculopleural (VPlS). Two VPSs failed due to a recurrent pseudocyst. The total all-cause failure rates at 1 year were as follows: 18% for VPSs and 50% for VASs.CONCLUSIONSFollowing treatment of a VPS-related sterile abdominal pseudocyst, laparoscopy-assisted placement of the distal catheter in the peritoneum is a viable and safe option for select patients, compared to a VAS or VPlS.

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.

Shunts and endoscopic third ventriculostomy

2010 ◽  
pp. 696-702 ◽  
Author(s):  
George Samandouras
Keyword(s):  
Endoscopic Third Ventriculostomy ◽  
Third Ventriculostomy ◽  
Csf Shunts

Chapter 12.4 covers CSF shunts and endoscopic third ventriculostomy (ETV).

Complications and subsequent removal of retained shunt hardware after endoscopic third ventriculostomy: case series

2013 ◽  
Vol 11 (6) ◽  
pp. 722-726 ◽  
Author(s):  
Jonathan Pindrik ◽  
George I. Jallo ◽  
Edward S. Ahn
Keyword(s):  
Endoscopic Third Ventriculostomy ◽  
Case Series ◽  
Wound Dehiscence ◽  
Third Ventriculostomy ◽  
Subsequent Removal ◽  
Shunt System ◽  
Shunt Valve ◽  
Shunt Insertion ◽  
History Of ◽  
Shunt Removal

This case series highlights multiple complications and subsequent removal of retained shunt hardware in pediatric patients after successful endoscopic third ventriculostomy (ETV). Removal or retention of existing shunt hardware following ETV represents an important dilemma. Prior studies have reported infections and organ perforation related to nonfunctioning shunts but none in the context of successful ETV. Data obtained in 3 children with hydrocephalus treated at the authors' institution were retrospectively reviewed after the patients experienced complications due to retained shunt hardware following ETV. Etiologies of hydrocephalus included tectal glioma and intraventricular hemorrhage. All 3 patients had a history of multiple shunt revisions and underwent urgent ETV in the setting of a shunt malfunction. In each case, the entire shunt system was left in situ, but it became the source of subsequent complications. Two of the 3 patients presented with the shunt infected by gram-negative bacilli 10 days and 4.5 months postoperatively, respectively. The remaining patient experienced wound dehiscence over the shunt valve 4.5 months after ETV. In all patients, the complications were managed successfully by removing the shunt hardware. None of the patients required repeat shunt insertion from the time of removal throughout the follow-up period (mean 24 months, range 9–36 months). During the study period, a total of 6 patients with indwelling shunt hardware underwent ETV with the expectation of being shunt independent. Among these 6 patients, 3 experienced no complications from the retained hardware whereas 3 patients (50%) ultimately experienced adverse consequences related to retained hardware. This case series illustrates complications involving retained shunt hardware after successful ETV. These examples support consideration of shunt removal at the time of ETV in the appropriate context.

Long-term Control of Hydrocephalus via Endoscopic Third Ventriculostomy in Children with Tectal Plate Gliomas

Neurosurgery ◽  
2002 ◽  
Vol 51 (1) ◽  
pp. 63-68 ◽  
Author(s):  
John C. Wellons ◽  
R. Shane Tubbs ◽  
Jason T. Banks ◽  
Brenda Grabb ◽  
Jeffrey P. Blount ◽  
...  
Keyword(s):  
Endoscopic Third Ventriculostomy ◽  
Third Ventriculostomy ◽  
Primary Therapy ◽  
Ventricular Size ◽  
Imaging Studies ◽  
Successful Treatment Outcome ◽  
Tectal Plate ◽  
Shunt Removal

Abstract OBJECTIVE We report the control of hydrocephalus in children with presumed tectal plate gliomas by the use of endoscopic third ventriculostomy (ETV). METHODS The hospital records, office charts, and imaging studies from children who underwent ETV at the Children's Hospital of Alabama were reviewed. Thirteen children with the diagnosis of tectal plate glioma and hydrocephalus were identified. ETV was the primary therapy instituted for all but one of these children. Successful treatment outcome was defined as shunt freedom, improvement in symptoms, and reduced ventricular size. RESULTS Thirteen children underwent a total of 15 ETVs, and all children were shunt-free at their most recent follow-up examinations. One child underwent successful secondary ETV, one child underwent shunt removal concomitant with the initial ETV, and one child underwent shunt removal concomitant with secondary ETV. Symptoms and signs resolved in all patients. All postoperative cranial imaging studies revealed normal or reduced ventricular size as compared with preoperative cranial imaging scans. The median follow-up period was 31 months. CONCLUSION In our surgical experience, ETV has been uniformly successful in the management of hydrocephalus caused by tectal plate gliomas in children. ETV should be considered the treatment of choice for hydrocephalus in pediatric patients with tectal plate gliomas.

The Use of an Aspirating/Resecting Device to Reduce Stoma Closure Following Endoscopic Third Ventriculostomy for Aqueductal Stenosis

2015 ◽  
Vol 11 (4) ◽  
pp. 512-517 ◽  
Author(s):  
C Rory Goodwin ◽  
Eric W Sankey ◽  
Ignacio Jusué-Torres ◽  
Benjamin D Elder ◽  
Thomas A Kosztowski ◽  
...  
Keyword(s):  
Endoscopic Third Ventriculostomy ◽  
Surgical Intervention ◽  
Obstructive Hydrocephalus ◽  
Aqueductal Stenosis ◽  
Third Ventriculostomy ◽  
Stoma Closure ◽  
Resonance Imaging ◽  
Gradient Echo ◽  
Low Rate ◽  
Symptom Recurrence

Abstract BACKGROUND Endoscopic third ventriculostomy (ETV) is commonly used to treat obstructive hydrocephalus. Closure of the stoma can be associated with symptom recurrence and need for further surgical intervention. OBJECTIVE To describe the use of a side-cutting aspiration device for treatment of aqueductal stenosis in patients undergoing ETV. METHODS A retrospective review of 30 consecutive adults with aqueductal stenosis treated with ETV using an adjunct side-cutting aspiration device between 2011 and 2013 was performed. Patients included in the study ranged from 35 to 64 years of age. ETV success was determined by the absence of stoma closure (aqueductal and cisternal flow assessed by high-resolution, gradient-echo magnetic resonance imaging), post-ETV symptom recurrence, and need for subsequent surgical intervention. RESULTS Patients treated by using a side-cutting aspirator had no observed stoma closure (0%) and a 10% (n = 3) rate of post-ETV symptom recurrence. Three patients (10%) demonstrated a need for surgical revision following initial ETV with the side-cutting aspirator. CONCLUSION Adult patients with obstructive hydrocephalus secondary to aqueductal stenosis exhibited a low rate of stoma closure with the use of a side-cutting aspiration device, and a rate of complications comparable to the known literature. Likewise, patients treated with a side-cutting aspirator may have lower symptom recurrence post-ETV and require fewer revisions in comparison with the known literature. As such, a side-cutting aspirator may be considered as a useful adjunct to traditional ETV for the treatment of obstructive hydrocephalus secondary to aqueductal stenosis.

scholarly journals Pediatric hydrocephalus: systematic literature review and evidence-based guidelines. Part 4: Cerebrospinal fluid shunt or endoscopic third ventriculostomy for the treatment of hydrocephalus in children

2014 ◽  
Vol 14 (Supplement_1) ◽  
pp. 30-34 ◽  
Author(s):  
David D. Limbrick ◽  
Lissa C. Baird ◽  
Paul Klimo ◽  
Jay Riva-Cambrin ◽  
Ann Marie Flannery
Keyword(s):  
Systematic Review ◽  
Cerebrospinal Fluid ◽  
Endoscopic Third Ventriculostomy ◽  
Task Force ◽  
Third Ventriculostomy ◽  
Evidence Based ◽  
Class Iii ◽  
Csf Shunts ◽  
Pediatric Hydrocephalus ◽  
Evidence Based Guidelines

Object The objective of this systematic review was to examine the existing literature comparing CSF shunts and endoscopic third ventriculostomy (ETV) for the treatment of pediatric hydrocephalus and to make evidence-based recommendations regarding the selection of surgical technique for this condition. Methods Both the US National Library of Medicine and the Cochrane Database of Systematic Reviews were queried using MeSH headings and key words specifically chosen to identify published articles detailing the use of CSF shunts and ETV for the treatment of pediatric hydrocephalus. Articles meeting specific criteria that had been determined a priori were examined, and data were abstracted and compiled in evidentiary tables. These data were then analyzed by the Pediatric Hydrocephalus Systematic Review and Evidence-Based Guidelines Task Force to consider treatment recommendations based on the evidence. Results Of the 122 articles identified using optimized search parameters, 52 were recalled for full-text review. One additional article, originally not retrieved in the search, was also reviewed. Fourteen articles met all study criteria and contained comparative data on CSF shunts and ETV. In total, 6 articles (1 Class II and 5 Class III) were accepted for inclusion in the evidentiary table; 8 articles were excluded for various reasons. The tabulated evidence supported the evaluation of CSF shunts versus ETV. Conclusions Cerebrospinal fluid shunts and ETV demonstrated equivalent outcomes in the clinical etiologies studied. Recommendation: Both CSF shunts and ETV are options in the treatment of pediatric hydrocephalus. Strength of Recommendation: Level II, moderate clinical certainty.

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