Ventriculoauriculostomy-associated infection

1971 ◽  
Vol 35 (6) ◽  
pp. 686-694 ◽  
Author(s):  
David B. Shurtleff ◽  
Dennis Christie ◽  
Eldon L. Foltz
Keyword(s):  
Cerebrospinal Fluid ◽  
Infection Rate ◽  
Blood Cultures ◽  
Operative Procedures ◽  
Cerebrospinal Fluid Shunts ◽  
Postoperative Infections ◽  
Content Type ◽  
Delayed Group ◽  
Fine Print

✓ A series of 102 newly referred and uninfected patients on whom 299 operative procedures to insert ventriculoauricular cerebrospinal fluid shunts were performed over a 12-year period were studied for the rate and cause of associated sepsis. It was found that 15.7% of the shunt insertions were followed by infection, and 1.3% of the revisions, for an overall infection rate of 14%. There were two clinical groups, those who developed acute postoperative infections (9%) and those with delayed infections developing 1 month to 6 years after operation (5%). The causes of the infections are discussed. It is suggested that careful follow-up with frequent blood cultures will reveal more infected cases in the delayed group, and that bacteriocidal agents selected for the specific organism should be maintained in cerebrospinal fluid and blood for long periods.

Surgical treatment of spontaneous spinal cerebrospinal fluid leaks

1998 ◽  
Vol 88 (2) ◽  
pp. 243-246 ◽  
Author(s):  
Wouter I. Schievink ◽  
Vittorio M. Morreale ◽  
John L. D. Atkinson ◽  
Fredric B. Meyer ◽  
David G. Piepgras ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Surgical Treatment ◽  
Intracranial Hypotension ◽  
Csf Leak ◽  
Preoperative Imaging ◽  
Content Type ◽  
Surgical Exploration ◽  
Fine Print ◽  
Csf Leaks

Object. Spontaneous spinal cerebrospinal fluid (CSF) leaks are an increasingly recognized cause of intracranial hypotension and may require neurosurgical intervention. In the present report the authors review their experience with the surgical management of spontaneous spinal CSF leaks. Methods. Between 1992 and 1997, 10 patients with spontaneous spinal CSF leaks and intracranial hypotension were treated surgically. The mean age of the seven women and three men was 42.3 years (range 22–61 years). Preoperative imaging showed a single meningeal diverticulum in two patients, a complex of diverticula in one patient, and a focal CSF leak alone in seven patients. Surgical exploration in these seven patients demonstrated meningeal diverticula in one patient; no clear source of CSF leakage could be identified in the remaining six patients. Treatment consisted of ligation of the diverticula or packing of the epidural space with muscle or Gelfoam. Multiple simultaneous spinal CSF leaks were identified in three patients. Conclusions. All patients experienced complete relief of their headaches postoperatively. There has been no recurrence of symptoms in any of the patients during a mean follow-up period of 19 months (range 3–58 months; 16 person-years of cumulative follow up). Complications consisted of transient intracranial hypertension in one patient and leg numbness in another patient. Although the disease is often self-limiting, surgical treatment has an important role in the management of spontaneous spinal CSF leaks. Surgery is effective in eliminating the headaches and the morbidity is generally low. Surgical exploration for a focal CSF leak, as demonstrated on radiographic studies, usually does not reveal a clear source of the leak. Some patients may have multiple simultaneous CSF leaks.

Ventriculoperitoneal shunt malfunction during pregnancy

1985 ◽  
Vol 63 (3) ◽  
pp. 459-460 ◽  
Author(s):  
Junya Hanakita ◽  
Takanori Suzuki ◽  
Yoshisuke Yamamoto ◽  
Yuji Kinuta ◽  
Kiyoshi Nishihara
Keyword(s):  
Cerebrospinal Fluid ◽  
Ventriculoperitoneal Shunt ◽  
Shunt Malfunction ◽  
Cerebrospinal Fluid Shunts ◽  
Shunt System ◽  
Content Type ◽  
Fine Print

✓ Malfunction of a ventriculoperitoneal shunt is reported in a 25-year-old woman at 32 weeks of gestation. Pregnancies and delivery in women with cerebrospinal fluid shunts are rarely reported, and malfunction of a shunt system during pregnancy is extremely unusual.

Recurrent spontaneous spinal cerebrospinal fluid leaks and intracranial hypotension: a prospective study

2003 ◽  
Vol 99 (5) ◽  
pp. 840-842 ◽  
Author(s):  
Wouter I. Schievink ◽  
M. Marcel Maya ◽  
Mary Riedinger
Keyword(s):  
Cerebrospinal Fluid ◽  
Intracranial Hypotension ◽  
Surgical Repair ◽  
Csf Leak ◽  
Content Type ◽  
Cerebrospinal Fluid Leaks ◽  
The Mean ◽  
A Prospective Study ◽  
Fine Print

Object. Intracranial hypotension due to a spontaneous spinal cerebrospinal fluid (CSF) leak is an increasingly recognized cause of postural headaches, but reliable follow-up data are lacking. The authors undertook a study to determine the risk of a recurrent spontaneous spinal CSF leak. Methods. The patient population consisted of a consecutive group of 18 patients who had been evaluated for consideration of surgical repair of a spontaneous spinal CSF leak. The mean age of the 15 women and three men was 38 years (range 22–55 years). The mean duration of follow up was 36 months (range 6–132 months). The total follow-up time was 654 months. A recurrent spinal CSF leak was defined on the basis of computerized tomography myelography evidence of a CSF leak in a previously visualized but unaffected spinal location. Five patients (28%) developed a recurrent spinal CSF leak; the mean age of these four women and one man was 36 years. A recurrent CSF leak developed in five (38%) of 13 patients who had undergone surgical CSF leak repair, compared with none (0%) of five patients who had been treated non-surgically (p = 0.249). The recurrent leak occurred between 10 and 77 months after the initial CSF leak, but within 2 or 3 months of successful surgical repair of the leak in all patients. Conclusions. Recurrent spontaneous spinal CSF leaks are not rare, and the recent successful repair of such a leak at another site may be an important risk factor.

Use of percutaneous endoscopy to place syringopleural or cystoperitoneal cerebrospinal fluid shunts

2005 ◽  
Vol 2 (4) ◽  
pp. 498-504 ◽  
Author(s):  
James D. Guest ◽  
Lisa Silbert ◽  
Carlos E. Casas
Keyword(s):  
Cerebrospinal Fluid ◽  
Cerebrospinal Fluid Shunts ◽  
Peritoneal Catheter ◽  
Content Type ◽  
Shunt Placement ◽  
Spinal Cysts ◽  
Safe Access ◽  
Percutaneous Endoscopy ◽  
Entire Procedure ◽  
Fine Print

✓ The authors describe a technique for percutaneous endoscopic shunt placement to treat clinically symptomatic spinal cysts. Seven patients underwent the procedure—five with syringomyelia, one with a symptomatic perineurial cyst, and one with a large arachnoid cyst. In all patients the shunt was successfully placed, and clinical improvement occurred in six. In four patients the entire procedure was performed endoscopically, whereas in three conversion to an open surgical exposure was required for safe access of a syrinx cavity. Overall, however, the pleural or peritoneal catheter was successfully placed endoscopically in all seven patients. There were two cases of postoperative positional headaches of which one required valve revision. In one case the catheter migrated and required repositioning. Percutaneous endoscopic shunt placement appears feasible in appropriately selected patients.

Precise anatomic localization of atraumatic sphenoethmoidal cerebrospinal fluid rhinorrhea by metrizamide CT cisternography

1980 ◽  
Vol 53 (2) ◽  
pp. 222-228 ◽  
Author(s):  
Thomas P. Naidich ◽  
Christopher J. Moran
Keyword(s):  
Cerebrospinal Fluid ◽  
Ct Cisternography ◽  
Content Type ◽  
Cerebrospinal Fluid Rhinorrhea ◽  
Single Procedure ◽  
Osseous Defect ◽  
Metrizamide Ct Cisternography ◽  
Anatomic Localization ◽  
Fine Print

✓ Metrizamide computerized tomographic cisternography (MCTC) has proved 100% successful in documenting the precise anatomic location of the dural osseous defect in three patients with sphenoethmoidal rhinorrhea. In each patient, direct surgical approach to the site indicated by MCTC terminated the leakage in a single procedure. Clinical evaluation has disclosed no renewed leakage during a follow-up period from 6 to 18 months.

Radionuclide cisternographic evaluation and follow-up of posttraumatic subconjunctival CSF loculation

1976 ◽  
Vol 44 (4) ◽  
pp. 496-499 ◽  
Author(s):  
James E. McLennan ◽  
J. Parker Mickle ◽  
Salvadore Treves
Keyword(s):  
Cerebrospinal Fluid ◽  
Postoperative Management ◽  
Content Type ◽  
Radionuclide Cisternography ◽  
Fluid Collections ◽  
Fine Print

✓ The case of a patient with massive, posttraumatic, subconjunctival cerebrospinal fluid collections is described in which diagnosis and postoperative management was simplified by serial radionuclide cisternography.

Long-term results of praziquantel therapy in neurocysticercosis

1987 ◽  
Vol 66 (3) ◽  
pp. 359-363 ◽  
Author(s):  
Clemente Robles ◽  
Ana Maria Sedano ◽  
Noe Vargas-Tentori ◽  
Sonia Galindo-Virgen
Keyword(s):  
Cerebrospinal Fluid ◽  
Intracranial Hypertension ◽  
Tissue Damage ◽  
Long Term Results ◽  
Content Type ◽  
Low Concentration ◽  
Praziquantel Treatment ◽  
Fine Print

✓ The long-term results of praziquantel therapy in 141 patients with neurocysticercosis are presented. Seventy-five patients (53%) were considered to be cured because the cysts or nodules disappeared or became calcified following praziquantel treatment and the patients were asymptomatic at the end of a 5-year follow-up period. An additional 35 patients (24.8%) improved clinically and radiographically. The intraventricular Cysticercus cysts of five patients in this group were not affected by praziquantel and had to be surgically removed. The remaining 31 patients (21.9%) were unchanged or became worse probably because, prior to therapy, Cysticercus larvae had caused tissue damage. The fact that praziquantel did not affect intraventricular cysts suggests a low concentration of the drug in the cerebrospinal fluid. Surgery continues to be an important tool in the treatment of cysticercosis to remove parasites that do not respond to praziquantel therapy as well as for the relief of intracranial hypertension.

Cerebrospinal fluid shunt infections with anaerobic diphtheroids (Propionibacterium species)

1976 ◽  
Vol 44 (5) ◽  
pp. 580-584 ◽  
Author(s):  
E. Dale Everett ◽  
Theodore C. Eickhoff ◽  
Richard H. Simon
Keyword(s):  
Cerebrospinal Fluid ◽  
Spinal Fluid ◽  
Cerebrospinal Fluid Shunts ◽  
Cerebrospinal Fluid Shunt ◽  
Laboratory Findings ◽  
Content Type ◽  
Central Nervous System Dysfunction ◽  
Symptoms And Signs ◽  
Shunt Infections ◽  
Fine Print

✓ The clinical and laboratory findings in six cases of anaerobic diphtheroid infection of cerebrospinal fluid shunts are described. These organisms have been infrequently reported as a cause of shunt infections but our data indicate that such infections may be more common than currently appreciated. Propionibacterium species are common contaminants of cerebrospinal fluid specimens, but when isolated from the spinal fluid of a patient with a shunt who has symptoms and signs compatible with infection, the organism should not be dismissed as a contaminant. Fever was a constant finding frequently accompanied by signs of central nervous system dysfunction. Spinal fluid pleocytosis was usually limited to 1 to 200 cells and protein and sugar values were variable. The organisms grow slowly, therefore spinal fluid cultures should be held for at least 14 days before they are reported as negative.

Intraventricular administration of amikacin for complicated Gram-negative meningitis and ventriculitis

1979 ◽  
Vol 50 (1) ◽  
pp. 95-99 ◽  
Author(s):  
Timothy C. Wirt ◽  
Zell A. McGee ◽  
Edward H. Oldfield ◽  
William F. Meacham
Keyword(s):  
Cerebrospinal Fluid ◽  
Persistent Infection ◽  
Intraventricular Administration ◽  
Antimicrobial Drugs ◽  
Gram Negative ◽  
Content Type ◽  
Neurosurgical Patients ◽  
Fine Print

✓ Four pediatric neurosurgical patients with Gram-negative meningitis and ventriculitis were treated with parenteral and intraventricular amikacin, a new aminoglycoside. The organisms infecting these patients were resistant to multiple antimicrobial drugs but were sensitive to amikacin. Treatment was continued for 14 days after cerebrospinal fluid cultures became negative. All four patients were cured and have demonstrated no nephrotoxicity, ototoxicity, or evidence of persistent infection on follow-up examination.

Ventricular cerebrospinal fluid eosinophilia in children with ventriculoperitoneal shunts

1991 ◽  
Vol 75 (4) ◽  
pp. 541-544 ◽  
Author(s):  
Howard Tung ◽  
Corey Raffel ◽  
J. Gordon McComb
Keyword(s):  
Cerebrospinal Fluid ◽  
Clinical Course ◽  
Laboratory Finding ◽  
Parasitic Infection ◽  
Shunt Infection ◽  
Shunt Revision ◽  
Shunt Insertion ◽  
Content Type ◽  
Fine Print

✓ To determine the significance of cerebrospinal fluid (CSF) eosinophilia, the charts of 106 patients treated with shunt-related procedures during the calendar year 1985 were reviewed. Sixty-nine patients presented for a shunt revision; their charts were retrospectively reviewed from the time of shunt insertion until January, 1988. The remaining 37 patients had a ventriculoperitoneal shunt inserted during the study period and were subsequently followed to January, 1988. A total of 558 shunt-related procedures were performed on these patients during the study period, with a mean follow-up period of 6.9 years. The infection rate was 3.8%. Eosinophilia was diagnosed when eosinophils accounted for 8% or more of the total CSF white blood cell count. Ventricular CSF eosinophilia occurred in 36 patients sometime during their clinical course. These 36 patients required a mean of 8.5 shunt revisions, while the remaining patients required a mean of 2.5 revisions (p < 0.001). Shunt infections were also more frequent in patients with eosinophilia (p < 0.01). In no case was peripheral eosinophilia or a parasitic infection present. This study demonstrates that CSF eosinophilia is common in children with shunts. Children with this laboratory finding will experience more shunt failures. In addition, the new appearance of eosinophilia in the CSF of a patient with a shunt in place suggests the possibility of a shunt infection.

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