Pericardial tamponade by Holter ventriculoatrial shunts

1971 ◽  
Vol 35 (6) ◽  
pp. 695-699 ◽  
Author(s):  
Stavros Tsingoglou ◽  
Herbert B. Eckstein
Keyword(s):  
Pericardial Tamponade ◽  
Shunt Revision ◽  
Shunt Insertion ◽  
Distal Catheter ◽  
Revision Procedure ◽  
Content Type ◽  
Cardiac Perforation ◽  
Cardiac Wall ◽  
Cardiac Silhouette ◽  
Fine Print

✓ Ten cases of cardiac tamponade caused by pericardial perforation by a Holter catheter in the treatment of hydrocephalus by ventriculoatrial drainage are reported. These 10 cases occurred in an 8-year practice of two surgeons in a period during which approximately 1800 Holter shunts were inserted and an approximately equal number of operations for lengthening of the distal catheter were performed. The etiological factors, the clinical picture, and the diagnosis are discussed. Cardiac perforation is caused either by forceful introduction of the distal catheter during a shunt revision procedure or by too long a distal catheter that ulcerates through the cardiac wall. Enlargement of cardiac silhouette after shunt insertion is virtually diagnostic of a pericardial effusion. If undiagnosed, this condition was invariably fatal, but if diagnosed in time, immediate treatment was always curative. The distal catheter should be shortened, but suture of the cardiac perforation itself is not necessary.

Increased risk of distal ventriculoperitoneal shunt obstruction associated with slit valves or distal slits in the peritoneal catheter

1997 ◽  
Vol 87 (5) ◽  
pp. 682-686 ◽  
Author(s):  
Jeffrey W. Cozzens ◽  
James P. Chandler
Keyword(s):  
Shunt Revision ◽  
Ventricular Catheter ◽  
Peritoneal Catheter ◽  
Distal Catheter ◽  
Content Type ◽  
Vp Shunt ◽  
Increased Risk ◽  
Catheter Obstruction ◽  
Shunt Obstruction ◽  
Fine Print

✓ The authors describe a relationship between the presence of distal shunt catheter side-wall slits and distal catheter obstruction in a single-surgeon series of ventriculoperitoneal (VP) shunt revisions. Between 1985 and 1996, 168 operations for VP shunt revision were performed by the senior author (J.W.C.) in 71 patients. Indications for shunt revision included obstruction in 140 operations; overdrainage or underdrainage requiring a change of valve in 17 operations; inadequate length of distal shunt tubing resulting in the distal end no longer reaching the peritoneum in five operations; the ventricular catheter in the wrong ventricle or space, requiring repositioning in five operations; and a disconnected or broken shunt in one operation. Of the 140 instances of shunt obstruction, the blockage occurred at the ventricular end in 108 instances (77.1%), the peritoneal end in 17 (12.1%), the ventricular and the peritoneal end in 14 (10%), and in the valve mechanism (not including distal slit valves) in one (0.8%). Thus, the peritoneal end was obstructed in 31 (22.1%) of 140 cases of shunt malfunction. In every case in which the peritoneal end was obstructed, some form of distal slit was found: either a distal slit valve in an otherwise closed catheter or slits in the side of an open catheter. No instances were found of distal peritoneal catheter obstruction when the peritoneal catheter was a simple open-ended tube with no accompanying side slits (0 of 55). It is concluded that side slits in the distal peritoneal catheters of VP shunts are associated with a greater incidence of distal shunt obstruction.

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.

Subtle deterioration in shunted childhood hydrocephalus

1986 ◽  
Vol 65 (2) ◽  
pp. 211-216 ◽  
Author(s):  
Arno Fried ◽  
Kenneth Shapiro
Keyword(s):  
Buffering Capacity ◽  
Volume Index ◽  
Shunt Revision ◽  
Pressure Waves ◽  
Ventricular Size ◽  
Csf Shunts ◽  
Content Type ◽  
The Mean ◽  
Childhood Hydrocephalus ◽  
Fine Print

✓ Eighteen hydrocephalic children who presented with subtle deterioration when their shunts malfunctioned were studied during shunt revision by means of the pressure-volume index (PVI) technique. Bolus manipulation of cerebrospinal fluid (CSF) was used to determine the PVI and the resistance to the absorption of CSF (Ro). Ventricular size was moderately to severely enlarged in all the children. Steady-state intracranial pressure (ICP) at the time of shunt revision was 17.5 ± 7.3 mm Hg (range 8 to 35 mm Hg). Pressure waves could not be induced by bolus injections in the 8- to 35-mm Hg range of ICP tested. The mean ± standard deviation (SD) of the predicted normal PVI for this group was 18.5 ± 2.7 ml. The mean ± standard error of the mean of the measured PVI was 35.5 ± 2.1 ml, which represented a 187% ± 33% (± SD) increase in volume-buffering capacity (p < 0.001). The ICP did not fall after bolus injections in three children, so that the Ro could not be measured. In the remaining 15 patients, Ro increased linearly as a function of ICP (r = 0.74, p < 0.001). At ICP's below 20 mm Hg, Ro ranged from 2.0 to 5.0 mm Hg/ml/min, but increased to as high as 21 mm Hg/ml/min when ICP was above 20 mm Hg. This study documents that subtle deterioration in shunted hydrocephalic children is accompanied by abnormally compliant pressure-volume curves. These children develop ventricular enlargement and neurological deterioration without acute episodic pressure waves. The biomechanical profile of this group differs from other children with CSF shunts.

Transesophageal Echocardiography-Guided Ventriculoatrial Shunt Insertion

2019 ◽  
Vol 19 (1) ◽  
pp. 25-31
Author(s):  
Albert McAnsah Isaacs ◽  
Danae Krahn ◽  
Andrew M Walker ◽  
Heather Hurdle ◽  
Mark G Hamilton
Keyword(s):  
Transesophageal Echocardiography ◽  
Perioperative Complications ◽  
Superior Vena ◽  
Vena Cava ◽  
Shunt Revision ◽  
Shunt Valve ◽  
Shunt Insertion ◽  
Distal Catheter ◽  
Shunt Placement ◽  
Time Required

Abstract BACKGROUND Determining an optimal location within the right atrium (RA) for placement of the distal ventriculoatrial (VA) shunt catheter offer several operative challenges that place patients at risk for perioperative complications and downstream VA shunt failure. Utilizing transesophageal echocardiography (TEE) guidance to place distal VA shunt catheters may help to circumvent these risks. OBJECTIVE To review our current practice of VA shunt insertion using TEE guidance. METHODS A retrospective review of all consecutive patients who underwent VA shunt procedures between December 19, 2016 and January 22, 2019, during which time intraoperative TEE was used for shunt placement was performed. Data on the time required for shunt placement and total procedure time, baseline echocardiography findings, and short- and long-term complications of shunt placement were assessed. RESULTS A total of 33 patients underwent VA shunt procedures, with a median follow-up time of 250 (88-412) d. The only immediate complication related to shunt placement or TEE use was transient ectopy in 1 patient. The mean time for atrial catheter insertion was 12.6 ± 4.8 min. Right-heart catheters were inserted between the RA-superior vena cava junction and 22 mm within the RA in all but 3 procedures. A total of 7/33 patients (21%) underwent shunt revision. Indications for revisions included distal clots, proximal obstruction, positive blood culture, and shunt valve revision. No other complications of VA shunt insertion were reported. CONCLUSION VA shunt insertion using TEE allows for precise distal catheter placement. Early patient experience confirms this technique has a low complication rate.

Deep and brainstem cavernomas: a consecutive 8-year series

2003 ◽  
Vol 99 (1) ◽  
pp. 31-37 ◽  
Author(s):  
Tiit Mathiesen ◽  
Göran Edner ◽  
Lars Kihlström
Keyword(s):  
Basal Ganglia ◽  
Neurological Deterioration ◽  
Radical Excision ◽  
Long Term Outcomes ◽  
Total Removal ◽  
Shunt Insertion ◽  
Content Type ◽  
Operative Notes ◽  
Fine Print

Object. The goal of this study was to provide epidemiological and clinical data on the management of cavernomas of the basal ganglia and brainstem from a long-term series at one institution. Methods. All 68 patients who were referred to the authors' department between 1992 and 2000 for deep cavernomas were evaluated by clinic examinations, review of neuroimaging examinations, and review of charts and operative notes. Twenty-nine patients underwent microsurgical procedures, which carried a 69% risk of transitory neurological deterioration. Radical excision was achieved in 25 of these patients, as determined by a review of neuroimages; the remaining four patients all experienced new hemorrhages that led to increased morbidity or even to mortality. Surgical results were better if surgery was performed early, within 1 month posthemorrhage, than if operations were postponed. In selected patients, deep lesions not reaching a pial surface could be safely removed from the thalamus, basal ganglia, or medulla oblongata. Of five patients who underwent gamma knife surgery, two experienced hemorrhages, one at 2 and the other at 5 years following treatment. Patients who did not undergo surgery had a yearly incidence of hemorrhage that was 2% in cases of incidental cavernomas and 7% in symptomatic ones. Conclusions. Over the long term, outcomes were worse following conservative treatment or shunt insertion surgery than after microsurgery of symptomatic cavernomas. Incidental cavernomas carried a low risk of neurological deterioration. Surgery should follow generally accepted indications, but only with the confidence that total removal can be safely achieved. Surgery that is performed within 10 to 30 days following ictus may be preferable to delayed surgery.

Cerebrospinal fluid shunt placement for pseudotumor cerebri—associated intractable headache: predictors of treatment response and an analysis of long-term outcomes

2004 ◽  
Vol 101 (4) ◽  
pp. 627-632 ◽  
Author(s):  
Matthew J. Mcgirt ◽  
Graeme Woodworth ◽  
George Thomas ◽  
Neil Miller ◽  
Michael Williams ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Pseudotumor Cerebri ◽  
Shunt Revision ◽  
Csf Shunts ◽  
Content Type ◽  
Shunt Placement ◽  
Increased Risk ◽  
Shunt Obstruction ◽  
Fine Print

Object. Cerebrospinal fluid (CSF) shunts effectively reverse symptoms of pseudotumor cerebri postoperatively, but long-term outcome has not been investigated. Lumboperitoneal (LP) shunts are the mainstay of CSF shunts for pseudotumor cerebri; however, image-guided stereotaxy and neuroendoscopy now allow effective placement of a ventricular catheter without causing ventriculomegaly in these cases. To date it remains unknown if CSF shunts provide long-term relief from pseudotumor cerebri and whether a ventricular shunt is better than an LP shunt. The authors investigated these possibilities. Methods. The authors reviewed the records of all shunt placement procedures that were performed for intractable headache due to pseudotumor cerebri at one institution between 1973 and 2003. Using proportional hazards regression analysis, predictors of treatment failure (continued headache despite a properly functioning shunt) were assessed, and shunt revision and complication rates were compared between LP and ventricular (ventriculoperitoneal [VP] or ventriculoatrial [VAT]) shunts. Forty-two patients underwent 115 shunt placement procedures: 79 in which an LP shunt was used and 36 in which a VP or VAT shunt was used. Forty patients (95%) experienced a significant improvement in their headaches immediately after the shunt was inserted. Severe headache recurred despite a properly functioning shunt in eight (19%) and 20 (48%) patients by 12 and 36 months, respectively, after the initial shunt placement surgery. Seventeen patients without papilledema and 19 patients in whom preoperative symptoms had occurred for longer than 2 years experienced recurrent headache, making patients with papilledema or long-term symptoms fivefold (relative risk [RR] 5.2, 95% confidence interval [CI] 1.5–17.8; p < 0.01) or 2.5-fold (RR 2.51, 95% CI 1.01–9.39; p = 0.05) more likely to experience headache recurrence, respectively. In contrast to VP or VAT shunts, LP shunts were associated with a 2.5-fold increased risk of shunt revision (RR 2.5, 95% CI 1.5–4.3; p < 0.001) due to a threefold increased risk of shunt obstruction (RR 3, 95% CI 1.5–5.7; p < 0.005), but there were similar risks between the two types of shunts for overdrainage (RR 2.3, 95% CI 0.8–7.9; p = 0.22), distal catheter migration (RR 2.1, 95% CI 0.3–19.3; p = 0.55), and shunt infection (RR 1.3, 95% CI 0.3–13.2; p = 0.75). Conclusions. Based on their 30-year experience in the treatment of these patients, the authors found that CSF shunts were extremely effective in the acute treatment of pseudotumor cerebri—associated intractable headache, providing long-term relief in the majority of patients. Lack of papilledema and long-standing symptoms were risk factors for treatment failure. The use of ventricular shunts for pseudotumor cerebri was associated with a lower risk of shunt obstruction and revision than the use of LP shunts. Using ventricular shunts in patients with papilledema or symptoms lasting less than 2 years should be considered for those with pseudotumor cerebri—associated intractable headache.

Cerebrospinal fluid edema: a rare complication of shunt operations for hydrocephalus

1982 ◽  
Vol 57 (5) ◽  
pp. 697-700 ◽  
Author(s):  
Yasuhiro Chiba ◽  
Hiroshi Takagi ◽  
Fumoto Nakajima ◽  
Satoshi Fujii ◽  
Takao Kitahara ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
White Matter ◽  
Rare Complication ◽  
Shunt Revision ◽  
Ventricular Catheter ◽  
Shunt Operation ◽  
Low Density ◽  
Content Type ◽  
Low Density Area ◽  
Fine Print

✓ Three cases are presented in which a rare complication occurred after a shunt operation for hydrocephalus. On postoperative computerized tomography (CT) scans, extensive low-density areas appeared in the white matter along the ventricular catheter. After shunt revision, gradual resolution or disappearance of the low-density area was clearly demonstrated on CT. In one patient, a collection of cerebrospinal fluid (CSF) was confirmed at operation and appeared to lie in the extracellular spaces of the white matter. The phenomenon is considered to be localized CSF edema, different from porencephaly.

Sylvian aqueduct syndrome and global rostral midbrain dysfunction associated with shunt malfunction

1999 ◽  
Vol 90 (2) ◽  
pp. 227-236 ◽  
Author(s):  
Giuseppe Cinalli ◽  
Christian Sainte-Rose ◽  
Isabelle Simon ◽  
Guillaume Lot ◽  
Spiros Sgouros
Keyword(s):  
Pressure Gradient ◽  
Obstructive Hydrocephalus ◽  
Shunt Malfunction ◽  
Shunt Revision ◽  
Third Ventriculostomy ◽  
Content Type ◽  
Upward Gaze Palsy ◽  
Ocular Signs ◽  
Gaze Palsy ◽  
Fine Print

Object. This study is a retrospective analysis of clinical data obtained in 28 patients affected by obstructive hydrocephalus who presented with signs of midbrain dysfunction during episodes of shunt malfunction.Methods. All patients presented with an upward gaze palsy, sometimes associated with other signs of oculomotor dysfunction. In seven cases the ocular signs remained isolated and resolved rapidly after shunt revision. In 21 cases the ocular signs were variably associated with other clinical manifestations such as pyramidal and extrapyramidal deficits, memory disturbances, mutism, or alterations in consciousness. Resolution of these symptoms after shunt revision was usually slow. In four cases a transient paradoxical aggravation was observed at the time of shunt revision. In 11 cases ventriculocisternostomy allowed resolution of the symptoms and withdrawal of the shunt.Simultaneous supratentorial and infratentorial intracranial pressure recordings performed in seven of the patients showed a pressure gradient between the supratentorial and infratentorial compartments, with a higher supratentorial pressure before shunt revision. Inversion of this pressure gradient was observed after shunt revision and resolution of the gradient was observed in one case after third ventriculostomy. In six recent cases, a focal midbrain hyperintensity was evidenced on T2-weighted magnetic resonance imaging sequences at the time of shunt malfunction. This rapidly resolved after the patient underwent third ventriculostomy.Conclusions. It is probable that in obstructive hydrocephalus, at the time of shunt malfunction, the development of a transtentorial pressure gradient could initially induce a functional impairment of the upper midbrain, inducing upward gaze palsy. The persistence of the gradient could lead to a global dysfunction of the upper midbrain. Third ventriculostomy contributes to equalization of cerebrospinal fluid pressure across the tentorium by restoring free communication between the infratentorial and supratentorial compartments, resulting in resolution of the patient's clinical symptoms.

Gamma knife surgery for multiple hemangioblastomas

2005 ◽  
Vol 102 (Special_Supplement) ◽  
pp. 97-101 ◽  
Author(s):  
Yong Sook Park ◽  
Jong Hee Chang ◽  
Jin Woo Chang ◽  
Sang Sup Chung ◽  
Yong Gou Park
Keyword(s):  
Gamma Knife ◽  
Small Diameter ◽  
Gamma Knife Surgery ◽  
Tumor Control ◽  
Posterior Fossa Decompression ◽  
Shunt Insertion ◽  
Content Type ◽  
Multiple Lesions ◽  
The Mean ◽  
Fine Print

Object. The authors describe their experience in treating patients with hemangioblastoma, especially multiple lesions, with gamma knife surgery (GKS). Methods.Nine patients with 84 hemangioblastomas underwent GKS between July 1992 and May 2003. Three patients harbored a single lesion and six patients had multiple lesions. Of the six patients with multifocal tumors, a diagnosis of von Hippel—Lindau disease had been established in five. In the patients with multiple lesions, the mean radiation dose delivered to the tumor margin was 16.6 Gy (range 12.8–29.75 Gy). The mean margin isodose was 60% (range 40–95%). Three of the 84 lesions failed to be controlled after a mean follow-up period of 4.3 years (range 8.6–141 months). One patient who had undergone two GKS treatments suffered delayed radiation-induced complications, and posterior fossa decompression and ventriculoperitoneal shunt insertion were required. Conclusions. To achieve tumor control and avoid morbidity, the surgeon should keep in mind minimizing field overlapping by using a small-diameter collimator or applying a steep dose gradient, and by accurate dose prescription.

A flow-regulating device to control differential pressure in CSF shunt systems

1982 ◽  
Vol 57 (4) ◽  
pp. 570-573 ◽  
Author(s):  
Hiroshi Yamada
Keyword(s):  
Experimental Study ◽  
Flow Rate ◽  
Csf Shunt ◽  
Csf Flow ◽  
Csf Shunts ◽  
Shunt System ◽  
Distal Catheter ◽  
Content Type ◽  
Teflon Tube ◽  
Fine Print

✓ A method of regulating flow rate through cerebrospinal fluid (CSF) shunts with the addition of a flow-regulating device (FRD) is reported. The FRD consists of a small-caliber (0.4 mm) Teflon tube placed in the usual connector. This device has the advantage of converting the original shunt valves to valves for higher-resistance flow without replacing the entire distal catheter. An experimental study revealed that this device reduced the CSF flow rate in the shunt system by approximately 30%. The author has found it reliable in 32 patients, without causing CSF obstruction. The device is easily installed and removed.

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