Malfunction of ventriculoatrial shunts caused by the circulatory dynamics of coughing

1972 ◽  
Vol 36 (3) ◽  
pp. 283-286 ◽  
Author(s):  
Stephen E. Natelson ◽  
William Molnar
Keyword(s):  
Right Atrium ◽  
Normal Pressure ◽  
Adult Patients ◽  
Ventriculoatrial Shunt ◽  
Content Type ◽  
Atrial Catheter ◽  
Pressure Changes ◽  
Circulatory Dynamics ◽  
Fine Print

✓ Three adult patients are presented in whom the atrial catheter coiled on itself after a ventriculoatrial shunt. Pressures in the jugular and subclavian veins and right atrium were measured during respiration and coughing. It is suggested that the normal pressure changes during the act of coughing facilitate coiling if the atrial catheter material is not sufficiently rigid.

Intravascular repositioning of a ventriculoatrial shunt

1972 ◽  
Vol 36 (4) ◽  
pp. 512-514 ◽  
Author(s):  
William J. McSweeney
Keyword(s):  
Right Atrium ◽  
Superior Vena ◽  
Vena Cava ◽  
Ventriculoatrial Shunt ◽  
Content Type ◽  
Gentle Traction ◽  
Left Innominate Vein ◽  
The Right ◽  
In Infants And Children ◽  
Fine Print

✓ Intravascular repositioning of a misdirected ventriculoatrial shunt from the left innominate vein into the right atrium was accomplished using a Muller guidewire deflector system. The guidewire and its surrounding small polyethylene catheter were inserted into a left superficial saphenous vein and advanced through the right side of the heart into the superior vena cava. The deflector system was activated and easily hooked the misplaced ventriculoatrial catheter. With gentle traction it was repositioned in the right atrium. The simplicity and safety of this approach make it recommended for use in infants and children.

Percutaneous technique for insertion of an atrial catheter for CSF shunting

1981 ◽  
Vol 55 (3) ◽  
pp. 488-490 ◽  
Author(s):  
Kheder Ashker ◽  
John L. Fox
Keyword(s):  
Internal Jugular Vein ◽  
Jugular Vein ◽  
Guide Wire ◽  
Percutaneous Technique ◽  
Ventriculoatrial Shunt ◽  
Content Type ◽  
Csf Shunting ◽  
Atrial Catheter ◽  
Fine Print

✓ A percutaneous technique for insertion of the atrial end of a ventriculoatrial shunt is described. The technique utilizes a catheter introducer set with a guide wire for insertion of the atrial catheter through the internal jugular vein.

Risks in using siphon-reducing devices in adult patients with normal-pressure hydrocephalus: bench test investigations with Delta valves

1996 ◽  
Vol 84 (4) ◽  
pp. 634-641 ◽  
Author(s):  
Mahmood Hassan ◽  
Sotaro Higashi ◽  
Junkoh Yamashita
Keyword(s):  
Normal Pressure Hydrocephalus ◽  
Normal Pressure ◽  
Adult Patients ◽  
Mastoid Process ◽  
Bench Test ◽  
Foramen Of Monro ◽  
Content Type ◽  
Physiological Variation ◽  
Closing Pressure ◽  
Fine Print

✓ To elucidate the reason for malfunction of Delta valves in patients with normal-pressure hydrocephalus, the authors applied a new concept of the bench test and simulated intracranial pressure (ICP) to measure the resultant flow with a complete shunt system. Subcutaneous pressure on the valve, valve implantation site, and postural hydrostatic differentialpressure changes were simulated in this bench test designed for adult patients with normal-pressure hydrocephalus. Subcutaneous pressure ranged within 6.4 ± 0.9 cm H2O (mean ± standard deviation) on the 7th day after the implantation of the valve in rats. A linear correlation between valve closing pressures and the external pressure was observed: gradual increase of the latter resulted in an approximately equal rise in the closing pressure. Closing pressure ranged within the physiological variation of ICP (10 ± 5 cm H2O) in the supine position. In the erect position it was higher than the physiological variation (+5 to −5 cm H2O) when the valve was placed at the level of the foramen of Monro and lower when placed at the level of the clavicle. This observation indicates that the subcutaneous pressure around the Delta valve significantly affects its closing pressure. An excessive reduction of flow or a functional obstruction occurs when the patient with a Delta valve implanted at the foramen of Monro assumes an erect posture. The authors conclude that Delta valves are not recommended for implantation at the level of the foramen of Monro in patients with normal-pressure hydrocephalus because of the risk of underdrainage. The mastoid process or clavicle may be the alternative levels for its implantation to prevent underdrainage; however, the possibility of shunt malfunction should be kept in mind because subcutaneous pressure is variable among patients and that might affect the performance characteristics of these valves.

Echocardiographic placement of cardiac tube in ventriculoatrial shunt

1996 ◽  
Vol 85 (4) ◽  
pp. 723-724 ◽  
Author(s):  
Marek Robert Szczerbicki ◽  
Malgorzata Michalak
Keyword(s):  
Right Atrium ◽  
Visual Assessment ◽  
New Technique ◽  
Ventriculoatrial Shunt ◽  
Content Type ◽  
Postoperative Course ◽  
Echocardiographic Examination ◽  
A New Technique ◽  
The Right ◽  
Fine Print

✓ A new technique using an echocardiographic examination for preoperative visual assessment of the right atrium as an aid to accurate placement of a cardiac tube in a ventriculoatrial shunt is described. This method provides correct localization of the tube end, is safe for the patient, and is repeatable in the postoperative course.

Shunt system patency testing by lumbar infusion

1976 ◽  
Vol 45 (1) ◽  
pp. 60-65 ◽  
Author(s):  
Jack Woodford ◽  
Richard L. Saunders ◽  
Ernest Sachs
Keyword(s):  
Normal Pressure Hydrocephalus ◽  
Normal Pressure ◽  
Adult Patients ◽  
Shunt Malfunction ◽  
Infusion Test ◽  
Shunt Surgery ◽  
Shunt System ◽  
Content Type ◽  
Ventriculoperitoneal Shunts ◽  
Fine Print

✓ A simple and reliable bedside infusion test is described to evaluate shunt-system patency in adult patients with treated “normal” pressure hydrocephalus. Fifteen consecutive patients with ventriculoperitoneal shunts were tested by a two-part infusion test between 2 days and 32 months after shunt surgery. When we used the criteria presented, shunt patency could be established with certainty, and shunt malfunction could be established with relative certainty. Shunt malfunction was verified surgically.

Effect of respiratory movement on cerebrospinal fluid dynamics in hydrocephalic infants with shunts

1975 ◽  
Vol 42 (2) ◽  
pp. 194-200 ◽  
Author(s):  
Hiroshi Yamada ◽  
Masataka Tajima ◽  
Masahiro Nagaya
Keyword(s):  
Fluid Dynamics ◽  
Cerebrospinal Fluid ◽  
Ventriculoperitoneal Shunt ◽  
Respiratory Movement ◽  
Cerebrospinal Fluid Dynamics ◽  
Ventriculoatrial Shunt ◽  
Content Type ◽  
Intracranial Pressures ◽  
Pressure Changes ◽  
Fine Print

✓ The authors report a study of the effect of respiratory movement on intracranial, auricular, and intraperitoneal cerebrospinal fluid (CSF) pressure in hydrocephalic infants with shunts. Postoperative intraventricular pressures were also recorded for comparison. The intraventricular, right auricular, and intraperitoneal pressures rose during expiration and dropped during inspiration; the pressure changes were most marked while the infants were crying or straining. All pressures dropped simultaneously at the time of inspiration, but the auricular pressure was most significantly affected. It dropped to −100 to −200 mm H2O when the patients cried, while intraventricular and intraperitoneal pressures remained above 0 mm H2O. The postoperative intracranial pressures were in accord with these results; the pressures after ventriculoatrial shunt were significantly lower than those after ventriculoperitoneal shunt when the same pressure valves were used.

Cerebral hemodynamics in normal-pressure hydrocephalus

1984 ◽  
Vol 61 (3) ◽  
pp. 510-514 ◽  
Author(s):  
Norihiko Tamaki ◽  
Tadaki Kusunoki ◽  
Toshimitsu Wakabayashi ◽  
Satoshi Matsumoto
Keyword(s):  
Computerized Tomography ◽  
Transit Time ◽  
Normal Pressure Hydrocephalus ◽  
Mean Transit Time ◽  
Contrast Material ◽  
Normal Pressure ◽  
Cerebral Hemodynamics ◽  
Content Type ◽  
Poor Outcome ◽  
Fine Print

✓ Cerebral hemodynamics in 31 patients with suspected normal-pressure hydrocephalus were studied by means of the xenon-133 (133Xe) inhalation method and on dynamic computerized tomography (CT) scanning. Cerebral blood flow (CBF) is reduced in all patients with dementia. Hypoperfusion was noted in a frontal distribution in these patients compared with normal individuals. There was no difference in CBF patterns between patients with good and those with poor outcome. The CBF was increased following cerebrospinal fluid (CSF) shunting in patients who responded to that procedure: increase in flow correlated with clinical improvement, frontal and temporal lobe CBF was most markedly increased, and the CBF pattern became normal. In contrast, CBF was decreased after shunt placement in patients who were considered to have suffered from degenerative dementia, as evidenced by non-response to shunting. Dynamic computerized tomography studies demonstrated that patients with a good outcome showed a postoperative reduction in mean transit time of contrast material, most prominent in the frontal and temporal gray matter, and slight in the deep frontal structures, but not in the major cerebral vessels. Patients with poor outcome after shunting, however, had an increase in transit time in all regions. This corresponded well with the results as determined by the 133Xe inhalation method.

Intraoperative echocardiographic control during ventriculoatrial shunt placement

1985 ◽  
Vol 62 (5) ◽  
pp. 783-784 ◽  
Author(s):  
Giuliano Bosi ◽  
Emilio Zorzi ◽  
Pietro Guerrini ◽  
Jean P. Lintermans
Keyword(s):  
Simple Procedure ◽  
Ventriculoatrial Shunt ◽  
Content Type ◽  
Shunt Placement ◽  
Fine Print

✓ A method for positioning the cardiac end of a ventriculoatrial shunt with the aid of echocardiography is described. This simple procedure has resulted in safe and accurate shunt placement in infants.

The influence of sex and the presence of giant cells on postoperative long-term survival in adult patients with supratentorial glioblastoma multiforme

2004 ◽  
Vol 101 (2) ◽  
pp. 219-226 ◽  
Author(s):  
Naoki Shinojima ◽  
Masato Kochi ◽  
Jun-Ichiro Hamada ◽  
Hideo Nakamura ◽  
Shigetoshi Yano ◽  
...  
Keyword(s):  
Glioblastoma Multiforme ◽  
Giant Cell ◽  
Adult Patients ◽  
Term Survival ◽  
Long Term Survival ◽  
Content Type ◽  
Free Interval ◽  
Younger Age ◽  
Fine Print

Object. Glioblastoma multiforme (GBM) remains incurable by conventional treatments, although some patients experience long-term survival. A younger age, a higher Karnofsky Performance Scale (KPS) score, more aggressive treatment, and long progression-free intervals have been reported to be positively associated with long-term postoperative patient survival. The aim of this retrospective study was the identification of additional favorable prognostic factors affecting long-term survival in surgically treated adult patients with supratentorial GBM. Methods. Of 113 adult patients newly diagnosed with histologically verified supratentorial GBM who were enrolled in Phase III trials during the period between 1987 and 1998, six (5.3%) who survived for longer than 5 years were defined as long-term survivors, whereas the remaining 107 patients served as controls. All six were women and were compared with the controls; they were younger (mean age 44.2 years, range 31–60 years), and their preoperative KPS scores were higher (mean 85, range 60–100). Four of the six patients underwent gross-total resection. In five patients (83.3%) the progression-free interval was longer than 5 years and in three a histopathological diagnosis of giant cell GBM was made. This diagnosis was not made in the other 107 patients. Conclusions. Among adult patients with supratentorial GBM, female sex and histopathological characteristics consistent with giant cell GBM may be predictive of a better survival rate, as may traditional factors (that is, younger age, good KPS score, more aggressive resection, and a long progression-free interval).

Cerebral cysticercosis with aqueductal obstruction

1980 ◽  
Vol 53 (2) ◽  
pp. 252-255 ◽  
Author(s):  
Tung Pui Poon ◽  
Edward J. Arida ◽  
Wolodymyr P. Tyschenko
Keyword(s):  
Intracranial Hypertension ◽  
Brain Stem ◽  
Normal Pressure Hydrocephalus ◽  
Signs And Symptoms ◽  
Normal Pressure ◽  
Content Type ◽  
Neurological Signs ◽  
Cerebral Cysticercosis ◽  
The Brain ◽  
Fine Print

✓ The authors report a case of cerebral cysticercosis which presented with generalized nonspecific neurological signs and symptoms attributed to acute aqueductal obstruction, with concomitant intracranial hypertension. These were characteristic intracranial calcifications along with angiographically demonstrated signs of hydrocephalus. Contrast encephalography clearly demonstrated aqueductal obstruction. Pathologically, the aqueductal obstruction was shown to be due to parasitic invasion of the brain stem with compression of the aqueduct. The presence of typical intracranial calcification in conjunction with either obstructive or normal-pressure hydrocephalus should alert the observer to the possibility of cerebral cysticercosis.

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