Cerebrospinal fluid shunt infection

1984 ◽  
Vol 60 (5) ◽  
pp. 1014-1021 ◽  
Author(s):  
Beverly C. Walters ◽  
Harold J. Hoffman ◽  
E. Bruce Hendrick ◽  
Robin P. Humphreys
Keyword(s):  
Cerebrospinal Fluid ◽  
Initial Treatment ◽  
Clinical Presentation ◽  
Shunt Infection ◽  
Shunt Malfunction ◽  
Shunt Revision ◽  
Csf Shunts ◽  
Content Type ◽  
Operative Removal ◽  
Fine Print

✓ A retrospective study of the management of patients with infected cerebrospinal fluid (CSF) shunts was undertaken, covering the 20 years from 1960 to 1979, inclusive, and involving 222 patients with 267 infections. The data were analyzed with emphasis on influences surrounding treatment choice and subsequent outcome. Treatment was classified into three major categories: medical management (antibiotics alone), surgical management (antibiotics plus operative removal of the infected shunt), and no treatment (ranging from admission and observation only to shunt revision), the diagnosis of shunt infection having been missed. Results showed surgical treatment to be more efficacious than medical or no treatment, with a higher rate of initial cure, and lower morbidity and mortality rates. Also examined were the relationships among clinical presentation, infection rate, and results of specimens sent for culture, and initial treatment. The definitive nature of initial treatment was revealed to be directly proportional to the aggressiveness of microbiological investigation. This latter aspect was related to clinical presentation, with shunt malfunction being the least recognized symptom of shunt infection. Patients presenting with blocked shunts were less likely to receive therapy appropriate for infection than any other group, leading to the conclusion that shunt malfunction may be more specific to infection than heretofore believed.

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.

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.

Abdominal pseudocysts and ascites formation after ventriculoperitoneal shunt procedures

1975 ◽  
Vol 43 (4) ◽  
pp. 476-480 ◽  
Author(s):  
S. Walton Parry ◽  
John F. Schuhmacher ◽  
Raeburn C. Llewellyn
Keyword(s):  
Cerebrospinal Fluid ◽  
Ventriculoperitoneal Shunt ◽  
Signs And Symptoms ◽  
Late Complications ◽  
Neurological Symptoms ◽  
Shunt Malfunction ◽  
Content Type ◽  
Ventriculoperitoneal Shunts ◽  
Ascites Formation ◽  
Fine Print

✓The authors report three patients with abdominal pseudocysts and one with cerebrospinal fluid ascites as late complications of ventriculoperitoneal shunts. The presenting signs and symptoms were those of an intraabdominal abnormality, with no neurological symptoms suggestive of shunt malfunction.

Cerebral cyst infection with Micrococcus sedentarius

1980 ◽  
Vol 52 (1) ◽  
pp. 126-128 ◽  
Author(s):  
Gerald R. Greene ◽  
Catherine Mc Ninch ◽  
Eldon L. Foltz
Keyword(s):  
Cerebrospinal Fluid ◽  
Local Therapy ◽  
Shunt Infection ◽  
Congenital Hydrocephalus ◽  
Content Type ◽  
Cyst Infection ◽  
Focus Of Infection ◽  
Brain Cysts ◽  
Shunt Infections ◽  
Fine Print

✓ A 7-year-old boy with congenital hydrocephalus and a left septate cerebral cyst presented with a shunt infection due to Micrococcus sedentarius, resistant to all penicillins. The shunt infection was persistent despite several courses of parenteral, intraventricular, and intracyst antibiotics. Evaluation of the ventricular fluid revealed adequate “killing power” against the patient's microorganism. No extracranial focus of infection could be found. Computerized tomographic scanning, along with air ventriculography, identified a noncommunicating area of the cerebral cyst. Only when communication between this location and the rest of the cyst was established were the antibiotics efficacious. Undercirculated areas of cerebrospinal fluid should be sought when shunt infections and ventriculitis persist in spite of adequate parenteral and local therapy in patients with brain cysts.

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.

Haemophilus influenzae infections of cerebrospinal fluid shunts

1981 ◽  
Vol 54 (2) ◽  
pp. 261-263 ◽  
Author(s):  
Stephen J. Lerman
Keyword(s):  
Cerebrospinal Fluid ◽  
Haemophilus Influenzae ◽  
Clinical Presentation ◽  
Shunt Infection ◽  
Antibiotic Administration ◽  
Cerebrospinal Fluid Shunts ◽  
Content Type ◽  
Systemic Antibiotic Therapy ◽  
The Central Nervous System ◽  
Meningitis In Children

✓ Two (1%) of 165 episodes of Haemophilus influenzae infection of the central nervous system occurred in patients with cerebrospinal fluid shunts. Both cases were caused by strains that could not be typed. The clinical presentation was similar to that of other forms of shunt infection, yet the pathogenesis may be similar to that of H. influenzae meningitis in children without shunts. Systemic antibiotic therapy, without shunt replacement or intraventricular antibiotic administration, may be more successful in shunt infections caused by H. influenzae than in those caused by other organisms.

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.

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.

Pneumocephalus in patients with CSF shunts

1985 ◽  
Vol 63 (4) ◽  
pp. 532-536 ◽  
Author(s):  
John R. Ruge ◽  
Leonard J. Cerullo ◽  
David G. McLone
Keyword(s):  
Cerebrospinal Fluid ◽  
Intracranial Pressure ◽  
Mental Status ◽  
Aqueductal Stenosis ◽  
Increased Intracranial Pressure ◽  
Csf Shunts ◽  
Content Type ◽  
Presenting Symptoms ◽  
Fine Print

✓ The authors present two cases of pneumocephalus occurring in patients with permanent shunts and review nine previously reported cases. Mental status changes and headache are the most common presenting symptoms. Six of the 11 cases of pneumocephalus occurred in patients with shunt placement for hydrocephalus secondary to aqueductal stenosis. In these patients, thinned cerebrospinal fluid barriers secondary to longstanding increased intracranial pressure may predispose them to pneumocephalus. Temporary extraventricular drainage is an effective method of treatment in this group of patients. Two other etiologies are identified with significance to treatment, and the role of craniotomy is discussed.

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