Results of surgical treatment of neurocysticercosis in 69 cases

1986 ◽  
Vol 65 (3) ◽  
pp. 309-315 ◽  
Author(s):  
Benedicto Oscar Colli ◽  
Nelson Martelli ◽  
João Alberto Assirati ◽  
Hélio Rubens Machado ◽  
Sylvio de Vergueiro Forjaz
Keyword(s):  
Posterior Fossa ◽  
Complement Fixation Test ◽  
Shunt Infection ◽  
Shunt Revision ◽  
Csf Shunt ◽  
Increased Intracranial Pressure ◽  
Csf Shunts ◽  
Content Type ◽  
Cerebral Parenchyma

✓ The clinical course of 69 patients with neurocysticercosis who underwent surgery to control increased intracranial pressure (ICP) or cyst removal is analyzed. Increased ICP was caused by hydrocephalus in 63 patients, by cerebral edema in four, and by giant cysts in two. Skull x-ray films showed calcifications in 14% and signs of elevated ICP in 46%. Examination of cerebrospinal fluid (CSF) revealed pleocytosis with eosinophils in 52% of cases and a positive complement fixation test for cysticercosis in 66%. Ventriculography allowed localization of the CSF obstruction and ventricular cysts, and generally differentiated between an obstruction due to cysts and an inflammatory process. Computerized tomography showed cysts in the cerebral parenchyma and ventricular dilatation. Ventricular cysts were best seen when intraventricular metrizamide was used. Intracranial shunting and posterior fossa exploration were less effective in the treatment of hydrocephalus than was ventriculoatrial (VA) or ventriculoperitoneal (VP) shunting, although VA or VP shunting was associated with a high percentage of complications. Quality of survival was good in 87% of the cases in the first 3 postoperative months and in 93% of patients who survived 2 years after surgery. Fortyseven patients (68%) were readmitted one or more times for CSF shunt revision; 14 of them for shunt infection (meningitis). The early operative mortality rate was 1.8% for patients with VA or VP shunt placement and 5.3% for those with posterior fossa exploration. The authors conclude that placement of CSF shunts is indicated in the treatment of hydrocephalus, and cyst removal is indicated only when the cyst exhibits tumor-like behavior. Surgical exploration is also indicated when the diagnosis is uncertain.

scholarly journals Action of Linezolid or Vancomycin on Biofilms in Ventriculoperitoneal ShuntsIn Vitro

2012 ◽  
Vol 56 (6) ◽  
pp. 2842-2845 ◽  
Author(s):  
Roger Bayston ◽  
Gautham Ullas ◽  
Waheed Ashraf
Keyword(s):  
Staphylococcus Aureus ◽  
Staphylococcus Epidermidis ◽  
Shunt Infection ◽  
Csf Shunt ◽  
Csf Shunts ◽  
Content Type ◽  
Shunt Removal ◽  
Biofilm Development ◽  
Surgical Shunt

ABSTRACTCerebrospinal fluid (CSF) shunts used to treat hydrocephalus have an overall infection rate of about 10% of operations. The commonest causative bacteria areStaphylococcus epidermidis, followed byStaphylococcus aureusand enterococci. Major difficulties are encountered with nonsurgical treatment due to biofilm development in the shunt tubing and inability to achieve sufficiently high CSF drug levels by intravenous administration. Recently, three cases ofS. epidermidisCSF shunt infection have been treated by intravenous linezolid without surgical shunt removal, and we therefore investigated vancomycin and linezolid against biofilms of these bacteriain vitro. A continuous-perfusion model of shunt catheter biofilms was used to establish mature (1-week) biofilms ofStaphylococcus aureus,Staphylococcus epidermidis(both methicillin resistant [MRSA and MRSE]),Enterococcus faecalis, andEnterococcus faecium. They were then “treated” with either vancomycin or linezolid in concentrations achievable in CSF for 14 days. The biofilms were then monitored for 1 week for eradication and for regrowth. Enterococcal biofilms were not eradicated by either vancomycin or linezolid. Staphylococcal biofilms were eradicated by both antibiotics after 2 days and did not regrow. No resistance was seen. Linezolid at concentrations achievable by intravenous or oral administration was able to eradicate biofilms of bothS. epidermidis(MRSE) andS. aureus(MRSA). Neither vancomycin at concentrations achievable by intrathecal administration nor linezolid was able to eradicate enterococcal biofilms. It is hoped that thesein vitroresults will stimulate further clinical trials with linezolid, avoiding surgical shunt removal.

Management of hydrocephalus secondary to posterior fossa tumors

1977 ◽  
Vol 46 (1) ◽  
pp. 52-55 ◽  
Author(s):  
Leland Albright ◽  
Donald H. Reigel
Keyword(s):  
Posterior Fossa ◽  
External Ventricular Drainage ◽  
Csf Shunt ◽  
Safe Procedure ◽  
Tumor Removal ◽  
Posterior Fossa Tumors ◽  
Csf Shunts ◽  
Content Type ◽  
Suboccipital Craniectomy ◽  
Methods Of Treatment

✓ The records of children with hydrocephalus secondary to posterior fossa tumors were reviewed and the methods of treatment compared with their subsequent clinical course. Of 86 patients evaluated, 47 had no treatment for hydrocephalus prior to tumor removal, 12 had external ventricular drainage, and 27 had cerebrospinal fluid (CSF) shunts before suboccipital craniectomy. Children with CSF shunts before tumor removal had significantly better postoperative conditions than the children without shunts (p < 0.01). Operative mortality of children without treatment of hydrocephalus before tumor surgery was 12.8%; it was 3.7% in the children with preexisting shunts. Treatment of hydrocephalus with a CSF shunt prior to suboccipital craniectomy was a safe procedure that significantly lowered the morbidity and mortality of subsequent tumor removal.

Quality of life in children treated for brain tumors

1983 ◽  
Vol 58 (1) ◽  
pp. 1-6 ◽  
Author(s):  
Larry E. Kun ◽  
Raymond K. Mulhern ◽  
J. Jeffrey Crisco
Keyword(s):  
Brain Tumors ◽  
Posterior Fossa ◽  
Cranial Irradiation ◽  
Social Emotional ◽  
Increased Intracranial Pressure ◽  
Primary Tumor Site ◽  
Content Type ◽  
Postoperative Irradiation ◽  
Iq Scores

✓ Thirty children with primary brain tumors were evaluated for alterations in intellectual, emotional, and academic functions. Nine were studied following surgery (prior to irradiation) and 21 after postoperative irradiation. Twenty-four patients (80%) showed no serious disabilities on routine medical and neurological examinations. Nineteen patients (63%) had normal intelligence quotient (IQ) levels. Qualitative disabilities on routine examinations were observed in six children: two of nine tested postoperatively, one of six tested after posterior fossa irradiation, and three of 15 tested after cranial irradiation. Subnormal IQ levels were also noted in two of nine children tested prior to irradiation and one of six after posterior fossa irradiation. Of the 15 studied after cranial irradiation, eight had subnormal IQ scores. Serial postirradiation testing in 10 patients revealed improvement in two, stability in five, and further deterioration in three. Ten children were placed in learning disability settings due to achievement delays or problems with selective attending. Social-emotional evaluations detected excessive tendencies toward psychotic symptomatology. Potential etiological factors, including primary tumor site, extent of irradiation, age, and increased intracranial pressure, are discussed. Preliminary findings suggest a greater than normal risk for late neuropsychological alterations among children with supratentorial tumors and/or cranial irradiation.

Corynebacterium Group JK pathogen in cerebrospinal fluid shunt infection

1988 ◽  
Vol 68 (4) ◽  
pp. 648-650 ◽  
Author(s):  
Gershon Keren ◽  
Tal Geva ◽  
Bianca Bogokovsky ◽  
Ethan Rubinstein
Keyword(s):  
Cerebrospinal Fluid ◽  
Normal Skin ◽  
Shunt Infection ◽  
Csf Shunt ◽  
Significant Feature ◽  
Csf Shunts ◽  
Laboratory Findings ◽  
Content Type ◽  
Central Nervous System Dysfunction ◽  
Skin Flora

✓ The clinical and laboratory findings in two cases of aerobic Corynebacterium Group JK infection of cerebrospinal fluid (CSF) shunts are described. These organisms have occasionally been reported as a cause of serious infections in man but have not been reported as a cause of shunt infection. In both cases, CSF pleocytosis was limited to 20 or 60 cells with variable protein and sugar values. Fever was a constant finding, frequently accompanied by signs of central nervous system dysfunction. Corynebacterium Group JK organisms are common contaminants of the normal skin flora. When isolated from the blood and/or the CSF of a patient with a CSF shunt who has symptoms and signs compatible with infection, the organism should not be dismissed as a contaminant. A significant feature of this group is its resistance to almost all presently available antibiotics including penicillin, the cephalosporins, and the aminoglycosides. These organisms are, however, sensitive to vancomycin.

Presence of vitronectin and activated complement factor C9 on ventriculoperitoneal shunts and temporary ventricular drainage catheters

1999 ◽  
Vol 90 (1) ◽  
pp. 101-108 ◽  
Author(s):  
Fredrik Lundberg ◽  
Dai-Qing Li ◽  
Dan Falkenback ◽  
Tor Lea ◽  
Peter Siesjö ◽  
...  
Keyword(s):  
Shunt Infection ◽  
Csf Shunt ◽  
Complement Factor ◽  
Ventricular Drainage ◽  
Csf Shunts ◽  
Native Form ◽  
Content Type ◽  
Csf Shunt Infection ◽  
Catheter Surface ◽  
Fine Print

Object. The pathogenesis of cerebrospinal fluid (CSF) shunt infection is characterized by staphylococcal adhesion to the polymeric surface of the shunt catheter. Proteins from the CSF—fibronectin, vitronectin, and fibrinogen—are adsorbed to the surface of the catheter immediately after insertion. These proteins can interfere with the biological systems of the host and mediate staphylococcal adhesion to the surface of the catheter. In the present study, the presence of fibronectin, vitronectin, and fibrinogen on CSF shunts and temporary ventricular drainage catheters is shown. The presence of fragments of fibrinogen is also examined.Methods. The authors used the following methods: binding radiolabeled antibodies to the catheter surface, immunoblotting of catheter eluates, and scanning force microscopy of immunogold bound to the catheter surface. The immunoblot showed that vitronectin was adsorbed in its native form and that fibronectin was degraded into small fragments. Furthermore, the study demonstrated that the level of vitronectin in CSF increased in patients with an impaired CSF—blood barrier. To study complement activation, an antibody that recognizes the neoepitope of activated complement factor C9 was used. The presence of activated complement factor C9 was shown on both temporary catheters and shunts.Conclusions. Activation of complement close to the surface of an inserted catheter could contribute to the pathogenesis of CSF shunt infection.

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.

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.

scholarly journals Stenotrophomonas maltophilia as a rare cause of meningitis and ventriculoperitoneal shunt infection

2021 ◽  
Vol 3 (10) ◽  
Author(s):  
Adarsh Manuel ◽  
Akarsh Jayachandran ◽  
Srinivasan Harish ◽  
Thenozhi Sunil ◽  
Vishnu Das K. R. ◽  
...  
Keyword(s):  
Ventriculoperitoneal Shunt ◽  
Stenotrophomonas Maltophilia ◽  
Type Species ◽  
Shunt Infection ◽  
Young Female ◽  
Shunt Revision ◽  
Content Type ◽  
Shunt Tube ◽  
Link Type ◽  
Ventriculoperitoneal Shunt Infection

Stenotrophomonas maltophilia is an extremely rare pathogen responsible for ventriculoperitoneal shunt infection and meningitis. This young female patient with history of multiple shunt revisions in the past, came to us with shunt dysfunction and exposure of the ventriculoperitoneal shunt tube in the neck. The abdominal end of the shunt tube was seen migrating into the bowel during shunt revision. The cerebrospinal fluid analysis showed evidence of Stenotrophomonas maltophilia growth. This is the first reported case of Stenotrophomonas maltophilia meningitis associated with ventriculoperitoneal shunt migration into the bowel.

Conray ventriculography in the diagnosis of intraventricular and posterior fossa lesions

1971 ◽  
Vol 34 (3) ◽  
pp. 405-407 ◽  
Author(s):  
Salvador Gonzalez-Cornejo
Keyword(s):  
Intracranial Pressure ◽  
Posterior Fossa ◽  
Increased Intracranial Pressure ◽  
Content Type ◽  
Conray Ventriculography ◽  
Fine Print

✓ The author reports the safe and satisfactory use of Conray ventriculography in 26 patients with increased intracranial pressure and discusses his technique for this procedure.

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.

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