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.

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.

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.

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.

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.

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.

Multiple schwannomas: schwannomatosis or neurofibromatosis type 2?

1998 ◽  
Vol 89 (1) ◽  
pp. 36-41 ◽  
Author(s):  
Matti Tapio Seppälä ◽  
Markku Alarik Sainio ◽  
Matti Jouko Johannes Haltia ◽  
Jaakko Jyri Kinnunen ◽  
Kirsi Hannele Setälä ◽  
...  
Keyword(s):  
Clinical Course ◽  
Positive Family History ◽  
Neurofibromatosis Type ◽  
Magnetic Resonance Images ◽  
Neurofibromatosis Type 2 ◽  
Long Term Outcome ◽  
Content Type ◽  
Fine Print

Object. The aim of this study was to clarify the clinical outcome of schwannomatosis, a rare condition characterized by multiple nonvestibular schwannomas in the absence of meningiomas, intraspinal ependymomas, and other clinical signs of neurofibromatosis type 2 (NF2). Methods. Nine patients with schwannomatosis treated at one institution are presented and their clinical course during a median follow-up time of 9.9 years is discussed. The patients were typically middle-aged at the time of their first operation (median 43.5 years), none had a positive family history of schwannomatosis or NF2, and none showed cutaneous or ocular signs of NF2. On histopathological examination the tumors from the patients with schwannomatosis showed a lobular appearance and frequent Verocay bodies, signs indicating NF2, more often than 20 sporadic schwannomas that were investigated as controls. Two patients died of unrelated causes at 3.2 and 9.9 years, respectively, of follow up. Magnetic resonance images of the head and spine were obtained in seven patients at the end of the follow-up period. New spinal schwannomas were detected in one patient and a residual schwannoma in three. No germline mutations of the NF2 gene were found in these seven patients. Two additional patients originally included in the schwannomatosis group who were 8.6 and 11.7 years old at initial surgery had NF2. One was diagnosed at follow-up review and the other developed a fulminant disease that led to death in 4 years. Conclusions. The clinical course, long-term outcome, and genetic mechanism of schwannomatosis differ from that of NF2.

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.

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.

Peritoneal cerebrospinal fluid shunt insertion: a technique for protection of the abdominal catheter

1995 ◽  
Vol 82 (2) ◽  
pp. 305-306 ◽  
Author(s):  
Joseph H. Piatt
Keyword(s):  
Cerebrospinal Fluid ◽  
Wound Infection ◽  
Abdominal Wound ◽  
Cerebrospinal Fluid Shunt ◽  
Shunt Insertion ◽  
Content Type ◽  
A Minor ◽  
Fine Print

✓ A minor modification of the technique of peritoneal cerebrospinal fluid shunt insertion allows more anatomical closure of the abdominal wound and may protect the shunt from contamination by superficial abdominal wound infection.

Clinical course of patients with ossification of the posterior longitudinal ligament: a minimum 10-year cohort study

2004 ◽  
Vol 100 (3) ◽  
pp. 245-248 ◽  
Author(s):  
Shunji Matsunaga ◽  
Takashi Sakou ◽  
Eiji Taketomi ◽  
Setsuro Komiya
Keyword(s):  
Cohort Study ◽  
Clinical Course ◽  
Japanese Orthopaedic Association ◽  
Posterior Longitudinal Ligament ◽  
Cervical Canal ◽  
Content Type ◽  
Significant Difference ◽  
Fine Print

Object. Ossification of the posterior longitudinal ligament (OPLL) may produce quadriplegia. The course of future neurological deterioration in patients with radiographic evidence of OPLL, however, is not known. The authors conducted a long-term follow-up cohort study of more than 10 years to clarify the clinical course of this disease progression. Methods. A total of 450 patients, including 304 managed conservatively and 146 treated by surgery, were enrolled in the study. All patients underwent neurological and radiographical follow-up examinations for a mean of 17.6 years. Myelopathy was graded using Nurick classification and the Japanese Orthopaedic Association scale. Fifty-five (17%) of 323 patients without myelopathy evident at the first examination developed myelopathy during the follow-up period. Risk factors associated with the evolution of myelopathy included greater than 60% OPLL-induced stenotic compromise of the cervical canal, and increased range of motion of the cervical spine. Using Kaplan—Meier analysis, the myelopathy-free rate in patients without first-visit myelopathy was 71% after 30 years. A significant difference in final functional outcome was not observed between nonsurgical and surgical cases in which preoperative Nurick grades were 1 or 2. In patients with Nurick Grade 3 or 4 myelopathy, however, only 12% who underwent surgery eventually became wheelchair bound or bedridden compared with 89% of those managed conservatively. Surgery proved ineffective in the management of patients with Grade 5 disease. Conclusions. Results of this long-term cohort study elucidated the clinical course of OPLL following conservative or surgical management. Surgery proved effective for the management of patients with Nurick Grades 3 and 4 myelopathy.

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