Otogenic tension pneumocephalus complicated by eustachian tube insufflation in a patient with a ventriculoperitoneal shunt

2007 ◽  
Vol 106 (6) ◽  
pp. 1098-1101 ◽  
Author(s):  
Hidemasa Nagai ◽  
Kouzo Moritake
Keyword(s):  
Eustachian Tube ◽  
Valsalva Maneuver ◽  
Csf Shunt ◽  
Tympanic Cavity ◽  
Shunt Surgery ◽  
Shunt Insertion ◽  
Vp Shunt ◽  
Tension Pneumocephalus ◽  
Tegmen Tympani ◽  
Osseous Defects

✓Spontaneous tension pneumocephalus (TPC) related to shunt surgery has sometimes been reported with reference to the Valsalva maneuver and osseous defects of the tegmen tympani. Here, the authors report on a case of TPC complicated by eustachian tube (ET) insufflation and a ventriculoperitoneal (VP) shunt. This 78-year-old man had undergone VP shunt insertion 3 weeks before readmission to the hospital with a diagnosis of TPC, a left temporal porencephalic cyst, and air accumulation and late leakage of cerebrospinal fluid (CSF) into the left tympanic cavity. The TPC was controlled successfully by ligation of the shunt tube. The authors discuss the pathophysiology of this complicated TPC case, which illustrates the risk of ET insufflation in patients undergoing CSF shunt surgery.

scholarly journals Case Report: A case report of dry tap during ventriculostomy

F1000Research ◽  
2015 ◽  
Vol 4 ◽  
pp. 188
Author(s):  
Sunil Munakomi ◽  
Binod Bhattarai
Keyword(s):  
Case Report ◽  
External Ventricular Drain ◽  
Foramen Of Monro ◽  
Shunt Insertion ◽  
Gradual Improvement ◽  
Vp Shunt ◽  
Tension Pneumocephalus ◽  
Frontal Horn ◽  
Increased Risk ◽  
Ventricular Puncture

Pneumocephalus following ventriculoperitoneal (VP) shunt insertion is an exceptionally rare occurrence. We report such an event after attempting ventricular puncture (ventriculostomy) for VP shunt insertion and then discuss the management of the same. Dry tap can lead to multiple attempts for ventriculostomy with the associated added risks of complications, as well as complicating the subsequent management. In addition, there is an increased risk of tension pneumocephalus, seizure and shunt failure due to a blockage by air bubbles. Our patient presented with features of raised intracranial pressure two months following craniotomy and evacuation of traumatic subdural hematoma. External ventricular puncture revealed egress of CSF under pressure. Upon attempting VP shunting for post-traumatic hydrocephalus, we experienced dry tap during ventricular puncture that complicated further management. We placed the proximal shunt in the presumed location of the foramen of Monro of ipsilateral frontal horn of lateral ventricle and did not remove the external ventricular drain. Post-operative CT scan revealed pneumoventriculi as the cause for the dry tap during ventricular puncture. Patient was managed with 100% oxygen. He showed gradual improvement and was later discharged. This case shows that variations in the procedure, including head down positioning, adequate cruciate dural incision prior to cortex puncture, and avoiding excessive egress of CSF can help to prevent such complications.

Shunt complications in children with myelomeningocele: effect of timing of shunt placement

2009 ◽  
Vol 3 (6) ◽  
pp. 516-520 ◽  
Author(s):  
Farid Radmanesh ◽  
Farideh Nejat ◽  
Mostafa El Khashab ◽  
Syed Mohammad Ghodsi ◽  
Hasan Eftekhar Ardebili
Keyword(s):  
Shunt Infection ◽  
High Rate ◽  
Csf Shunt ◽  
Complication Rates ◽  
Shunt Surgery ◽  
Shunt Insertion ◽  
Shunt Complications ◽  
Shunt Placement ◽  
Initial Surgery ◽  
Significant Difference

Object There has been controversy over whether CSF shunt insertion simultaneously with repair of myelomeningocele (MMC) might increase shunt-related complications. The purpose of this study was to evaluate shunt complication rates in patients who underwent concurrent MMC surgery and shunt placement and compare them to the rates in patients treated with shunt placement in a separate procedure. Methods The authors retrospectively reviewed the outcome of shunt placement in 127 patients with MMC who were followed up for ≥ 1 year after shunt surgery. In 65 patients shunt surgery was performed in a second operation after MMC repair and in 46 the 2 procedures were performed concurrently. In 7 patients shunt placement was the initial surgery, and in 9 it was the only procedure performed. The patients were evaluated for shunt complications. Results There was no statistically significant between-groups difference in age at which patients underwent shunt placement. The overall rates of shunt infection and shunt malfunction were 16.5 and 39.4%, respectively. There was a high rate of shunt infection and mortality in those patients treated with CSF shunting only. There was no statistically significant difference between complication rates in patients in whom the 2 procedures were performed concurrently and those who underwent separate operations. Conclusions The order in which myelomeningocele repair and shunt placement were carried out did not have a significant effect on the rate of shunt complications. Thus, when indicated these procedures can be performed concurrently with a level of risk comparable to that associated with delayed shunt placement.

scholarly journals Indications of ventriculoperitoneal shunt: a prospective study

2017 ◽  
Vol 4 (4) ◽  
pp. 1319
Author(s):  
Ritvik D. Jaykar ◽  
Shrikant P. Patil
Keyword(s):  
Ct Scan ◽  
Tuberculous Meningitis ◽  
Surgical Techniques ◽  
Congenital Hydrocephalus ◽  
Clinical Feature ◽  
Communicating Hydrocephalus ◽  
Shunt Surgery ◽  
Shunt Insertion ◽  
Female Ratio ◽  
Vp Shunt

Background: Shunts have been used to drain the Cerebrospinal fluid into practically every body cavity, organ system and tissue spaces. Scraff has critically reviewed the efficacy of various shunts.  These are of historical interest.  Ventriculo peritoneal and ventriculo cardiac shunts continue to remain the chief surgical techniques in the management of hydrocephalus.Methods: This study included sixty cases where VP shunt insertion surgery was indicated. Chhabra’s medium pressure VP shunt was used in all 60 cases.  32 out of 60 cases were below 2 years (53.3%) .70% of the patients were male and 30% were female. Male to female ratio was 2.3:1. Out of 24 cases of congenital hydrocephalus 16 were due to aqueductal stenosis i.e. 66.6 % of cases. Dandy Walker malformation was found in 2 cases. And in 2 more cases, Arnold Chiari malformation was found. In acquired group 22 cases had tuberculous meningitis, 4 cases were of post meningitis aetiology and 10 cases were of communicating hydrocephalus with history of trauma.Results: In congenital group of patients, most common clinical feature was ‘enlargement of head’ bulging of fontanelle.  In acquired group of patients the common clinical features were headache, vomiting, fever and convulsions. USG cranium and CT scan proved to be highly informative investigations and were done wherever necessary. Out of 36 cases of acquired group the percentage of tuberculous meningitis was 61.6% and communicating hydrocephalus with trauma was about 27%. USG cranium was also used in follow up congenital hydrocephalus to assess the position and functioning of shunt.  Even CT scan was used in adult age group to assess the position of shunt and condition of the brain. All patients of with VP shunt surgery were treated with higher antibiotics preoperatively and postoperatively.Conclusions: Common complications included, shunt infections, shunt obstruction, shunt malposition. Rare complications included shunt migration through anus and shunt ascites. Four patients died after VP shunt surgery, two were operated case of encephalocele with associated congenital anomalies with uremia and other two were with dreaded shunt infection with septicaemia. Ten (16.6%) patients required revision of VP shunt surgery in present study.

scholarly journals Case Report: A case report of dry tap during ventriculostomy

F1000Research ◽  
2015 ◽  
Vol 4 ◽  
pp. 188
Author(s):  
Sunil Munakomi ◽  
Binod Bhattarai
Keyword(s):  
Case Report ◽  
External Ventricular Drain ◽  
Foramen Of Monro ◽  
Shunt Insertion ◽  
Gradual Improvement ◽  
Vp Shunt ◽  
Tension Pneumocephalus ◽  
Frontal Horn ◽  
Increased Risk ◽  
Ventricular Puncture

Pneumocephalus following ventriculoperitoneal (VP) shunt insertion is an exceptionally rare occurrence. We report such an event after attempting ventricular puncture (ventriculostomy) for VP shunt insertion and then discuss the management of the same. Dry tap can lead to multiple attempts for ventriculostomy with the associated added risks of complications, as well as complicating the subsequent management. In addition, there is an increased risk of tension pneumocephalus, seizure and shunt failure due to a blockage by air bubbles. Our patient presented with features of raised intracranial pressure two months following craniotomy and evacuation of traumatic subdural hematoma. External ventricular puncture revealed egress of CSF under pressure. Upon attempting VP shunting for post-traumatic hydrocephalus, we experienced dry tap during ventricular puncture that complicated further management. We placed the proximal shunt in the presumed location of the foramen of Monro of ipsilateral frontal horn of lateral ventricle and did not remove the external ventricular drain. Post-operative CT scan revealed pneumoventriculi as the cause for the dry tap during ventricular puncture. Patient was managed with 100% oxygen. He showed gradual improvement and was later discharged. This case shows that variations in the procedure, including head down positioning, adequate cruciate dural incision prior to cortex puncture, and avoiding excessive egress of CSF can help to prevent such complications.

Analysis of Factors associated with Revision of Ventriculoperitoneal shunt at National Institute of Neurological and Allied Science, Nepal

2019 ◽  
Vol 4 (2) ◽  
pp. 10-19
Author(s):  
Nikunja Yogi ◽  
Suraj Thulung ◽  
Mayush Bahadur Munakarmi ◽  
Rachana Nakarmi ◽  
Dinesh Nath Gongal
Keyword(s):  
External Ventricular Drain ◽  
Shunt Revision ◽  
Categorical Variables ◽  
Shunt Surgery ◽  
Shunt Insertion ◽  
Vp Shunt ◽  
Factors Associated ◽  
Duration Of Surgery ◽  
Drain Placement ◽  
One Year

Introduction: Ventriculoperitoneal (VP) shunt is the commonest procedure for hydrocephalus. The cases requiring shunt revision is a major obstacle in its management. Various factors have been implicated for failure or revision of shunt like patient’s age, sex, cause of hydrocephalus, duration of surgery. This study aims to analyze the rate of VP shunt revision and various factors associated with it. Methods: In this study, we analyzed 237 cases aged three months to 75 years, of VP shunt from January 2010-December 2014 with at least one year follow up at National Institute of Neurological and Allied Sciences. We evaluated the rate of VP shunt revision and various factors associated with it. The categorical variables were evaluated by chi-square test. Odds ratio was calculated for each factors at 95% CI. Results: There were 54 (22.78%) cases having at least one revision within one year of shunt insertion. The odds of revision of shunt was 6.58 times higher when inserted through frontal approach than occipital approach. The external ventricular drain placement prior to shunt surgery had statistically significant association with shunt revision (p=0.02). There was no difference in patients requiring/not requiring shunt revision when compared in terms of age group, gender, various etiologies and side of shunt insertions. Conclusions: The rate of shunt revision in our study was 22.78% which is comparable to other studies. Frontal approach in VP shunt insertion was associated with increased rate of shunt failure thus requiring revision. Likewise, external ventricular drain placement prior to shunt surgery was associated with increased incidence of revision surgery.

scholarly journals A Prospective Study and Analysis of Ventriculoperitoneal Shunt Surgery: Their Indication and Complication in a Single Tertiary Care Center

2021 ◽  
Author(s):  
Barnava Pal ◽  
Sambuddha Dhar ◽  
Anurag Sahu ◽  
Sumita Kumari ◽  
Kulwant Singh ◽  
...  
Keyword(s):  
Obstructive Hydrocephalus ◽  
Care Center ◽  
Tertiary Care ◽  
Normal Pressure ◽  
Shunt Surgery ◽  
Shunt Insertion ◽  
Vp Shunt ◽  
Male Predominance ◽  
Shunt Complications ◽  
Csf Analysis

Abstract Background Ventriculoperitoneal (VP) shunt insertion is routinely performed for the treatment of hydrocephalus due to different indications like congenital, infective, tumor, posttraumatic, and normal pressure hydrocephalus (NPH). A lot of common and rare complications following this procedure have been reported. Objectives To analyze the clinical profile, indications, anesthetic, and postoperative complications for VP shunt surgery in our center. Materials and Methods This prospective clinical review study was conducted in the Department of Neurosurgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, between October 2018 to January 2020 and included 454 cases of hydrocephalus who underwent VP shunt surgery. The data was compiled and analyzed. Results A total of 454 patients with male predominance were studied. Pediatric and adolescent patients were 48.9% (222/454). Obstructive hydrocephalus due to tumors was the etiology of 48.7% (221/454) cases. The incidence of overall shunt complications was 9.7% (44/454), of which obstruction and infection was 5.9% (27/454) and 3.1% (14/454), respectively. Factors associated with increased shunt complications include redo and infective etiology and cases having higher protein in perioperative cerebrospinal fluid (CSF) analysis. Neuronavigation, antibiotic-impregnated shunt and biventricular shunt are associated with lower complications. Conclusion Obstructive hydrocephalus due to tumors happened to be the most common cause of VP shunt, and shunt obstruction is most common complication, especially in infective and redo cases.

scholarly journals Brain Studded with Innumerable Larger Stones: Starry Sky at Night Appearance: Multiple Calcified Giant Tuberculoma with 15 Years of Follow-up

2017 ◽  
Vol 06 (02) ◽  
pp. 155-158
Author(s):  
Guru Satyarthee ◽  
P. Chandra ◽  
A. Mahapatra
Keyword(s):  
Central Nervous System Involvement ◽  
Definitive Diagnosis ◽  
Shunt Surgery ◽  
Unique Case ◽  
Major Health Problem ◽  
Major Health ◽  
Vp Shunt ◽  
Cranial Ct ◽  
Rising Incidence

AbstractTuberculosis is rapidly reemerging as a major health problem due to rising incidence of HIV cases across the globe. Central nervous system involvement is rare, but rarely multiple intracerebral granulomas can occur or occasional solitary tuberculoma also develops. The authors report a unique case of 24-year-old woman suffering from pulmonary tuberculosis developed headache and vomiting. Cranial CT scan revealed multiple widespread deposit of intracranial granuloma of sizeable lesion mimicking starry sky at night appearance. Excision of one tuberculoma was done for confirmation of definitive diagnosis, and histopathology was suggestive of tuberculoma. The patient also underwent VP shunt surgery. At last follow-up at 15 years following surgery, she was doing well.

scholarly journals Reconstruction of the Eustachian Tube and Anterior Tympanic Cavity

1980 ◽  
Vol 73 (2) ◽  
pp. 155-161
Author(s):  
Kiyotaka Murata ◽  
Akira Takagi
Keyword(s):  
Eustachian Tube ◽  
Tympanic Cavity

Cerebrospinal fluid shunt insertion: techniques of peritoneal catheter placement separate from abdominal fascial and peritoneal incisions

2010 ◽  
Vol 113 (1) ◽  
pp. 79-81 ◽  
Author(s):  
Abdurrahim A. Elashaal ◽  
Michael Corrin ◽  
Michael D. Cusimano
Keyword(s):  
Abdominal Wall ◽  
Csf Shunt ◽  
Abdominal Wall Closure ◽  
Peritoneal Catheter ◽  
Effective Technique ◽  
Shunt Insertion ◽  
Risk Patients ◽  
Abdominal Operations ◽  
Insertion Techniques ◽  
Almost All

Good abdominal wall closure is one of the basic surgical skills and is a common feature of almost all modernday CSF shunt operations. The fact that some patients require multiple abdominal operations highlights the need for a simple and effective technique for peritoneal catheter insertion through the abdominal wall and abdominal wall closure. Although technically simple, abdominal wall closure becomes more complex when combined with the requirement to maintain CSF shunt function in cases in which the shunt catheter passes through the abdominal wall into the peritoneal cavity. In this report, the authors describe a simple technique for passing the peritoneal catheter of a ventriculoperitoneal shunt through the abdominal wall on a pathway separate from the fascial opening. This technique minimizes the risk of abdominal wall–related complications and is especially important in high-risk patients such as those with obesity and/or diabetes and in children.

scholarly journals Unusual Gross Pneumocephalus and Pneumoperitoneum after VP Shunt Surgery: A Case Report

2015 ◽  
Vol 4 (2) ◽  
Author(s):  
A Khanolkar ◽  
YK Sarin
Keyword(s):  
Case Report ◽  
Unusual Case ◽  
Shunt Surgery ◽  
Vp Shunt ◽  
Shunt Procedure ◽  
Surgical Emphysema

We report an unusual case where a two-month infant developed a simultaneous and spontaneous pneumocephalus and gross pneumoperitoneum along with progressive surgical emphysema after VP shunt procedure.

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