Rethinking the indications for the ventriculoperitoneal shunt tap

2008 ◽  
Vol 1 (6) ◽  
pp. 435-438 ◽  
Author(s):  
Jonathan P. Miller ◽  
Steven C. Fulop ◽  
Shervin R. Dashti ◽  
Shenandoah Robinson ◽  
Alan R. Cohen
Keyword(s):  
Ventriculoperitoneal Shunt ◽  
Shunt Infection ◽  
Shunt Malfunction ◽  
Shunt Revision ◽  
Status Change ◽  
Suspected Infection ◽  
Evaluation Protocol ◽  
Distal Obstruction ◽  
Abdominal Radiographs ◽  
Shunt Obstruction

Object Tapping of a suspected malfunctioning ventriculoperitoneal shunt is usually easy, sometimes informative, but also potentially misleading. The purpose of this study was to determine the effectiveness of a shunt evaluation protocol that does not involve direct shunt tapping except in rare and specific cases. Methods The authors adopted a protocol for shunt evaluation that involves shunt tapping only in selected cases of suspected infection or in patients with noncommunicating hydrocephalus and equivocal computed tomography (CT) findings of shunt infection. They then reviewed the clinical characteristics and surgical findings in 373 consecutive assessments of 155 pediatric patients who were evaluated for shunt malfunction and/or infection by using this protocol between January 2003 and December 2005. Results Mental status change and headache were the symptoms most concordant with shunt malfunction, but no symptom had a predictive value much better than 50%. Follow-up CT scans demonstrated enlarged ventricles in 72 of 126 cases of shunt revision. Among those with obstruction but without remarkable CT changes, 8 patients had evidence of distal obstruction on x-ray “shunt series” consisting of skull, chest, and abdominal radiographs, and 5 had obvious symptoms that rendered further testing unnecessary; 38 cases of obstruction were diagnosed based on elevated opening pressure on lumbar puncture (mean 34.7 cm H2O). A shunt tap was required in only 8 cases (2%). Conclusions The authors have shown that it is possible to evaluate the majority of ventricular shunt malfunctions without tapping the device. Because it is possible to diagnose shunt obstruction correctly by other means, the shunt tap may not be obligatory as a routine test of the device's patency.

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.

Risk factors for unchanged ventricles during pediatric shunt malfunction

2021 ◽  
pp. 1-7
Author(s):  
Rebecca A. Reynolds ◽  
Ranbir Ahluwalia ◽  
Vishal Krishnan ◽  
Katherine A. Kelly ◽  
Jaclyn Lee ◽  
...  
Keyword(s):  
Risk Factors ◽  
Multivariable Analysis ◽  
Shunt Infection ◽  
Shunt Malfunction ◽  
Shunt Revision ◽  
Diagnostic Dilemma ◽  
Wound Drainage ◽  
Abdominal Pseudocyst ◽  
Programmable Valve ◽  
Matched Case

OBJECTIVE Children whose ventricles do not change during shunt malfunction present a diagnostic dilemma. This study was performed to identify risk factors for unchanged ventricular size at shunt malfunction. METHODS This retrospective 1:1 age-matched case-control study identified children with shunted hydrocephalus who underwent shunt revision with intraoperative evidence of malfunction at one of the three participating institutions from 1997 to 2019. Cases were defined as patients with a change of < 0.05 in the frontal–occipital horn ratio (FOR) between malfunction and baseline, and controls included patients with FOR changes ≥ 0.05. The presence of infection, abdominal pseudocyst, pseudomeningocele, or wound drainage and lack of baseline cranial imaging at the time of malfunction warranted exclusion. RESULTS Of 450 included patients, 60% were male, 73% were Caucasian, and 67% had an occipital shunt. The median age was 4.3 (IQR 0.97–9.21) years at malfunction. On univariable analysis, unchanged ventricles at malfunction were associated with a frontal shunt (41% vs 28%, p < 0.001), programmable valve (17% vs 9%, p = 0.011), nonsiphoning shunt (85% vs 66%, p < 0.001), larger baseline FOR (0.44 ± 0.12 vs 0.38 ± 0.11, p < 0.001), no prior shunt infection (87% vs 76%, p = 0.003), and no prior shunt revisions (68% vs 52%, p < 0.001). On multivariable analysis with collinear variables removed, patients with a frontal shunt (OR 1.67, 95% CI 1.08–2.70, p = 0.037), programmable valve (OR 2.63, 95% CI 1.32–5.26, p = 0.007), nonsiphoning shunt at malfunction (OR 2.76, 95% CI 1.63–4.67, p < 0.001), larger baseline FOR (OR 3.13, 95% CI 2.21–4.43, p < 0.001), and no prior shunt infection (OR 2.34, 95% CI 1.27–4.30, p = 0.007) were more likely to have unchanged ventricles at malfunction. CONCLUSIONS In a multicenter cohort of children with shunt malfunction, those with a frontal shunt, programmable valve, nonsiphoning shunt, baseline large ventricles, and no prior shunt infection were more likely than others to have unchanged ventricles at shunt failure.

scholarly journals Clinical study and management of hydrocephalus in children

2020 ◽  
Vol 7 (4) ◽  
pp. 1258
Author(s):  
Santoshkumar N. Deshmukh ◽  
Ashishkumar T. Yadav
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Congenital Anomalies ◽  
Shunt Infection ◽  
Aqueductal Stenosis ◽  
Shunt Revision ◽  
Medical College ◽  
Shunt Obstruction ◽  
The Brain

Background: Hydrocephalus is a condition in which an accumulation of cerebrospinal fluid (CSF) occurs within the brain. Hydrocephalus can occur at any age, but it is more common in infants. Long-term complications of hydrocephalus can vary widely and are often difficult to predict and may result in significant intellectual, developmental and physical disabilities. Ventriculoperitoneal shunt remains mainstay of treatment even today as it is easily available and inexpensive.Methods: The study was conducted in Dr. V. M. Government Medical College and Hospital located in Solapur (Maharashtra) from September 2016 to 2018.  It was a prospective descriptive study. 30 cases up to the age 14 years with diagnosis of hydrocephalus undergoing VP (ventriculo-peritoneal) shunt surgery were included in the study.Results: Aqueductal stenosis and tuberculous meningitis were the commonest causes of congenital and acquired hydrocephalus in children respectively. Shunt infection and shunt obstruction were the commonest post-operative complications required shunt revision. Low birth weight and other associated congenital anomalies increased the mortality rate.Conclusions: VP shunt placement has been the main treatment modality for hydrocephalus. VP shunts procedures are associated with complications and morbidity. Number of revision shunt procedures, low birth weight, associated congenital anomalies adversely affected the final surgical outcome.

Abdominal X-ray and Pathological Findings in Distal Unishunt Obstruction

Neurosurgery ◽  
1988 ◽  
Vol 23 (6) ◽  
pp. 749-752 ◽  
Author(s):  
Peter Le Roux ◽  
Mitchel Berger ◽  
Denis Benjamin
Keyword(s):  
Surgical Revision ◽  
Shunt Malfunction ◽  
Pathological Findings ◽  
X Ray ◽  
Computed Tomographic ◽  
Distal Obstruction ◽  
Shunt Obstruction

Abstract A new x-ray finding suggesting distal obstruction of the Unishunt is described. Fusiform swelling of the distal slit valve (“pantaloon sign”) seen on an abdominal x-ray film was associated with surgically proven distal shunt obstruction in 8 of 10 patients. No patient with a normally functioning (n = 67) or proximally malfunctioning shunt (n = 6) displayed this abnormality. This finding in association with clinical and computed tomographic evidence of shunt malfunction can direct surgical revision to the appropriate site. The pathology of distal shunt malfunction is also reviewed.

scholarly journals VP Shunt Complications: Ten Years Experience at UDMNINAS

2019 ◽  
Vol 16 (3) ◽  
pp. 40-42
Author(s):  
Subash Lohani ◽  
Aashish Baniya
Keyword(s):  
Retrospective Review ◽  
Pediatric Population ◽  
Shunt Infection ◽  
Shunt Malfunction ◽  
Shunt Revision ◽  
Shunt Complication ◽  
Vp Shunt ◽  
Shunt Complications ◽  
International Data ◽  
Ventriculo Peritoneal Shunt

Ventriculo-Peritoneal shunt is significantly associated with complications like malfunction and infection. In this study, we aim to review our infection and malfunction rate. This is a retrospective review of charts of patients who underwent ventriculo-peritonealshunt at Upendra Devkota Memorial National Institute of Neurological and Allied Sciences, Bansbari, Nepal between 2008 and 2018. Patients were interviewed via telephone for information regarding shunt complications in the form of malfunction, infection, and the need for revision. A total of 357 patients underwent ventriculoperitonealshunt over a period of 10 years.   of patients was 37.08 years. There were224 males and133 females with M:F::1.7:1.265 patients were available over telephone for interview. 54 of 265 (20.37%) patients needed shunt revision. 32 (12.07%) of them had shunt malfunction. 21 (7.92%) of them had shunt infection. One (0.37%) patient had problems with over drainage. Shunt complications were proportionate in pediatric population as well. Shunt complication at Upendra Devkota Memorial National Institute of Neurological and Allied Sciences is comparable to international data.

A Novel Technique for Distal Shunt Revision: Retrospective Analysis of Guidewire-Assisted Distal Catheter Replacement

2015 ◽  
Vol 11 (3) ◽  
pp. 367-370
Author(s):  
Eric A Sribnick ◽  
Frederick H Sklar ◽  
David M Wrubel
Keyword(s):  
Ventriculoperitoneal Shunt ◽  
Postoperative Outcome ◽  
Late Complications ◽  
Shunt Malfunction ◽  
Shunt Revision ◽  
Seldinger Technique ◽  
Entry Site ◽  
Common Procedure ◽  
Distal Catheter ◽  
Catheter Replacement

Abstract BACKGROUND Ventriculoperitoneal shunt revision is a common procedure. Disconnection and fracture of the distal catheter remain a common cause of ventriculoperitoneal shunt malfunction. OBJECTIVE To describe a novel procedure for peritoneal replacement of the distal catheter by using a guidewire and a modified Seldinger technique (guidewire-assisted distal catheter replacement) and retrospectively evaluate the results of the surgical procedure. METHODS Between September 2005 and December 2013, 68 patients were treated by a single surgeon (DMW) with distal catheter replacement using our technique. In brief, the previously placed distal catheter was exposed at its entry site into the abdomen. A soft guidewire with hydrophilic coating was inserted down the distal catheter into the peritoneum. The distal catheter was then removed over the guidewire, leaving the guidewire in place. A peel-away sheath and dilator were then inserted over the guidewire, and the dilator and guidewire were removed. The new distal catheter was then passed from the valve to the abdomen and was then fed through the peel-away sheath into the peritoneum. Charts were retrospectively reviewed for preoperative presentation, operative technique, and postoperative outcome. Records were specifically examined for any early or late complications. RESULTS The mean patient age at surgery was 13 years. No immediate acute complications were noted. Of the 68 total patients, 45 patients had more than 6 months of follow-up. Of the 68 patients, 7 patients required another distal revision after guidewire-assisted distal catheter replacement. CONCLUSION Distal shunt malfunction due to a mechanical failure is a common reason for shunt revision. We describe a technique for guidewire-assisted distal catheter replacement.

Ventriculoperitoneal Shunt Malfunction during Pregnancy

Neurosurgery ◽  
1990 ◽  
Vol 27 (6) ◽  
pp. 969-971 ◽  
Author(s):  
Michael D. Cusimano ◽  
Filomena M. Meffe ◽  
Fred Gentili ◽  
Mathew Sermer
Keyword(s):  
Cerebrospinal Fluid ◽  
Ventriculoperitoneal Shunt ◽  
Reproductive Age ◽  
Shunt Malfunction ◽  
Cerebrospinal Fluid Shunts ◽  
Third Trimester ◽  
The Third ◽  
Shunt Obstruction

Abstract Many women with cerebrospinal fluid shunts are now reaching reproductive age. Shunt malfunction may occur during pregnancy, and management requires a well-planned, combined neurosurgical and obstetrical approach. We present a case of ventriculoperitoneal shunt obstruction manifesting during the third trimester managed successfully in a conservative fashion. The literature on ventriculoperitoneal shunt malfunction during pregnancy is reviewed.

Characteristics of Ventricular Shunt Malfunctions among Patients with Neurocysticercosis

Neurosurgery ◽  
2002 ◽  
Vol 50 (4) ◽  
pp. 757-762 ◽  
Author(s):  
Rosemarie Kelley ◽  
Duc H. Duong ◽  
George E. Locke
Keyword(s):  
Disease Activity ◽  
Ventriculoperitoneal Shunt ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Distal Segment ◽  
Shunt Malfunction ◽  
Proximal Segment ◽  
Shunt Failure ◽  
Shunt Placement ◽  
Shunt Obstruction

Abstract OBJECTIVE: Ventricular shunts used to relieve hydrocephalus among patients with neurocysticercosis have been plagued by high shunt malfunction rates. We examined the characteristics of shunt malfunctions among patients with neurocysticercosis. METHODS: This is a retrospective chart review of data for 122 patients who were admitted with a diagnosis of cysticercosis during a 5.5-year period. Cases of hydrocephalus requiring shunt placement were reviewed with respect to the segment of shunt obstruction, disease activity at the time of shunt placement, and the effects of antihelminthic treatment on shunt failures and longevity. RESULTS: Twenty-one patients required 49 operations for relief of hydrocephalus, including 22 new shunt placements, 23 revisions, and 4 cyst extirpations. Of these shunt failures, 78% occurred within the first 12 months and 96% within 3 years. Of the failures that occurred in the distal segment, 75% occurred within 6 months. By comparison, 33% of proximal segment obstructions and 50% of the total number of valve obstructions occurred within the first 6 months. Of the shunts placed during the vesicular stage of infection, 63% required revisions, compared with 29% of those placed during the colloidal through calcified stages. Nineteen shunts were placed during the vesicular stage, and nine patients received a full course of antihelminthic treatment after shunt placement. In less than 6 months, 33% of the cases involving shunt placement followed by antihelminthic treatment exhibited shunt failure, compared with 90% of the cases without antihelminthic treatment (P &lt; 0.05, χ2 test). CONCLUSION: Among patients with vesicular stage cysticercosis, placement of a ventriculoperitoneal shunt followed by a course of antihelminthic medication seems to promote shunt longevity.

scholarly journals A study of VP shunt in management of hydrocephalus

2017 ◽  
Vol 4 (5) ◽  
pp. 1697
Author(s):  
Sudhir Singh Pal ◽  
Saurabh Dubey
Keyword(s):  
Shunt Infection ◽  
Shunt Malfunction ◽  
Shunt Revision ◽  
Chi Square ◽  
Vp Shunt ◽  
Shunt Complications ◽  
Medical College ◽  
Chi Square Test ◽  
Gandhi Medical College ◽  
Shunt Migration

Background: Hydrocephalus a neurological disorder common in both children and adults. VP shunt placement is considered the mainstay of management. The aim was to study complications of VP Shunt and factors influencing shunt malfunction and prognosis.Methods: This study was conducted in the Department of Surgery, Gandhi Medical College Bhopal, Madhya Pradesh, India between January 2013 to August 2016 and included all patients of hydrocephalus who underwent VP shunt surgery. We performed a retrospective and prospective data review which was subjected to statistical analysis, frequency determination, determination of mean and standard deviation, Pearson’s Chi-square test for studying associations between variables.Results: A total of 198 patients were studied. The predominant etiologies being congenital hydrocephalus, aqueduct stenosis, spina bifida/MMC, intracranial space occupying lesions and tuberculous meningitis. The incidence of overall shunt complications was 28.8%, incidence of shunt revision was 21.2%, shunt blockade 7.6%), shunt migration 5.05%, shunt infection 4.5%, and shunt malfunction due to other causes 8.6%. The mortality rate was 20.2%.  Factors associated with increased shunt complications included infective etiology of the hydrocephalus and CSF culture positivity in preoperative period.Conclusions: Infective and traumatic causes of hydrocephalus are more likely to be associated with complications like infection and obstruction. Shunt migration is seen in paediatric patients.

Chronic Headache in the Shunt-dependent Adolescent with Nearly Normal Ventricular Volume

Neurosurgery ◽  
1978 ◽  
Vol 3 (3) ◽  
pp. 339-343
Author(s):  
Fred Epstein ◽  
Arthur E. Marlin ◽  
Alvin Wald
Keyword(s):  
Chronic Headache ◽  
Positive Contrast ◽  
Ventricular Volume ◽  
Comprehensive Approach ◽  
Shunt Malfunction ◽  
Shunt Revision ◽  
Icp Monitoring ◽  
Dependent Child ◽  
Axial Tomography ◽  
Distal Obstruction

Abstract The shunt-dependent adolescent will occasionally manifest shunt malfunction by intermittent or chronic headache without any obvious signs of increased intracranial pressure (ICP). A small percentage of these patients will have nearly normal ventricular volume, making the diagnosis and treatment difficult. The authors present a comprehensive approach to this problem that uses computerized axial tomography (CT), ICP monitoring, positive contrast or isotope shunt scan, shunt revision, subtemporal craniectomy, or medical management as the individual situation dictates. The CT scan identifies patients with nearly normal ventricular volume. ICP monitoring then determines whether there is shunt malfunction. The shunt scan aids in localization of the malfunction. For distal obstruction, a simple revision is performed. When proximal shunt malfunction occurs, either subtemporal craniectomy or revision is carried out. It has been documented that occasionally ICP is episodically increased in the absence of shunt malfunction. This is secondary to abnormal brain compliance, and subtemporal craniectomy alone or in conjunction with corticosteroids is curative. This comprehensive approach is designed to provide a method for recognizing and treating intermittently increased ICP in the shunt-dependent child.

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