Use of percutaneous endoscopy to place syringopleural or cystoperitoneal cerebrospinal fluid shunts

2005 ◽  
Vol 2 (4) ◽  
pp. 498-504 ◽  
Author(s):  
James D. Guest ◽  
Lisa Silbert ◽  
Carlos E. Casas
Keyword(s):  
Cerebrospinal Fluid ◽  
Cerebrospinal Fluid Shunts ◽  
Peritoneal Catheter ◽  
Content Type ◽  
Shunt Placement ◽  
Spinal Cysts ◽  
Safe Access ◽  
Percutaneous Endoscopy ◽  
Entire Procedure ◽  
Fine Print

✓ The authors describe a technique for percutaneous endoscopic shunt placement to treat clinically symptomatic spinal cysts. Seven patients underwent the procedure—five with syringomyelia, one with a symptomatic perineurial cyst, and one with a large arachnoid cyst. In all patients the shunt was successfully placed, and clinical improvement occurred in six. In four patients the entire procedure was performed endoscopically, whereas in three conversion to an open surgical exposure was required for safe access of a syrinx cavity. Overall, however, the pleural or peritoneal catheter was successfully placed endoscopically in all seven patients. There were two cases of postoperative positional headaches of which one required valve revision. In one case the catheter migrated and required repositioning. Percutaneous endoscopic shunt placement appears feasible in appropriately selected patients.

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.

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.

Cerebrospinal fluid shunt infections with anaerobic diphtheroids (Propionibacterium species)

1976 ◽  
Vol 44 (5) ◽  
pp. 580-584 ◽  
Author(s):  
E. Dale Everett ◽  
Theodore C. Eickhoff ◽  
Richard H. Simon
Keyword(s):  
Cerebrospinal Fluid ◽  
Spinal Fluid ◽  
Cerebrospinal Fluid Shunts ◽  
Cerebrospinal Fluid Shunt ◽  
Laboratory Findings ◽  
Content Type ◽  
Central Nervous System Dysfunction ◽  
Symptoms And Signs ◽  
Shunt Infections ◽  
Fine Print

✓ The clinical and laboratory findings in six cases of anaerobic diphtheroid infection of cerebrospinal fluid shunts are described. These organisms have been infrequently reported as a cause of shunt infections but our data indicate that such infections may be more common than currently appreciated. Propionibacterium species are common contaminants of cerebrospinal fluid specimens, but when isolated from the spinal fluid of a patient with a shunt who has symptoms and signs compatible with infection, the organism should not be dismissed as a contaminant. Fever was a constant finding frequently accompanied by signs of central nervous system dysfunction. Spinal fluid pleocytosis was usually limited to 1 to 200 cells and protein and sugar values were variable. The organisms grow slowly, therefore spinal fluid cultures should be held for at least 14 days before they are reported as negative.

Ventriculoauriculostomy-associated infection

1971 ◽  
Vol 35 (6) ◽  
pp. 686-694 ◽  
Author(s):  
David B. Shurtleff ◽  
Dennis Christie ◽  
Eldon L. Foltz
Keyword(s):  
Cerebrospinal Fluid ◽  
Infection Rate ◽  
Blood Cultures ◽  
Operative Procedures ◽  
Cerebrospinal Fluid Shunts ◽  
Postoperative Infections ◽  
Content Type ◽  
Delayed Group ◽  
Fine Print

✓ A series of 102 newly referred and uninfected patients on whom 299 operative procedures to insert ventriculoauricular cerebrospinal fluid shunts were performed over a 12-year period were studied for the rate and cause of associated sepsis. It was found that 15.7% of the shunt insertions were followed by infection, and 1.3% of the revisions, for an overall infection rate of 14%. There were two clinical groups, those who developed acute postoperative infections (9%) and those with delayed infections developing 1 month to 6 years after operation (5%). The causes of the infections are discussed. It is suggested that careful follow-up with frequent blood cultures will reveal more infected cases in the delayed group, and that bacteriocidal agents selected for the specific organism should be maintained in cerebrospinal fluid and blood for long periods.

Mixed bacterial meningitis: A complication of ventriculo- and lumboperitoneal shunts

1977 ◽  
Vol 47 (6) ◽  
pp. 961-964 ◽  
Author(s):  
Itzhak Brook ◽  
Neil Johnson ◽  
Gary D. Overturf ◽  
Jeanette Wilkins
Keyword(s):  
Cerebrospinal Fluid ◽  
Bacterial Meningitis ◽  
Infectious Complications ◽  
Colonic Perforation ◽  
Shunt Surgery ◽  
Peritoneal Catheter ◽  
Distal Limb ◽  
Content Type ◽  
Aerobic And Anaerobic ◽  
Fine Print

✓ Infectious complications of ventriculo- and lumboperitoneal shunts in two patients are presented. Cerebrospinal fluid infection due to aerobic and anaerobic enteric flora was characteristic of each case. Both infections occurred several months after shunt surgery and were associated with colonic perforation by the distal limb of the peritoneal catheter. These cases emphasize this unusual hazard of peritoneal shunts and demonstrate methods for diagnosis and effective therapy.

Evaluation of CSF shunt patency by means of technetium-99m DTPA

1982 ◽  
Vol 57 (2) ◽  
pp. 262-266 ◽  
Author(s):  
Peter Graham ◽  
Robert Howman-Giles ◽  
Ian Johnston ◽  
Michael Besser
Keyword(s):  
Cerebrospinal Fluid ◽  
Csf Shunt ◽  
Cerebrospinal Fluid Shunts ◽  
Simple Method ◽  
Content Type ◽  
Documented Case ◽  
Technetium 99M ◽  
Shunt Tubing ◽  
Fine Print

✓ Evaluation of 192 cerebrospinal fluid shunts was performed using 1 mCi of technetium-99m DTPA which was injected into the shunt tubing. This was found to be a safe, simple method of evaluating shunt patency. No complications were noted with this procedure, nor was there any documented case of infection related to the injection of the isotope. The sensitivity of the test for evaluation of patency was 97%, specificity 90%, and accuracy 93%. Various patterns of tracer clearance are noted and discussed. The role of this test as an aid in making management decisions is detailed.

Age dependency of resistance to cerebrospinal fluid outflow

1998 ◽  
Vol 89 (2) ◽  
pp. 275-278 ◽  
Author(s):  
Michael J. Albeck ◽  
Claus Skak ◽  
Per R. Nielsen ◽  
Karsten S. Olsen ◽  
Svend E. Børgesen ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Clinical Effect ◽  
Csf Shunt ◽  
Elderly Persons ◽  
Patient Age ◽  
Content Type ◽  
Shunt Placement ◽  
Residual Variation ◽  
Patient Âgé ◽  
Fine Print

Object. Resistance to cerebrospinal fluid (CSF) outflow (Rout) is an important parameter in assessing the need for CSF shunt placement in patients with hydrocephalus. The normal lower limit of Rout has been estimated on the basis of the clinical effect of shunt placement in patients with varying values of Rout and in young healthy volunteers. The lack of clinical effect from CSF shunts in some elderly patients, despite elevated Rout, suggests that the normal value of Rout increases with age and may be higher in elderly persons. The aim of the present study was to examine the relationship between Rout and age in patients without known CSF dynamic disturbances. Methods. Fifty-two patients ranging from 20 to 88 years of age and with no known CSF dynamic disorders were examined. The Rout was measured using a lumbar computerized infusion test. The correlation between Rout and age was analyzed by performing linear regression. The Rout increased significantly with patient age. The Rout in a patient in the eighth decade will be approximately 5 mm Hg/ml/minute higher than in a young patient. Conclusions. The present study shows a small but critical increase in Rout with increased patient age. A notable residual variation was present and borderline values of Rout should be regarded and used with caution.

Endoscopic third ventriculostomy in patients with cerebrospinal fluid infection and/or hemorrhage

2002 ◽  
Vol 97 (3) ◽  
pp. 519-524 ◽  
Author(s):  
Vitaly Siomin ◽  
Giuseppe Cinalli ◽  
Andre Grotenhuis ◽  
Aprajay Golash ◽  
Shizuo Oi ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Success Rate ◽  
Endoscopic Third Ventriculostomy ◽  
Aqueductal Stenosis ◽  
Third Ventriculostomy ◽  
Content Type ◽  
Vp Shunt ◽  
Shunt Placement ◽  
History Of ◽  
Fine Print

Object. In this study the authors evaluate the safety, efficacy, and indications for endoscopic third ventriculostomy (ETV) in patients with a history of subarachnoid hemorrhage or intraventricular hemorrhage (IVH) and/or cerebrospinal fluid (CSF) infection. Methods. The charts of 101 patients from seven international medical centers were retrospectively reviewed; 46 patients had a history of hemorrhage, 42 had a history of CSF infection, and 13 had a history of both disorders. All patients experienced third ventricular hydrocephalus before endoscopy. The success rate for treatment in these three groups was 60.9, 64.3, and 23.1%, respectively. The follow-up period in successfully treated patients ranged from 0.6 to 10 years. Relatively minor complications were observed in 15 patients (14.9%), and there were no deaths. A higher rate of treatment failure was associated with three factors: classification in the combined infection/hemorrhage group, premature birth in the posthemorrhage group, and younger age in the postinfection group. A higher success rate was associated with a history of ventriculoperitoneal (VP) shunt placement before ETV in the posthemorrhage group, even among those who had been born prematurely, who were otherwise more prone to treatment failure. The 13 premature infants who had suffered an IVH and who had undergone VP shunt placement before ETV had a 100% success rate. The procedure was also successful in nine of 10 patients with primary aqueductal stenosis. Conclusions. Patients with obstructive hydrocephalus and a history of either hemorrhage or infection may be good candidates for ETV, with safety and success rates comparable with those in more general series of patients. Patients who have sustained both hemorrhage and infection are poor candidates for ETV, except in selected cases and as a treatment of last resort. In patients who have previously undergone shunt placement posthemorrhage, ETV is highly successful. It is also highly successful in patients with primary aqueductal stenosis, even in those with a history of hemorrhage or CSF infection.

Persistent bilateral hearing loss after shunt placement for hydrocephalus

1999 ◽  
Vol 90 (4) ◽  
pp. 773-775 ◽  
Author(s):  
Sandro J. Stoeckli ◽  
Andreas Böhmer
Keyword(s):  
Cerebrospinal Fluid ◽  
Hearing Loss ◽  
Sensorineural Hearing Loss ◽  
Low Frequency ◽  
Content Type ◽  
Bilateral Hearing Loss ◽  
Shunt Placement ◽  
Cochlear Aqueduct ◽  
Fine Print

✓ Transient hearing decrease following loss of cerebrospinal fluid (CSF) has been reported in patients undergoing lumbar puncture, spinal anesthesia, myelography, and/or different neurosurgical interventions. The authors present the first well-documented case of a patient with persistent bilateral low-frequency sensorineural hearing loss after shunt placement for hydrocephalus and discuss the possible pathophysiological mechanisms including the role of the cochlear aqueduct. These findings challenge the opinion that hearing decreases after loss of CSF are always transient. The authors provide a suggestion for treatment.

Recurrent intracranial solitary fibrous tumor with cerebrospinal fluid dissemination

2004 ◽  
Vol 101 (6) ◽  
pp. 1045-1048 ◽  
Author(s):  
Katsuyoshi Miyashita ◽  
Yutaka Hayashi ◽  
Hironori Fujisawa ◽  
Mitsuhiro Hasegawa ◽  
Junkoh Yamashita
Keyword(s):  
Cerebrospinal Fluid ◽  
Malignant Transformation ◽  
Solitary Fibrous Tumor ◽  
S100 Protein ◽  
Spinal Tumors ◽  
Content Type ◽  
Csf Dissemination ◽  
Fibrous Tumor ◽  
Fine Print ◽  
Mib 1

✓ Solitary fibrous tumor (SFT) is a benign and rare neoplasm. To date, only 37 patients with intracranial SFTs have been reported. Although a number of the tumors were recurrent and some later underwent malignant transformation, none of these lesions progressed to cerebrospinal fluid (CSF) dissemination. In this paper the authors report a case of SFT in which the lesion recurred several times and ultimately was disseminated by the CSF. The patient was a 63-year-old woman with multiple intracranial and spinal tumors. Fifteen years before this presentation, at the age of 48 she had been hospitalized for resection of a falcotentorial tumor. During the ensuing 15 years she underwent multiple surgeries and sessions of radiation therapy for recurrent lesions. The exclusive location of her tumors in the subarachnoid space at the end of this 15-year period indicate CSF dissemination of the tumor. The tumor that was resected when the patient was 48 years old and the latest resected lesion were analyzed by performing immunohistological CD34, epithelial membrane antigen, vimentin, S100 protein, and reticulin staining, and determining the MIB-1 labeling index (LI). Most of the results were identical, and both tumors were diagnosed as SFT according to a staining pattern that showed a strong and diffuse positive reaction for CD34. Nevertheless, the authors noted that the MIB-1 LI increased from less than 1% in the original tumor to 13% in the latest tumor. The increased proliferation of MIB-1 indicates that the malignant transformation could have occurred during tumor recurrence with CSF dissemination.

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