scholarly journals Experience with Ventriculoatrial Shunt

2021 ◽  
Vol 24 (4) ◽  
pp. 376-380
Author(s):  
Muna Saleh Alnamlah ◽  
Muhammad Sohail Umerani ◽  
Amjad Abdel Qader Darwish ◽  
Muhammad Shamoon Umerani ◽  
Asad Abbas
Keyword(s):  
Arabian Gulf ◽  
Standard Of Care ◽  
Gulf Region ◽  
Shunt Insertion ◽  
Vp Shunt ◽  
First Choice ◽  
History Of ◽  
Csf Diversion ◽  
Peritoneal Infection ◽  
Shunt Obstruction

Cerebrospinal fluid (CSF) diversion through shunting, either internal or external, is the standard of care for hydrocephalic patients. Although Ventriculoperitoneal (VP) shunt is always the first choice, right atrium for Ventriculoatrial (VA) shunt is considered a suitable and convenient option for drainage of excess CSF in patients with history of abdominal surgeries, peritoneal infection or shunt obstruction.1 Here we are reporting our experience with a patient who underwent VA shunt insertion because of a previous malfunctioning VP shunt. A thorough review of the literature revealed that, although reported worldwide, there is an apparent deficiency of similar reports from Arabian Gulf region. Through this case report, we aim to shed light on this internal CSF diversion method, which could be considered in centers lacking advanced care facilities for procedures like Endoscopic 3rd Ventriculostomy (ETV).

Differences in Outcome Between Open vs Laparoscopic Insertion of Ventriculoperitoneal Shunts

2021 ◽  
pp. 000313482110505
Author(s):  
Aaron B. Lopacinski ◽  
Kevin M. Guy ◽  
Jessica R. Burgess ◽  
Jay N. Collins
Keyword(s):  
Abdominal Surgery ◽  
General Surgery ◽  
Operation Time ◽  
Laparoscopic Group ◽  
Prior History ◽  
Team Approach ◽  
Tertiary Referral Hospital ◽  
Shunt Insertion ◽  
Vp Shunt ◽  
History Of

Background Abdominal access during ventriculoperitoneal (VP) shunt insertion has historically been obtained by neurosurgeons via an open abdominal approach. With recent advances in laparoscopy, neurosurgeons frequently consult general surgery for aid during the procedure. The goal of this study is to identify if laparoscopic assistance improves the overall outcomes of the procedure. Methods This retrospective study included all patients who underwent open or laparoscopic VP shunt placement between September 2012 and August 2020 at our tertiary referral hospital. Patient demographics, comorbidities, prior history of abdominal surgery, open vs. laparoscopic insertion, operation time, and complications within 30 days were obtained. Results Neurosurgery placed 107 shunts using an open abdominal technique and general surgery placed 78 using laparoscopy. The average OR time in minutes was 75.5 minutes for the open cohort and 61.8 for the laparoscopic cohort ( p = 0.006). In patients without a history of abdominal surgery, the average OR time in minutes was 79.4 in the open cohort and 57.1 in the laparoscopic cohort ( p = 0.015). The postoperative shunt infection rate was 10.2% in the open group and 3.8% in the laparoscopic group ( p = 0.077). Discussion Laparoscopic placement of VP shunts is a reasonable alternative to open placement and results in shorter OR times. There is also a trend toward few infections in the laparoscopic placement. There appears to be an advantage with a team approach and laparoscopic placement of the peritoneal portion of the shunt.

Ventriculoperitoneal Shunt versus Endoscopic Third Ventriculostomy in the treatment of Obstructive Hydrocephalus in Pediatric Midline Posterior Fossa tumors

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Mohammed Tarek ◽  
Hamdy Ibrahim ◽  
H Jalalod'din ◽  
SR Tawadros
Keyword(s):  
Posterior Fossa ◽  
Ventriculoperitoneal Shunt ◽  
Endoscopic Third Ventriculostomy ◽  
Obstructive Hydrocephalus ◽  
Clinical Findings ◽  
Third Ventriculostomy ◽  
Posterior Fossa Tumors ◽  
Shunt Insertion ◽  
Vp Shunt ◽  
Csf Diversion

Abstract Background Treatment of secondary hydrocephalus due to posterior fossa tumors in these children is still a matter of controversy, although preoperative ventriculo-peritoneal shunt (VP shunt) insertion before tumor excision is widely accepted among neurosurgeons but many attempts are rising to minimize permanent VP shunt insertion and associated complications and introducing third endoscopic ventriculostomy (ETV) as one of the options of 2ry hydrocephalus. Objectives Comparing the post-operative clinical success with resolution of the manifestations and post-operative complications between endoscopic third ventriculostomy and ventriculoperitoneal shunt as different modes of CSF diversion in children with 2ry hydrocephalus due to midline posterior fossa tumors. Methods The following electronic databases were searched from June 2009 to june2019: PubMed, Google scholar search engine. Cochrane database of systematic reviews, EMBASE and science Direct, using the keywords ―hydrocephalus; posterior fossa tumors; pediatrics; ventriculoperitoneal shunt; endoscopic third ventriculostomy‖. Studies were eligible if they contain the target keywords in title or abstract, addressing the Pediatric age group with 2ry hydrocephalus due to de novo posterior fossa tumor manifested by signs of increase the intra cranial tension including persistent headache and vomiting, blurred vision, 6th nerve palsy, papilledema in fundus examination, acute DCL and 2ry hydrocephalus confirmed by brain imaging. Exclusion criteria included studies including age group below 1yr or above 18 yr, or patients with recurrent post fossa tumors and operated before or patients presented by failed previously attempt of CSF diversion. Results: A total of 1255 citations were screened for eligibility,6 studies were included in our systematic review discussing, comparing and evaluating the durability of ETV versus VP shunt in treatment the 2ry hydrocephalusdue to pediatric posterior fossa tumor.. Overall study population reached 474 patients. the overall clinical findings at presentation and postoperative outcomes regarding the clinical findings improvement, radiological improvement and postoperative complications between ETV and VP shunt are compared and showing that ETV should be considered as an alternative procedure to VP shunt in controlling severe hydrocephalus related to posterior fossa tumors to relieve symptoms quickly during the preoperative period when patients should wait for their definite tumor excision. Conclusion The shorter duration of surgery, the lower incidence of morbidity, the absence of mortality, the lower incidence of procedure failure of endoscopic third ventriculostomy as compared to ventriculoperitoneal shunt, and the significant advantage of not becoming shunt dependent make endoscopic third ventriculostomy to be recommended as the first choice in the treatment of pediatric patients with marked obstructive hydrocephalus due to posterior fossa tumors. It is a preliminary, simple, safe, effective, physiological, minimally invasive procedure for the relief of elevated intracranial pressure before direct tumor removal.

Gender Equity in Surgical Academia in Kuwait and the Arabian Gulf Region

2020 ◽  
pp. 237-251 ◽  
Author(s):  
Asmaa Al-Rashed ◽  
Maha Al-Gilani
Keyword(s):  
Gender Equity ◽  
Arabian Gulf ◽  
Current Status ◽  
Islamic Culture ◽  
Gulf Region ◽  
Gender Inequity ◽  
Women Surgeons ◽  
Arabian Gulf Region ◽  
History Of ◽  
Surgical Field

Gender equity has been a topic of interest in medicine for decades; however, it has extended to include surgery, a field that has been dominated by men for centuries. Nowadays, gender inequity in surgery is a worldwide issue that needs to be addressed since significant disparities exist in the surgical field compared to the medical one. In this chapter, authors introduce the current status of Kuwait and the Gulf region regarding gender equality, and outline the history of women surgeons in the region. The evolution of medical education in surgery and the evolution of the healthcare system and how these relate to gender equity in surgical academia is presented. Challenges related to the uniqueness of the Arabic and the Islamic culture and the future directions of where the field of surgery is headed in relation to gender equity is discussed.

scholarly journals Neuromyelitis optica spectrum disorders in the Arabian Gulf: challenges and growing experience

2020 ◽  
Vol 6 (1) ◽  
pp. 205521731985019
Author(s):  
Raed Alroughani ◽  
Najeeb Qadi ◽  
Jihad Inshasi ◽  
Eslam Shosha
Keyword(s):  
Neuromyelitis Optica ◽  
Arabian Gulf ◽  
Target Antigen ◽  
Neuromyelitis Optica Spectrum Disorders ◽  
Gulf Region ◽  
Presenting Symptoms ◽  
Disease Pattern ◽  
Variable Sensitivity ◽  
History Of ◽  
Spectrum Disorders

Neuromyelitis optica spectrum disorders (NMOSD) have been studied in different ethnic groups, including Asians, African-Americans, and Caucasians. Demonstrating the clinical features among diverse communities is important to understand the variable disease phenotypes, which will lead to further classification and better clinical management. Testing for antibody against aquaporin-4 (AQP4), the most common target antigen in NMOSD, is not available in many countries and tests use different methods, with variable sensitivity. With negative antibody results, the diagnosis of NMOSD becomes challenging and may affect the outcomes of patients with NMOSD. There are no adequate studies that assess NMOSD cohorts in the Arabian Gulf region, despite the increasing number of diagnosed cases. It is worth assessing NMOSD cohorts in the Arabian Gulf population to study the natural history of disease and to establish an epidemiological background for future perspectives. Various challenges to implement such a mission are outlined, including disease rarity, overlapping presenting symptoms and signs, which posed the issue of mimickers in the differential diagnosis, lack of specialized clinics, absence of highly sensitive testing methods for diagnosis, and the indefinite agreement on the negative AQP4 NMOSD criteria. Collaborative efforts started to take a place among many experts in the region to establish a registry of NMOSD patients for better perception of the disease pattern.

scholarly journals Exuberant mesothelial proliferation mimicking malignant mesothelioma in a patient with prolonged VP shunt: A case report

2016 ◽  
Vol 4 (1) ◽  
pp. 4
Author(s):  
Mohamad Kanso ◽  
Cleo Massad ◽  
Nina Shabb ◽  
Bilal Anouti ◽  
Reem Akel ◽  
...  
Keyword(s):  
Malignant Mesothelioma ◽  
Cell Lymphoma ◽  
Final Diagnosis ◽  
Shunt Insertion ◽  
American University ◽  
Vp Shunt ◽  
American University Of Beirut ◽  
History Of ◽  
Nodular Lesions ◽  
Pathology Specimen

Background: Ventriculo-peritoneal shunt (VP shunt) surgery is the most widely used procedure in the treatment of hydrocephalus. Common complications post-VP shunt insertion are infection, mechanical failure, as well as functional complications such as overor underdrainage. Rarely, abdominal complications can present remotely after the time of VP shunt insertion. We found no reportsin the literature describing peritoneal exuberant mesothelial hyperplasia mimicking mesothelioma, clinically, radiologically, andpathologically in a setting of VP shunt.Case: A 22-year-old female with a history of T cell lymphoma in 2002, suffered from CNS recurrence and increased intracranialpressure (ICP) in 2004 necessitating a VP shunt insertion. In 2015, she presented with abdominal pain. CT scan of the abdomenshowed omental nodular lesions that were biopsied and read first by a private pathology center as atypical mesothelial proliferationfavoring malignant mesothelioma. However, after reviewing the full medical history and evaluating additional surgical materialfrom the patient, review of the pathology specimen at the American University of Beirut concluded that the final diagnosis isatypical mesothelial proliferation favoring exuberant mesothelial hyperplasia possibly as a reaction to the long-standing VPshunt.Conclusion: It is often difficult for the pathologist to differentiate a malignant from a reactive mesothelial hyperplasia especiallyon biopsies or limited material due to sampling issues. Many features of reactive mesothelial hyperplasia can mimic malignantmesothelioma. This complication took place in the setting of a VP shunt.

scholarly journals The Visit of the Shah of Iran to Washington in October 21-23, 1969: A study in the U.S Department of State’s reports

2018 ◽  
Vol 225 (2) ◽  
pp. 1-20
Author(s):  
Dr. Ahmed Shaker Abdel-Alak ◽  
Dr. Abdullah Lafteh Al-Budairi
Keyword(s):  
Turning Point ◽  
Arabian Gulf ◽  
The United States ◽  
Gulf Region ◽  
Oil Companies ◽  
The Us ◽  
History Of ◽  
The Many ◽  
The Military ◽  
The U.S

Shah Mohammad Reza Pahlavi tried in his visit to Washington to give the impression to the US administration that he was able to protect the interests of the United States in Iran and in the whole Arabian Gulf and the Middle East. The visit of the Shah represented a new turning point in the history of the Iranian - US relations. It included the discussion of issues concerning both countries, especially the issue of arms and the production and sale of Iranian oil after the announcement of the British government's desire to withdraw from the Gulf region within three years. The American leaders focused on meeting the demands of the Shah, specifically the military ones, to discuss oil production topics and methods of exporting and cooperation with US oil companies, have expressed American sympathy in dealing with the many issues.

scholarly journals Delayed Intracerebral Hemorrhage after Placement of a Ventriculoperitoneal Shunt in a Case of Hydrocephalus: A Rare Case Report and Review of Literature

2019 ◽  
Vol 10 (03) ◽  
pp. 533-536
Author(s):  
Siddartha Reddy Musali ◽  
Srikrishnaditya Manne ◽  
Hemant K. Beniwal ◽  
Nagarjuna Butkuri ◽  
Prakash Rao Gollapudi ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Intracerebral Hematoma ◽  
Review Of Literature ◽  
Vp Shunt ◽  
Sudden Loss ◽  
Rare Case Report ◽  
History Of ◽  
Csf Diversion ◽  
Gcs Score ◽  
The Brain

AbstractVentriculoperitoneal (VP) shunt is a frequently performed operation to achieve cerebrospinal fluid (CSF) diversion but is associated with many complications. Postoperative delayed intracerebral hemorrhage is a kind of rare but catastrophic complication of a VP shunt which questions the survival of a seemingly recovered patient. Here, we present one such case where the patient presented to casualty in altered sensorium and with a history of vomiting. On examination, the Glasgow Coma Scale (GCS) score was E2V1M3; pupils were middilated but reactive. Computerized tomography of the brain showed ventriculomegaly and hydrocephalus, and an emergency VP shunt was done. There was an initial phase of good recovery followed by sudden loss consciousness, vomiting, and a fall in the GCS scores on postoperative day 7. Computed tomography showed an intracerebral hematoma along the shunt track and an intraventricular bleed. The presumed cause for this occurrence is a deranged coagulation profile.

The Ventriculo-Gallbladder Shunt in the Treatment of Refractory Hydrocephalus: A Review of the Current Literature

2009 ◽  
Vol 75 (8) ◽  
pp. 734-737 ◽  
Author(s):  
Micah E. Girotti ◽  
R. Ramesh Singh ◽  
Bradley M. Rodgers
Keyword(s):  
Case Series ◽  
Standard Of Care ◽  
The Other ◽  
Cerebrospinal Fluid Drainage ◽  
Chronic Hydrocephalus ◽  
Vp Shunt ◽  
Distal Obstruction ◽  
History Of ◽  
Low Incidence

The ventriculo-gallbladder (VGB) shunt has been reported on several occasions for the alleviation of ventriculo-peritoneal (VP) –shunt-refractory hydrocephalus. There is little data regarding VGB shunts and a need for delineating appropriate surgical therapy when cerebrospinal fluid drainage to the peritoneum becomes infeasible. We report our experience with VGB shunt placement in three patients with chronic hydrocephalus. All three had a history of prior VP-shunt placements and revisions due to distal obstruction or infection, or contraindications to alternative forms of ventricular drainage. In one patient, the VGB shunt functioned well for 9 years but was revised due to contamination during an unrelated operation. Neither of the other two patients have experienced VGB shunt-related complications. VP shunts are presently regarded as the standard of care for uncomplicated hydrocephalus. When VP shunts fail, the most common alternatives have been ventriculo-atrial and ventriculo-pleural shunts. In five case series involving 59 patients with VGB shunts, the long-term success rate was 62.7 per cent. Infection (10.2%) and obstruction (10.2%) were the most common complications. Based on durability and a low incidence of complications, it is the current consensus that VGB shunts are a viable alternative with good outcomes in the case of failed VP shunts.

Iraq's alternatives in light of the challenges surrounding the security of the Arabian Gulf: the challenges of security of navigation in the Strait of Hormuz

2020 ◽  
pp. 221
Author(s):  
Amer Hassan Thabit
Keyword(s):  
Arabian Gulf ◽  
Gulf Region ◽  
Regional Conflicts ◽  
Regional Conflict ◽  
Political Events ◽  
Strait Of Hormuz ◽  
Maritime Navigation ◽  
Arab Gulf ◽  
Multiple Challenges ◽  
The Persian Gulf

The Arab Gulf region in particular, and with it the entire Arab region in general, is witnessing multiple challenges and conflicts, escalating, in a way that reflects the presence of overlapping in the dimensions: internal, regional and international, which imposes important effects on Iraq. Iraq is part of the Arab Gulf region, and it interferes with it: historically, geographically, ethnically, and politically. It cannot be overlooked that Iraq was in historical stages that was considered the dominant force in this region, especially in the stage of the civilization’s dominance before the role of Iraq and its place in civilization declines. Today, the region is witnessing multiple challenges, which began with the escalation of regional sectarian political events associated with the event of the occupation of Iraq, with a tendency to disturb the regional balance due to the dismantling of the capabilities of Iraq, and the matter came to the loosening of regional conflicts due to what the region is going through, and the perspective of the active forces in it, which has overcome the perspective The struggle for cooperation. The entry or presence of the international worker in the regional conflicts in the Arab Gulf region caused the intensity of the conflicts to multiply instead of settling them, and Iran has presented on more than one occasion that it has the capabilities to implement the option of closing the Strait of Hormuz or impeding the freedom and safety of maritime navigation in international waters in the Arabian Gulf, And the matter was not related to the US sanctions regime on Iran in the year 2018 and beyond, but it is before it.     The Iranian threat to close the Strait of Hormuz at the very least, or any development in the regional conflict in the region, can damage the interests of Iraq and its security, for two reasons: First, most of Iraq’s trade passes through the waters of the Persian Gulf, and the second is that there is an overlap between Iraq and peoples and countries The region, and just as sectarianism moved from Iraq to the region after 2003, the Gulf conflict and tension can move into Iraq or affect Iraq’s policy. Iraq should search for political alternatives that help it in dealing with the developments of the conflict in the Arab Gulf region. Perhaps this research presents some of the options and alternatives that can help the Iraqi decision-maker, if there is an important development in the Gulf-Western conflict with Iran

Branding of Germany’s Transnational Education and its Potentials in the Arabian Gulf Region

2018 ◽  
Vol 2 (3) ◽  
Author(s):  
Sanaa Ashour
Keyword(s):  
Higher Education ◽  
Arabian Gulf ◽  
Current Debate ◽  
Transnational Education ◽  
Gulf Region ◽  
Demand For Education ◽  
Financial Gain ◽  
Arabian Gulf Region ◽  
Global Demand ◽  
Foreign Education

Transnational education (TNE), responding to the growing global demand for education, plays a fundamental role in the current debate on the internationalisation and globalisation of higher education. Conducting a systematic literature review, this paper examines the characteristics of German transnational education, which has little in common with the American and British models, the reasons for its limited presence in the Gulf and its potential for having a stronger footprint. Since education for Germany is a public good, financial gain has never been a decisive factor for German universities to venture abroad. Whilst the Gulf Region is the largest importer of foreign education, German TNE is only represented by one university there, compared to the overwhelming number of US, UK and Australian higher education institutions. Although the Gulf Region is considered as a lucrative and appealing market for foreign education, lack of engagement of German TNE there could be interpreted through public policy-related reasons. Since Germany has already established its footprint in creating a unique brand of TNE, the paper recommends to build upon the country’s expertise in low-risk option for Germany to invest in the Gulf. For this to materialise, Germany must build awareness of its unique brand to stand out among the competition. 

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