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Author(s):  
Rajendra K. Ghritlaharey

Trans-umbilical extrusion of the distal ventriculoperitoneal shunt catheter is a rare complication of the VPS insertion. The objectives of this review were to analyze various variables like the age, sex, indication for VPS insertion, clinical presentation, the operative therapy offered for the management, and outcome of the cases published/managed for the trans-umbilical extrusion of the distal VPS shunt catheter. In 1973, the maiden case of trans-umbilical extrusion of the distal VPS catheter was published. Literature/case reports were retrieved from 1973 to October 31, 2021. A total of n=24 (12 males, 12 females) cases were recruited for this systematic review. All of them were children below the age of 13-years. In four-fifths (n=19) of children, the initial VPS catheter was inserted during the first 6-months of life. The median age of children at the time of diagnosis of the above-described VPS complication was 7.5 (42.21 SD) months, and it ranged from 2 months to 13 years of age. The median interval from the initial VPS insertion/last VPS revision to the diagnosis of complication was 4 (24.77 SD) months, and it ranged from 3 weeks to 8 years. The main complaint was the extrusion of the distal VPS catheter through the umbilicus. Surgical procedures performed for the management were (a) removal of the entire VPS catheter n=15, (b) removal of distal/part of distal VPS catheter n=5, and (C) others n=2. For VPS catheter revision; delayed re-VPS insertion was performed in n=10, immediate revision of the distal VPS catheter in n=3, and others. Three (12.5%) children died during the postoperative and follow-up period. The distal VPS catheter extrusion through the umbilicus is a rare complication of VPS insertion, and it occurred exclusively in children. In 70% (n=17) of children, it was documented ≤6 months afterward of the VPS insertion. Delayed re-VPS catheter insertion was preferred for 40% of the children for VPS revision procedures.  


Author(s):  
Chiboub Najib ◽  
Hicham Abdellaoui ◽  
Alaoui Othmane ◽  
Mahmoudi Abdelhalim ◽  
Khattala Khalid ◽  
...  

Cureus ◽  
2021 ◽  
Author(s):  
Caio Perret ◽  
Raphael Bertani ◽  
Barbara Pilon ◽  
Stefan W Koester ◽  
Hugo C Schiavini

2021 ◽  
Vol 29 ◽  
pp. 3-10
Author(s):  
Zhijun Song ◽  
Xiaolei Chen ◽  
Zhenghui Sun ◽  
Fangye Li ◽  
Zhe Xue ◽  
...  

BACKGROUND: Ventriculo-peritoneal shunt (VPS) is one of the routine methods used to treat communicating hydrocephalus. OBJECTIVE: To sum up the clinical effectiveness of ventriculo-peritoneal shunt (VPS), assisted with neuroendoscopy and laparoscopy, for the treatment of patients with communicating hydrocephalus. METHODS: From January 2010 to 2014, we performed VPS surgery on 209 patients with communicating hydrocephalus, using neuroendoscopy and laparoscopy, which helped to implant the shunt catheter in a suitable position in the ventricles and abdominal cavity, respectively. The subsequent survival following the surgery was analyzed using Kaplan-Meier analysis. RESULTS: A total of 209 patients received 255 VPSs or revisions and all the operations were successfully completed. Open operation or oraniotomy was not needed for any technical complications, while 46 revisions were performed. After the operations, 203 patients with communicating hydrocephalus exhibited improvement of symptoms following surgery. The follow-up period ranged from one month to four years; the shunt surgery efficiencies were 91.0%, 86.7%, 83.9%, and 82.0% in the first, second, third, and fourth years, respectively. CONCLUSION: For ventriculo-peritoneal shunt, laparoscopy and neuroendoscopy can help to implant shunt catheter in a suitable position, in the ventricles or abdominal cavity, respectively. Hence, the combination of the two techniques can reduce the failure rate of VPS, and has an obvious impact on survival following the surgery.


2021 ◽  
Vol 146 ◽  
pp. 177-178
Author(s):  
Zaid Aljuboori ◽  
Emily Sieg

2021 ◽  
Vol 55 (4) ◽  
pp. 322
Author(s):  
Asra Al Fauzi ◽  
Muhammad Arifin Parenrengi ◽  
Joni Wahyuhadi ◽  
Eko Agus Subagio ◽  
Agus Turchan

The complications of ventriculoperitoneal (VP) shunts are many and are reported in literature extensively. The complication of transanal extrusion after bowel perforation is known although rare. This complication is very well described amongst the children. The authors describe the case of bowel perforation and transanal extrusion of a VP shunt occurring in a 51-year-old adult patient. The patient has a history of craniotomy for acute subdural hematoma after severe head injury one year ago continued with VP shunt for post-traumatic hydrocephalus. Home care with bedridden conditions is done at home until finally, the family gets the catheter extrude from the transanal. Bowel perforation and transanal extrusion of VP shunt catheter is a rare but serious problem. The exact pathogenesis of shunt-related organ perforation and extrusion through the anus is unclear, and various mechanisms have been suggested, Among many factors, age is the prominent factor for bowel perforation.1 Because of weak bowel musculature and stronger peristaltic activity, children are more susceptible to bowel perforation than adult patients. In adult shunted patient, one of the risk factors is related to PVS with chronic immobilization, as described in this case. Risk factors of bowel perforation in adult are quite distinct from children. Persistent vegetative state (PVS) with chronic immobilization is one of the risk factors to be aware of.


Author(s):  
Matthew T. Grant ◽  
Nicole A. Wilson ◽  
Martin S. Keller ◽  
Anna L. Huguenard ◽  
Jennifer M. Strahle ◽  
...  

2021 ◽  
Vol 82 (02) ◽  
pp. e17-e20
Author(s):  
Lacey M. Carter ◽  
Camille K. Milton ◽  
Kyle P. O'Connor ◽  
Arpan R. Chakraborty ◽  
Tressie M. Stephens ◽  
...  

AbstractShunt failure requiring reintervention remains a common complication of hydrocephalus treatment. Here, we report a novel cause of mechanical shunt obstruction in an adult patient: position-dependent intermittent occlusion via an infusion port catheter. A 51-year-old woman with a grade II oligodendroglioma presented in a delayed fashion following surgery with a pseudomeningocele. She underwent ventriculoperitoneal shunt placement due to communicating hydrocephalus, resolving her pseudomeningocele. Shortly thereafter, she underwent placement of a subclavian infusion port at an outside institution. Her pseudomeningocele returned. Imaging demonstrated close proximity of her port catheter to the shunt catheter overlying the clavicle. Her shunt was tapped demonstrating a patent ventricular catheter with normal pressure. She underwent shunt exploration after her pseudomeningocele did not respond to valve adjustment. Intraoperative manometry demonstrated head position-dependent distal catheter obstruction. Repeat manometry following distal catheter revision demonstrated normal runoff independent of position. Her pseudomeningocele was resolved on follow-up. To our knowledge, this is the only reported case of intermittent, position-dependent distal catheter obstruction. Shunted patients with concern for malfunction following subclavian infusion port placement should be evaluated for possible dynamic obstruction of their distal catheter when the two catheters are in close proximity along the clavicle.


Author(s):  
Sulmaz Zahedi ◽  
Miles Hudson ◽  
Xin Jin ◽  
Richard Justin Garling ◽  
Jacob Gluski ◽  
...  

OBJECTIVEThis investigation is aimed at gaining a better understanding of the factors that lead to mechanical failure of shunts used for the treatment of hydrocephalus, including shunt catheter-valve disconnection and shunt catheter fracture.METHODSTo determine the root cause of mechanical failure, the authors created a benchtop mechanical model to mimic mechanical stressors on a shunt system. To test shunt fracture, cyclical loading on the catheter-valve connection site was tested with the shunt catheter held perpendicular to the valve. Standard methods were used to secure the catheter and valves with Nurolon. These commercial systems were compared to integrated catheters and valves (manufactured as one unit). To test complete separation/disconnection of the shunt catheter and valve, a parallel displacement test was conducted using both Nurolon and silk sutures. Finally, the stiffness of the catheters was assessed. All mechanical investigations were conducted on shunts from two major shunt companies, assigned as either company A or company B.RESULTSCyclical loading experiments found that shunts from company B fractured after a mean of 4936 ± 1725 cycles (95% CI 2990–6890 cycles), while those of company A had not failed after 8000 cycles. The study of parallel displacement indicated complete disconnection of company B’s shunt catheter-valve combination using Nurolon sutures after being stretched an average 32 ± 5.68 mm (95% CI 25.6–38.4 mm), whereas company A’s did not separate using either silk or Nurolon sutures. During the stiffness experiments, the catheters of company B had statistically significantly higher stiffness of 13.23 ± 0.15 N compared to those of company A, with 6.16 ± 0.29 N (p < 0.001).CONCLUSIONSMechanical shunt failure from shunt catheter-valve disconnection or fracture is a significant cause of shunt failure. This study demonstrates, for the first time, a correlation between shunt catheters that are less mechanically stiff and those that are less likely to disconnect from the valve when outstretched and are also less likely to tear when held at an angle from the valve outlet. The authors propose an intervention to the standard of care wherein less stiff catheters are trialed to reduce disconnection.


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