A novel trans-occipital catheter placement guide for ventriculoperitoneal shunts.

We have designed a novel device that facilitates the accurate placement of occipital ventricular catheters in ventriculoperitoneal shunt procedures. After 7 years of clinical use, this device has consistently demonstrated its simplicity, user-friendliness, and effectiveness. It enables both experienced surgeons and novices to confidently and accurately position the ventricular catheter to a satisfactory location.

Practical techniques for safely removing long-term implanted ventricular catheters to minimize bleeding.

INTRODUCTION: Removing ventricular catheters, particularly those implanted for extended periods, poses significant challenges for neurosurgeons due to potential complications such as bleeding from adhesions to the ependyma or choroid plexus. OBJECTIVE: This study aimed to review various techniques for safely removing ventricular catheters, emphasizing methods that minimize the risk of hemorrhagic complications. METHODS: A comprehensive narrative review focused on techniques developed and documented in the literature for safely detaching ventricular catheters adhered to brain structures. RESULTS: Various techniques have been identified that enhance the safety of catheter removal. Notably, the use of monopolar diathermy to coagulate and release adhesions has proven effective. Innovations such as insulated suction devices and the strategic use of flexible endoscopes have also contributed to safer removal procedures, minimizing the risk of damaging surrounding cerebral tissue and preventing catastrophic hemorrhage. CONCLUSION: The removal of ventricular catheters, especially those with long-term implantation, requires precise and cautious techniques to avoid severe complications. The study underscores the importance of adopting advanced surgical techniques and the continuous evolution of safer practices in neurosurgery. These methods not only ensure patient safety but also facilitate the handling of potentially complex and life-threatening situations during catheter removal.

Transcortical transcatheter ultrasound-assisted technique for deep-seated brain tumors. Technical note.

PURPOSE: Surgery of deep-seated brain tumors can be challenging. Several methods have been described to facilitate transcortical approaches, including ultrasound-assisted resection. Ultrasound-guided placement of a standard ventricular catheter is a widely reported technique and has been used to approach these lesions via the transcortical route. We describe how we usually perform this useful technique to assist and enhance the transcortical resection of some deep-seated brain tumors. METHODS: Standard electromagnetic frameless navigation (S8 Neuronavigation System, Medtronic, Minneapolis, USA) was employed to focus the craniotomy and to plan the trajectory of the ventricular catheter. After dural opening, an ultrasound device (Arietta 850, Hitachi-Aloka Medical, Tokyo, Japan) was used for intraoperative ultrasound (IOUS) assessment. A ventricular catheter was placed from the cortex to the lateral wall of the tumor under direct real-time IOUS visualization to guide the further transcortical dissection. RESULTS: Transcortical transcatheter ultrasound-assisted technique involved minimal time and infrastructure requirements. There were no major technical difficulties during its use, providing confidence and improving subcortical white matter dissection by guiding the route to the tumor. CONCLUSIONS: Recent improvement of IOUS image-quality devices offers several attractive options for real-time navigation. The combination of conventional neuronavigation systems with real-time IOUS assessment during the intradural step provides a higher degree of control by improving the execution of the surgery. We hope this description may be a useful tool for some selected cases and contribute to the further enhancement and improvement of this widely used technique.

An Atypical Presentation of Pancreatitis Secondary to a Ventriculoperitoneal Shunt.

Ventriculoperitoneal (VP) shunts are catheters inserted to drain excess cerebrospinal fluid (CSF) when there is an obstruction in the normal outflow or a decreased absorption of the fluid leading to hydrocephalus. Recognised complications of placement of the distal catheter are malposition, obstruction, pseudocysts and infection. Here, we present a case of a 23-year-old female with acute pancreatitis following the placement of a VP shunt in the lesser sac. The patient originally had a VP shunt placed in infancy for congenital hydrocephalus with one revision at four years old. She presented with a three-day history of worsening epigastric pain with an associated lipase of 3030 (10-60IU), CRP 157 (<5mg/L) and normal liver function tests. A CT scan showed acute pancreatitis with an associated collection within the lesser sac extending to the greater omentum. This was due to the malposition of the VP shunt after a recent revision surgery. It was managed with a diagnostic laparoscopy, washout and shunt externalisation. This is an atypical presentation of acute pancreatitis secondary to a VP shunt. A high index of suspicion is needed for diagnosis. Management of both pancreatitis and VP shunt complications need to be considered.

Efficacy and safety of cysto-ventricular catheter implantation for space-occupying cysts arising from glioma and brain metastasis: a retrospective study.

BACKGROUND: Cysto-ventricular catheters (CVC) have emerged as promising treatment option for cystic craniopharyngioma and arachnoid cysts, but their effectiveness in treating cysts originating from glioma or brain metastasis (BM) remains limited. This study aimed to analyze the efficacy of CVC in patients with glioma and BM as well as procedure-associated morbidity. METHODS: This single-center retrospective study included all patients treated with CVC placement for acquired space-occupying cysts deriving from previously treated glioma or BMs between 1/2010 and 12/2021. RESULTS: A total of 57 patients with a median age of 47 years (IQR 38-63) were identified. Focal neurological deficits were the predominant symptoms in 60% of patients (n = 34), followed by cephalgia in 14% (n = 8), and epileptic seizures in 21.1% (n = 12). Accurate CVC placement was achieved in all but one case requiring revision surgery due to malposition. Three months after CVC implantation, 70% of patients showed symptomatic improvement. Multivariate logistic regression analysis identified the development of space-occupying cysts later in the course of the disease (OR 1.014; p = 0.04) and a higher reduction of cyst-volume postoperatively (OR 1.055; p = 0.05) were significant predictors of postoperative symptomatic improvement following CVC placement. Local cyst recurrence was observed in three cases during follow-up MRI after an average time of 5 months (range 3-9 months). Further complications included secondary malresorptive hydrocephalus in three cases and meningeosis neoplastica in one patient. CONCLUSIONS: Stereotactic implantation of CVC is an efficient treatment option for patients suffering from symptomatic space-occupying cysts from BMs or glioma, independently from their CNS WHO grade. However, a vigilant approach is crucial regarding potential complications and treatment failures.

Intervenciones especializadas de enfermería en el cuidado de drenajes cerebrales / Specialized nursing interventions in the care of brain drains

Los drenajes cerebrales son dispositivos utilizados como métodos terapéuticos, permitiendo la salida de líquido normal o patológico a personas que cursen por alguna enfermedad neurológica, convirtiéndose en uno de los procedimientos más comunes en el área de la enfermería neurológica. He aquí que los cuidados de enfermería deben ser considerados específicos para poder visualizar resultados satisfactorios en pacientes portadores de estos sistemas en áreas críticas. Por este motivo, las intervenciones especializadas de enfermería en el cuidado a los drenajes cerebrales se basaron en la necesidad de elaborar una guía de intervenciones específicas, y especializadas, para personas con uso de drenajes cerebrales siendo un tema de importancia en enfermería neurológica.

Brain drains are devices used as therapeutic methods, allowing the exit of normal or pathological fluid to people suffering from a neurological disease, becoming one of the most common procedures in the area of neurological nursing. Here, nursing care must be considered specific in order to visualize satisfactory results in patients with these systems in critical areas. For this reason, specialized nursing interventions in the care of brain drains were based on the need to develop a guide for specific and specialized interventions for people with use of brain drains, being a topic of importance in neurological nursing.

Weaning rápido vs. weaning gradual de ventriculostomía externa en hidrocefalia secundaria a hemorragia subaracnoidea: Revisión sistemática de la literatura y metaanálisis / Weaning fast vs. Gradual Weaning of External Ventriculostomy in Hydrocephalus Secondary to Subarachnoid Hemorrhage: A Systematic Review of the Literature and Meta-analysis

Objetivo: Realizar una revisión sistemática comparando dos estrategias de weaning de Derivación Ventricular externa (DVE) en pacientes con hidrocefalia aguda y su asociación con la proporción de derivación definitiva, infección del sistema nervioso central y duración de la estancia hospitalaria en cada una de las estrategias. Diseño: Revisión sistemática de la literatura. Fuentes de datos: Se realizaron búsquedas en PubMed, Embase, Lilacs. Se incluyò literatura gris, realizando búsquedas en Google académico, Dialnet, Open gray, Teseo y Worldcat hasta el 10 de septiembre de 2019. Métodos: Se realizó una búsqueda exhaustiva de estudios de los últimos 20 años en inglés, español y portugués, que compararan dos estrategias de weaning de DVE: rápida (WR) vs gradual (WG) en pacientes con hidrocefalia aguda. El resultado primario para esta Revisión Sistemática fue la proporción de derivación definitiva en cada uno de los regímenes. Se evaluó además, la proporción de infección del sistema nervioso central y la duración de la estancia hospitalaria. Dos investigadores extrajeron de forma independiente la información de los estudios y los resultados en concordancia con la Guía PRISMA. Resultados: La revisión arrojó en total 3 artículos que cumplían con los criterios de inclusión y que se consideraron de calidad metodológica aceptable, con un número de 1198 participantes no superpuestos, 569 que fueron sometidos a weaning rápido (WR), 629 en el grupo de weaning gradual (WG). No se encontró asociación estadisticamente significativa entre las estrategias de weaning y DVP OR 0.78 (Intervalo de confianza del 95% 0.3 a 2.06; P= 0.001; I2=85%), ni para infección del sistema nervioso central OR 0.54 (IC 95% 0,07 a 4.24); P= 0,05; I2= 74%) pero si se encontró diferencia estadísticamente significativa en la duración de la estancia hospitalaria a favor de la estrategia de weaning ràpido, OR -4.34 (IC 95% -5.92 a -2.75, P= <0,00001; I2= 57%). Conclusión: Con la evidencia disponible actualmente no es posible concluir cuál es la mejor estrategia de weaning para DVE con respecto a la proporción de derivación definitiva o infecciones del sistema nervioso central; sin embargo, si se observa una tendencia clara frente a la duración de la estancia hospitalaria en la estrategia de WR. Se requiere establecer criterios claros en cuanto a la definición de WR o WG y a crear estándares en cuanto los tiempos y la definiciòn precisa de falla terapeutica respecto a estas pruebas, para posteriormente integrar y probar estos métodos en estudios idealmente prospectivos y aleatorizados.

Objective: To conduct a systematic review by comparing two strategies of external ventricular drain (EVD) in patients with acute hydrocephalus and its association with the proportion of definite drain, infection of the central nervous system, and duration of hospital stay in each strategy. Design: Systematic review of literature.Data sources: PubMed, Embase, Lilacs. Grey literature was included by conducting searches through Scholar Google, Dialnet, Open Gray, Teseo and Worldcat until the 10th September, 2019. Methods: An exhaustive search of studies was done of the last 20 years in English, Spanish and Portuguese, which compares two strategies of external ventricular drain weaning (EVD): Rapid (WR) Vs Gradual (WG)in patients with acute hydrocephalus. The primary result for this systematic review was the proportion of Ventriculoperitoneal (VP) shunt placement in each of the regimes. Besides, the proportion of the infection of the central nervous system and the duration of the hospital stay was evaluated. Two researchers extracted in an independent way the information of the studies and results according to the guide PRISMA. Results: The review produced 3 articles in total which followed with the criteria of inclusion and which were considered of acceptable methodological quality, with 1198 non-superimposed participants, 569 who were subjected to rapid weaning (RW), 629 in the group of Gradual Weaning (GW). There were no significant differences between the 2 weaning ́s groups and DVP OR 0.78 (IC 95% 0.3 a 2.06; P= 0.001; I2=85%), for the infection of the Central Nervous System (CNS) OR 0.54 (IC 95% 0,07 a 4.24); P= 0,05; I2= 74%) but a significant differences was found in the duration of the hospital stay in favour of the strategy of RW, OR -4.34 (IC 95% -5.92 a -2.75, P= <0,00001; I2= 57%). Conclusion: With the current available evidence is not possible to conclude which is the best strategy of weaning for EVD regarding to the proportion of definite shunt or infections of the CNS; but if there is a clear trend regarding the length of hospital stay in the WR strategy. It is necessary to establish clear criteria as to the definition of WR or WG and to create standards as to the times and the precise definition of therapeutic failure with respect to these tests, to later integrate and test these methods in ideally prospective and randomized studies.