Endoscopic Third Ventriculostomy: Success and Failure

Endoscopic third ventriculostomy (ETV) has now become an accepted mode of hydrocephalus treatment in children. Varying degrees of success for the procedure have been reported depending on the type and etiology of hydrocephalus, age of the patient and certain technical parameters. Review of these factors for predictability of success, complications and validation of success score is presented.

Performance of the fixed pressure valve with antisiphon device SPHERA® in the treatment of normal pressure hydrocephalus and prevention of overdrainage / Efeito da válvula de pressão fixa com antisifão SPHERA®no tratamento da hidrocefalia de pressão normal e prevenção de hiperdrenagem

ABSTRACT Normal pressure hydrocephalus (NPH) is characterized by the triad of gait apraxia, dementia and urinary incontinence associated with ventriculomegaly and normal pressure of cerebrospinal fluid. Treatment is accomplished through the implantation of a ventricular shunt (VPS), however some complications are still frequent, like overdrainage due to siphon effect. This study analyses the performance of a valve with anti-siphon device (SPHERA®) in the treatment of patients with NPH and compares it with another group of patients with NPH who underwent the same procedure without anti-siphon mechanism (PS Medical® valve). 30 patients were consecutively enrolled in two groups with 15 patients each and followed clinically and radiologically for 1 year. Patients submitted to VPS with SPHERA® valve had the same clinical improvement as patients submitted to VPS with PS Medical®. However, complications and symptomatology due to overdrainage were significantly lower in SPHERA® group, suggesting it as a safe tool to treat NPH.

RESUMO A hidrocefalia de pressão normal (HPN) é caracterizada pela tríade de sintomas de apraxia de marcha, demência e incontinência urinária. O tratamento padrão é realizado através de implantação de derivação ventricular, porém várias complicações são frequentes, como a hiperdrenagem secundária ao efeito sifão. Este estudo avaliou o resultado da válvula SPHERA® no tratamento desses pacientes em comparação com um grupo controle (PS Medical®). 30 pacientes foram consecutivamente alocados em dois grupos de 15 e seguidos por 1 ano. Pacientes com a válvula SPHERA® tiveram o mesmo grau de melhora clínica em comparação ao grupo controle, no entanto as complicações diagnósticadas e sintomatologia secundária à hiperdrenagem foi significativamente inferior no grupo da válvula SPHERA® group, sugerindo-a como uma ferramenta segura e aplicável.

Clinical Experience of Infantile Posthemorrhagic Hydrocephalus Treated with Ventriculo-Peritoneal Shunt / 대한신경손상학회지

OBJECTIVE: Infantile posthemorrhagic hydrocephalus (IPHH) is the most common cause of infantile acquired hydrocephalus. We present and discuss our experience of treatment of six IPHH patients treated by a ventriculo-peritoneal (VP) shunt. METHODS: Six preterm infants treated by a VP shunt due to germinal matrix hemorrhage and hydrocephalus were included in our study. External ventricular drainage (EVD) was performed in patients with symptomatic ventricular dilatation, and a VP shunt was placed in the case of no improvement of the ventricular index despite several rounds of EVD. Radiographic findings and surgical outcomes were analyzed retrospectively. RESULTS: Four patients were male and two were female. Mean gestational age was 25 weeks and mean weight at birth was 868.3 g. One patient had a Papile grade II (16.7%) hemorrhage, three had a grade III (50%) hemorrhage, and two had a grade IV (33.3%) hemorrhage. EVD complications (one case of ventriculitis and one case of a ventricular abscess) occurred in two patients. VP shunt complications occurred in two patients (33.3%). Three cases had an isolated 4th ventricle; two of these cases had a VP shunt placed whereas the other case had a VP shunt placed in addition to aqueductoplasty using a neuroendoscope. At the last follow-up, three of the six patients had severe neurodevelopmental delay, two had mild neurodevelopmental delay, and one had normal development status. CONCLUSION: In our study, although it is difficult to present the significant result for management of IPHH, we think that varied efforts are required to treat IPHH patients.

Factors Related with Infection after Cerebrospinal Fluid Shunt and Nursing Interventions / 中国康复理论与实践

@# Objective To explore the factors related with the infection after cerebrospinal fluid shunt (CFS) and nursing interventions.Methods 115 patients receiving CFS were reviewed. Results From November, 2009 to December, 2011, infection was found in 11 of 60 patients receiving CFS (18.3%). After intensive intervention, no infected case was found from January, 2012 to August, 2013 in 55 cases receiving CFS. Factors related with the infection included non-antibiotic-soaked shunt, non-laminar flow operating room, one-glove surgical procedure, and too many persons in the operating room. Conclusion Intensive nursing interventions can prevent the infection after CFS.

Functioning periods and complications of 246 cerebrospinal fluid shunting procedures in 208 children

To investigate the functioning periods and the causes of cerebrospinal fluid shunt failures, 246 shunts inserted in 208 children from October 1985 to August 1992 at the authors' institute were retrospectively reviewed. The mean age at shunt insertion was 4.0 years and the reasons for the shunting procedures were congenital hydrocephalus (47.6% per procedure), tumor-associated hydrocephalus (21.1%), postmeningitic hydrocephalus (11.8%), congenital cyst (10.6%) and others (8.9%). All except 2 were shunted to the peritoneal cavity. Forty-five operations for shunt failure were done (18.3%) during the follow-up period (mean, 32 months). The functioning (shunt survival) rates at 6, 12, 24 and 36 months after surgery were 91.6%, 86.6%, 83.6% and 82.9%, respectively. The complications were mechanical malfunction (12.2%), infection (4.1%), subdural fluid collection which required drainage (1.6%) and migration (0.4%). About half of the mechanical malfunctions and infections which had occurred during the follow-up period were within 6 months and 2 months after surgery, respectively. There was no shunt-related mortality. These chronological data should be considered in the planning of follow-up schedules.