ABSTRACT
Introducción. La infección es de las complicaciones más frecuentes de los sistemas de derivación ventricular de líquido cefalorraquídeo. El objetivo fue describir las características clínicas, microbiológicas y evolutivas de niños con infección asociada a sistemas de derivación ventricular de líquido cefalorraquídeo y analizar los factores de riesgo, relacionados con la mortalidad. Población y métodos. Estudio descriptivo, retrospectivo, llevado a cabo en el Hospital "Prof. Dr. Juan P. Garrahan" de la Ciudad de Buenos Aires. Se evaluaron todos los pacientes internados desde el 1/1/2012 y el 31/12/2015 compatibles con ventriculitis y cultivo de líquido cefalorraquídeo positivo. Resultados. Se incluyeron 49 pacientes con 57 infecciones. La mediana de edad fue de 62 meses (rango intercuartílico: 19-114). Predominó el sexo masculino: 34 (70%). El tumor del sistema nervioso central fue la enfermedad de base más frecuente: 20 (40%). Se aisló estafilococo coagulasa negativo en 26 (46%), Staphylococcus aureus en 13 (23%), bacilos Gramnegativos en 11 (19%) y otros en 7 (12%). En 55 (97%) de las infecciones, se realizó tratamiento quirúrgico con retiro del sistema de derivación ventricular más antibioticoterapia. La mortalidad fue del 9%. Los únicos factores asociados a la mortalidad estadísticamente significativos fueron hemocultivos positivos (p= 0,04), fiebre al ingreso (p= 0,04) y shock séptico (p= 0,0006). Conclusiones. El estafilococo coagulasa negativo fue el germen más frecuente. El retiro de la válvula, junto con la antibioticoterapia, fue el tratamiento más utilizado. La presencia de fiebre al ingreso, hemocultivos positivos y shock séptico fueron predictores de mortalidad.
Introduction. Infections are the most common complications of ventricular cerebrospinal fluid shunts. The objective of this study was to describe the clinical, microbiological, and evolutionary characteristics of children with ventricular cerebrospinal fluid shunt-associated infections and analyze the risk factors for mortality. Population and methods. Descriptive, retrospective study carried out at Hospital "Prof. Dr. Juan P. Garrahan" in the Autonomous City of Buenos Aires. All patients hospitalized between January 1st, 2012 and December 31st, 2015 who were compatible with ventriculitis and had a positive cerebrospinal fluid culture were assessed. Results. A total of 49 patients with 57 infections were included. Their median age was 62 months (interquartile range: 19-114). Males predominated: 34 (70%). A central nervous system tumor was the most common underlying disease: 20 (40%). Coagulase-negative Staphylococcus was isolated in 26 (46%); Staphylococcus aureus, in 13 (23%); Gram-negative bacilli, in 11 (19%); and other microorganism, in 7 (12%). Treatment consisted of removal of ventricular shunt plus antibiotic therapy for 55 (97%) infections. The mortality rate was 9%. The only statistically significant factors associated with mortality were positive blood cultures (p= 0.04), fever at the time of admission (p= 0.04), and septic shock (p= 0.0006). Conclusions. Coagulase-negative Staphylococcus was the most common microorganism. Valve removal plus antibiotic therapy was the most frequently instituted treatment. Fever at the time of admission, positive blood cultures, and septic shock were predictors of mortality.
Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Bacteria/isolation & purification , Bacterial Infections/epidemiology , Cerebrospinal Fluid Shunts/adverse effects , Anti-Bacterial Agents/administration & dosage , Argentina/epidemiology , Shock, Septic/mortality , Shock, Septic/epidemiology , Bacterial Infections/microbiology , Bacterial Infections/mortality , Epidemiology, Descriptive , Retrospective Studies , Risk Factors , Device Removal , HospitalizationABSTRACT
Los sistemas de derivación ventricular de líquido cefalorraquí- deo son frecuentemente utilizados en neurocirugía pediátrica para el tratamiento de la hidrocefalia de diversas etiologías. La infección es una de las principales causas de morbimortalidad en niños que son sometidos a procedimientos de colocación de derivaciones. Resumimos en esta actualización el manejo de las infecciones asociadas a shunt de acuerdo a la mejor evidencia disponible. (AU)
Shunting systems of the ventricular cerebrospinal fluid are often used in pediatric neurosurgery for the treatment of hydrocephalus due to different etiologies. Infection is one of the main causes of morbidity and mortality in children who undergo shunting procedures. We present an evidence-based update on the management of shunt-related infections. (AU)
Subject(s)
Humans , Infant , Child, Preschool , Child , Adolescent , Anti-Bacterial Agents/therapeutic use , Bacterial Infections/diagnosis , Bacterial Infections/therapy , Cerebrospinal Fluid Shunts/adverse effects , Antibiotic Prophylaxis , Ventriculoperitoneal Shunt/adverse effectsABSTRACT
ABSTRACT BACKGROUND AND OBJECTIVES: Pulmonary edema is caused by the accumulation of fluid within the air spaces and the interstitium of the lung. Neurogenic pulmonary edema is a clinical syndrome characterized by the acute onset of pulmonary edema following a significant central nervous system insult. It may be a less-recognized consequence of raised intracranial pressure due to obstructive hydrocephalus by blocked ventricular shunts. It usually appears within minutes to hours after the injury and has a high mortality rate if not recognized and treated appropriately. CASE REPORT: We report a patient with acute obstructive hydrocephalus due to ventriculo-atrial shunt dysfunction, proposed to urgent surgery for placement of external ventricular drainage, who presented with neurogenic pulmonary edema preoperatively. She was anesthetized and supportive treatment was instituted. At the end of the procedure the patient showed no clinical signs of respiratory distress, as prompt reduction in intracranial pressure facilitated the regression of the pulmonary edema. CONCLUSIONS: This report addresses the importance of recognition of neurogenic pulmonary edema as a possible perioperative complication resulting from an increase in intracranial pressure. If not recognized and treated appropriately, neurogenic pulmonary edema can lead to acute cardiopulmonary failure with global hypoperfusion and hypoxia. Therefore, awareness of and knowledge about the occurrence, clinical presentation and treatment are essential.
RESUMO JUSTIFICATIVA E OBJETIVOS: o edema pulmonar é causado pelo acúmulo de líquido nos alvéolos e no interstício pulmonar. Edema pulmonar neurogênico é uma síndrome clínica caracterizada por edema pulmonar de início agudo após um acometimento súbito do sistema nervoso central. Pode ser uma consequência menos reconhecida de pressão intracraniana aumentada por causa da hidrocefalia obstrutiva por derivações ventriculares bloqueadas. Geralmente aparece em minutos ou horas após o insulto e tem uma alta taxa de mortalidade, caso não seja identificado e tratado adequadamente. RELATO DE CASO: relatamos o caso de paciente com hidrocefalia obstrutiva aguda por causa da disfunção da derivação ventrículo-atrial, programado para cirurgia em caráter de urgência para a colocação de derivação ventricular externa, que apresentou edema pulmonar neurogênico no pré-operatório. A paciente foi anestesiada e o tratamento de manutenção instituído. No fim do procedimento, a paciente não apresentou quaisquer sinais de distúrbio respiratório, pois a redução rápida da pressão intracraniana facilitou a regressão do edema pulmonar. CONCLUSÕES: este relato aborda a importância da identificação de um edema pulmonar neurogênico como uma possível complicação no período perioperatório resultante de um aumento da pressão intracraniana. Quando não identificado e tratado adequadamente, o edema pulmonar neurogênico pode levar à insuficiência cardiorrespiratória aguda, com hipoperfusão global e hipóxia. Portanto, a conscientização e o conhecimento de sua ocorrência, apresentação clínica e seu tratamento são essenciais.
Subject(s)
Humans , Female , Adolescent , Pulmonary Edema/etiology , Cerebrospinal Fluid Shunts/adverse effects , Intracranial Hypertension/complications , Hydrocephalus/etiology , Pulmonary Edema/pathology , Pulmonary Edema/therapy , Acute Disease , Intracranial Hypertension/therapy , Hydrocephalus/pathologyABSTRACT
Objective: Identify the factors co-responsible for infection related to external ventricular shunt (EVS). Method: This is a retrospective study with quantitative data analysis developed at the Medical Archive Service of a public hospital which is a reference in neurosurgery in Pernambuco, Brazil. The sample consisted of 140 patients who underwent the insertion of external ventricular shunt. Data were collected through a semi-structured questionnaire and analyzed using the software Statistical Package for the Social Sciences (SPSS), version 13.0. Results: Predominance of males (39.7%); age between 20 and 39 years (52%); length of hospital stay over 60 days (72.7%); multiple EVS placed (100%); length of EVS use over 30 days (96.2%). Conclusion: Statistical significance for the factors: prolonged length of hospital stay; number of EVS placed; length of EVS use; and the development of infection. Nursing actions are emerging and they're aimed at ensuring patient safety in the hospital environment
Objetivo: Identificar os fatores corresponsáveis de infecção relacionada à derivação ventricular externa (DVE). Método: Trata-se de estudo retrospectivo com análise quantitativa dos dados desenvolvido no Serviço de Arquivo Médico de um hospital público que é referência em neurocirurgia em Pernambuco. A amostra foi constituída por 140 pacientes submetidos a inserção de derivação ventricular externa. Os dados foram coletados por meio de um questionário semiestruturado e analisados com o programa Statistical Package for the Social Sciences (SPSS), versão 13.0. Resultados: Predominância do sexo masculino (39,7%); idade entre 20 e 39 anos (52%); tempo de internamento acima de 60 dias (72,7%); múltiplas DVEs colocadas (100%); tempo de uso da DVE acima de 30 dias (96,2%). Conclusão: Significância estatística para os fatores: tempo de internação prolongado; número de DVEs colocadas; tempo de uso da DVE; e o desenvolvimento de infecção. As ações de enfermagem são emergentes e visam a garantir a segurança do paciente no ambiente hospitalar
Objetivo: Identificar los factores co-responsables de infección relacionada con la derivación ventricular externa (DVE). Método: Esto es un estudio retrospectivo con análisis cuantitativo de datos desarrollado en el Servicio de Archivo Médico de un hospital público que es referencia en neurocirugía en Pernambuco, Brasil. La muestra consistió de 140 pacientes que se sometieron a inserción de una derivación ventricular externa. Los datos fueron recogidos por medio de un cuestionario semi-estructurado y analizados con el programa Statistical Package for the Social Sciences (SPSS), versión 13.0. Resultados: Predominio del sexo masculino (39,7%); edad entre 20 y 39 años (52%); tiempo de hospitalización mayor que 60 días (72,7%); múltiples DVEs colocadas (100%); tiempo de utilización de la DVE mayor que 30 días (96,2%). Conclusión: Significancia estadística para los factores: tiempo prolongado de hospitalización; número de DVEs colocadas; tiempo de utilización de la DVE; y el desarrollo de infección. Las acciones de enfermería están surgiendo y tienen el fin de garantizar la seguridad del paciente en el entorno hospitalario
Subject(s)
Humans , Male , Female , Cerebrospinal Fluid Shunts/adverse effects , Cerebrospinal Fluid Shunts/nursing , Cerebrospinal Fluid Shunts/statistics & numerical data , Patient Safety/statistics & numerical dataABSTRACT
Idiopathic normal pressure hydrocephalus (iNPH) is characterized by gait disturbance, dementia and /or urinary incontinence, dilation of the ventricular system and normal opening cerebrospinal fluid pressure. Shunt surgery is the standard treatment of iNHP. Diversions with programmable valves are recommended, once drainage pressure can be changed. However, well-defined protocols still lack guiding the steps to attain proper pressure for each patient. Methods: In our study, we reported the experience of shunting 24 patients with iNPH using Strata® (Medtronic) valve, following a protocol based on a positive Tap Test. Results: We observed clinical improvement in 20 patients and stability/worsening in 4 patients. Complications occurred in five patients, including one death. The results display improvement, and complications occurred at a lower rate than reported in other studies. Conclusions: The Strata® valve used in the proposed protocol represents an efficient and safe tool in the treatment of iNPH. .
A hidrocefalia de pressão normal idiopática (iNPH) é caracterizada por alterações na marcha, demência e/ou incontinência urinária, além de dilatação dos ventrículos com pressão normal de abertura no líquido cefalorraquidiano. A cirurgia de derivação é o principal tratamento da iNHP. São recomendadas válvulas programáveis, pois a pressão de drenagem pode ser alterada. Embora as válvulas programáveis sejam utilizadas, não há protocolos para atingir a pressão adequada de cada paciente. Métodos: Neste estudo, relatamos nossa experiência com 24 pacientes com iNPH que usaram a válvula Strata® (Medtronic), seguindo protocolo baseado em um Tap test positivo. Resultados: Observamos melhora em 20 pacientes e estabilidade ou piora em 4. Ocorreram complicações em cinco pacientes, tendo um deles falecido. Houve importante melhora clínica, e as complicações ocorreram em taxa mais baixa do que as relatadas em outros estudos. Conclusões: A válvula Strata® utilizada no protocolo proposto representa uma ferramenta eficiente e segura no tratamento de iNPH. .
Subject(s)
Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Cerebrospinal Fluid Shunts/instrumentation , Hydrocephalus, Normal Pressure/surgery , Cerebrospinal Fluid Shunts/adverse effects , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
Patients with hydrocephalus and risk factors for overdrainage may be submitted to ventricular shunt (VS) implant with antisiphon device. The objective of this study was to prospectively evaluate for two years the clinical and tomographic results of the implant of fixed-pressure valves with antisiphon device SPHERA® in 35 adult patients, with hydrocephalus and risk factors for overdrainage. Of these, 3 had congenital hydrocephalus in adult patients with very dilated ventricles (Evans index >50%), 3 had symptomatic overdrainage after previous VS implant (subdural hematoma, hygroma or slit ventricle syndrome), 1 had previous chronic subdural hematoma, 15 had normal pressure hydrocephalus with final lumbar pressure <5 cm H2O after tap test (40 mL), 6 had pseudotumor cerebri, and 7 had hydrocephalus due to other causes. Clinical improvement was observed and sustained in 94.3% of the patients during the two-year period with no computed tomography (CT) evidence of hypo or overdrainage, and no immediate early or late significant complications.
Pacientes com hidrocefalia e fatores de risco para hiperdrenagem podem ser submetidos ao implante de derivação ventricular (VS) com mecanismo antissifão. O objetivo deste trabalho foi avaliar prospectivamente os resultados clínicos e tomográficos do implante de válvulas de pressão fixa com antissifão SPHERA® em 35 pacientes adultos, com hidrocefalia e risco de hiperdrenagem, acompanhados por dois anos. Destes, 3 apresentavam hidrocefalia congênita em adulto, com ventrículos muito dilatados (índice de Evans >50%); 3 tinham hiperdrenagem sintomática pós-derivação ventricular prévia (hematoma subdural, higroma ou síndrome dos ventrículos colabados; 1 apresentava hematoma subdural crônico pregresso; 15 apresentavam hidrocefalia de pressão normal com pressão lombar final <5 cm H2O após tap test (40 mL); 6 apresentavam pseudotumor cerebral; e 7, devido a outras causas. A melhoria clínica foi detectada e sustentada em 94,3% dos pacientes no período de dois anos, sem indícios tomográficos de hipo ou hiperdrenagem e sem complicações significativas imediatas, precoces ou tardias.
Subject(s)
Adolescent , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Young Adult , Cerebrospinal Fluid Shunts/instrumentation , Drainage/instrumentation , Hydrocephalus/surgery , Hydrostatic Pressure/adverse effects , Cerebrospinal Fluid Pressure/physiology , Cerebrospinal Fluid Shunts/adverse effects , Equipment Design , Hematoma, Subdural/etiology , Hydrocephalus, Normal Pressure/physiopathology , Hydrocephalus, Normal Pressure/surgery , Hydrocephalus/physiopathology , Prospective Studies , Pseudotumor Cerebri/etiology , Slit Ventricle Syndrome/etiology , Tomography, X-Ray ComputedSubject(s)
Child , Humans , Anti-Bacterial Agents/pharmacology , Cerebrospinal Fluid Shunts , Cerebrospinal Fluid/microbiology , Gram-Negative Bacteria/drug effects , Gram-Positive Bacteria/drug effects , Cerebrospinal Fluid Shunts/adverse effects , Drug Resistance, Bacterial , Gram-Negative Bacteria/isolation & purification , Gram-Positive Bacteria/isolation & purification , Iran , Microbial Sensitivity TestsABSTRACT
Ventriculo-pleural shunt [VPLS] is an acceptable alternative in the management of hydrocephalus. Imbalance between the production and absorption of cerebrospinal fluid an lead to formation of pleural effusion in patient with VPLS and on occasion produce symptoms. Pleural effusion could be a transudate or a non-specific exudate. We report our experience with this modality in relation to formation of pleural effusion and review the literature to make recommendation for its management. Information related to patients' demographics, smoking history, prior pulmonary and occupational history, indication, duration and complications of the VPLS and their management was gathered to substantiate current recommendation with our experience
Subject(s)
Humans , Male , Female , Cerebrospinal Fluid Shunts/adverse effects , Hydrocephalus/surgery , Cerebrospinal Fluid , Pleura , Review Literature as TopicABSTRACT
Cerebrospinal fluid [CSF] leak is a well recognized complication of basilar skull fracture, skull base surgery and neurootological procedures. Continuous CSF drainage has been a widely accepted procedure to prevent and treat such leaks. Though generally the procedure is innocuous, it can cause complications like headache, nausea, vomiting, subdural bleeding, infection and tension pneumocephalus. Though the development of intracranial subdural haematomas have been reported in a number of cases after deliberate lumbar CSF drainage or inadvertent CSF leak following spine surgery; lumbar CSF drain causing an intracerebral haemorrhage has not been reported previously as per the authors' review of literature. We report a rare case of intracerebral haematoma following lumbar CSF drainage which was managed by timely diagnosis and early evacuation. The authors recommend close neurological monitoring of patients who require continuous lumbar drainage to detect any life-threatening complications
Subject(s)
Humans , Female , Middle Aged , Cerebrospinal Fluid Shunts/adverse effects , Tomography, X-Ray ComputedABSTRACT
We have here, a case report of an infant who presented with subdural and intracerebral hematoma distantly from the site of insertion of a ventriculoperitoneal shunt 6 days after operation. Though this complication has been previously reported, it remains a rare event. Both pathogenesis and treatment still represent a problem
Subject(s)
Humans , Male , Cerebral Hemorrhage , Cerebrospinal Fluid Shunts/adverse effects , Tomography, X-Ray ComputedABSTRACT
La utilización de catéteres intracraneanos, fundamentalmente los drenajes ventriculares externos, es una práctica de relativa frecuencia en el manejo de pacientes con neuroinjuria grave en las unidades de cuidados intensivos. Debido a que se asocian con un aumento significativo del riesgo de infecciones del sistema nervioso central (SNC) posneuroquirúrgicas, es necesario estandarizar su manejo para lograr mejores resultados. Se consensuaron pautas de manejo de estos dispositivos mediante revisión de la bibliografía y discusión entre las cátedras de Medicina Intensiva y Neurocirugía de la Facultad de Medicina. Se establecieron las indicaciones y técnica para su inserción, la descripción detallada del sistema de derivación y drenaje de líquido cefalorraquídeo, así como el manejo del mismo contemplando las eventuales complicaciones. Se determinaron, también, los criterios diagnósticos de infecciones del SNC posneuroquirúrgicas más relevantes, como meningitis y ventriculitis.
Subject(s)
Ventriculostomy , Central Nervous System Infections , Drainage , Cerebrospinal Fluid Shunts/adverse effects , Cerebrospinal Fluid Shunts/methods , Cerebrospinal Fluid ShuntsABSTRACT
Os objetivos deste estudo foram analisar as características epidemiológicas e clínicas de 243 crianças com hidrocefalia derivada, acompanhadas durante 1 a 27 anos, assim como identificar os fatores relacionados aos distúrbios psicomotores, epilepsia e ao óbito. A meningite pós-derivação e os distúrbios mecânicos do sistema foram as complicações mais freqüentes (22,3 por cento e 30,7 por cento, respectivamente). A média de derivação por paciente foi 1,47. Distúrbios motores graves ocorreram em 34,3 por cento, déficit cognitivo em 58,5 por cento e epilepsia em 43,6 por cento dos pacientes. Os distúrbios motores correlacionaram-se positivamente com o grau da hidrocefalia. Houve maior incidência de déficit cognitivo e epilepsia nos casos de hidrocefalia pós-meningite. O óbito ocorreu em 52 pacientes e estes apresentaram um percentual maior de neoplasia do sistema nervoso central e de distúrbios motores na última avaliação, assim como de retirada da primeira derivação por meningite precoce, ocorrida até 2 meses após a derivação.
Subject(s)
Adolescent , Child , Child, Preschool , Female , Humans , Infant , Infant, Newborn , Male , Cerebrospinal Fluid Shunts , Hydrocephalus/epidemiology , Hydrocephalus/surgery , Age of Onset , Cause of Death , Cerebrospinal Fluid Shunts/adverse effects , Epilepsy/epidemiology , Epilepsy/etiology , Epilepsy/physiopathology , Hydrocephalus/etiology , Psychomotor Disorders/epidemiology , Psychomotor Disorders/etiology , Psychomotor Disorders/physiopathology , Retrospective StudiesSubject(s)
Humans , Male , Female , Cerebrospinal Fluid Shunts/adverse effects , Postoperative Complications , InfectionsABSTRACT
Shunt infection is one of the commonest and most troublesome cause of shunt failure. According to the etiology and clinical presentations it has been divided into external and internal types. METHOD: We hereby present four pediatric cases, who presented with atypical manifestations not coinciding with the above mentioned types of shunt infection. Three patients developed round, globular or diffuse fluctuant CSF filled swellings at the burr hole site, one of whom had involvement of the entire pericatheteral extent upto the abdomen. RESULT: The fourth child developed spontaneous expulsion of ventricular end of shunt tube through the dehiscent and infected chest wall incision site. CONCLUSION: First three of the above children were diagnosed as having internal type of shunt infections, while the fourth had mixed manifestations of external and internal type.
Subject(s)
Anti-Bacterial Agents , Cerebrospinal Fluid Shunts/adverse effects , Child , Child, Preschool , Drug Therapy, Combination/therapeutic use , Female , Follow-Up Studies , Humans , Hydrocephalus/surgery , Infant , Male , Retrospective Studies , Staphylococcal Infections/drug therapyABSTRACT
We report a child with hydrocephalus due to tuberculous meningitis who developed a subcutaneous fluid collection around the ventriculoperitoneal shunt tube entry point, after one month of shunting. On investigation, he had decompressed ventricles with bilateral fronto parietal subdural hygroma. Bifrontal burr hole drainage helped resolution of both subdural effusion and subcutaneous scalp swelling. This complication is unique and its pathogenesis has been postulated.