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Background: Ventriculo -peritoneal [VP] shunt is the most commonly used cerebrospinal ?uid (CSF) diversion procedure for the management of hydrocephalus. However, when the absorption of CSF from the peritoneum is defective, it results in abdominal distension with CSF ascites. In such cases, an alternate diversion procedure - the ventriculo-atrial [VA] shunt – may be performed. However, this procedure is also associated with several perioperative problems like arrhythmias, air embolism and infection. Materials and methods: A retrospective analysis of 40 cases on the perioperative concerns of VA shunt procedures, performed in our institute, was done. Indication of the shunt, preoperative status & work -up, intraoperative adverse events & management and immediate post-operative complications were assessed. Out of the 40 patients, there were 25 male Results: s and 15 females and there were a total of 12 paediatric patients. Blocked shunt, abdominal infection and CSF ascites were common indications for VA shunt. All patients received general endotracheal anaesthesia with preoperative hypovolemia correction. Intraoperative tachycardia and arrhythmia were noted. Various Conclusion : preoperative concerns like distended abdomen and compromised respiration increase risk of VA shunt procedures. A better understanding of the underlying disease pathology and anticipation of related complications along with cautious and meticulous management can help prevent most of the complications of VA shunt procedure and thereby improve outcome
RESUMO
Objective To summarize the observation points and nursing experience after minimally invasive ventriculo-atrial shunt. Methods 45 patients after minimally invasive ventficulo-atrial shunt were given preoperative psychological care and preparations, postoperative observation of vital signs, con-sciousness, pupil, with or without intracranial hypertension, inadequate shunt or transitional symptoms, in-fectious symptoms, specific and basic care, awareness of postoperative complications and detailed guidance for discharge and follow-up jobs. Results Half month after shunt 28 cases regained consciousness, 9 cases with alleviated consciousness dysfunction, 8 cases with unchanged consciousness dysfunction, 5 cases with shunt blockage; 3 cases with over-shunt; 5 cases with inadequate shunt, 1 case with blood-borne in-fection, 1 case with shunt exposed, no intracranial infection, air embolism, complications such as endocardi-tis took place. Conclusions Adequate preoperative preparation and close postoperative observation, ef-fective specific care and basic care can increase success rate of ventriculo-atrial shunt and improve the quality of life of patients.
RESUMO
Pineal germinoma is one of the most radiosensitive intracranial tumors and so recently a regime of radiotherapy combined with ventricular shunting was advocated. But not infrequently seeding through the subarachnoid space and shunting system was observed. We have experienced a pineal tumor, which was treated completely by irradiation following ventriculo-atrial shunt but without evidence of intracranial recurrence spinal metastasis occurred 16 months later. After myelography total laminectomy from L1 to L3 was performed and intradural tumor was removed. Histopathological diagnosis was germinoma. After would healing spinal axis irradiation was performed with symptomatic improvement.