Lumboperitoneal Shunts - Patient Selection, Technique, and Complication Avoidance: An Experience of 426 Cases.

BACKGROUND: Lumboperitoneal shunt is a known procedure for communicating hydrocephalus. Being an extracranial procedure, it can also be utilized in normal-sized ventricles. OBJECTIVE: To report our experience of lumboperitoneal shunt done with a minimal follow-up of 12 months with an emphasis on patient selection, technique, and complication avoidance. METHODS: This was a retrospective analysis of patients who underwent LP shunt during October 2014-October 2019 at the authors' institute. Inclusion criteria were patients with communicating hydrocephalus due to tubercular meningitis, normal pressure hydrocephalus, idiopathic intracranial hypertension, and postoperative refractory cerebrospinal fluid leaks. Data were collected for demographics, Glasgow coma scale and Glasgow outcome scale, vision, gait, memory, urinary incontinence, failed attempts, and complications. RESULTS: A total of 426 patients underwent the LP shunt procedure. The commonest indication was tubercular meningitis followed by idiopathic intracranial hypertension and normal pressure hydrocephalus. Age ranged from 16 to 72 years. There were 255 male and 171 female patients. The mean follow-up was 41 ± 8 months. Overall, 301 patients (70.6%) had neurological improvement. Shunt-related complications occurred in 112 (26.29%) patients, of which shunt block was the commonest. Other complications were infection in 17 (3.9%) patients and extrusion in four (0.9%) patients. Transient postural headache was seen in 46 (10.7%) patients, which gradually improved. CONCLUSION: Lumboperitoneal shunt was found to be a safe and effective treatment in appropriately selected communicating hydrocephalus patients. A meticulous technique reduces the complication rate.

Lazy Glass Microsurgical Trainer: A Frugal Solution for Microsurgical Training.

BACKGROUND: The art of surgery is becoming increasingly complex and dependent on scopes, screens, and technology, inviting a complex learning curve and development of hand-eye coordination and dexterity among other skills. We introduce an affordable, do-it-yourself microsurgical simulator that can be set up using a smartphone and a pair of reflective prism glasses. The glasses employ periscopic prisms on either side that reflect light perpendicularly. When the visual input is combined with the magnification of a smartphone camera, a real-time microsurgical experience can be simulated. METHODS: We analyzed the performance of 2 trainee residents in performing their first 5 successful sutures with 5-0 polypropylene thread on the cut ends of a glove over the course of 3 months. The module was also assessed in a survey at an international conference of neurosurgeons. RESULTS: A significant improvement was observed in both residents at the end of each month versus baseline (P < 0.05). Of 27 survey participants, 3 (11%) reported access to a training laboratory in their institute. The module was rated 4/5 in terms of hand-eye coordination, 3.5/5 in management of microsurgical field, and 3.5/5 in depth perception. CONCLUSIONS: The microsurgical simulation technique proved to be useful in performing complex microsurgical tasks. A significant improvement in microsurgical skills was observed among our trainees. The cost of building the module can be as low as U.S. $5. We endorse the use of this technique for resident training and skill development, especially in resource-challenged environments.

Duodenal carcinoid with carcinoid syndrome.

Carcinoid tumours are uncommon well-differentiated neuroendocrine tumours. Primary duodenal carcinoids account for less than 2% of all gastrointestinal carcinoids. Duodenal carcinoids are seldom associated with carcinoid syndrome. We report a rare case of duodenal carcinoid presenting as a carcinoid syndrome in a middle-aged man with upper abdominal pain, hot flushes, diarrhoea and dry cough. Endoscopy-guided biopsy and 24 h urine 5-hydroxyindoleacetic acid (5-HIAA) proved the diagnosis. He was further evaluated and managed with definitive surgical treatment.