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1.
World Neurosurg ; 133: e397-e400, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31526889

RESUMO

OBJECTIVE: Neonatal hydrocephalus remains a difficult condition to manage, due to high failure rates among all management strategies. Neurosurgeons commonly manage hydrocephalus with ventriculoperitoneal shunt (VPS) implantation, and valves of variable sizes and profiles are available for implantation. This study examines primary ventricular shunt valve implantation complication rates based on valve profiles in pediatric patients with hydrocephalus. METHODS: This study retrospectively reviews pediatric patients younger than 1 year of age who underwent ventricular shunt placement at a single institution from January 2001 to January 2017. Patients were classified by valve profile and categorized as either ultrasmall valves or regular-sized valves. Time until complication and type of complication were studied. RESULTS: A total of 156 patients met the inclusion criteria. Forty-eight (31%) patients received an ultrasmall shunt valve, while 108 patients received a regular valve. On average, patients undergoing ultrasmall valve placement were younger (2.1 months) than patients undergoing placement of regular valves (3.1 months) (P = 0.03). The overall complication rate within 2 years of VPS placement was 37.5% in patients with the ultrasmall valve and 41.7% in the regular valve population. There was no difference in 1-year shunt survival rate between the 2 cohorts. CONCLUSION: Our review did not find a significant difference in complication rates between ultrasmall and regular valves in patients under 1 year of age. However, the etiology of shunt malfunction did differ between the groups. This work further supports evidence suggesting a surgeon's preference for shunt hardware alone does not significantly impact outcome.


Assuntos
Hidrocefalia/cirurgia , Derivação Ventriculoperitoneal/instrumentação , Tamanho Corporal , Peso Corporal , Desenho de Equipamento , Falha de Equipamento , Feminino , Idade Gestacional , Humanos , Hidrocefalia/congênito , Hidrocefalia/etiologia , Lactente , Recém-Nascido , Masculino , Meningomielocele/complicações , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Derivação Ventriculoperitoneal/efeitos adversos
2.
BMJ Case Rep ; 12(9)2019 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-31537610

RESUMO

Neuroendocrine neoplasms (NENs) are malignancies with rare reports of central nervous system development. A 34-year-old woman was found to have a primary NEN of the brain, and she had recurrence with identical histology 10 years later. Extracranial NENs were excluded. She had routine surveillance for the first 5 years with MRIs and positron emission tomography/CTs after the initial presentation which was treated with radiation followed by cisplatin and etoposide. This case highlights the difference in primary NENs versus NEN metastases to the brain, and that longer periods of surveillance are likely required for primary NENs. This is important because the prognosis between primary NENs and metastatic NENs to the brain are vastly different and should not be treated as equal diseases. The patient eventually died of her recurrence secondary to complications of a ventriculoperitoneal shunt placed for treatment of hydrocephalus from the disease.


Assuntos
Carcinoma Neuroendócrino/patologia , Neoplasias do Sistema Nervoso Central/patologia , Recidiva Local de Neoplasia/etiologia , Derivação Ventriculoperitoneal/efeitos adversos , Adulto , Antineoplásicos/administração & dosagem , Antineoplásicos/uso terapêutico , Carcinoma Neuroendócrino/tratamento farmacológico , Carcinoma Neuroendócrino/radioterapia , Neoplasias do Sistema Nervoso Central/diagnóstico por imagem , Cisplatino/administração & dosagem , Cisplatino/uso terapêutico , Terapia Combinada , Etoposídeo/administração & dosagem , Etoposídeo/uso terapêutico , Evolução Fatal , Feminino , Humanos , Imagem por Ressonância Magnética/métodos , Tomografia por Emissão de Pósitrons/métodos
4.
Lancet ; 394(10208): 1530-1539, 2019 10 26.
Artigo em Inglês | MEDLINE | ID: mdl-31522843

RESUMO

BACKGROUND: Insertion of a ventriculoperitoneal shunt for hydrocephalus is one of the commonest neurosurgical procedures worldwide. Infection of the implanted shunt affects up to 15% of these patients, resulting in prolonged hospital treatment, multiple surgeries, and reduced cognition and quality of life. Our aim was to determine the clinical and cost-effectiveness of antibiotic (rifampicin and clindamycin) or silver shunts compared with standard shunts at reducing infection. METHODS: In this parallel, multicentre, single-blind, randomised controlled trial, we included patients with hydrocephalus of any aetiology undergoing insertion of their first ventriculoperitoneal shunt irrespective of age at 21 regional adult and paediatric neurosurgery centres in the UK and Ireland. Patients were randomly assigned (1:1:1 in random permuted blocks of three or six) to receive standard shunts (standard shunt group), antibiotic-impregnated (0·15% clindamycin and 0·054% rifampicin; antibiotic shunt group), or silver-impregnated shunts (silver shunt group) through a randomisation sequence generated by an independent statistician. All patients and investigators who recorded and analysed the data were masked for group assignment, which was only disclosed to the neurosurgical staff at the time of operation. Participants receiving a shunt without evidence of infection at the time of insertion were followed up for at least 6 months and a maximum of 2 years. The primary outcome was time to shunt failure due the infection and was analysed with Fine and Gray survival regression models for competing risk by intention to treat. This trial is registered with ISRCTN 49474281. FINDINGS: Between June 26, 2013, and Oct 9, 2017, we assessed 3505 patients, of whom 1605 aged up to 91 years were randomly assigned to receive either a standard shunt (n=536), an antibiotic-impregnated shunt (n=538), or a silver shunt (n=531). 1594 had a shunt inserted without evidence of infection at the time of insertion (533 in the standard shunt group, 535 in the antibiotic shunt group, and 526 in the silver shunt group) and were followed up for a median of 22 months (IQR 10-24; 53 withdrew from follow-up). 32 (6%) of 533 evaluable patients in the standard shunt group had a shunt revision for infection, compared with 12 (2%) of 535 evaluable patients in the antibiotic shunt group (cause-specific hazard ratio [csHR] 0·38, 97·5% CI 0·18-0·80, p=0·0038) and 31 (6%) of 526 patients in the silver shunt group (0·99, 0·56-1·74, p=0·96). 135 (25%) patients in the standard shunt group, 127 (23%) in the antibiotic shunt group, and 134 (36%) in the silver shunt group had adverse events, which were not life-threatening and were mostly related to valve or catheter function. INTERPRETATION: The BASICS trial provides evidence to support the adoption of antibiotic shunts in UK patients who are having their first ventriculoperitoneal shunt insertion. This practice will benefit patients of all ages by reducing the risk and harm of shunt infection. FUNDING: UK National Institute for Health Research Health Technology Assessment programme.


Assuntos
Infecções Relacionadas a Cateter/prevenção & controle , Stents Farmacológicos/economia , Derivação Ventriculoperitoneal/economia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/administração & dosagem , Infecções Relacionadas a Cateter/sangue , Infecções Relacionadas a Cateter/líquido cefalorraquidiano , Criança , Pré-Escolar , Análise Custo-Benefício , Stents Farmacológicos/efeitos adversos , Feminino , Humanos , Hidrocefalia/cirurgia , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Prata/economia , Método Simples-Cego , Derivação Ventriculoperitoneal/efeitos adversos , Adulto Jovem
5.
J Clin Neurosci ; 67: 288-293, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31266714

RESUMO

Extraneural dissemination of primary intracranial tumours to the peritoneal cavity via ventriculoperitoneal shunts is rare, with medulloblastoma and germ-cell tumours most common and gliomas seldom implicated. This report is the first described case of a diffuse midline glioma H3 K27M-mutant disseminating to the peritoneal cavity via a shunt. A four-year-old female presented with a large solid-cystic lesion centred on the suprasellar cistern, histologically revealed to be diffuse midline glioma H3 K27M-mutant. The patient received multiple courses of radiotherapy to the primary lesion and metachronous spinal metastases, and underwent bilateral ventriculoperitoneal shunts. She presented fourteen months following diagnosis with acute hydrocephalus and massive ascites revealed to be due to histologically confirmed intra-abdominal glioma metastasis secondary to shunting. Bilateral ventriculoatrial shunts along with targeted abdominal radiotherapy and repeated ascitic drainage were performed. The patient died one month later. A literature review demonstrated that intra-abdominal glioma metastasis is an extremely rare complication of cerebrospinal fluid diversion predominantly affecting paediatric patients with high-grade lesions within the first year after diagnosis and portends poor prognosis. Predisposition to metastasis is likely associated with tumour proximity to cerebrospinal fluid spaces and tumour biology. Contraindicating shunting in the presence of an intracranial tumour cannot be endorsed but rather shunt-related metastasis should be an acknowledged risk, and not-to-be-forgotten presentation.


Assuntos
Neoplasias Encefálicas/patologia , Glioma/patologia , Inoculação de Neoplasia , Neoplasias Peritoneais/secundário , Derivação Ventriculoperitoneal/efeitos adversos , Neoplasias Encefálicas/cirurgia , Pré-Escolar , Feminino , Glioma/cirurgia , Humanos
6.
World Neurosurg ; 130: 493-498, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31295607

RESUMO

BACKGROUND: Symptomatic slit ventricle is one of the most challenging complications of shunt surgery in children. Clinical signs and symptoms may appear with a wide range of intracranial pressure (ICP) values. We report the case of a 10-year-old girl, who did not present the classic clinical features of extremely elevated ICP, which was proven by multiple invasive ICP recordings, performed during shunt revisions. CASE DESCRIPTION: At the age of 6 months, the patient presented squeal for many hours, accompanied with sunset eyes, bulging anterior fontanel, and dilated ventricles of all 4 ventricles on computed tomography scan. Acute ventriculoperitoneal shunt insertion was performed with adjustable valve. During the following 9 years, she was regularly seen and medically treated for intermittent headache, with nausea and vomiting. From 9 years of age, she was hospitalized for severe (10/10 on the visual analog scale), unbearable headache, agitation, and screaming on multiple occasions. Altogether, we had to revise the shunt system 5 times throughout 1 year. Radiologic imaging always showed narrow ventricles. Ophthalmologic examination of the fundus never revealed signs of raised ICP. Perioperative monitoring of the ICP with intraparenchymal sensor showed unexpected high values of 40-45 mm Hg. However, repetitive shunt revisions were successful only temporarily because the symptoms always returned. Only bilateral shunting of the ventricular system was able to eliminate the symptoms permanently. CONCLUSIONS: Images of slit ventricle can be associated either with low or extremely high ICP needing urgent surgical consideration, including ICP monitoring. Bilateral shunt insertion can be effective treatment for slit ventricle syndrome.


Assuntos
Ventrículos Cerebrais/cirurgia , Síndrome do Ventrículo Colabado/diagnóstico , Síndrome do Ventrículo Colabado/cirurgia , Derivação Ventriculoperitoneal/efeitos adversos , Ventrículos Cerebrais/diagnóstico por imagem , Ventrículos Cerebrais/patologia , Criança , Feminino , Humanos , Pressão Intracraniana , Reoperação , Síndrome do Ventrículo Colabado/complicações , Resultado do Tratamento
7.
Pediatr Neurosurg ; 54(4): 233-236, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31291639

RESUMO

INTRODUCTION: Ventriculoperitoneal (VP) shunt is a commonly performed neurosurgical procedure in pediatric surgical practice. This study is aimed at determining the outcome of congenital hydrocephalus patients who underwent shunt surgery at our center. MATERIALS AND METHODS: A total of 278 operated cases of congenital hydrocephalus with a minimum follow-up of 6 months were analyzed in terms of complications. Hydrocephalus associated with intracranial hemorrhage, neural tube defects, and ventriculitis were excluded from the study. RESULTS: Complications were observed in 32.0% (89/278) of cases. Shunt block and chamber migration were the most common complications (29.21%). Abdominal wound complications were seen in 4.49% of cases. Shunt exposure due to erosion of overlying skin was noted in 6 patients. Shunt infection was diagnosed in only 9 patients (4.4%). New-onset seizures were seen in 4 cases. Overall, 21% of patients required redo shunt and there were 2 mortalities. CONCLUSION: VP shunt continues to have high complication rates. Shunt migration and new-onset seizure disorders are important late complications. In spite of inherent problems, shunt surgery is the procedure of choice until a safer effective alternative is available.


Assuntos
Hidrocefalia/cirurgia , Avaliação de Resultados da Assistência ao Paciente , Complicações Pós-Operatórias , Derivação Ventriculoperitoneal/efeitos adversos , Feminino , Humanos , Hidrocefalia/complicações , Índia , Lactente , Recém-Nascido , Masculino , Procedimentos Neurocirúrgicos , Reoperação , Estudos Retrospectivos , Centros de Atenção Terciária
8.
World Neurosurg ; 130: 470-473, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31302272

RESUMO

BACKGROUND: Ventriculoperitoneal (VP) shunt infection, which is 1 of the most important complications of VP shunt is observed at a rate of 4%-17%. Staphylococcus epidermidis is the most common causative agent. Vancomycin-resistant Enterococcus (VRE) is an increasingly common nosocomial pathogen that rarely causes central nervous system infections globally. Current treatment options that have shown appreciable activity against various VRE infections include daptomycin, linezolid, inquinupristin/dalfopristin, and tigecycline. Daptomycin has a particular mode of action and a potent bactericidal activity, making it a useful addition to the clinician's antibiotic collection. Global surveillance data indicate <1.0% rates of daptomycin resistance in enterococci. CASE DESCRIPTION: Here, we describe, to the best of our knowledge, the first case of successful intraventricular plus intravenous use of tigecycline to treat VP shunt infections caused by daptomycin resistant VRE faecium. CONCLUSION: Tigecycline is a life-saving option in the treatment of resistant nosocomial infections but it has not yet been approved for use and there are not enough data in terms of dose and side effects associated with its use in children.


Assuntos
Antibacterianos/administração & dosagem , Infecção Hospitalar/tratamento farmacológico , Daptomicina/administração & dosagem , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Tigeciclina/administração & dosagem , Enterococos Resistentes à Vancomicina/patogenicidade , Derivação Ventriculoperitoneal/efeitos adversos , Administração Intravenosa , Feminino , Infecções por Bactérias Gram-Positivas/etiologia , Humanos , Lactente , Injeções Intraventriculares , Complicações Pós-Operatórias/tratamento farmacológico , Complicações Pós-Operatórias/microbiologia , Resultado do Tratamento
9.
World Neurosurg ; 129: 440-444, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31203068

RESUMO

BACKGROUND: Trapped or isolated fourth ventricle is a known, late sequela after lateral ventricular shunt placement for hydrocephalus, particularly after infection or hemorrhage. It may cause brainstem compression and insidiously present with ataxia, dysarthria, and intracranial hypertension, further delaying diagnosis. There is no universally agreed on treatment algorithm, and options include open fenestration through a suboccipital craniotomy, fourth ventricle shunting, and minimally invasive options including endoscopic stenting and fenestration through a precoronal approach. CASE DESCRIPTION: We describe a young child with epilepsy and symptomatic brainstem compression from a dilated fourth ventricle, with a history of streptococcal parietal abscess and posthemorrhagic hydrocephalus requiring shunt placement. Given his history of infection and nearly neurologically intact examination, we pursued minimally invasive endoscopy through a suboccipital, transaqueductal approach to fenestrate his fourth ventricle. CONCLUSIONS: Magnetic resonance imaging (MRI) demonstrated complex, loculated hydrocephalus and a dilated fourth ventricle. Under electromagnetic navigation, we endoscopically fenestrated his fourth ventricle using a rarely described suboccipital, transaqueductal approach. He tolerated the procedure without complication and improved neurologically, although his follow-up MRI demonstrated no change in fourth ventricular dilation at 1 year. Although there was no decrease in size of the fourth ventricle on follow-up MRI, we describe an alternative, well-tolerated, suboccipital approach for the management of a trapped fourth ventricle. Fenestration of a web of tissue in the aqueduct of Sylvius provided long-term clinical improvement and may provide a rescue approach for patients who are not candidates for standard approaches.


Assuntos
Neuroendoscopia/métodos , Complicações Pós-Operatórias/cirurgia , Ventriculostomia/métodos , Pré-Escolar , Quarto Ventrículo/cirurgia , Humanos , Masculino , Complicações Pós-Operatórias/etiologia , Derivação Ventriculoperitoneal/efeitos adversos
10.
A A Pract ; 12(11): 401-402, 2019 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-31162168

RESUMO

A 20-year-old man submitted to surgical insertion of a lumboperitoneal drain as a treatment for intracranial hypertension, secondary to venous sinus thrombosis, developed severe headache accompanied by nausea, vomiting, and diplopia 24 hours postoperative. Cerebral spinal fluid low-pressure headache was diagnosed. A transnasal sphenopalatine ganglion block with ropivacaine was performed without complications. Pain relief was immediate, complete, and sustained for about 24 hours; a second block was performed effectively with pain control, and the patient was discharged. Sphenopalatine ganglion block may be a safe and efficient treatment for the cerebral spinal fluid hypotension headache secondary to lumboperitoneal shunt.


Assuntos
Cefaleia/terapia , Ropivacaina/administração & dosagem , Bloqueio do Gânglio Esfenopalatino/métodos , Derivação Ventriculoperitoneal/efeitos adversos , Cefaleia/etiologia , Humanos , Hipertensão Intracraniana/cirurgia , Masculino , Resultado do Tratamento , Adulto Jovem
11.
World Neurosurg ; 129: e458-e463, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31154105

RESUMO

BACKGROUND: Idiopathic normal pressure hydrocephalus (iNPH) is one of the very few treatable types of dementia. Shunt therapy has been shown to be effective in improving symptoms. However, the long-term results of cerebrospinal fluid diversion are variable. The aim of this retrospective study was to investigate long-term outcomes of patients with idiopathic normal pressure hydrocephalus treated with ventriculoperitoneal shunt by using programmable valves. METHODS: Symptoms before treatment were recorded. Clinical symptoms and outcome after ventriculoperitoneal shunt were assessed based on changes in gait, urinary incontinence, and cognitive dysfunction at yearly follow-up spanning at least 10 years. RESULTS: Among 50 patients treated, 5 had died at the time of the evaluation. Median age was 71 years, and mean follow-up time of the surviving patients was 120.2 ± 2.3 years. Overall, there was a significant and lasting improvement among all symptoms compared with the baseline (P < 0.05). Gait showed better and sustained improvement compared with the baseline (P < 0.05). Cognitive impairment and urinary incontinence improved in the early follow-up (P < 0.05) followed by declines in long-term follow-up. Ten patients (20%) required surgical revisions for shunt malfunction. Change in valve pressure was performed in 20 patients (40%). Overall, 93.3% revisions resulted in clinical improvement. CONCLUSIONS: Surgical treatment for idiopathic normal pressure hydrocephalus by ventriculoperitoneal shunt is a safe modality that improves symptoms in most patients, including in the long-term. Strict follow-up is necessary for early diagnosis of shunt malfunction or need for valve adjustment.


Assuntos
Hidrocefalia de Pressão Normal/cirurgia , Derivação Ventriculoperitoneal/métodos , Idoso , Idoso de 80 Anos ou mais , Disfunção Cognitiva/etiologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Derivação Ventriculoperitoneal/efeitos adversos
12.
Pediatr Neurosurg ; 54(3): 207-211, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31238324

RESUMO

Fungal infections of the central nervous system and pediatric brain abscess are rare but serious conditions in terms of morbidity and mortality that need immediate diagnosis and treatment. It can be seen in congenital or acquired immunosuppressed patients as opportunistic infections as well as in low-birth-weight, premature infants with ventriculoperitoneal shunt, external ventricular drainage, or with a history of craniotomy. Our aim is to emphasize the giant cerebral Candida abscess of a 13-month-old female infant who previously had eight ventriculoperitoneal shunt operations due to hydrocephalus. The patient was taken to pediatric emergency care with complaints of feeding difficulty and discomfort and was hospitalized due to the detection of an intracranial mass by contrast-enhanced brain tomography. After total excision of the mass with its capsule, the patient was pathologically diagnosed with Candida abscess, and the treatment was started. The patient was discharged by the end of the 6th week.


Assuntos
Abscesso Encefálico/cirurgia , Candida , Candidíase/tratamento farmacológico , Fluconazol/uso terapêutico , Hidrocefalia/complicações , Encéfalo , Feminino , Humanos , Hidrocefalia/cirurgia , Lactente , Derivação Ventriculoperitoneal/efeitos adversos
13.
J Coll Physicians Surg Pak ; 29(5): 478-480, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31036124

RESUMO

Ventriculoperitoneal shunt (VPS) placement is an effective and most frequently used surgical method in the treatment of hydrocephalus, but the mechanical and infective complications are often seen after this surgical procedure. Bowel perforation after VPS surgery is rarely seen complication that is reported ranging between 0.1% and 0.7% in the literature. We report a case of 10-month baby who was shunted at day three of her life and has presented to us with protruding distal end of the ventricular catheter through anus. Mechanism of migration of VPS is unclarified yet; nevertheless, children with myelomeningocele have weakness of the bowel muscles, which probably makes it more sensitive for perforation. Additionally, sharp and stiff end of the VPS, use of trocar by some surgeons, chronic irritation by the shunt, previous surgery, infection and silicone allergy are other possible reasons of bowel perforation. Peritonitis and ventriculitis have a high morbidity and mortality that may occur after VPS-related bowel perforations; hence, it should be managed rapidly and aggressively to reduce morbidity and mortality.


Assuntos
Cateteres de Demora/efeitos adversos , Migração de Corpo Estranho , Hidrocefalia/cirurgia , Perfuração Intestinal/etiologia , Derivação Ventriculoperitoneal/efeitos adversos , Canal Anal , Humanos , Hidrocefalia/congênito , Hidrocefalia/diagnóstico por imagem , Lactente , Perfuração Intestinal/cirurgia , Tomografia Computadorizada por Raios X , Resultado do Tratamento
14.
World Neurosurg ; 129: 514-521.e3, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31132499

RESUMO

BACKGROUND: The posterior ventriculoperitoneal shunt (VPS) placement procedure is technically efficient and cosmetically appealing. The main limitations of the posterior approach relate to the technical challenges associated with accurately placing the ventricular catheter. In this report, we describe methods and simple devices used for posterior VPS surgery that have evolved over a >25-year period to enhance catheter placement accuracy and reduce complication rates. OBJECTIVE: We describe the combination of methods and customized devices used at a single institution to perform posterior VPS surgery. Results are presented for the most recent 11-year epoch, along with a description of sources of technical errors and plans for further methodologic refinements. MATERIALS AND METHODS: The medical records and imaging studies of 468 patients undergoing posterior VPS, from 2007 to 2018 were reviewed. Ventricular catheter placement accuracy data were collected and complications were identified and recorded. RESULTS: Optimal ventricular catheter placement was achieved in 98.29%. Of the remaining 1.71%, one half (0.85%) required acute revision surgery. Four patients (0.85%) developed new neurologic deficits following surgery; 2 were related to intraparenchymal hemorrhages and 2 (0.43%) as a result of a misplaced catheter. The deficits resulting from poor catheter placement were transient. The complication rates due to causes other than catheter placement accuracy compared favorably with those reported previously in the literature. CONCLUSIONS: Using the methods and devices described in this series, posterior VPS operations can be performed safely with a high degree of ventricular catheter placement accuracy.


Assuntos
Complicações Pós-Operatórias/epidemiologia , Derivação Ventriculoperitoneal/efeitos adversos , Derivação Ventriculoperitoneal/instrumentação , Derivação Ventriculoperitoneal/métodos , Humanos , Estudos Retrospectivos
15.
World Neurosurg ; 129: 334-340, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31136836

RESUMO

OBJECTIVE: Endoscopic third ventriculostomy (ETV) and ventriculoperitoneal shunt (VPS) are 2 surgical methods used for the treatment of obstructive hydrocephalus. However, the efficacy and safety of these 2 procedures are unknown. Therefore we conducted a meta-analysis to compare the safety and efficiency of ETV and VPS in patients with obstructive hydrocephalus. METHODS: In January 2019, a comprehensive search strategy of 3 electronic databases was initiated. A systematic search from database inception to December 30, 2018, on clinical outcome, safety, and efficiency of ETV and VPS in the treatment of obstructive hydrocephalus was conducted. The following electronic databases were searched: PubMed, Embase, and Cochrane Library for related randomized controlled trials (RCTs). Main outcomes included postoperative hematoma, postoperative infection, postoperative cerebrospinal fluid leakage, blockage rate, and mortality. RESULTS: Of the 546 studies identified, 4 RCTs involving 250 patients met our inclusion criteria. The pooled results show that ETV was associated with lower incidence of postoperative infection (risk ratio [RR] 0.09, 95% confidence interval [CI]: 0.02-0.32, P = 0.0002); postoperative hematoma (RR 0.26, 95% CI: 0.08-0.88, P = 0.03); and blockage rate (RR 0.28, 95% CI: 0.13-0.60, P = 0.001) compared with VPS. Compared with VPS, ETV had no significant effect on incidence rate of postoperative cerebrospinal fluid leakage (RR 2.00, 95% CI: 0.30-13.16, P = 0.47) and mortality rates (RR 0.19, 95% CI: 0.03-1.09, P = 0.06), but there have been no deaths in patients treated with ETV. CONCLUSIONS: On the basis of the meta-analysis of RCTs evaluating ETV and VPS, the incidence of complications and mortality was higher with the VPS procedure, and therefore greater benefits can be achieved using ETV.


Assuntos
Hidrocefalia/cirurgia , Neuroendoscopia/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto , Derivação Ventriculoperitoneal/métodos , Ventriculostomia/métodos , Humanos , Incidência , Neuroendoscopia/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Resultado do Tratamento , Derivação Ventriculoperitoneal/efeitos adversos , Ventriculostomia/efeitos adversos
16.
J Craniofac Surg ; 30(3): e243-e244, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31048620

RESUMO

The authors report an unusual case of distal ventriculoperitoneal shunt catheter into the pulmonary vasculature. The migrated catheter was extracted through a thoracotomy and venotomy, with the cooperation of Neuroneurosurgery and Cardiovascular team. This rare complication after ventriculoperitoneal shunt surgery should be paid enough attention. There were 2 possible mechanisms. To solve the problem, multidisciplinary cooperation should be applied.


Assuntos
Cateteres/efeitos adversos , Migração de Corpo Estranho/diagnóstico por imagem , Coração/diagnóstico por imagem , Artéria Pulmonar/diagnóstico por imagem , Derivação Ventriculoperitoneal/efeitos adversos , Migração de Corpo Estranho/etiologia , Humanos , Hidrocefalia/terapia , Masculino , Tomografia Computadorizada por Raios X , Adulto Jovem
17.
World Neurosurg ; 127: e799-e808, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30954740

RESUMO

BACKGROUND: Endoscopic third ventriculostomy (ETV) is now widely used to manage ventriculoperitoneal shunt (VPS) malfunctions, but outcome predictors are still debated. Different opinions exist about the prognostic factors, but shunt duration is generally considered unimportant although its influence remains poorly investigated. METHODS: A total of 139 patients undergoing ETV for VPS malfunction were reviewed. Successful ETV was defined as shunt independence. There were 56 children and 83 adults; hydrocephalus had different causes. The mean VPS-ETV interval was 8.1 years. RESULTS: Ninety patients (64.7%) became shunt free. Children and adults achieved comparable success rates (64.3% and 65.1%, respectively). Age, gender, and cause of shunt malfunction were scarcely significant. The success rates were 86.8% (33/38 patients) in obstructive hydrocephalus (OH), 55.2% (36/67) in communicating hydrocephalus, and 58.8% (21/34) in myelomeningocele-related hydrocephalus, which was significant (P = 0.02). History of multiple revisions was a negative predictor (P < 0.001): success rate, 39% (16/48) versus 81.3% (74/91). Any individual time step increase reduced the odds of ETV success by 34% (P = 0.014). In OH, the results were good regardless of any other factor, including shunt duration. In communicating hydrocephalus, short VPS-ETV intervals correlated with better outcome (P = 0.021), although they were irrelevant in perinatal posthemorrhagic hydrocephalus. In myelomeningocele-related hydrocephalus, shunt duration had intermediate effects. CONCLUSIONS: ETV is the first option for shunt malfunctions in OH and perinatal posthemorrhagic hydrocephalus, regardless of other factors. Conversely, in other types of hydrocephalus, the chances of shunt independence are lower and shunt duration and history of multiple shunt revisions are significant.


Assuntos
Hidrocefalia/cirurgia , Terceiro Ventrículo/cirurgia , Derivação Ventriculoperitoneal , Ventriculostomia , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Endoscopia/métodos , Feminino , Humanos , Lactente , Masculino , Meningomielocele/complicações , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Próteses e Implantes/efeitos adversos , Resultado do Tratamento , Derivação Ventriculoperitoneal/efeitos adversos , Derivação Ventriculoperitoneal/métodos , Ventriculostomia/efeitos adversos , Ventriculostomia/métodos , Adulto Jovem
18.
BMJ Case Rep ; 12(4)2019 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-30992281

RESUMO

We present the case of a 14-year-old immune-competent girl with ventriculoperitoneal shunt who was repeatedly hospitalised with meningeal signs despite repeated shunt revision surgeries. Eventually Mycobacterium fortuitum was isolated and the patient improved after specific treatment. M. fortuitum is a rapidly growing, non-tuberculous mycobacterium (NTM). NTMs are associated with postsurgical, post-trauma and device-related infections. Most of the present-day surgical equipment, catheters, prostheses and indwelling devices comprised silicone, stainless steel, polyvinyl chloride and polycarbonate, on which NTMs have the tendency to form biofilms. Central nervous system infection caused by NTM carries a high mortality rate (ranging from 35% to 70%), especially in immune-compromised patients. Indwelling device removal along with prolonged treatment with a combination regimen is recommended in such cases.


Assuntos
Infecções do Sistema Nervoso Central/diagnóstico , Infecções por Micobactéria não Tuberculosa/diagnóstico , Derivação Ventriculoperitoneal/efeitos adversos , Adolescente , Antibacterianos/administração & dosagem , Infecções do Sistema Nervoso Central/líquido cefalorraquidiano , Infecções do Sistema Nervoso Central/tratamento farmacológico , Feminino , Humanos , Imunocompetência , Infecções por Micobactéria não Tuberculosa/líquido cefalorraquidiano , Infecções por Micobactéria não Tuberculosa/tratamento farmacológico , Mycobacterium fortuitum/isolamento & purificação , Reoperação/efeitos adversos
19.
J Clin Neurosci ; 64: 141-144, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31000330

RESUMO

The ventriculoperitoneal (VP) shunt is a gold standard procedure to treat hydrocephalus. However, shunt malfunction is the common complications after surgery. In this study, we utilize phase-contrast cine magnetic resonance imaging (PC cine MRI) to improve the diagnosis of VP shunt malfunction. In in vitro and in vivo experiment results demonstrate the cerebrospinal fluid (CSF) flow velocities in the shunt tube are significantly decreased in the shunt malfunction group, which indicated PC cine MRI could evaluate the CSF flow dynamics of VP shunt effectively. This method is noninvasive and simple, also can improve the diagnosis of shunt malfunction.


Assuntos
Falha de Equipamento , Imagem Cinética por Ressonância Magnética/métodos , Neuroimagem/métodos , Complicações Pós-Operatórias/diagnóstico por imagem , Derivação Ventriculoperitoneal/efeitos adversos , Feminino , Humanos , Hidrocefalia/cirurgia , Masculino
20.
World Neurosurg ; 127: 446-450, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31029817

RESUMO

BACKGROUND: Schizencephaly is a rare congenital central nervous system malformation characterized by linear, thickened clefts of the cerebral mantle. Recently, germline mutations in collagen type IV alpha 1 (COL4A1) have been reported to be a genetic cause of schizencephaly as a result of prenatal stroke. Patients with COL4A1 mutation demonstrate a variety of disease phenotypes. However, little is known about the potential complications of patients with COL4A1 mutations before and after neurologic surgery. CASE DESCRIPTION: A 9-month-old boy with schizencephaly and a congenital cataract underwent a ventriculoperitoneal shunt for progressive hydrocephalus. Postoperatively, he developed malignant hyperthermia and cerebral venous thrombosis. Early treatment with dantrolene sodium and hydration was effective. Genetic testing revealed a germline COL4A1 mutation. CONCLUSIONS: To our knowledge, malignant hyperthermia and cerebral venous thrombosis have not been reported in the literature in patients with COL4A1 mutations after surgery. Schizencephaly arising from COL4A1 mutations might be a disease prone to these adverse effects because this mutation is known to be associated with venous tortuosity, venous vulnerability, and muscle spasms due to basement membrane protein abnormalities. We need to better understand the wide spectrum of clinical phenotypes of COL4A1 mutations and potential complications in order to better manage surgery of patients with schizencephaly.


Assuntos
Colágeno Tipo IV/genética , Mutação em Linhagem Germinativa/genética , Hipertermia Maligna/etiologia , Esquizencefalia/genética , Trombose dos Seios Intracranianos/etiologia , Derivação Ventriculoperitoneal/efeitos adversos , Dantroleno/uso terapêutico , Hidratação/métodos , Humanos , Hidrocefalia/tratamento farmacológico , Hidrocefalia/cirurgia , Lactente , Masculino , Relaxantes Musculares Centrais/uso terapêutico , Complicações Pós-Operatórias/etiologia , Trombose dos Seios Intracranianos/tratamento farmacológico
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