Thoracoscopic-Assisted Ventriculo-Azygous Shunt Placement for the Treatment of Hydrocephalus

2015 ◽  
Vol 11 (4) ◽  
pp. 491-494 ◽  
Author(s):  
Jonathan Pace ◽  
Gabriel A Smith ◽  
Andrea Pannunzio ◽  
Brian D. Rothstein ◽  
Alan Markowitz ◽  
...  
Keyword(s):  
Multidisciplinary Approach ◽  
Shunt Revision ◽  
Neurosurgical Procedures ◽  
Shortness Of Breath ◽  
Azygous Vein ◽  
Shunt Placement ◽  
Cerebrospinal Fluid Diversion ◽  
History Of ◽  
Shunt Dependence

Abstract BACKGROUND Cerebrospinal fluid diversion is one of the most frequent neurosurgical procedures across the world and can be challenging in select patients who fail standard distal drainage sites. OBJECTIVE To present the case of a woman after failing peritoneal, pleural, and atrial distal drainage sites who underwent a thoracoscopic-assisted ventriculo-azygous vein shunt placement. METHODS A 32-year-old woman presented to our hospital with long-standing history of hydrocephalus and shunt dependence. She had failed peritoneal and atrial shunts secondary to infection, scarring, and clot formation. At presentation, she had a pleural shunt in place and developed a large pleural effusion with shortness of breath. RESULTS She was taken to the operating room where a thoracoscopic-assisted ventriculo-azygous vein shunt was placed through a mini-thoracotomy. Postoperatively, she has not required a shunt revision in >2 years of follow-up. CONCLUSION When other distal sites fail, our case report illustrates a novel surgical technique capable of being performed through a multidisciplinary approach.

Transventricular, transaqueductal scope-in-scope endoscopic excision of fourth ventricular neurocysticercosis: a series of 13 cases and a review

2008 ◽  
Vol 1 (1) ◽  
pp. 35-39 ◽  
Author(s):  
Ashish Suri ◽  
Rohit Kumar Goel ◽  
Faiz Uddin Ahmad ◽  
Ananth Kesav Vellimana ◽  
Bhawani Shankar Sharma ◽  
...  
Keyword(s):  
English Language ◽  
Third Ventriculostomy ◽  
Cyst Excision ◽  
Shunt Placement ◽  
Cerebrospinal Fluid Diversion ◽  
The Central Nervous System ◽  
The Mean ◽  
Clinical Records ◽  
Ventricle Size

Object Neurocysticercosis (NCC) is the most common parasitic infestation of the central nervous system worldwide. In patients presenting with acute hydrocephalus due to intraventricular NCC, surgery is the only option. Still, there is no consensus regarding the optimal surgical strategy, although neuroendoscopic excision is a promising method. However, the literature regarding the use of this modality in fourth ventricular NCC is scarce. The authors describe a series of patients with fourth ventricular NCC treated endoscopically. Methods The clinical records of 13 patients with fourth ventricular NCC who had presented with hydrocephalus were retrospectively analyzed. A fourth ventricular cyst was completely excised in all patients by using a transventricular, transaqueductal “scope-in-scope” endoscopic technique. Twelve endoscopic third ventriculostomies and 1 septostomy had been performed. Results Shunt placement was avoided in all patients. There were minimal peri- and postoperative complications. The mean duration of follow-up was 22.3 months (range 3–41 months). All patients had an improved clinical outcome. Follow-up neuroimaging revealed no residual lesion and a decreased ventricle size in all patients. Conclusions The present series of patients with fourth ventricular NCC is the largest in the existing English-language medical literature. Endoscopic fourth ventricular cysticercal cyst excision along with internal cerebrospinal fluid diversion via endoscopic third ventriculostomy is an effective alternative to open microneurosurgical procedures and avoids shunt placement and its related complications.

A MULTI-INSTITUTIONAL, 5-YEAR ANALYSIS OF INITIAL AND MULTIPLE VENTRICULAR SHUNT REVISIONS IN CHILDREN

Neurosurgery ◽  
2008 ◽  
Vol 62 (2) ◽  
pp. 445-454 ◽  
Author(s):  
Jay G. Berry ◽  
Matthew A. Hall ◽  
Vidya Sharma ◽  
Liliana Goumnerova ◽  
Anthony D. Slonim ◽  
...  
Keyword(s):  
Multivariate Regression ◽  
Hospital Volume ◽  
Revision Rate ◽  
Shunt Revision ◽  
Children's Hospitals ◽  
Shunt Placement ◽  
Hospital Variation ◽  
Children’S Hospitals ◽  
Year 2000

Abstract OBJECTIVE To evaluate risk factors and predictors of cerebrospinal ventricular shunt revisions in children. METHODS A retrospective, longitudinal cohort of 1307 children ages 0 to 18 years undergoing initial ventricular shunt placement in the year 2000, with follow-up through 2005, from 32 freestanding children's hospitals within the Pediatric Health Information Systems database was studied. Rates of ventricular shunt revision were compared with patient demographic, clinical, and hospital characteristics with use of bivariate and multivariate regression accounting for hospital clustering. RESULTS Thirty-seven percent of children required at least one shunt revision within 5 years of initial shunt placement; 20% of children required two or more revisions. Institutional rates of first shunt revision ranged from 20 to 70% of initial shunts placed among the 32 hospitals in the cohort. Hospitals where one to 20 initial shunt placements per year experienced the highest initial shunt revision rate (42%). Hospitals performing over 83 initial shunt placements per year experienced the lowest revision rate (22%). We found that children undergoing shunt placement in the Midwest were more likely to experience multiple shunt revisions (odds ratio, 1.25; 95% confidence interval, 1.06–1.47) after controlling for hospital volume, shunt type, age, and diagnosis associated with initial shunt placement. CONCLUSION Higher hospital volume of initial shunt placement was associated with lower revision rates. Substantial hospital variation in the rates of ventricular shunt revision exists among children's hospitals. Future prospective studies are needed to examine the reasons for the variability in shunt revision rates among hospitals, including differences in specific processes of care.

Development of new cold antibodies in a patient with a history of warm autoimmune haemolytic anaemia

2020 ◽  
Vol 13 (6) ◽  
pp. e232224 ◽  
Author(s):  
Meghan Anderson ◽  
Megan Winter ◽  
Vinicius Jorge ◽  
Claudia Dourado
Keyword(s):  
Chest Pain ◽  
Haemolytic Anaemia ◽  
Acute Treatment ◽  
Autoimmune Disorder ◽  
Shortness Of Breath ◽  
History Of ◽  
Mixed Pattern ◽  
Lost To Follow Up ◽  
Record Review

A 31-year-old male presented to our facility with complaints of shortness of breath and left-sided chest pain. On record review, it was revealed that he had been seen in 2014 for an almost identical presentation and had been found to have haemolytic anaemia with warm autoantibodies. Following his acute treatment during that hospital admission, he was lost to follow-up. During his subsequent admission, 5 years later, he was found to have a systemic autoimmune disorder with a superimposed acute bacterial infection leading to a second case of haemolytic anaemia and at this time with both cold and warm antibodies present. While his diagnosis was initially difficult to make due to both derangements in expected laboratory values and the mixed pattern of the haemolytic anaemia, he was promptly treated with intravenous immune globulin and steroids and was able to make a full recovery.

Management of Adult Hydrocephalus With Ventriculoperitoneal Shunts: Long-term Single-Institution Experience

Neurosurgery ◽  
2011 ◽  
Vol 69 (4) ◽  
pp. 774-781 ◽  
Author(s):  
G Kesava Reddy ◽  
Papireddy Bollam ◽  
Runhua Shi ◽  
Bharat Guthikonda ◽  
Anil Nanda
Keyword(s):  
Median Time ◽  
Adult Patients ◽  
Shunt Revision ◽  
Shunt Failure ◽  
Single Institution ◽  
Ventriculoperitoneal Shunts ◽  
Shunt Placement ◽  
Ventriculoperitoneal Shunting

Abstract BACKGROUND: Ventriculoperitoneal shunting is the most widely used neurosurgical procedure for the management of hydrocephalus. OBJECTIVE: To evaluate our long-term single-institution experience in the management of adult hydrocephalus patients with ventriculoperitoneal shunts. METHODS: Adult patients who underwent ventriculoperitoneal shunt placement for hydrocephalus from October 1990 to October 2009 were included. Medical charts, operative reports, imaging studies, and clinical follow-up evaluations were reviewed and analyzed retrospectively for clinical outcome in adult hydrocephalus patients. RESULTS: A total of 683 adult patients were included in the study. The most common etiologies of hydrocephalus include idiopathic (29%), tumors and cysts (20%), postcraniotomy (13%), and subarachnoid hemorrhage (13%). The overall shunt failure rate was 32%, and the majority (74%) of shunt revisions occurred within the first 6 months. The median time to first shunt revision was 9.31 months. Etiology of hydrocephalus showed a significant impact on the incidence of shunt revision/failure and on the median time to shunt revision. Similarly, the type of hydrocephalus had a significant effect on the incidence of shunt failure and the median time to shunt revision. CONCLUSION: A large proportion of patients (32%) experience shunt failure after shunt placement for hydrocephalus. Although the overall incidence of shunt revision was comparable to previously reported studies, the fact that a large proportion of adult populations with shunt placement experience shunt failure is a concern.

Ventriculoperitoneal Shunt Surgery Outcome in Adult Transition Patients With Pediatric-Onset Hydrocephalus

Neurosurgery ◽  
2011 ◽  
Vol 70 (2) ◽  
pp. 380-389 ◽  
Author(s):  
G. Kesava Reddy ◽  
Papireddy Bollam ◽  
Gloria Caldito ◽  
Bharat Guthikonda ◽  
Anil Nanda
Keyword(s):  
Ventriculoperitoneal Shunt ◽  
Shunt Revision ◽  
Shunt Failure ◽  
Shunt Surgery ◽  
Shunt Placement ◽  
Adult Transition ◽  
Shunt Survival ◽  
Pediatric Onset

Abstract BACKGROUND: Ventriculoperitoneal shunting remains the most widely used neurosurgical procedure for the management of hydrocephalus, albeit with many complications. OBJECTIVE: To review and assess the long-term clinical outcome of ventriculoperitoneal shunt surgery in adult transition patients with pediatric-onset hydrocephalus. METHODS: Patients 17 years or older who underwent ventriculoperitoneal shunt placement for hydrocephalus during their pediatric years (younger than 17 years) were included. Medical charts, operative reports, imaging studies, and clinical follow- up evaluations were reviewed and analyzed retrospectively. RESULTS: A total of 105 adult patients with pediatric-onset hydrocephalus were included. The median age of the patients was 25.9 years. The median age at the time of the initial ventriculoperitoneal shunt placement was 1.0 year. The median follow-up time for all patients was 17.7 years. The incidence of shunt failure at 6 months was 15.2%, and the overall incidence of shunt failure was 82.9%. Single shunt revision occurred in 26.7% of the patients, and 56.2% had multiple shunt revisions. The cause of hydrocephalus was significantly associated with shunt survival for patients who had shunt failure before the age of 17 years. Being pediatric at first shunt revision, infection, proximal shunt complication, and other causes were independently associated with multiple shunt failures. CONCLUSION: The findings of this retrospective study show that the long-term ventriculoperitoneal shunt survival remains low in adult transition patients with pediatric-onset hydrocephalus.

Rare giant frontal sinus osteoma mimicking fibrous dysplasia

2015 ◽  
Vol 129 (3) ◽  
pp. 283-287 ◽  
Author(s):  
R P Exley ◽  
A Markey ◽  
S Rutherford ◽  
R K Bhalla
Keyword(s):  
Fibrous Dysplasia ◽  
Frontal Sinus ◽  
Multidisciplinary Approach ◽  
Effective Management ◽  
Computerised Tomography ◽  
Orbital Roof ◽  
Custom Made ◽  
History Of ◽  
Titanium Cranioplasty

AbstractObjective:To present the first report of a giant frontal sinus osteoma treated by excision and single-stage reconstruction with custom-made titanium cranioplasty and left orbital roof prostheses.Case report:A 31-year-old man with a history of chronic frontal sinusitis presented with a deforming, painless, midline forehead swelling of 11 years' duration, which had been treated unsuccessfully in Nigeria. Differential diagnosis included both benign and malignant bony tumours. Computerised tomography revealed a giant bony frontal sinus tumour extending beyond the sinus roof and breaching the left orbit, consistent with fibrous dysplasia. Given the extent of the tumour, open craniectomy was performed for surgical extirpation. Histological analysis identified multiple osteomas. This surgical approach achieved excellent cosmesis, with no evidence of recurrence at 12-month follow up.Conclusion:Forehead swelling may pose diagnostic and management dilemmas for the ENT surgeon; however, effective management is facilitated by a multidisciplinary approach.

scholarly journals A Case Report of Malaria-associated Secondary Hemophagocytic Lymphohistiocytosis and a Review of the Literature

2020 ◽  
Author(s):  
Xiao Zhou ◽  
Meili Duan
Keyword(s):  
Intensive Care ◽  
Hemophagocytic Lymphohistiocytosis ◽  
Multidisciplinary Approach ◽  
Review Of The Literature ◽  
Intermittent Fever ◽  
Case Presentation ◽  
Satisfactory Outcome ◽  
History Of ◽  
Secondary Hemophagocytic Lymphohistiocytosis

Abstract Background: Malaria-associated secondary hemophagocytic lymphohistiocytosis (HLH) is rare. Moreover, the literature on malaria-associated HLH is sparse, and there are no similar cases reported in China.Case presentation: We report a case of a 29-year-old young woman with unexplained intermittent fever who was admitted to our hospital due to an unclear diagnosis. The patient concealed her history of travel to Nigeria and Dubai before onset. We made a diagnosis of malaria-associated secondary HLH. The treatment strategy for the patient included treatment of the inciting factor (artemether for 9 days followed by artemisinin for 5 days), the use of immunosuppressants (steroids, intravenous immunoglobulin) and supportive care. The patient was discharged in normal physical condition after 25 days of intensive care. No relapses were documented on follow-up at six months and 1 year. Conclusion: Early diagnosis of the primary disease along with timely intervention and a multidisciplinary approach can help patients achieve a satisfactory outcome.

Long-term results of cystoperitoneal shunt placement for the treatment of arachnoid cysts in children

2012 ◽  
Vol 10 (4) ◽  
pp. 302-305 ◽  
Author(s):  
Bin Zhang ◽  
Yuqi Zhang ◽  
Zhenyu Ma
Keyword(s):  
Arachnoid Cysts ◽  
Long Term Results ◽  
Shunt Revision ◽  
Single Institution ◽  
Group 13 ◽  
Shunt Placement ◽  
Shunt Treatment ◽  
Shunt Dependency

Object The authors present a single-institution experience in shunt treatment for arachnoid cysts (ACs). Methods Between January 2003 and January 2005, 62 patients with ACs underwent cystoperitoneal (CP) shunt placement at the authors' institution. All patients were evaluated with CT or MRI studies and had regular follow-up examinations. Results Forty-six cysts (74%) were within the sylvian fissure, 8 (13%) were in the cerebral convexity, and 8 (13%) were infratentorial. A CP shunt was placed in all patients. Follow-up imaging studies showed that 59 (95%) of 62 ACs reduced in size during a mean postoperative follow-up period of 6.5 years (range 6–8 years). Although a CP shunt was effective in achieving early obliteration, shunt dependency occurred within the patient group (13%). Shunt revision for various reasons was performed in 16 patients (26%). Conclusions Shunt placement is a safe and effective surgical treatment for symptomatic ACs in children, although efforts should be made to decrease complications in the procedure.

scholarly journals C-5 palsy after cerebrospinal fluid diversion in posttraumatic syringomyelia: case report

2015 ◽  
Vol 22 (4) ◽  
pp. 394-398 ◽  
Author(s):  
George M. Ghobrial ◽  
Sara Beygi ◽  
Matthew J. Viereck ◽  
Joshua E. Heller ◽  
Ashwini Sharan ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Injury ◽  
Foraminal Stenosis ◽  
Potential Complication ◽  
Csf Flow ◽  
Cerebrospinal Fluid Diversion ◽  
Cord Injury ◽  
History Of ◽  
Positional Shift

Syringomyelia is a potentially debilitating disease that involves abnormal CSF flow mechanics; its incidence after traumatic spinal cord injury (SCI) is approximately 15%. Treatment consists of restoration of CSF flow, typically via arachnoidolysis and syrinx decompression. The authors present a case of pronounced syringomyelia in a patient with concomitant severe cervical myelomalacia to demonstrate unilateral C-5 palsy as a potential complication of aggressive syrinx decompression at a remote level. A 56-year-old man with a remote history of SCI at T-11 (ASIA [American Spinal Injury Association] Grade A) presented with complaints of ascending motor and sensory weakness into the bilateral upper extremities that had progressed over 1 year. MRI demonstrated severe distortion of the spinal cord at the prior injury level of T10–11, where an old anterior column injury and prior hook-rod construct was visualized. Of note, the patient had a holocord syrinx with demonstrable myelomalacia. To restore CSF flow and decompress the spinal cord, T-2 and T-3 laminectomies, followed by arachnoidolysis and syringopleural shunt placement, were performed. Postoperatively on Day 1, with the exception of a unilateral deltoid palsy, the patient had immediate improvement in upper-extremity strength and myelopathy. He was discharged from the hospital on postoperative Day 5; however, at his 2-week follow-up visit, a persistent unilateral deltoid palsy was noted. MRI demonstrated a significant reduction in the holocord syrinx, no neural foraminal stenosis, and a significant positional shift of the ventral spinal cord. Further motor recovery was noted at the 8-month follow-up. Syringomyelia is a debilitating disease arising most often as a result of traumatic SCI. In the setting of myelomalacia with a pronounced syrinx, C-5 palsy is a potential complication of syrinx decompression.

Revision rate of pediatric ventriculoperitoneal shunts after 15 years

2013 ◽  
Vol 11 (1) ◽  
pp. 15-19 ◽  
Author(s):  
Jonathan J. Stone ◽  
Corey T. Walker ◽  
Maxwell Jacobson ◽  
Valerie Phillips ◽  
Howard J. Silberstein
Keyword(s):  
Transition To Adulthood ◽  
Pediatric Patients ◽  
Medical Center ◽  
High Rate ◽  
Shunt Revision ◽  
Congenital Defects ◽  
Vp Shunt ◽  
Shunt Placement ◽  
Catheter Occlusion

Object Ventriculoperitoneal (VP) shunt placement remains the mainstay treatment for pediatric hydrocephalus. These devices have a relatively high complication and failure rate, often requiring multiple revisions. The authors present a single institution's experience of pediatric patients treated with VP shunts. With an average follow-up time of 20 years, this study is among the longest reports of VP shunt revision in the literature to date. Hydrocephalus origins, shunt revision rates, and causes of shunt failure are described. Patients who underwent their first shunt revision more than 10 years after initial shunt placement were also explored. Methods A retrospective chart review was performed on all pediatric patients who underwent VP shunt placement from January 1990 through November 1996 at the University of Rochester Medical Center. Only patients who had at least 15 years of follow-up since their initial shunting procedure were included. Results A total of 234 procedures were performed on 64 patients, with a mean follow-up of 19.9 years. Patients ranged from a few days to 17.2 years old when they received their original shunt, with a median age of 4 months; 84.5% of the patients required 1 or more shunt revisions and 4.7% required 10 or more. Congenital defects, Chiari Type II malformations, tumors, and intraventricular hemorrhage were the most common causes of hydrocephalus. Overall, patients averaged 2.66 revisions, with proximal (27%) and distal (15%) catheter occlusion, disconnection (11%), and infection (9%) comprising the most common reasons for shunt malfunction. Notably, 12.5% of patients did not require their first shunt revision until more than 10 years after initial device placement, a previously undescribed finding due to the short follow-up duration in previous studies. Conclusions This long-term retrospective analysis of pediatric VP shunt placement revealed a relatively high rate of complications with need for shunt revision as late as 17 years after initial placement. Catheter occlusion represented a significant percentage of shunt failures. Cerebrospinal fluid shunting has a propensity for mechanical failure and patients with VP shunts should receive follow-up through the transition to adulthood.

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