T-Connector Modification for Reducing Recurrent Distal Shunt Failure: Report of 2 Cases

2017 ◽  
Vol 13 (6) ◽  
pp. E33-E36
Author(s):  
Joseph A Carnevale ◽  
Nigar Ahmedli ◽  
John F Morrison ◽  
Wael F Asaad ◽  
Petra Klinge ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Peritoneal Cavity ◽  
Clinical Presentation ◽  
The Body ◽  
Abdominal Pressure ◽  
Obese Patients ◽  
Shunt Failure ◽  
Cerebrospinal Fluid Shunt ◽  
Peritoneal Catheter ◽  
Distal Catheter

Abstract BACKGROUND AND IMPORTANCE Cerebrospinal fluid shunt placement is used to treat the various causes of hydrocephalus by redirecting the cerebrospinal fluid to the body, most commonly from the ventricle to the peritoneum. Distal catheter displacement from the peritoneal cavity can occur as a complication, necessitating reoperation. CLINICAL PRESENTATION We report 2 such cases in obese patients involving retropulsion of the distal tubing. To address this complication, we implanted a T-connector to the distal catheter construct. CONCLUSION This study supports the use of a T-connector catheter construct to decrease and prevent the possibility of distal peritoneal catheter retropulsion in cases of elevated intra-abdominal pressure, both prophylactically and in revisions.

A novel solution to reduce the complications of distal shunt catheter displacement associated with obesity

2010 ◽  
Vol 113 (6) ◽  
pp. 1314-1316 ◽  
Author(s):  
John F. Morrison ◽  
Kristin E. Sung ◽  
Ari M. Bergman ◽  
Michael S. Rosenblatt ◽  
Jeffrey E. Arle
Keyword(s):  
The Body ◽  
Intraabdominal Pressure ◽  
Obese Patients ◽  
Csf Flow ◽  
Peritoneal Catheter ◽  
Distal Catheter ◽  
Catheter Tip ◽  
Peritoneal Space ◽  
Catheter Tube ◽  
Catheter Tubing

Despite the varied sources of hydrocephalus, all shunt-treated conditions involve redirection of CSF to the body, commonly the peritoneum. Migration of the distal catheter tip out of the peritoneal space can occur, leading to the need for reoperation. Although uncommon, the authors have recently had 3 such cases in obese patients involving distal tubing retropulsion in otherwise uncomplicated surgeries. In addressing this issue, the authors performed anchoring of the distal catheter tubing through a small abdominal mesh, which is commonly used for hernia repair to increase catheter tube friction without compromising CSF flow. The results suggest this method may mitigate the chance of peritoneal catheter displacement in patients with higher than normal intraabdominal pressure.

Determination of cerebrospinal fluid shunt function with water-soluble contrast medium

1978 ◽  
Vol 49 (3) ◽  
pp. 398-407 ◽  
Author(s):  
Mario Savoiardo ◽  
Carlo L. Solero ◽  
Angelo Passerini ◽  
Franco Migliavacca
Keyword(s):  
Cerebrospinal Fluid ◽  
Contrast Medium ◽  
Water Soluble ◽  
Ventricular Catheter ◽  
Cerebrospinal Fluid Shunt ◽  
Distal Catheter ◽  
Content Type ◽  
Water Soluble Contrast ◽  
Water Soluble Contrast Medium

✓ Determination of cerebrospinal fluid shunt patency with water-soluble contrast medium is a simple, rapid, reliable, and safe technique. Since September, 1974, the authors performed 113 examinations. With the Spitz-Holter valve, only the atrial catheter can be studied, but, with the Pudenz valve and with the shunting devices that have a double-dome reservoir, both the proximal and the distal catheter can be visualized. Through the ventricular catheter a full ventriculographic study can be made, demonstrating ventricular size, malposition of the catheter, and the lesion that caused the hydrocephalus, or its evolution. The problem of collapsed ventricles, in which clinical and “manual” evaluation of the flushing device can give misleading findings, is emphasized. The injection of the atrial or peritoneal catheter in the pathological cases demonstrated its blockage, level of disconnection, malposition, sleeve, or cyst formation. Computerized tomography has only slightly decreased the number of these studies: when the ventricles are large, the examination with water-soluble contrast medium is still needed to demonstrate the exact level of malfunction. This demonstration has decreased the number of the total revisions or complete changes of shunting systems, eliminating some unnecessary changes of normally functioning catheters.

Flow characteristics of cerebrospinal fluid shunt tubing

2012 ◽  
Vol 9 (2) ◽  
pp. 191-197 ◽  
Author(s):  
Joseph T. Cheatle ◽  
Alexis N. Bowder ◽  
Sandeep K. Agrawal ◽  
Michael D. Sather ◽  
Leslie C. Hellbusch
Keyword(s):  
Cerebrospinal Fluid ◽  
Flow Characteristics ◽  
Hydrodynamic Resistance ◽  
Csf Shunt ◽  
Effective Diameter ◽  
Cerebrospinal Fluid Shunt ◽  
Shunt System ◽  
Shunt Valve ◽  
Cross Sectional ◽  
Distal Catheter

Object Cerebrospinal fluid shunt systems malfunction for a multitude of reasons, including malpostitioning, obstruction of the ventricular or distal catheter, obstruction of the shunt valve, and catheter disruptions or disconnections. The goal of this study was to examine the hydrodynamic resistance and flow in new and explanted catheters and also in catheters with 1 or 2 straight connectors. Methods Explanted catheters of multiple lengths, 2-piece catheters, 3-piece catheters, and new catheters were attached to a proximal and distal manometer. A flask with artificial CSF attached to the proximal end provided flow. The flow was allowed to stabilize over 1 hour; then the change in pressure between the proximal and distal end of the catheter was measured. Results The resistance to flow was calculated for new, never-implanted catheters and compared with the resistance of explanted distal shunt catheters. The resistance of the new catheters was examined after the addition of 1 and 2 straight connectors. Explanted catheters exhibited a slight increase in the resistance to flow of artificial CSF compared with new catheters. Two-piece and 3-piece catheters had a significant increase in resistance to flow compared with new catheters. For all catheters, resistance to flow increased as length increased (new, p = 0.01; explanted, p = 0.009; 1 connector, p = 0.01; 2 connectors, p = 0.03). In this paper, effective diameter is defined as the available cross-sectional area of catheter contacted by the artificial CSF. For new and explanted catheters, a decrease in the effective diameter of the catheter was associated with an increase in the resistance to flow of artificial CSF (new, p = 0.1083; explanted, p = 0.0091). However, after the addition of 1 or 2 connectors, an inverse trend was observed: resistance to flow increased with effective diameter. Conclusions There appears to be some increase in resistance of CSF shunt catheters as they age, altering flow dynamics. In addition, the use of straight connectors within a CSF shunt system increases the resistance to flow of artificial CSF within the shunt system. The increase in resistance appears to be related to the duration of implantation and the length of the catheter and inversely related to the diameter of the catheter. This increase in resistance may be related to sterile shunt malfunction. The addition of straight connectors is associated with a significant increase in resistance in comparison with catheters without connectors (p = 0.005).

Liver Cyst Caused by the Peritoneal Catheter of a Cerebrospinal Fluid Shunt

2007 ◽  
Vol 43 (4) ◽  
pp. 343-344 ◽  
Author(s):  
Siddharth Banka ◽  
Karl Johnson ◽  
Spyros Sgouros
Keyword(s):  
Cerebrospinal Fluid ◽  
Liver Cyst ◽  
Cerebrospinal Fluid Shunt ◽  
Peritoneal Catheter

Cardiovascular responses to elevation of intra-abdominal hydrostatic pressure

1985 ◽  
Vol 248 (2) ◽  
pp. R208-R213 ◽  
Author(s):  
G. E. Barnes ◽  
G. A. Laine ◽  
P. Y. Giam ◽  
E. E. Smith ◽  
H. J. Granger
Keyword(s):  
Hydrostatic Pressure ◽  
Peritoneal Cavity ◽  
Femoral Vein ◽  
Pressure Rise ◽  
Intrathoracic Pressure ◽  
Cardiovascular Responses ◽  
The Body ◽  
Whole Body ◽  
Positive Pressure ◽  
Abdominal Pressure

Intra-abdominal fluid volume and hydrostatic pressure were elevated by positive pressure infusion of Tyrode solution into the peritoneal cavity of anesthetized dogs. The compliance of the peritoneal cavity fell from 10.8 to 0.56 ml X mmHg-1 X kg-1 of body wt as intra-abdominal pressure increased from 0 to 40 mmHg. Intrathoracic pressure also increased as elevated peritoneal pressure caused diaphragmatic bulging. Cardiac output and stroke volume were reduced by 36% after an intra-abdominal pressure rise of 40 mmHg; in contrast, heart rate did not change. Flow in the celiac, superior mesenteric, and renal arteries was reduced by 42, 61, and 70%, respectively. Pressure in the femoral vein increased to 46 mmHg, while flow in the femoral artery decreased by 65%. Whole-body O2 consuxmption, pH, and arterial PO2 decreased as intra-abdominal pressure rose. The peritoneal cavity, with its high initial compliance, affords the body an ideal location for the temporary accumulation of small to moderate volumes of fluid during episodes of increased vascular pressure or permeability. The marked alterations in the hemodynamic properties of the cardiovascular system are indicative of the physiological changes that occur when intra-abdominal fluid accumulation becomes excessive and peritoneal pressure rises to high levels.

Ventriculoperitoneal Shunt Dysfunction in Adults Secondary to Conditions Causing a Transient Increase in Intra-abdominal Pressure: Report of Three Cases

Neurosurgery ◽  
2004 ◽  
Vol 55 (2) ◽  
pp. 444-E448 ◽  
Author(s):  
Vincent J. Miele ◽  
Bernard Bendok ◽  
Stephen M. Bloomfield ◽  
Stephen L. Ondra ◽  
Julian E. Bailes
Keyword(s):  
Small Bowel ◽  
Small Bowel Obstruction ◽  
Bowel Obstruction ◽  
Peritoneal Cavity ◽  
Shunt Malfunction ◽  
Abdominal Pressure ◽  
Shunt Failure ◽  
Radiographic Evidence ◽  
Vp Shunt ◽  
Shunt Dysfunction

Abstract OBJECTIVE AND IMPORTANCE: Ventriculoperitoneal (VP) shunts function because of the pressure differential between the intracranial space and the peritoneal cavity. The pressure in the peritoneal cavity is the lower of the two in a properly functioning shunt; thus, cerebrospinal fluid flows distally. Although not reported in the literature, adult constipation, ileus, or small bowel obstruction can alter this pressure balance and cause dysfunction. If not recognized as a transient, easily treated phenomenon, patients may be subjected to unnecessary shunt revisions. This study analyzed the occurrence of shunt malfunction in three adults secondary to transient increases in intra-abdominal pressure. CLINICAL PRESENTATION: Three patients with clinical symptoms and radiographic evidence of VP shunt malfunction at presentation were found to have transient conditions causing a significant increase in intra-abdominal pressure. These patients' records were evaluated with an emphasis on risk factors, treatments, and outcomes. INTERVENTION: After resolution of the patients' abdominal issues, clinical signs and symptoms of VP shunt dysfunction resolved within 24 hours. Radiographic evidence of the resolution of shunt failure also was observed. CONCLUSION: Shunt malfunction or dysfunction consumes many person-hours and healthcare dollars. This study provides anecdotal evidence that transient and easily reversible increases in the intra-abdominal pressure of adults with VP shunts can result in dysfunction. Although it may not be practical to delay shunt revision while attempting to correct constipation, ileus, or small bowel obstruction, clinicians treating patients with these abdominal conditions should be aware that they could cause transient VP shunt failure. It would seem prudent that patients with VP shunts be started on a prophylactic bowel regimen before surgical procedures to decrease the risk of this somewhat preventable result.

scholarly journals Mechanisms and Major Sites of Distal Catheter Migration in Ventriculoperitoneal Shunting Maneuvers: A Review Article

2018 ◽  
Vol 4 (2) ◽  
pp. 141-155
Author(s):  
Ismatullah Soufiany ◽  
Khalil Ahmad Hijrat ◽  
Spina Soufiany ◽  
Lukui Chen
Keyword(s):  
Peritoneal Cavity ◽  
Intrathoracic Pressure ◽  
The Body ◽  
Intraabdominal Pressure ◽  
Jugular Veins ◽  
Distal Catheter ◽  
Iatrogenic Perforation ◽  
Catheter Migration ◽  
Ventriculoperitoneal Shunting ◽  
The Many

A ventriculoperitoneal shunt (VPS) is a medical device used to deflect cerebrospinal fluid from cerebral ventricles to the peritoneal cavity. Since 1908, ventriculoperitoneal shunts have been considered the best option in hydrocephalus management. Manifestation related to VPS may arise anywhere whilst tunneling the VPS from the ventricle to the peritoneal cavity, but complications associated with the distal catheter are especially common and a leading cause of revision surgeries. Among the many complications associated with peritoneal shunts, migration of the catheter into other parts of the body is still common. Scrotal migration mainly takes place in children aged 4 days to 5 years. Patent processus vaginalis, formation of an inguinal hernia, and increased intraabdominal pressure are leading risk factors associated with migration of the peritoneal catheter into the scrotum. Thoracic migration of peritoneal catheters predominantly occurs in adult patients. Important mechanisms in thoracic migration include (1) iatrogenic perforation of the external or internal jugular veins by the surgeon during tunneling and (2) gradual destruction of the venous structures by the catheter due to routine extension and flexion of the neck. After entering the vessel, negative intrathoracic pressure combined with positive intraabdominal pressure aids migration into the thoracic cavity. Sharp tips or shunt types contribute to intraabdominal migration and perforation.

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