scholarly journals Overshunting-Related Cervical Myelopathy Causing Progressive Gait Disturbance: A Case Report

2021 ◽  
pp. 312-317
Author(s):  
Eva Vister ◽  
Sebastiaan Hammer ◽  
Rudolf W.M. Keunen ◽  
Astrid L. Rijssenbeek ◽  
Niels A. van der Gaag
Keyword(s):  
Cerebrospinal Fluid ◽  
Cervical Myelopathy ◽  
Complete Resolution ◽  
Late Complication ◽  
Gait Disturbance ◽  
Shunt Revision ◽  
Proper Treatment ◽  
Cervical Stenosis ◽  
Vp Shunt ◽  
Associated Symptoms

A complication of ventriculoperitoneal (VP) shunting is overdrainage or overshunting of cerebrospinal fluid, which can cause formation of hygroma but in rare cases also cervical myelopathy at a later stage. In this article, we describe a very late complication of VP shunting. We present a 75-year-old man, previously given a VP shunt at the age of 46, who developed a progressive gait disturbance and ataxia of the limbs after 27 years. MRI showed a cervical stenosis and myelopathy as a result of venous engorgement due to chronic overshunting of the VP shunt. Revision of the VP shunt resulted in complete resolution of his neurological symptoms and the cervical myelopathy. Cervical myelopathy due to chronic overshunting is a rare and potentially very late complication of a VP shunt. Our case underlines the importance of awareness of this complication while proper treatment can reverse the associated symptoms fully.

RECURRENT CEREBROSPINAL FLUID (CSF) PLEURAL EFFUSION AFTER VENTRICULOPERITONEAL (VP) SHUNT REVISION: BRIEF REPORT AND LITERATURE REVIEW

CHEST Journal ◽  
2009 ◽  
Vol 136 (4) ◽  
pp. 61S ◽  
Author(s):  
Hiroshi Sekiguchi ◽  
Rodrigo Cartin-Ceba ◽  
Eric J. Olson ◽  
Nicholas M. Wetjen ◽  
John J. Mullon
Keyword(s):  
Cerebrospinal Fluid ◽  
Pleural Effusion ◽  
Literature Review ◽  
Shunt Revision ◽  
Vp Shunt

Cerebrospinal fluid shunting protocol for idiopathic intracranial hypertension for an improved revision rate

2021 ◽  
pp. 1-6
Author(s):  
Luke Galloway ◽  
Kishan Karia ◽  
Anwen M. White ◽  
Marian E. Byrne ◽  
Alexandra J. Sinclair ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Intracranial Hypertension ◽  
Idiopathic Intracranial Hypertension ◽  
Revision Rate ◽  
Shunt Revision ◽  
Csf Shunt ◽  
Peritoneal Catheter ◽  
Vp Shunt ◽  
Primary Surgery ◽  
Csf Shunting

OBJECTIVE Cerebrospinal fluid (CSF) shunting in idiopathic intracranial hypertension (IIH) is associated with high complication rates, primarily because of the technical challenges that are related to small ventricles and a large body habitus. In this study, the authors report the benefits of a standardized protocol for CSF shunting in patients with IIH as relates to shunt revisions. METHODS This was a retrospective study of consecutive patients with IIH who had undergone primary insertion of a CSF shunt between January 2014 and December 2020 at the authors’ hospital. In July 2019, they implemented a surgical protocol for shunting in IIH. This protocol recommended IIH shunt insertion by neurosurgeons with expertise in CSF disorders, a frontal ventriculoperitoneal (VP) shunt with an adjustable gravitational valve and integrated intracranial pressure monitoring device, frameless stereotactic insertion of the ventricular catheter, and laparoscopic insertion of the peritoneal catheter. Thirty-day revision rates before and after implementation of the protocol were compared in order to assess the impact of standardizing shunting for IIH on shunt complications. RESULTS The 81 patients included in the study were predominantly female (93%), with a mean age of 31 years at primary surgery and mean body mass index (BMI) of 37 kg/m2. Forty-five patients underwent primary surgery prior to implementation of the protocol and 36 patients after. Overall, 12 (15%) of 81 patients needed CSF shunt revision in the first 30 days, 10 before and 2 after introduction of the protocol. This represented a significant reduction in the early revision rate from 22% to 6% after the protocol (p = 0.036). The most common cause of shunt revision for the whole cohort was migration or misplacement of the peritoneal catheter, occurring in 6 of the 12 patients. Patients with a higher BMI were significantly more likely to have a shunt revision within 30 days (p = 0.022). CONCLUSIONS The Birmingham standardized IIH shunt protocol resulted in a significant reduction in revisions within 30 days of primary shunt surgery in patients with IIH. The authors recommend standardization for shunting in IIH as a method for improving surgical outcomes. They support the notion of subspecialization for IIH shunts, the use of a frontal VP shunt with sophisticated technology, and laparoscopic insertion of the peritoneal end.

scholarly journals Cerebrospinal fluid biomarkers of neuroinflammation in children with hydrocephalus and shunt malfunction

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Carolyn A. Harris ◽  
Diego M. Morales ◽  
Rooshan Arshad ◽  
James P. McAllister ◽  
David D. Limbrick
Keyword(s):  
Cerebrospinal Fluid ◽  
Inflammatory Cytokines ◽  
Protein Concentration ◽  
Shunt Revision ◽  
Csf Shunt ◽  
Shunt Failure ◽  
Revision Operation ◽  
Protein Levels ◽  
Anti Inflammatory ◽  
Pro Inflammatory Cytokines

Abstract Background Approximately 30% of cerebrospinal fluid (CSF) shunt systems for hydrocephalus fail within the first year and 98% of all patients will have shunt failure in their lifetime. Obstruction remains the most common reason for shunt failure. Previous evidence suggests elevated pro-inflammatory cytokines in CSF are associated with worsening clinical outcomes in neuroinflammatory diseases. The aim of this study was to determine whether cytokines and matrix metalloproteinases (MMPs) contribute towards shunt failure in hydrocephalus. Methods Using multiplex ELISA, this study examined shunt failure through the CSF protein concentration profiles of select pro-inflammatory and anti-inflammatory cytokines, as well as select MMPs. Interdependencies such as the past number of previous revisions, length of time implanted, patient age, and obstruction or non-obstruction revision were examined. The pro-inflammatory cytokines were IL-1β, IL-2, IL-5, IL-6, IL-8, IL-12, IL-17, TNF-α, GM-CSF, IFN-γ. The anti-inflammatory cytokines were IL-4 and IL-10, and the MMPs were MMP-2, MMP-3, MMP-7, MMP-9. Protein concentration is reported as pg/mL for each analyte. Results Patient CSF was obtained at the time of shunt revision operation; all pediatric (< 18), totaling n = 38. IL-10, IL-6, IL-8 and MMP-7 demonstrated significantly increased concentrations in patient CSF for the non-obstructed subgroup. Etiological examination revealed IL-6 was increased in both obstructed and non-obstructed cases for PHH and congenital hydrocephalic patients, while IL-8 was higher only in PHH patients. In terms of number of past revisions, IL-10, IL-6, IL-8, MMP-7 and MMP-9 progressively increased from zero to two past revisions and then remained low for subsequent revisions. This presentation was notably absent in the obstruction subgroup. Shunts implanted for three months or less showed significantly increased concentrations of IL-6, IL-8, and MMP-7 in the obstruction subgroup. Lastly, only patients aged six months or less presented with significantly increased concentration of IL-8 and MMP-7. Conclusion Non-obstructive cases are reported here to accompany significantly higher CSF cytokine and MMP protein levels compared to obstructive cases for IL-10, IL-6, IL-8, MMP-7 and MMP-9. A closer examination of the definition of obstruction and the role neuroinflammation plays in creating shunt obstruction in hydrocephalic patients is suggested.

scholarly journals Hemorrhagic abdominal pseudocyst following ventriculoperitoneal shunt: a case report

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Hong-Cai Wang ◽  
Yi-Lei Tong ◽  
Shi-Wei Li ◽  
Mao-Song Chen ◽  
Bo-Ding Wang ◽  
...  
Keyword(s):  
Fibrous Tissue ◽  
Clinical Signs ◽  
Chronic Subdural Hematoma ◽  
Normal Pressure ◽  
Cystic Mass ◽  
Shunt Revision ◽  
Subdural Effusion ◽  
Palpable Mass ◽  
Vp Shunt ◽  
Abdominal Pseudocyst

Abstract Background Abdominal cerebrospinal fluid (CSF) pseudocyst is an uncommon but important complication of ventriculoperitoneal (VP) shunts. While individual articles have reported many cases of abdominal CSF pseudocyst following VP shunts, no case of a hemorrhagic abdominal pseudocyst after VP shunts has been reported so far. Case presentation This article reports a 68-year-old woman with a 4-month history of progressive abdominal pain and distention. She denied any additional symptoms. A VP shunt was performed 15 years earlier to treat idiopathic normal pressure hydrocephalus and no other abdominal surgery was performed. Physical examination revealed an elastic palpable mass in her right lower abdomen, which was dull to percussion. Abdominal computed tomography (CT) scan indicated a large cystic collection of homogenous iso-density fluid in the right lower abdominal region with clear margins. The distal segment of the peritoneal shunt catheter was located within the cystic mass. Abdominal CSF pseudocyst was highly suspected as a diagnosis. Laparoscopic cyst drainage with removal of the whole cystic mass was performed, 15-cm cyst which found with thick walls and organized chronic hematic content. No responsible vessel for the cyst hemorrhage was identified. No further shunt revision was placed. Histological examination showed that the cyst wall consisted of outer fibrous tissue and inner granulation tissue without epithelial lining, and the cystic content was chronic hematoma. The patient had an uneventful postoperative course and remained asymptomatic for 8-mo follow-up. Conclusion To the best of our knowledge, this is the first report of hemorrhagic onset in the abdominal pseudocyst following VP shunt. Such special condition can accelerate the appearance of clinical signs of the abdominal pseudocyst after VP shunts, and its mechanisms may be similar to the evolution of subdural effusion into chronic subdural hematoma (CSDH).

Ventriculoperitoneal shunt failure causing myelopathy in a patient with bilateral jugular vein occlusion

2007 ◽  
Vol 6 (1) ◽  
pp. 60-63 ◽  
Author(s):  
William E. Humphries ◽  
Peter M. Grossi ◽  
Linda G. Liethe ◽  
Timothy M. George
Keyword(s):  
Spinal Cord ◽  
Ct Angiography ◽  
Jugular Vein ◽  
Cervical Spinal Cord ◽  
Venous Drainage ◽  
Shunt Revision ◽  
Shunt Failure ◽  
Vp Shunt ◽  
Physiological Importance ◽  
Vein Occlusion

✓The authors describe the case of a 36-year-old woman with bilateral internal jugular vein occlusion, hydrocephalus, and Dandy–Walker variant who presented with myelopathy that was ultimately attributed to ventriculoperitoneal (VP) shunt failure. Computed tomography (CT) angiography of the head and neck revealed epidural venous engorgement within the cervical spine, greater that 50% narrowing of the C2–5 spinal canal, and compression of the cervical spinal cord. After successful shunt revision, postoperative CT angiography revealed decreased venous engorgement as well as decompression of the cervical spinal cord, and the patient’s myelopathy improved. This case represents a fascinating clinical presentation of VP shunt failure, highlighting the physiological importance of the external jugular pathways involved in cerebral venous drainage.

scholarly journals Cerebrospinal Fluid Pseudocyst Complicating Ventriculoperitoneal Shunt: Report of Four Cases

2018 ◽  
Vol 07 (02) ◽  
pp. 135-138 ◽  
Author(s):  
Pradyumna Pan
Keyword(s):  
Cerebrospinal Fluid ◽  
Clinical Presentation ◽  
Abdominal Distension ◽  
Surgical Removal ◽  
Ultrasound Guided ◽  
Vp Shunt ◽  
Multilocular Cyst ◽  
Computed Tomographic ◽  
Abdominal Pseudocyst ◽  
Uncommon Complication

Abstract Background Cerebrospinal fluid (CSF) abdominal pseudocyst (APC) is an uncommon complication following ventriculoperitoneal (VP) shunt. Aim To study the clinical features and management of this entity. The authors present their experience with cases of CSF pseudocyst in children. Materials and Methods Retrospective analysis of four cases diagnosed to have APC following VP shunt between 2005 and 2015. Results Clinical presentation was with progressive abdominal distension, highlights of intestinal obstruction, and signs of raised intracranial pressure (ICP). Diagnosis is readily made with ultrasonography and computed tomographic (CT) scan of the abdomen. The duration between insertion of the shunt and the presentation ranged from 4.11 to 12 years. In three patients, the cyst was unilocular and of varying size. The fourth one had a multilocular cyst. In three patients, the treatment involved was surgical removal of the catheter with excision of the pseudocyst wall and placement of a new catheter intraperitoneally in a different quadrant. Ultrasound-guided aspiration of the cyst and relocation of the distal end was done in one patient. Conclusion Initial suspicion with appropriate investigation and early treatment can avert morbidity and mortality.

Upper cervical myelopathy due to arachnoiditis and spinal cord tethering from adjacent C-2 osteomyelitis

2007 ◽  
Vol 6 (1) ◽  
pp. 64-67 ◽  
Author(s):  
Sharad Rajpal ◽  
Krisada Chanbusarakum ◽  
Praveen R. Deshmukh
Keyword(s):  
Spinal Cord ◽  
Cervical Myelopathy ◽  
Complete Resolution ◽  
Magnetic Resonance Image ◽  
Epidural Abscess ◽  
Odontoid Process ◽  
Surgical Decompression ◽  
Upper Cervical ◽  
High Cervical ◽  
Spinal Cord Tethering

✓Myelopathy caused by a spinal cord infection is typically related to an adjacent compressive lesion such as an epidural abscess. The authors report a case of progressive high cervical myelopathy from spinal cord tethering caused by arachnoiditis related to an adjacent C-2 osteomyelitis. This 70-year-old woman initially presented with a methicillin-sensitive Staphylococcus aureus osteomyelitis involving the C-2 odontoid process. She was treated with appropriate antibiotic therapy but, over the course of 4 weeks, she developed progressive quadriparesis. A magnetic resonance image revealed near-complete resolution of the C-2 osteomyelitis, but new ventral tethering of the cord was observed at the level of the odontoid tip. She subsequently underwent open surgical decompression and cord detethering. Postoperatively she experienced improvement in her symptoms and deficits, which continued to improve 1 year after her surgery. To the authors’ knowledge, this is the first reported case of progressive upper cervical myelopathy due to arachnoiditis and cord tethering from an adjacent methicillin-sensitive S. aureus C-2 osteomyelitis.

scholarly journals Uterus-sparing myomectomy for idiopathic uterine pyomyoma in a young woman: A case report

2020 ◽  
Vol 2 (2) ◽  
pp. 19-22
Author(s):  
Ugur Sen ◽  
Tuğba Karadeniz ◽  
Emrah Beyan
Keyword(s):  
Risk Factor ◽  
Uterine Fibroids ◽  
Total Abdominal Hysterectomy ◽  
Abdominal Hysterectomy ◽  
Proper Treatment ◽  
Imaging Findings ◽  
Cervical Stenosis ◽  
Mortality And Morbidity ◽  
Risk Of Mortality ◽  
History Of

Pyomyoma, or suppurative leiomyoma, is a rare but serious complication of uterine fibroids. The mechanism of pyomyoma is an infection caused by microorganisms coming from ascending or hematogenously on the ground of necrosis following ischemia and infarction. It can be seen during the course of pregnancy or after abortion and birth. It can also develop after uterine instrumentation or due to cervical stenosis. Patients often present with pain and fever. It should be considered in cases had no other etiology of fever and had a history of uterine fibroids. Diagnosis and treatment are often delayed due to non-specific presentation and imaging findings. This delay increases the risk of mortality and morbidity such as fertility loss. In the vast majority of these cases, total abdominal hysterectomy is required. The case we presented is a premenopausal and sexually inactive woman without any history of pregnancy or uterine instrumentation or immunocompromised. This patient is the 5th case of pyomyoma without risk factor and the 3rd case that was successfully treated with myomectomy. Knowing the proper treatment of pyomyoma will be beneficial to prevent potential mortality and morbidity.

Transmastoid extracranial repair of CSF leaks following acoustic neuroma resection

1989 ◽  
Vol 103 (9) ◽  
pp. 842-844 ◽  
Author(s):  
A. K. Robson ◽  
P. M. Clarke ◽  
M. Dilkes ◽  
A. R. Maw
Keyword(s):  
Cerebrospinal Fluid ◽  
Surgical Management ◽  
Acoustic Neuroma ◽  
Complete Resolution ◽  
Sternomastoid Muscle ◽  
Translabyrinthine Approach ◽  
Suboccipital Craniectomy ◽  
Acoustic Neuromas ◽  
Good Access ◽  
Csf Leaks

AbstractAcoustic neuromas may be resected either by a suboccipital craniectomy or translabyrinthine approach; the latter gives good access without unduly traumatising the brainstem, but can lead to a higher incidence of cerebrospinal fluid (CSF) leaks. The surgical management of these leaks can be difficult; we describe a transmastoid extracranial technique using pedicled sternomastoid muscle that has produced complete resolution of the leak in all cases managed in this way.

ENDOSCOPIC THIRD VENTRICULOSTOMY (ETV) IS A BETTER ALTERNATIVE FOR VP SHUNT FAILURE IN NON-COMMUNICATING HYDROCEPHALUS

2021 ◽  
pp. 65-67
Author(s):  
Ramesh Tanger ◽  
Dinesh Kumar Barolia ◽  
Arka Chatterjee ◽  
Punit Singh Parihar ◽  
Arun Gupta
Keyword(s):  
Success Rate ◽  
Endoscopic Third Ventriculostomy ◽  
Obstructive Hydrocephalus ◽  
Shunt Revision ◽  
Third Ventriculostomy ◽  
Communicating Hydrocephalus ◽  
Shunt Failure ◽  
Shunt Insertion ◽  
Vp Shunt

CONTEXT: VP Shunt is most commonly used procedure for hydrocephalus but shunt failure is also the common complication in many patients. Endoscopic third ventriculostomy (ETV) is an accepted procedure for the treatment of obstructive hydrocephalus. The aim of our study is to evaluate the success rate AIM AND OBJECTIVE - of ETV in patients of obstructive hydrocephalus formerly treated by ventriculo-peritoneal (VP shunt) shunt. The failure VP shunt was removed before ETV. MATERIALS AND METHOD: This study was conducted between June 2015 and December 2019 in single unit of our department. Twenty one (n=21) patients were enrolled for this study. All patients were admitted with failure of VP shunt. They were known case of non-communicating hydrocephalus previously operated for VP shunt. Six patients were excluded for ETV because CT/MRI show grossly distorted anatomy of ventricles. Endoscopic third ventriculostomy was attempted in 15 patients, but ventriculostomy was done successfully in 10 patients, rests were treated with revision of VP shunt. All patients in this study were radiologically diagnosed RESULTS: case of hydrocephalus due to aqueduct stenosis. They were experienced VP shunt insertion but there were failure of shunt due to any reason. ETV procedures were done successfully in 10 patients. Out of 10 patients one patient needed shunt insertion due ineffective ETV. Shunt revision was done in 11 patients. There was no serious complication during and after ETV procedures. The follow-up period of patients with successful ETV was 6–60 months. This follow-up was uneventful and peaceful for their parents. ETV can be considered as an alternative treatment for the patients w CONCLUSION: ith VP shunt failure with an acceptable success rate of 80%, although long-term follow-up is needed for these patients.

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