Mechanisms and major sites of distal catheter migration in ventriculoperitoneal shunting maneuvers: A review article

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.

Bypass surgery for ischemic stroke caused by intracranial artery stenosis or occlusion

Surgical revascularization may be beneficial in patients with ischemic stroke caused by intracranial stenosis or occlusion who are ineligible for thrombolysis. Objective: To evaluate the outcome of superficial temporal artery to middle cerebral artery(STA-MCA) bypass in ischemic stroke caused by intracranial artery stenosis or occlusion. Methods: We retrospectively studied successive case series of 19 patients who underwent surgical treatment between 2013–2017 of STA-MCA bypass. Surgical procedure was performed for the patients with acute ischemic stroke who were ineligible for thrombolysis. Results: Of the 19 patients enrolled, symptom aggravation occurred during medical treatment, the patients were ineligible for thrombolysis despite being within 8 hours of symptom onset. Bypass significantly improved National Institutes of Health Stroke Scale scores, mean patient age was 78.05 years(range, 39-78 y). However, male 11(57.95%)out of nineteen patients were presented with left-sided-lesions while female 8(42%) had right-sided lesions with significant infarction growth by diffusion weighted imaging achieved, after surgical maneuver. No major complications occurred intraoperatively, in contrast to 2(10.5%) minor manifestation were suffering minor complications probably they included the remote infarction(posterior cerebral artery territory). Pooled analysis with our patients showed a significant neurological improvement and a good outcome in 13(68.4%) patients without hemorrhage or any other complication, 6(31.6%) patients with unfavorable outcome(severe disability 2; vegetative state 4, non of them are died 0;). Conclusion: STA-MCA bypass may be beneficial to patients with acute stroke or stenosis in progress who are ineligible for medical therapy. Furthermore, it appears safe when the infarction is small. These findings indicate that STA-MCA bypass could be considered as a treatment option in selected patients with ischemic stroke caused by intracranial stenosis or occlusion.