Minimally-invasive treatment of communicating hydrocephalus using a percutaneous lumboperitoneal shunt

Objective:To investigate the clinical value of a minimally-invasive treatment of communicating hydrocephalus using a percutaneous lumboperitoneal (LP) shunt.Method:The clinical and long-term follow-up data of 256 patients suffering from communicating hydrocephalus and undergoing percutaneous LP shunt during 1998 to 2008 were retrospectively analyzed.Results:After the follow-up,which lasted 6 months to 10 years,219 cases of communicating hydrocephalus recovered well (ventricular size returned to normal and symptoms completely disappeared),25 cases were brought under control (ventricle size reduced by 50% and symptoms partially abated),and 12 cases showed no obvious changes.Fifteen obese subjects needed modifications of the shunt due to the obstruction of the abdominal end following wrapping,and one subject underwent extubation as the subject was unable to tolerate stimulation of the cauda equina.The effectiveness of shunting was 91.40% and the probability of shunt-tube obstruction,which occurs predominantly in the abdominal end,was only 5.85%,far lower than that of ventriculoperitoneal (VP) shunt.Three subjects had a history of infection following VP shunting.Conclusion:LP shunting is minimally invasive and effective in treating communicating hydrocephalus,with fewer complications.

Endoscopic third ventriculostomy in children:problems and surgical outcome:analysis of 34 cases

Background:Endoscopic third ventriculostomy(ETV)has been established as a viable treatment option for obstructive hydrocephalus of children over 6 weeks of age.ETV in pediatric groups may be unsuccessful due to the failure of absorption of cerebrospinal fluid(CSF)or reclosure of ventriculostomy stoma or due to infection.The exact cause is still debatable.Some issues like failure to eliminate the second membrane during the procedure or formation of the new arachnoid membrane at the stoma are still not clear.This study aims to assess the surgical failure of ETV and its predisposing factors.Methods:Thirty-four pediatric patients with hydrocephalus were analyzed retrospectively.The patients’age limit was between 2.5 months and 14 years.This is a retrospective study of 34 patients in a single private hospital between June 2012 and January 2018.Patients having hydrocephalus in pediatric groups more than 6 weeks of age were included in the study.Results:The mean age of all patients was 51.25±53.90 months and the mean follow-up period was 50.47±20.84 months.Of 34 surgeries,the success rate was 79%and the failure rate was 21%.Within 2 years,the success rate was 68.42%and above 2 years’success rate was 93.33%.In this series,7 cases of ETV were re-explored and found ventriculostomy stoma closure in 3 cases,the presence of the second membrane in re-exploration 2 cases,and presence of inflammatory arachnoid membrane in re-exploration 2 cases.The use of dexamethasone around the stoma in inflammatory stoma was useful,having no recurrence.In one patient of the second membrane probably due to absorption failure in communicating hydrocephalus re-exploration was failed and was managed successfully with VP shunt.Conclusions:Predisposing factors causing ETV failure are ventriculostomy stoma closure by new arachnoid granulation tissues,remnants of the second membrane inside the stoma,CSF absorption failure,infection/high protein in CSF and inappropriate patient selection.