ZHU Liping , WENG Xinhua , SHI Yaozhong, PAN Xiaozhang and MO Ling Department of Infectious Diseases, Hua Shan Hospital, Fudan University, Shanghai 200040, China (Zhu LP, Weng XH, Shi YZ, Pan XZ and Mo L)
Introduction: Pseudotumorcerebri(PTC) is a condition characterized by false brain tumor symptoms, caused by high intracranial pressure (ICP). Treatment options include medication, weight loss, surgery, and shunting. S...Introduction: Pseudotumorcerebri(PTC) is a condition characterized by false brain tumor symptoms, caused by high intracranial pressure (ICP). Treatment options include medication, weight loss, surgery, and shunting. Shunting, either ventriculoperitoneal (VP) or lumboperitoneal (LP), emerged as the preferred method of treatment, but there is an ongoing debate as to which technique should be prioritized. The aim of this study is to gather additional evidence to determine the optimal type of shunt for treating PTC. Materials and Methods: Ninety patients with PTC were studied at Damascus University between 2016 and 2021. The study monitored symptoms before and after treatment, with improvement related to the technique used (VP or LP shunts). Of all patients, 83 were women and 7 were men. In addition, complications were analyzed. Results: Both shunts showed similar postoperative rates of symptom improvement, but VP shunts were utilized more frequently overall in this study. Patients who received LP shunt surgery had a higher rate of postoperative complications compared to those who received VP shunt surgery, but the chi-squared analysis did not provide sufficient evidence to confirm a significant relationship between the type of surgery and the occurrence of postoperative complications. Conclusion: Despite ongoing controversy about the optimal treatment for benign intracranial hypertension (BTC), most authors approved the trend of using VP (ventriculoperitoneal) shunts, given a lower rate of complications. However, there is no statistically significant difference between outcomes of VP and LP (lumboperitoneal) shunting techniques, according to our research.展开更多
目的·比较二孔法腹腔镜辅助脑室腹腔分流术(laparoscopy-assisted ventriculoperitoneal shunt,LAVPS)与传统开腹脑室腹腔分流术(open ventriculoperitoneal shunt,OVPS)的临床疗效,探讨二孔法LAVPS中腹腔端分流管放置的临床实践...目的·比较二孔法腹腔镜辅助脑室腹腔分流术(laparoscopy-assisted ventriculoperitoneal shunt,LAVPS)与传统开腹脑室腹腔分流术(open ventriculoperitoneal shunt,OVPS)的临床疗效,探讨二孔法LAVPS中腹腔端分流管放置的临床实践与经验。方法·回顾性分析上海交通大学医学院附属仁济医院神经外科2016年1月—2018年12月收治的因脑积水行脑室腹腔分流术(ventriculoperitoneal shunt,VPS)的308例患者。其中,LAVPS治疗组(L组)90例,应用二孔法以及独创的线环法,将腹腔端分流管置入右肝膈间隙;传统OVPS治疗组(O组)218例,腹腔端分流管经剑突下正中切口置入左下腹。对比2种手术方式的手术时间和远端导管并发症等情况。结果·与O组相比,L组平均手术时间显著减少(54 min vs 90 min,P=0.000),远端导管并发症发生率也显著降低(0 vs 9.6%,P=0.002)。L组仅发生1例内脏损伤,1例远端导管移位,另发生1例近端导管堵塞;远端导管未有感染或堵塞,发生率均较O组显著降低(0 vs 4.6%,P=0.039;0 vs 5.0%,P=0.030)。O组则发生10例导管感染,11例导管堵塞,4例内脏损伤,2例切口疝。结论·经改良的以线圈引导、腹腔端分流管留置于右肝膈间隙的二孔法LAVPS是一种安全、经济和简便的手术方法,与传统OVPS相比,能够更为有效地治疗各种原因所致的脑积水。展开更多
Mycobacterium abscessus, a rapidly growing and potentially pathogenic Mycobacterium, is an environmental contaminant and is commonly found in tap water supplies. We report a case of M. abscessus meningitis following V...Mycobacterium abscessus, a rapidly growing and potentially pathogenic Mycobacterium, is an environmental contaminant and is commonly found in tap water supplies. We report a case of M. abscessus meningitis following VP shunt insertion. A 9-year-old male patient with previous history of aqueductal stenosis and hydrocephalus with VP shunt in situ, presented with pain abdomen of 10 days duration. Investigations revealed multiple mesenteric lymph nodes with impacted VP shunt tip within the omentum. Ascitic fluid and CSF tap showed Acid-Fast Bacilli, later confirmed to be M. abscessus. The patient was treated with Clarithromycin and Amikacin, leading to resolution of the infection. To the best of our knowledge, this is the first reported case of M. abscessus meningitis in an immunocompetent individual. We discuss the possible sources of infection and therapeutic challenges. It is of utmost importance to consider, with high index of suspicion, nontubercular Mycobacteria as the causative organism in patients, who do not respond to regular anti-tubercular regimen.展开更多
Neonatal hydrocephalus can arise from a multitude of disturbances, among them congenital aqueductal stenosis, myelomeningocele or posthemorrhagic complications in preterm infants. Diagnostic work-up comprises transfon...Neonatal hydrocephalus can arise from a multitude of disturbances, among them congenital aqueductal stenosis, myelomeningocele or posthemorrhagic complications in preterm infants. Diagnostic work-up comprises transfontanellar ultrasonography, T2 weighted MRI and clinical assessment for rare inherited syndromes. Classification of hydrocephalus and treatment guidelines is based on detailed consensus statements. The recent evidence favors catheter-based cerebrospinal fluid diversion in children below 6 months, but emerging techniques such as neuroendoscopic lavage carry the potential to lower shunt insertion rates. More long-term study results will be needed to allow for individualized, multidisciplinary decision making. This article gives an overview regarding contemporary pathophysiological concepts, the latest consensus statements and most recent technical developments.展开更多
Objective: The authors report a rare case of giant thoracic meningocele causing acute respiratory compromise, treated with a ventriculoperitoneal shunt. Case Report: We report the case of a 36-year-old with severe sco...Objective: The authors report a rare case of giant thoracic meningocele causing acute respiratory compromise, treated with a ventriculoperitoneal shunt. Case Report: We report the case of a 36-year-old with severe scoliosis status post repair over a decade ago, neurofibromatosis type I, and a known large meningocele in the left thoracic cavity, presenting with new acute respiratory compromise. She was taken to the operating room for a lumboperitoneal shunt, but the operation was aborted due to her severe spinal deformity. Two days later, she successfully underwent a procedure for ventriculoperitoneal shunt placement. Upon discharge a week later, the patient was hemodynamically stable, able to move all extremities with good strength, and demonstrated improved oxygenation. In the following 7 months, the patient demonstrated continued minimal requirement on nasal cannula, and MRI showed a stable left thoracic giant meningocele. Conclusion: Ventriculoperitoneal shunting is a method of treating and stabilizing acutely symptomatic giant meningoceles.展开更多
文摘ZHU Liping , WENG Xinhua , SHI Yaozhong, PAN Xiaozhang and MO Ling Department of Infectious Diseases, Hua Shan Hospital, Fudan University, Shanghai 200040, China (Zhu LP, Weng XH, Shi YZ, Pan XZ and Mo L)
文摘Introduction: Pseudotumorcerebri(PTC) is a condition characterized by false brain tumor symptoms, caused by high intracranial pressure (ICP). Treatment options include medication, weight loss, surgery, and shunting. Shunting, either ventriculoperitoneal (VP) or lumboperitoneal (LP), emerged as the preferred method of treatment, but there is an ongoing debate as to which technique should be prioritized. The aim of this study is to gather additional evidence to determine the optimal type of shunt for treating PTC. Materials and Methods: Ninety patients with PTC were studied at Damascus University between 2016 and 2021. The study monitored symptoms before and after treatment, with improvement related to the technique used (VP or LP shunts). Of all patients, 83 were women and 7 were men. In addition, complications were analyzed. Results: Both shunts showed similar postoperative rates of symptom improvement, but VP shunts were utilized more frequently overall in this study. Patients who received LP shunt surgery had a higher rate of postoperative complications compared to those who received VP shunt surgery, but the chi-squared analysis did not provide sufficient evidence to confirm a significant relationship between the type of surgery and the occurrence of postoperative complications. Conclusion: Despite ongoing controversy about the optimal treatment for benign intracranial hypertension (BTC), most authors approved the trend of using VP (ventriculoperitoneal) shunts, given a lower rate of complications. However, there is no statistically significant difference between outcomes of VP and LP (lumboperitoneal) shunting techniques, according to our research.
文摘目的·比较二孔法腹腔镜辅助脑室腹腔分流术(laparoscopy-assisted ventriculoperitoneal shunt,LAVPS)与传统开腹脑室腹腔分流术(open ventriculoperitoneal shunt,OVPS)的临床疗效,探讨二孔法LAVPS中腹腔端分流管放置的临床实践与经验。方法·回顾性分析上海交通大学医学院附属仁济医院神经外科2016年1月—2018年12月收治的因脑积水行脑室腹腔分流术(ventriculoperitoneal shunt,VPS)的308例患者。其中,LAVPS治疗组(L组)90例,应用二孔法以及独创的线环法,将腹腔端分流管置入右肝膈间隙;传统OVPS治疗组(O组)218例,腹腔端分流管经剑突下正中切口置入左下腹。对比2种手术方式的手术时间和远端导管并发症等情况。结果·与O组相比,L组平均手术时间显著减少(54 min vs 90 min,P=0.000),远端导管并发症发生率也显著降低(0 vs 9.6%,P=0.002)。L组仅发生1例内脏损伤,1例远端导管移位,另发生1例近端导管堵塞;远端导管未有感染或堵塞,发生率均较O组显著降低(0 vs 4.6%,P=0.039;0 vs 5.0%,P=0.030)。O组则发生10例导管感染,11例导管堵塞,4例内脏损伤,2例切口疝。结论·经改良的以线圈引导、腹腔端分流管留置于右肝膈间隙的二孔法LAVPS是一种安全、经济和简便的手术方法,与传统OVPS相比,能够更为有效地治疗各种原因所致的脑积水。
文摘Mycobacterium abscessus, a rapidly growing and potentially pathogenic Mycobacterium, is an environmental contaminant and is commonly found in tap water supplies. We report a case of M. abscessus meningitis following VP shunt insertion. A 9-year-old male patient with previous history of aqueductal stenosis and hydrocephalus with VP shunt in situ, presented with pain abdomen of 10 days duration. Investigations revealed multiple mesenteric lymph nodes with impacted VP shunt tip within the omentum. Ascitic fluid and CSF tap showed Acid-Fast Bacilli, later confirmed to be M. abscessus. The patient was treated with Clarithromycin and Amikacin, leading to resolution of the infection. To the best of our knowledge, this is the first reported case of M. abscessus meningitis in an immunocompetent individual. We discuss the possible sources of infection and therapeutic challenges. It is of utmost importance to consider, with high index of suspicion, nontubercular Mycobacteria as the causative organism in patients, who do not respond to regular anti-tubercular regimen.
文摘Neonatal hydrocephalus can arise from a multitude of disturbances, among them congenital aqueductal stenosis, myelomeningocele or posthemorrhagic complications in preterm infants. Diagnostic work-up comprises transfontanellar ultrasonography, T2 weighted MRI and clinical assessment for rare inherited syndromes. Classification of hydrocephalus and treatment guidelines is based on detailed consensus statements. The recent evidence favors catheter-based cerebrospinal fluid diversion in children below 6 months, but emerging techniques such as neuroendoscopic lavage carry the potential to lower shunt insertion rates. More long-term study results will be needed to allow for individualized, multidisciplinary decision making. This article gives an overview regarding contemporary pathophysiological concepts, the latest consensus statements and most recent technical developments.
文摘Objective: The authors report a rare case of giant thoracic meningocele causing acute respiratory compromise, treated with a ventriculoperitoneal shunt. Case Report: We report the case of a 36-year-old with severe scoliosis status post repair over a decade ago, neurofibromatosis type I, and a known large meningocele in the left thoracic cavity, presenting with new acute respiratory compromise. She was taken to the operating room for a lumboperitoneal shunt, but the operation was aborted due to her severe spinal deformity. Two days later, she successfully underwent a procedure for ventriculoperitoneal shunt placement. Upon discharge a week later, the patient was hemodynamically stable, able to move all extremities with good strength, and demonstrated improved oxygenation. In the following 7 months, the patient demonstrated continued minimal requirement on nasal cannula, and MRI showed a stable left thoracic giant meningocele. Conclusion: Ventriculoperitoneal shunting is a method of treating and stabilizing acutely symptomatic giant meningoceles.
