改良VPS治疗脑室出血后脑积水的效果及对神经功能、铁离子和水通道蛋白-4的影响

目的 探讨改良脑室-腹腔分流术(VPS)在脑室出血(IVH)后脑积水患者治疗中的应用价值。方法 选取2021年1月至2023年1月洛阳市中心医院收治的102例IVH后脑积水患者,采用简单随机化法分为两组,各51例。对照组接受传统VPS治疗,研究组接受改良VPS治疗。比较两组手术相关指标、神经功能评分[美国国立卫生院卒中量表(NIHSS)]及相关因子[白蛋白商(QAlb)、神经元特异性烯醇化酶(NSE)]、血清铁离子(Fe)、水通道蛋白-4(AQP-4)水平、认知功能[蒙特利尔认知评估量表(MoCA)评分]、生活能力[日常生活能力量表(ADL)评分]、步态障碍评分(Tinetti评分)、并发症及术后6个月情况良好率。结果 研究组通气时间、住院时间、住院费用均较对照组低(P<0.05);术后第7天,研究组NIHSS评分、脑脊液NSE和QAlb、血清Fe和AQP-4水平均较对照组低(P<0.05);研究组术后第6个月MoCA评分、ADL评分、Tinetti评分均较对照组高(P<0.05);研究组并发症发生率较对照组低,术后6个月预后良好率较对照组高(P<0.05)。结论 改良VPS治疗IVH后脑积水患者,可减轻神经功能损伤,恢复认知功能和步态,增强日常生存能力,改善患者预后,且能减少并发症及住院时间,减轻患者负担。

Is percutaneous endoscopic gastrostomy tube placement safe in patients with ventriculoperitoneal shunts?

AIM:To investigate whether percutaneous endoscopic gastrostomy (PEG) tube placement is safe in patients with ventriculoperitoneal (VP) shunts.METHODS: This was a retrospective study of all patients undergoing PEG insertion at our institution between June 1999 and June 2006. Post-PEG complications were compared between two groups according to the presence or absence of VP shunts. VP shunt infection rates, the interval between PEG placement and VP shunt catheter insertion, and long-term follow-up were also investigated.RESULTS: Fifty-five patients qualified for the study. Seven patients (12.7%) had pre-existing VP shunts. All patients received prophylactic antibiotics. The complication rate did not differ between VP shunt patients undergoing PEG (PEG/VP group) and non-VP shunt patients undergoing PEG (control group) [1 (14.3%) vs 6 (12.5%), P=1.000]. All patients in the PEG/VP group had undergone VP shunt insertion prior to PEG placement. The mean interval between VP shunt insertion and PEG placement was 308.7 d (range, 65-831 d). The mean follow-up duration in the PEG/VP group was 6.4 mo (range, 1-15 mo). There were no VP shunt infections, although one patient in the PEG/VP group developed a minor peristomal infection during follow-up.CONCLUSION: Complications following PEG placement in patients with VP shunts were infrequent in this study.

Risk factors for delayed intracranial hemorrhage secondary to ventriculoperitoneal shunt:A retrospective study

BACKGROUND Delayed intracranial hemorrhage(DICH),a potential complication of ventriculoperitoneal(VP)shunts,has been associated with high mortality,but its risk factors are still unclear.AIM To investigate the risk factors of DICH after VP shunts.METHODS We compared the demographic and clinical characteristics of DICH and non-DICH adult patients with VP shunts between January 2016 and December 2020.RESULTS The 159 adult VP shunt patients were divided into 2 groups according to the development of DICH:the DICH group(n=26)and the non-DICH group(n=133).No statistically significant difference was found in age,sex,laboratory examination characteristics or preoperative modified Rankin Scale(mRS)score between the DICH and non-DICH groups(P>0.05);however,a history of an external ventricular drain(EVD)[P=0.045;odds ratio(OR):2.814;95%CI:1.024-7.730]and postoperative brain edema around the catheter(P<0.01;OR:8.397;95%CI:3.043-23.171)were associated with a high risk of DICH.A comparison of preoperative mRS scores between the DICH group and the non-DICH group showed no significant difference(P=0.553),while a significant difference was found in the postoperative mRS scores at the 3-mo follow-up visit(P=0.024).CONCLUSION A history of EVD and postoperative brain edema around the catheter are independent risk factors for DICH in VP shunt patients.DICH patients with a high mRS score are vulnerable to poor clinical outcomes.

Migration of the distal ventriculoperitoneal shunt catheter into the stomach with or without trans-oral extrusion:A systematic literature review and meta-analysis

BACKGROUND Intra-gastric migration of the distal ventriculoperitoneal shunt(VPS)catheter clinically presenting with or without trans-oral extrusion is one of the rare complications of VPS catheter insertion.AIM To identify the demographics,clinical presentation,clinical findings,and results of surgical therapy offered for the treatment of intra-gastric migration of the distal VPS catheter,clinically presented with or without trans-oral extrusion.METHODS An online search was performed for the extraction/retrieval of the published/available literature pertaining to the above-mentioned VPS complication.Manuscripts were searched from PubMed,PMC(PubMed Central),ResearchGate,and Google Scholar databases using various terminology relating to the VPS complications.The first case of migration of a VPS catheter into the stomach was reported in the year 1980,and the data were retrieved from 1980 to December 2022.Cases were categorized into two groups;Group A:Cases who had migration of the distal VPS catheter into the stomach and clinically presented with trans-oral extrusion of the same,and Group B:Cases who had migration of the distal VPS catheter into the stomach,but presented without trans-oral extrusion.RESULTS A total of n=46 cases(n=27;58.69%male,and n=19;41.3%females)were recruited for the systematic review.Group A included n=32,and Group B n=14 cases.Congenital hydrocephalus was the indication for the primary VPS insertion for approximately half of the(n=22)cases.Approximately sixty percent(n=27)of them were children≤5 years of age at the time of the diagnosis of the complication mentioned above.In seventy-two percent(n=33)cases,this complication was detected within 24 mo after the VPS insertion/last shunt revision.Clinical diagnosis was evident for the entire group A cases.Various diagnostic modalities were used to confirm the diagnosis for Group B cases.Various surgical procedures were offered for the management of the complication in n=43 cases of both Groups.In two instances,intra-gastric migration of the distal VPS catheter was detected during the autopsy.This review documented four deaths.CONCLUSION Intra-gastric migration of the peritoneal end of a VPS catheter is one of the rare complications of VPS catheter implantation done for the treatment of hydrocephalus across all age groups.It was more frequently reported in children,although also reported in adults and older people.A very high degree of clinical suspicion is required for the diagnosis of a case of an intra-gastric migration of the distal VPS catheter clinically presenting without transoral extrusion.

Spinal Anesthesia in Infant with Ventriculoperitoneal Shunt: A Case Report of Inguinal Hernia Repair

We are describing a case of a female infant with ventriculoperitoneal shunt scheduled for inguinal hernia repair under spinal anesthesia. The child was a premature newborn who, in a recent past, underwent surgery in general anesthesia for retinopathy correction with subsequent difficult mechanical ventilation weaning. The benefit of spinal anesthesia in high-risk infant was described and the risks of spinal anesthesia in the presence of a ventricular shunt device-especially dural leakage and infections were briefly discussed.

Abdominal Cerebrospinal Fluid Pseudocyst—A Rare Complication of Ventriculoperitoneal Shunt

An abdominal cerebrospinal fluid pseudocyst is a rare complication of ventriculoperitoneal shunt. Several theories have been suggested to explain its occurrence. The main symptoms are painful abdominal distension and vomiting, abdominal distension on examination, as abdominal ultrasound and computed tomography confirm its diagnosis. The treatment involves drainage associated with drain relocation and resection of the pseudocyst’s wall. We report two patients diagnosed with this condition who underwent surgical treatment. The first patient had an unremarkable 12-month follow-up, while the second died on the seventh postoperative day due to intravascular disseminated coagulation. In these patients, the cause has not been identified;however, an infection cannot be ruled out.

Gigantic Abdominal Pseudocyst: An Unusual Evolution of the Ventriculoperitoneal Shunt

Background: The ventriculoperitoneal (VPS) shunt is the most common procedure in the treatment of hydrocephalus in children. Abdominal cerebrospinal fluid pseudocysts are a rare complication of the ventriculoperitoneal shunt with an incidence ranging from less than 1% to 10% and are more prevalent in children. The malfunction of the ventriculoperitoneal shunt can cause headaches, nausea, vomiting, altered level of consciousness and abdominal pain due to the accumulation of cerebrospinal fluid. There is no consensus on which type of treatment is better in this case, but there are several available methods. Aim: To report an unusual case of a giant abdominal cerebrospinal fluid pseudocyst as a complication of the VPS. Case Presentation: Female 1 y/3 months old patient, less than 7 kg, that has been diagnosed with hydrocephalus prenatally, confirmed postnatally associated with an esophageal atresia and distal tracheoesophageal fistula (AE/FTE, Gross III), was admitted to our service with progressive abdominal distention without obstructive intestinal signs or peritoneal inflammatory signs. The CT scan of the abdomen showed a large liquid collection (estimated volume of 600 ml), centered on the umbilical region, diagnosed as a giant abdominal cerebrospinal fluid (CSF) pseudocyst from the VPS. All of data and information were obtained from her medical records at the infirmary of the Conjunto Hospitalar de Sorocaba (CHS), São Paulo. Conclusion: Abdominal CSF as a cause of these giant pseudocysts should be considered as a diagnostic hypothesis for cases of large abdominal distensions without intestinal involvement in patients with a VPS. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Usage of neuronavigation system to treat a case of traumatic acute subdural hematoma after two-side ventriculoperitoneal shunt

Traumatic acute subdural hematoma is one of the most lethal causes of head injuries,which leads to high mortality.While combined diseases always make it more intractable for the treatment.We present a case of a 68-year-old female patient with traumatic acute subdural hematoma combined with hydrocephalus after ventriculoperitoneal shunt assisted by the neuronavigation system in January 12,2017.She was undergone ventriculoperitoneal shunt 6 years and 5 months ago on two sides respectively because of hydrocephalus,with the ventriculoperitoneal shunt device on the right side out of work.The initial neurological examination showed a Glasgow Coma Scale of E2V1M5 with no papillary defect.A CT scan of the head revealed a left homogeneously hyperdense and subdural hematoma,with compression of the lateral ventricle(2.6 cm thick)and a 0.5 cm midline shift.To protect the ventriculoperitoneal shunt device,we used neuronavigation system to precisely mark the relative location of the device and“invisible”subdural hematoma,thus to design a perfect incision preoperatively.Subsequently,evacuation of the subdural hematoma was performed via craniotomy without damaging the ventriculoperitoneal shunt device.Postoperative CT of the head showed totally removing of the subdural hematoma.The patient recovered three months later.With the assistant of neuronavigation system,it is much easier for the preoperative planning and to reduce the surgical risk.Our case gives a clue that more approaches can be considered when encountering acute head trauma with the complicated combined diseases.

Effect of Ventriculoperitoneal Shunt on the Recovery of Brain Function in Children with Hydrocephalus

Objective:To analyze the effect of ventriculoperitoneal shunt on the recovery of brain function in children with hydrocephalus.Methods:The clinical data of 40 children with hydrocephalus were retrospectively analyzed.Ventriculoperitoneal shunt was performed with 9003 shunt tube and P.S.Shunt tube,B.C.E.shunt tube.Electroencephalogram(EEG),and brain CT/MRI were performed before and after surgery,and postoperative follow-up was carried out to observe the therapeutic effect.Results:In this study,there were seven cases of intracranial injury,seven cases of congenital hydrocephalus,11 cases of ventricular end obstruction,three cases of abdominal end obstruction,nine cases complicated with bacterial infection,and 3 cases of shunt entering the scrotum.The prognosis of all the children was good,and there were no significant changes in eight cases.Conclusion:Ventriculoperitoneal shunt is effective in the treatment of children with hydrocephalus.

Basic research and technical improvement on minimally invasive ventriculoperitoneal shunt

Objective To explore a new approach for improving therapeutic effects and minimizing complications of ventriculoperitoneal shunt(VPS) . Methods The lengthof and lower edge of the greater omentum were measured and analyzed in 28 autopsies (16 adults and 12 children) and laparoscopic surgeries. 95 cases of hydrocephalus treated by MIVPS(minimally invasive ventriculoperitoneal shunt) were retrospectively reviewed. The depth and positions

Migration of distal catheter of ventriculoperitoneal shunt into heart:report of 2 cases and review of literature

Objective To discuss the mechanism,clinical features,complications,diagnosis criteria and treatment of intracardiac migration of the distal catheter of ventriculoperitoneal shunt. Methods The diagnosis criteria and treatment of 2 cases of intracardiac migration of the distal catheter of

VPS术与ETV术对脑积水术后婴幼儿脑室及脑认知功能的影响分析

目的探讨脑室-腹腔分流术(VPS)与神经内镜下第三脑室底造瘘术(ETV)对脑积水术后婴幼儿脑室及脑认知功能的影响。方法将我院2016年5月-2019年5月收治的93例脑积水婴幼儿按照手术方式分组,对照组46例行ETV治疗,观察组47例行VPS治疗。观察两组脑认知功能、脑室大小及术后并发症发生情况。结果观察组术后2个月末、6个月末脑认知功能评分较对照组高(P<0.05);观察组术后2个月末、6个月末脑电图异常和单光子发射计算机断层成像术(SPECT)异常比例较对照组低,脑室额角和第三脑室宽度较对照组小(P<0.05);两组患儿术后并发症发生率对比差异无统计学意义(P>0.05)。结论VPS可通过改善脑积水婴幼儿术后脑室状态,降低对脑认知功能损伤且术后并发症少。

Should a VP or LP Shunt be Used for the Treatment of Pseudotumorcerebri in Adults?

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.

Y-shaped shunt for the treatment of Dandy-Walker malformation combined with giant arachnoid cysts:A case report

BACKGROUND Dandy-Walker malformation(DWM)was first reported in 1914.In this case report,a pediatric case was complicated with giant and isolated arachnoid cysts in the right cerebellar hemisphere along with the typical DWM.CASE SUMMARY The patient was at 20 mo old boy,with the complaint of staggering for more than 2 mo.He was admitted to the hospital due to high intracranial pressure and staggering.At admission,the patient had typical manifestations of high intracranial pressure,including vomiting,poor appetite and feeding difficulty.Physical examination revealed increased head circumference,closed anterior fontanelle,unstable standing,staggering,leaning right while walking and ataxia.After admission,he was diagnosed with DWM accompanied by giant isolated arachnoid cysts in the posterior fossa.He underwent Y-shaped three-way valve repair for treating differential pressure between the supratentorial hydrocephalus and the subtentorial arachnoid cysts at once.The child recovered well after the surgery.CONCLUSION In this case,supratentorial and subtentorial shunts were placed,which solved the problem of differential pressure between the supratentorial and subtentorial parts simultaneously.This provides useful information regarding treatment exploration in this rare disease.

老年特发性正常压力性脑积水VP分流术的效果及影响因素分析

目的:探讨脑室腹腔分流术(VP分流术)对老年特发性正常压力性脑积水(INPH)的疗效及影响因素。方法:回顾性分析我科2010年1月~2018年5月收治的78例老年INPH患者的临床资料。采用单因素和多因素Logistic回归分析患者手术效果的影响因素。结果:78名INPH患者中,VP分流术后1年内,步态障碍改善54例(69.23%),认知改善48例(61.54%),小便失禁改善24例(30.77%)。年龄<65岁、女性、步态障碍病程<25月的患者术后症状改善较好(均P<0.05)。多因素Logistic回归分析显示,步态障碍病程<25月是患者预后的独立影响因素(P<0.05)。结论:VP分流术是治疗老年INPH的有效方法,步态障碍持续时间越短分流效果越好。

Displacement of peritoneal end of a shunt tube to pleural cavity: A case report

BACKGROUND The common treatment for hydrocephalus is insertion of a ventriculoperitoneal shunt.Shunt tube displacement is one of the common complications.Most shunt tube displacements occur in children and has a reportedly lower incidence in adults.CASE SUMMARY This study reports an adult patient(male,56 years)who suffered from intracranial aneurysm and subarachnoid hemorrhage and underwent aneurysm clipping following hospitalization.One month post onset of the disease,the patient underwent ventriculoperitoneal shunt due to hydrocephalus.The peritoneal end of the shunt tube was displaced in the peritoneal cavity 9 years after the aneurysm clipping.The peritoneal end of the shunt tube was removed and ventriculoperitoneal shunt was re-performed after anti-inflammatory treatment.CONCLUSION Shunt tube displacement has a low incidence in adults.In order to avoid shunt tube displacement,there is a need to summarize its causative factors and practice personalized medicine.

儿童复杂性脑积水的诊断与治疗策略

目的研究儿童复杂性脑积水的诊断标准以及有效的治疗策略。方法回顾性分析2014年—2024年中南大学湘雅医院收治的266例复杂性脑积水患者的病历资料,分析患者的临床资料,统计患者的年龄、性别、是否存在感染、是否具有多房结构、手术次数以及最终治疗效果,并总结治疗策略。结果266例复杂性脑积水患者中,男性169例,女性97例。其中,165例患者存在感染,130例患者存在多房结构;手术次数为1至6次不等;治愈例数240例,治愈率为240/266=90.2%。结论复杂性脑积水如果早期明确诊断,进行积极治疗,可以取得较好的诊疗效果。感染是形成复杂性脑积水最重要的原因,也是处理复杂性脑积水过程中的关键要素,控制感染是治疗成功的重要环节。复杂性脑积水需要多次手术,但是手术方式无优劣之分,尽可能选择简单的手术解决问题。

脑室腹腔分流术治疗正常压力脑积水的临床护理体会

目的探讨脑室-腹腔分流术(V-PS)治疗正常压力脑积水(NPH)的临床护理体会。方法选取2018年1月至2022年12月在郑州大学第一附属医院神经外科接受V-PS治疗的78例NPH患者作为研究对象,并随机分为观察组和对照组。观察组接受综合护理策略,对照组接受常规的护理模式,比较两组患者的术后临床疗效、不良反应及满意度。结果观察组出院总有效率(97.4%)高于对照组的79.5%;住院期间不良反应率观察组(5.1%)低于对照组的23.1%;观察组患者满意度高达94.9%,对照组为79.5%。两组患者临床总有效率、护理满意度及不良反应发生率差异均有统计学意义(P<0.05)。结论采用综合的护理干预策略可以明显地改善围手术期NPH患者的手术治疗效果,降低不良反应发生率,并有效提高患者的护理满意度。

可调压分流管在合并颅内高压的新型隐球菌性脑膜炎治疗中的应用

目的研究可调压分流管在合并颅内高压的新型隐球菌性脑膜炎治疗中的应用。方法选取2020年7月至2022年12月于赣州市人民医院就诊的40例合并颅内高压的新型隐球菌性脑膜炎患者作为研究对象,按照随机数字表法将其分为试验组(n=20)和对照组(n=20)。试验组采用抗真菌药物+可调压分流管实施脑室腹腔分流术治疗,对照组采用抗真菌药物+固定压分流管实施脑室腹腔分流术治疗。比较两组患者的临床疗效、住院天数、抗真菌药物使用天数、治疗前及治疗1周后两组患者的临床指标(颅内压、脑脊液隐球菌数)水平、引流术后并发症(硬脑膜下出血、脑室外出血、颅内感染)发生率。结果试验组患者的疗效优于对照组,差异有统计学意义(P<0.05)。试验组患者的住院天数和抗真菌药物使用天数短于对照组,差异有统计学意义(P<0.05)。治疗前,两组患者的颅内压和脑脊液隐球菌数比较,差异无统计学意义(P>0.05);治疗1周后,两组患者的颅内压和脑脊液隐球菌数均低于治疗前,且试验组低于对照组,差异有统计学意义(P<0.05)。试验组硬脑膜下出血发生率低于对照组,差异有统计学意义(P<0.05);两组患者的脑室外出血、颅内感染发生率比较,差异无统计学意义(P>0.05);试验组的并发症总发生率低于对照组,差异有统计学意义(P<0.05)。结论可调压分流管可有效改善合并颅内高压的新型隐球菌性脑膜炎患者的临床症状,有效控制颅内压力,缩短治疗周期,并提高其临床治愈率,降低其并发症发生率,利于其预后康复。

脑室腹腔分流术的时机与脑积水疗效的相关性研究

目的 比较不同时期行脑室腹腔(VP)分流术治疗脑积水的临床效果及预后。方法 回顾性分析2022年9月-2023年8月南京医科大学第一附属医院神经外科收治的130例继发性脑积水患者的临床资料,研究不同时机手术治疗前后的格拉斯哥昏迷量表(GCS)、Barthel指数(BI)、简易智能精神状态检查量表(MMSE)的改善情况。结果 各组VP分流术后的GCS、Barthel、MMSE均有不同程度提高,具有统计学差异(P<0.05);其中0~3个月组与3~6个月组的临床效果相比无明显统计学差异,但优于6个月以上组。结论 对于颅脑损伤、脑出血、颅内肿瘤、颅内动脉瘤等患者在其术后并发脑积水的情况通过采用VP分流术进行治疗可有效提升患者的神经功能,日常生活能力和智能精神状态。手术时间主张选择在6个月以内。