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.

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.

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.

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.

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

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.

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。

脑室腹腔分流术治疗犬脑积水的病例分析

为了探索犬脑积水(Hydrocephalus)的替代疗法并提高患犬生活质量,本文分析了1例临床50日龄患有脑积水的边境牧羊犬,初期尝试药物管理和最终采用手术治疗的方案。结果显示,采取药物保守治疗,目的为减少患犬脑脊液(CSF)的产生并增加其排出,但2周后临床症状无明显改善,遂进行脑室腹腔分流术治疗。术后患犬神经症状有所缓解,影像学检测结果显示CSF有所减少。术后约1个月,患犬因厌食、器官衰竭和手术引流失败而死亡。结果表明,在药物控制无效的情况下,脑室腹腔分流术可作为脑积水的替代治疗方法。虽然本病例患犬最终死亡,但为脑积水的诊断和治疗提供了参考。

结核性脑积水患者的侧脑室和腰大池脑脊液参数相关性分析

目的探讨在脑室腹腔分流术治疗结核性脑积水时,使用侧脑室脑脊液和使用腰大池脑脊液化验结果作为分流参考指标的差异。方法回顾性纳入28例结核性脑积水患者。在进行脑室腹腔分流术之前,分别从腰大池和侧脑室取脑脊液,送常规与生化检测。对上述来源两个不同部位的脑脊液进行参数分析,并随访患者手术疗效。结果腰大池有核细胞、葡萄糖、氯化物、蛋白质含量与侧脑室这些指标有明显相关性(P<0.05);腰大池脑脊液有核细胞和蛋白水平明显高于侧脑室(P<0.05)。后期随访过程中,除1例失去联系,其余患者手术效果良好。结论由于侧脑室脑脊液与腰大池脑脊液存在明显差异,脑室腹腔分流术应取侧脑室脑脊液作为分流的临床参考指标。

脑出血术后颅骨缺损合并脑积水同期行颅骨修补术和脑室-腹腔分流术疗效分析

目的分析脑出血术后颅骨缺损合并脑积水同期行颅骨修补术和脑室-腹腔分流术(VP分流术)的疗效。方法选取2021年1月至2023年9月蚌埠医科大学第一附属医院神经外科收治的45例脑出血术后骨缺损合并脑积水患者,观察组为同期行颅骨修补术和VP分流术21例,对照组为VP分流术后3个月内行颅骨修补术24例。统计术后并发症发生率,术前、术后2周比较V/Bp值,术前、术后3个月比较NIHSS评分、ADL评分、预后优良率。结果术前观察组与对照组V/Bp值差异无统计学意义(P>0.05);术后2周两组V/Bp值均明显降低,且观察组数值较对照组更低(P<0.05)。术前观察组与对照组NIHSS、ADL评分差异无统计学意义(P>0.05);术后3个月观察组与对照组NIHSS、ADL评分均明显改善,且观察组评分较对照组改善更多(P<0.05)。术后3个月预后优良率观察组(95.24%)高于对照组(70.83%)(P<0.05)。术后观察组并发症发生率(4.76%)低于对照组(33.33%)(P<0.05)。结论脑出血术后颅骨缺损合并脑积水患者同期行颅骨修补术和VP分流术术后患者脑积水改善明显、神经功能和生活能力提高、预后优良率高且并发症少,患者术后疗效更好。

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。

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.

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.

颅骨成形术对去骨瓣减压术后并发脑积水病人脑室-腹腔分流术后分流量的影响

目的探讨颅骨成形术对去骨瓣减压术后并发脑积水病人脑室-腹腔分流术后分流量的影响。方法2018年1月至2021年5月前瞻性收集去骨瓣减压术后并发脑积水病人18例,先行脑室-腹腔分流术,再行颅骨成形术。分流术使用成人可调压抗虹吸分流套装,分流阀放置于耳后。颅骨成形术前、术后7 d,将0.1 ml 5%葡萄糖注射液注入贮液囊,20 min后经储液囊取脑脊液0.1 ml,应用血糖仪检测残余葡萄糖浓度。结果颅骨成形术后7 d储液囊葡萄糖残余浓度[(9.2±4.8)mmol/L]较术前[(6.1±3.6)mmol/L]明显上升(P<0.01)。术后CT复查显示11例脑室扩大,5例变化不明显;分流管压力阀档位下调3例,保持原档位13例。结论去骨瓣减压术后并发脑积水病人,脑室-腹腔分流术后行颅骨成形术,脑脊液分流量减少,部分病人需要将分流阀压力下调。