Ommaya储液囊在儿童急性梗阻性脑积水中的应用

目的 探讨Ommaya储液囊在儿童急性梗阻性脑积水中的应用.方法 回顾性分析我科2006至2009年22例晚发维生素K依赖因子缺乏性脑室出血和结脑致急性梗阻性脑积水患儿,行Ommaya储液囊植入手术,观察脑室大小、脑脊液细胞数、蛋白含量变化.结果 结核性脑膜炎7例经储液囊植入行泵内多次注射抗生素,治疗2～4个月、随访脑脊液恢复正常,6例脑积水消失;晚发维生素K依赖因子缺乏性脑室出血伴脑积水15例植入脑室内行泵内穿刺冲洗引流,1～2周头颅CT复查脑室积血消失,脑积水减轻,2例行侧脑室腹腔分流术,无一例发生颅内感染.结论 Ommaya储液囊植入术治疗儿童急性梗阻性脑积水效果良好,手术简便、创伤小、并发症少,值得临床广泛应用.

Abstract：

Objective To review the Ommaya pump application in acute obstructive hydrocephalus in children. Methods We carried out a retrospective analysis of 22 children with obstructive hydrocephalus admitted into our department between 2006 2009. The causes of hydrocephalus included intraventricular hemorrhage secondary to vitamin K deficiency and tuberculous meningitis. Ommaya pump were implanted and the ventricle size and cerebrospinal fluid cell count, protein content were studied. Results Seven children had intracranial infection and treated with antibiotic injection into pump for 2-4 months. Follow-up revealed no recurrence. Fifteen children with ventricle hemorrhage and hydrocephalus underwent drainage from the pump. CT scan after 1-2 weeks demonstrated disappearance of ventricle hemorrhage. There was, no intracranial infection. Conclusions Ommaya pump for the treatment of acute obstructive hydrocephalus produces good result. The surgery is simple. It incurs less trauma and has less complications.     

Clinical feature analysis of subdural effusion/hematoma after shunt use of adjustable valves in children with hydrocephalus北大核心CSCD

Objective To analyze the clinical data of children with hydrocephalus suffering from subdural effusion/hematoma after shunt(SEHS) with adjustable valves, and to provide reference for postoperative follow - up. Methods A total of 102 children with hydrocephalus treated with adjustable valves in the Department of Neurosurgery, Wuhan Children's Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology from August 2017 to September 2021 were enrolled and studied retrospectively. There were 16 cases with SEHS, 11 of whom were male and 5 were female. The age ranged from 3 months to 13 years (median;2. 5 years). The age, clinical manifestations, the time of SEHS occurrence, treatment methods (pressure regulation only or combined with drilling and drainage), and prognosis of the patients were analyzed. The pressure adjustment treatment was to increase the by 10-20 mmH2O (1 mmH2O =0.0098 kPa) each time and the patients were followed up 2-4 weeks after the adjustment. If SEHS didn't improve according to the follow - up results, pressure regulation combined with drilling and drainage was recommended. Results Of the 16 patients with SEHS, 3 cases were over 3 years old, and the other 13 cases were 3 years old or below. Eleven cases were treated by pressure regulation only, and 5 cases who were all aged 3 years received pressure regulation combined with drilling and drainage. Symptoms occurred in 2 patients, including vomiting in 1 case, and head and limb shaking in the other case. Fourteen cases were asymptomatic. The time from shunt operation to the occurrence of SEHS was 1 month in 5 cases, who were all cured by pressure regulation only. SEHS occurred in 5 cases > 1-3 months after shunt surgery, and 2 cases of them were treated by pressure regulation combined with drilling and drainage. Three cases had SEHS > 3-6 months after shunt surgery, and 1 case of them was treated by pressure regulation combined with drilling and drainage. SEHS occurred in 3 cases more than 6 months after shunt surgery, and 1 case of them was treated by pressure regulation combined with drilling and drainage. For the patients who received pressure regulation combined with drilling and drainage, the time from shunt operation to the occurrence of SEHS was 1 month and 21 days, 2 months and 7 days, 4. 5 months, 7. 5 months, and 25. 0 months, respectively. The time from the occurrence of SEHS to the last reexamination with no SEHS detected was 1 month in 7 cases (all were cured by pressure regulation only); >1-3 months in 5 cases (3 cases were treated by pressure regulation combined with drilling and drainage); more than 3 months in 4 cases (2 cases were treated by pressure regulation combined with drilling and drainage). For the patients who received pressure regulation combined with drilling and drainage, the time from the occurrence of SEHS to the last reexamination with no SEHS detected was 1 month and 14 days, 2. 0 months, 3. 0 months, 7. 0 months and 8. 0 months, respectively. Except for 2 cases who experienced pressure regulating valve failure, all other cases were cured. Six cases were unilateral SEHS, and the SEHS volume was about 11 to 75 mL (median;39. 0 mL). Ten cases were bilateral SEHS, and the SEHS volume was about 23-380 mL (median; 158. 2 mL). The 6 cases were all cured by pressure regulation, and 5 cases of them had SEHS at the shunt tube insertion side. Conclusions SEHS in children with hydrocephalus is generally asymptomatic and rarely causes clinical symptoms. SEHS mostly occurs within 6 months after operation, especially within 3 months. SEHS found in 1 month after surgery can be cured by increasing the shunt valve pressure only. Therefore, SEHS can be cured by pressure regulation only by shortening follow - up and identifying SEHS early after shunt operation. This will also reduce the probability that patients require the drilling and drainage operation. © 2022 ＣｈｉｎＪＡｐｐｌＣｌｉｎＰｅｄｉａｔ. All rights reserved.     

经前路短节段固定矫形治疗青少年特发性脊柱侧弯的探讨

Objective To review our results of anterior approach of treating adolescent idiopathic lumbar and thoracic scoliosis with short-segment instrumentation. Methods Sixty-two cases of adolescent id-iopathic lumbar and thoracic scoliosis treated in our department from Jan 2002 to Dec 2007 were retrospec-tively analyzed. There were 39 cases of adolescent idiopathic lumbar scoliosis with Cobb angle from 45° to 75° (average 53.6°) and 23 cases of that with Cobb angle from 43° to 72° (average 51.7°). Detailed clinical and imaging assessment of each case were carried out. Lung function tests were performed to determine the vital capacity. Balloon blowing training was carried out for those with lung function less than 50% of normal The fixed segments and the scope of integration were prepared with preoperative imaging information. Results All patients were successfully operated on. The average correction rate for each group was 84.1% and 84.7% respectively. The complications included one spontaneous hemothorax,8 sympathetic trunk injury, one flatback deformity. Conclusions The anterior correction of scoliosis with short-segment instrumentation has minimal perioperative and long-term complications.     

经前路短节段固定矫形治疗青少年特发性脊柱侧弯的探讨

Objective To review our results of anterior approach of treating adolescent idiopathic lumbar and thoracic scoliosis with short-segment instrumentation. Methods Sixty-two cases of adolescent id-iopathic lumbar and thoracic scoliosis treated in our department from Jan 2002 to Dec 2007 were retrospec-tively analyzed. There were 39 cases of adolescent idiopathic lumbar scoliosis with Cobb angle from 45° to 75° (average 53.6°) and 23 cases of that with Cobb angle from 43° to 72° (average 51.7°). Detailed clinical and imaging assessment of each case were carried out. Lung function tests were performed to determine the vital capacity. Balloon blowing training was carried out for those with lung function less than 50% of normal The fixed segments and the scope of integration were prepared with preoperative imaging information. Results All patients were successfully operated on. The average correction rate for each group was 84.1% and 84.7% respectively. The complications included one spontaneous hemothorax,8 sympathetic trunk injury, one flatback deformity. Conclusions The anterior correction of scoliosis with short-segment instrumentation has minimal perioperative and long-term complications.     

经前路短节段固定矫形治疗青少年特发性脊柱侧弯的探讨

Objective To review our results of anterior approach of treating adolescent idiopathic lumbar and thoracic scoliosis with short-segment instrumentation. Methods Sixty-two cases of adolescent id-iopathic lumbar and thoracic scoliosis treated in our department from Jan 2002 to Dec 2007 were retrospec-tively analyzed. There were 39 cases of adolescent idiopathic lumbar scoliosis with Cobb angle from 45° to 75° (average 53.6°) and 23 cases of that with Cobb angle from 43° to 72° (average 51.7°). Detailed clinical and imaging assessment of each case were carried out. Lung function tests were performed to determine the vital capacity. Balloon blowing training was carried out for those with lung function less than 50% of normal The fixed segments and the scope of integration were prepared with preoperative imaging information. Results All patients were successfully operated on. The average correction rate for each group was 84.1% and 84.7% respectively. The complications included one spontaneous hemothorax,8 sympathetic trunk injury, one flatback deformity. Conclusions The anterior correction of scoliosis with short-segment instrumentation has minimal perioperative and long-term complications.     

经前路短节段固定矫形治疗青少年特发性脊柱侧弯的探讨

Objective To review our results of anterior approach of treating adolescent idiopathic lumbar and thoracic scoliosis with short-segment instrumentation. Methods Sixty-two cases of adolescent id-iopathic lumbar and thoracic scoliosis treated in our department from Jan 2002 to Dec 2007 were retrospec-tively analyzed. There were 39 cases of adolescent idiopathic lumbar scoliosis with Cobb angle from 45° to 75° (average 53.6°) and 23 cases of that with Cobb angle from 43° to 72° (average 51.7°). Detailed clinical and imaging assessment of each case were carried out. Lung function tests were performed to determine the vital capacity. Balloon blowing training was carried out for those with lung function less than 50% of normal The fixed segments and the scope of integration were prepared with preoperative imaging information. Results All patients were successfully operated on. The average correction rate for each group was 84.1% and 84.7% respectively. The complications included one spontaneous hemothorax,8 sympathetic trunk injury, one flatback deformity. Conclusions The anterior correction of scoliosis with short-segment instrumentation has minimal perioperative and long-term complications.     

经前路短节段固定矫形治疗青少年特发性脊柱侧弯的探讨

Objective To review our results of anterior approach of treating adolescent idiopathic lumbar and thoracic scoliosis with short-segment instrumentation. Methods Sixty-two cases of adolescent id-iopathic lumbar and thoracic scoliosis treated in our department from Jan 2002 to Dec 2007 were retrospec-tively analyzed. There were 39 cases of adolescent idiopathic lumbar scoliosis with Cobb angle from 45° to 75° (average 53.6°) and 23 cases of that with Cobb angle from 43° to 72° (average 51.7°). Detailed clinical and imaging assessment of each case were carried out. Lung function tests were performed to determine the vital capacity. Balloon blowing training was carried out for those with lung function less than 50% of normal The fixed segments and the scope of integration were prepared with preoperative imaging information. Results All patients were successfully operated on. The average correction rate for each group was 84.1% and 84.7% respectively. The complications included one spontaneous hemothorax,8 sympathetic trunk injury, one flatback deformity. Conclusions The anterior correction of scoliosis with short-segment instrumentation has minimal perioperative and long-term complications.     

经前路短节段固定矫形治疗青少年特发性脊柱侧弯的探讨

Objective To review our results of anterior approach of treating adolescent idiopathic lumbar and thoracic scoliosis with short-segment instrumentation. Methods Sixty-two cases of adolescent id-iopathic lumbar and thoracic scoliosis treated in our department from Jan 2002 to Dec 2007 were retrospec-tively analyzed. There were 39 cases of adolescent idiopathic lumbar scoliosis with Cobb angle from 45° to 75° (average 53.6°) and 23 cases of that with Cobb angle from 43° to 72° (average 51.7°). Detailed clinical and imaging assessment of each case were carried out. Lung function tests were performed to determine the vital capacity. Balloon blowing training was carried out for those with lung function less than 50% of normal The fixed segments and the scope of integration were prepared with preoperative imaging information. Results All patients were successfully operated on. The average correction rate for each group was 84.1% and 84.7% respectively. The complications included one spontaneous hemothorax,8 sympathetic trunk injury, one flatback deformity. Conclusions The anterior correction of scoliosis with short-segment instrumentation has minimal perioperative and long-term complications.     

经前路短节段固定矫形治疗青少年特发性脊柱侧弯的探讨

Objective To review our results of anterior approach of treating adolescent idiopathic lumbar and thoracic scoliosis with short-segment instrumentation. Methods Sixty-two cases of adolescent id-iopathic lumbar and thoracic scoliosis treated in our department from Jan 2002 to Dec 2007 were retrospec-tively analyzed. There were 39 cases of adolescent idiopathic lumbar scoliosis with Cobb angle from 45° to 75° (average 53.6°) and 23 cases of that with Cobb angle from 43° to 72° (average 51.7°). Detailed clinical and imaging assessment of each case were carried out. Lung function tests were performed to determine the vital capacity. Balloon blowing training was carried out for those with lung function less than 50% of normal The fixed segments and the scope of integration were prepared with preoperative imaging information. Results All patients were successfully operated on. The average correction rate for each group was 84.1% and 84.7% respectively. The complications included one spontaneous hemothorax,8 sympathetic trunk injury, one flatback deformity. Conclusions The anterior correction of scoliosis with short-segment instrumentation has minimal perioperative and long-term complications.     

经前路短节段固定矫形治疗青少年特发性脊柱侧弯的探讨

Objective To review our results of anterior approach of treating adolescent idiopathic lumbar and thoracic scoliosis with short-segment instrumentation. Methods Sixty-two cases of adolescent id-iopathic lumbar and thoracic scoliosis treated in our department from Jan 2002 to Dec 2007 were retrospec-tively analyzed. There were 39 cases of adolescent idiopathic lumbar scoliosis with Cobb angle from 45° to 75° (average 53.6°) and 23 cases of that with Cobb angle from 43° to 72° (average 51.7°). Detailed clinical and imaging assessment of each case were carried out. Lung function tests were performed to determine the vital capacity. Balloon blowing training was carried out for those with lung function less than 50% of normal The fixed segments and the scope of integration were prepared with preoperative imaging information. Results All patients were successfully operated on. The average correction rate for each group was 84.1% and 84.7% respectively. The complications included one spontaneous hemothorax,8 sympathetic trunk injury, one flatback deformity. Conclusions The anterior correction of scoliosis with short-segment instrumentation has minimal perioperative and long-term complications.     

经外周穿刺中心静脉导管在普通儿科病房中长期输液患儿应用的可行性研究

目的：分析经外周穿刺中心静脉导管（PICC）在普通儿科病房中需中长期输液患儿中应用的必要性及可行性,为普通儿科病房开展PICC置管提供依据。方法：纳入2015年12月至2017年2月在复旦大学附属儿科医院呼吸和消化科病房住院的符合PICC适应证且监护人同意PICC置管的连续病例,对置管原因、并发症、导管结局及相关效应指标进行分析。结果：60例PICC置管患儿（其中1例为禁忌证置管）进入本文分析,男38例,女22例,年龄1月4 d至14岁。置管原因包括输注胃肠外营养（PN） 45例（75.0%）,静脉输液＞6 d 9例（15.0%）,可预计的外周静脉通道无可选择的风险6例（10.0%）。导管实际留置时间（17.2±10.7）d,总留置时间为1 033导管日。22例患儿出现并发症23例次（22.3例次/1 000导管日）。其中,导管异位7例次,导管堵塞6例次,静脉炎3例次,导管破/断裂3例次,误伤动脉2例次,静脉痉挛1例次,静脉回流受阻1例次。经原位治疗后18例次导管继续使用,5例次拔管。导管结局：计划拔管42例（70.0%）,非计划拔管5例（8.3%）,包括导管破/断裂、导管堵塞无法再通各2例,无法纠正的静脉回流受阻1例,带管转科/出院13例（21.7%）。平均穿刺时间(68.2±43.5)min,PICC置管费用/住院总费用为7%。结论：普通儿科病房中长期输液患儿行PICC置管必要且可行,使用中需加强并发症的预防和处理。     

Complications of cerebrospinal fluid shunts

In the period 1972–81, 572 hydrocephalic children were treated using the Upadhyaya shunt valve, One hundred and seventys-even of these patients needed a total of 350 shunt revisions. Indications for revisions were; shunt blockage 245 (70% of total revisions) shunt infections 40 (11.5%) catheter disconnections/fractures 19 (5.5%) and intvacranial hemorrhage 9 (2.5%). Intracranial bleeds were more commonly seen in hydrocephalus associated with tuberculous meningitis and were invariably fatal. Infrequent complications were CSF leak, shunt extrusion, valve incompetence, pulmonary hypertension and pleural effusion. Thirty-nine patients died. Overall results of the Upadhyayay shunt valve compare favourably with other reported series.     

Comparison of total versus partial revision of initial ventriculoperitoneal shunt failures

BACKGROUND: Optimal surgical management of patients presenting with shunt failure in the age of neuroendoscopy remains complex. The value of replacing the entire shunt system as opposed to a single shunt component has not been assessed. METHODS: We reviewed the records of all pediatric patients who underwent their first shunt revision between January 1992 and December 1998. Patients with primary shunt failure attributed solely to proximal catheter obstruction or distal catheter obstruction were included for analysis. Shunt revisions were classified as total (entire shunt replaced) or partial (only malfunctioning component replaced). Kaplan-Meier (shunt survival curves) and log rank analysis were used to compare failure rates between partially and totally revised shunts according to the underlying diagnosis and failed shunt part. Significant differences in univariate analysis were confirmed with a multivariate proportional hazards regression model. RESULTS: 301 pediatric patients underwent primary shunt revision (183 total, 118 partial revisions). All shunts utilized distal slit peritoneal catheters. In shunt failures attributed to proximal obstruction, reutilization of the distal catheter was associated with a 57% increased risk of subsequent shunt failure (hazard ratio 1.57, 95% confidence interval 1.19-3.49). In shunt failures attributed to distal obstruction, subsequent shunt survival was not affected by reutilization of the proximal catheter (p = 0.581). When stratified according to the etiology of hydrocephalus, only patients with intraventricular hemorrhage (IVH) failed to demonstrate greater survival of totally revised shunts. CONCLUSIONS: In this series, in the setting of proximal shunt catheter obstruction, reutilizing the functional distal catheter was associated with an increase in subsequent shunt failure rates compared to revising the entire shunt system. Total revision was not associated with improved shunt survival in patients with IVH.     

Outcome analysis of initial neonatal shunts: does the valve make a difference?

OBJECTIVE: Ventriculoperitoneal shunts have one of the highest complication rates of all neurosurgical procedures. The purpose of this study was to identify factors associated with malfunction of shunts placed in infants with neonatal hydrocephalus, with the goal of maximizing long-term shunt survival. METHODS: We performed a retrospective chart review of 200 consecutive patients less than 1 year old who underwent primary intracranial shunt placement for hydrocephalus by one of two experienced pediatric neurosurgeons at a single institution. A multivariate analysis was conducted to identify variables that were statistically independent predictors of a shunt malfunction or problem. RESULTS: Adequate data were available for 158 patients, with a mean follow-up of 39.8 months (range 6-99 months). Variables tested for independent prediction of shunt revision included the etiology of the hydrocephalus, gestation period, age at shunt placement, surgeon, ventricular catheter entry site and valve opening pressure. Frontal versus occipital catheter entry site was not associated with a different revision rate. The only significant controllable factor associated with shunt malfunction was the valve opening pressure. The revision rate per year of follow-up was 4 times higher for patients with no valve or a low-pressure valve than for patients with a medium- or high-pressure valve. CONCLUSIONS: This retrospective review demonstrated that the valve opening pressure is an important component of the shunt complication rate. A prospective multicenter randomized trial is warranted to further evaluate the conclusions of this study.     

Broviac ventriculostomy for long-term external ventricular drainage.

A closed external ventricular drainage system that incorporates a Broviac catheter, with its dacron cuff, is described and its use is detailed. This device has been placed in 17 patients who have undergone 19 procedures. Indications for prolonged cerebrospinal fluid (CSF) drainage were: CSF leak (1 child) and shunt infection (16 children). Drainage was maintained for an average of 19 days, with a range of 6-47 days. The child with the CSF leak had resolution of this problem after 15 days, whereupon the system was removed. Thirteen of the 16 patients with shunt infections eventually underwent shunt placement. Two of the children in this group developed a shunt infection unrelated to their original septic episode that required placement of a second Broviac ventriculostomy. Two of the 3 children who did not undergo permanent shunt placement expired from other causes. Both of these children had clinically functioning Broviac ventriculostomies and culture-proven sterile CSF at the time of death. The remaining child with an infected shunt died of overwhelming sepsis. Complications included: ventricular catheter revision (4 cases), irrigation of the system (4 cases), and secondary CSF infection (1 case). The infection attack rate was 1 in 361 patient-catheter days, or 2.77/1,000 patient-catheter days. The advantages of the Broviac ventriculostomy are two. First, this system is highly resistant to infection. Second, the device is difficult to dislodge.     

Endoscopic approach to noncommunicating fluid spaces in the shunted patient

INTRODUCTION: It is well known that shunted hydrocephalic patients can, over time, develop entrapped ventricles or cystic spaces not in communication with the remaining ventricles. This situation has traditionally been treated with placement of an additional catheter or shunt system in the noncommunicating fluid space. With the advent of minimally invasive endoscopic techniques, it has become possible to fenestrate trapped fluid spaces into the shunted ventricular system, thus preventing the need for additional catheters. METHODS: Fifteen shunted patients presented with noncommunicating fluid spaces over a 4-year period at our two institutions. We attempted fenestration procedures in 14 of those patients. The various procedures included: septum pellucidum fenestration, cyst fenestration, third ventriculocisternostomy and a combination of the above. RESULTS: Thirteen of 16 (81%) endoscopic fenestrations successfully prevented the need for a complicated shunting system. There were 3 technical failures (3/16, 19%) in which an additional catheter was added to the existing shunt system at the time of the endoscopic procedure. There were no adverse neurologic effects from the endoscopic procedures; however, in 4 of the 14 patients (29%) a shunt revision was performed between 2 and 30 days following the fenestration. CONCLUSIONS: These results show that the endoscopic approach to establishing communication between noncommunicating CSF spaces in the shunted patient is safe and efficacious in preventing the need for additional CSF catheters. Though we encountered failures, the majority of cases are technically feasible. In these patients early shunt malfunction may occur, most likely due to intraoperative bleeding and will require shunt revision.     

Memory deficits in long-term survivors of childhood brain tumors may primarily reflect general cognitive dysfunctions

BACKGROUND: To analyze the impact of potential predictors on memory performance in survivors of childhood brain tumors and to examine whether deficits in memory after radiotherapy (RT) should be considered part of a more global mental dysfunction. PROCEDURE: We studied 126 patients with brain tumors diagnosed before the age of 15 years and treated January 1970 through February 1997 in Eastern Denmark. Sixty-nine of the 126 patients had received RT. In addition to working memory and long-term memory (LTM), general intelligence (IQ) was assessed. RESULTS: The mean test scores in nearly all memory tests were lower than expected from available norms. In multiple linear regression, treatment with RT, hemisphere tumor location, and hydrocephalus treated with a shunt at the time of diagnosis were found to be significant risk factors for memory deficits. When IQ was included as a covariate, RT did not significantly predict memory performance, while shunt and tumor location remained significant for several but not all tests. CONCLUSION: These results suggest that in patients treated with RT, memory deficits primarily reflect a general cognitive dysfunction, and it is likely that these intelligence deficits may compromise the chances of success of special memory training. In contrast, memory deficits in non-irradiated patients may to some degree reflect specific cognitive dysfunctions being most pronounced for patients treated with a shunt and for patients with hemispheric tumors.     

Abdominal pseudocysts complicating CSF shunting in infants and children. Report of 18 cases

Abdominal pseudocysts (APC) are rare complications of ventriculoperitoneal shunting for hydrocephalus. The authors studied retrospectively a series of 18 pediatric patients with APC. Signs and symptoms of shunt dysfunction were observed in 15 (83.3%), abdominal complaints in 10 (55.5%) and fever in 6 (33.3%). Prior to the diagnosis of APC, 2 patients suffered exploratory laparotomies due to important abdominal signs and symptoms. Ultrasonography was diagnostic in all cases and proved to be the method of choice in the evaluation of APC. Our series suggest that APC are strongly related to hardware infection and in some cases can result from a previous shunt infection not completely cured. The bacteriological examination of the tip of the peritoneal catheter was a reliable indicator of infection. According to our data, the best treatment seems to be the removal of the shunt system and the insertion of an external ventricular drainage. In our experience, almost half of the patients had a ventriculoatrial shunt replacing the peritoneal shunt at the end of the treatment.     

Abdominal pseudocyst: predisposing factors and treatment algorithm

Abdominal pseudocyst (APC) is an uncommon complication of ventriculoperitoneal shunts. Various predisposing factors have been attributed to it, including the presence of infection and multiple shunt revisions. We reviewed the records of shunt revisions performed over a 20-year period. During that time, 64 cases of APC were found in 36 patients. The records were then reviewed for the presence of infection, history of necrotizing enterocolitis, prior abdominal surgery, and treatment performed. Of the cases of APC, 46 were primary and 18 were recurrent. A history of prior abdominal surgery other than shunt revision was found in 47% of patients and a history of necrotizing enterocolitis was found in 19% of patients. The average number of prior shunt revisions was 4.1 per patient. Shunt infection as defined by positive cultures of either cerebrospinal fluid or abdominal fluid was present in only 23% of cases of APC. A history of prior shunt infection was present in 30% of patients. Infection was treated by shunt removal, external ventricular drainage, and appropriate antibiotics. After the infection was cleared or if no infection was present, treatment consisted of: (1) repositioning the distal catheter into the peritoneum, (2) repositioning the distal catheter into the pleural space, the atrium, or the gallbladder, (3) exploratory laparotomy with lysis of adhesions and repositioning the peritoneal catheter, (4) APC aspiration only, or (5) shunt removal or disconnection. Because of the complexity of APC management, we analyzed the outcomes of our cases and outlined an algorithm to simplify this process.     

Erosive bladder perforation as a complication of ventriculoperitoneal shunt with extrusion from the urethral meatus: case report and literature review

Ventriculoperitoneal (VP) shunt surgery is the most common technique used in the treatment of hydrocephalus. Erosive bladder perforation is an extremely rare complication of VP shunt surgery. Only 2 cases of erosive bladder perforation by a peritoneal catheter have been reported in the English literature. The authors present the case of a 14-year-old male with a history of cerebral palsy, severe developmental delay and hydrocephalus who presented with VP shunt tubing protruding from his urethral meatus. The patient had no evidence of neurological change. The VP shunt had been last revised over 11 years prior to admission. Imaging demonstrated the VP shunt to be intact, but displaced inferiorly, with the ventricular catheter in the extracranial soft tissue of the neck and the peritoneal catheter passing into the abdomen, bladder, and out through the urethra. Shunt removal was achieved through a multidisciplinary approach, involving both neurosurgery and urology teams. The authors discuss other reported cases of perforation by a VP shunt, potential mechanisms, and considerations for management of this rare complication.