Sterile ascites from a ventriculoperitoneal shunt: a case report and review of the literature

Background Symptomatic, sterile cerebrospinal fluid (CSF) ascites is a rare complication of ventriculoperitoneal (VP) shunt surgery. To date, reports in the literature have linked this unusual circumstance to various intra-abdominal, CNS, or nonspecific inflammatory causes.Case report We present the case of a four-year-old boy with a recently fenestrated arachnoid cyst and VP shunt, who presented with sudden-onset, sterile CSF ascites. The ascites resolved with conversion of the preexisting VP shunt to a ventriculoatrial shunt.     

Spinal subdural Staphylococcus aureus abscess: case report and review of the literature

Spinal subdural abscesses (SSA) are rare and to date only 57 cases have been reported. The exact incidence of the SSA is unknown. The most affected region is the thoraco-lumbar spine and the most common bacterial source is Staphylococcus aureus. The timing for magnetic resonance imaging is very important in these patients. Because early diagnosis and emergent treatment is vital to prevent the formation or progression of neurologic deficits.     

Cervical extramedullary mass lesion due to chronic CSF overshunting: case report and literature review

Introduction  Several emerging clinical and neuroimaging conditions due to CSF intracranial hypotension have been documented. Recently, a few instances of a severe form of cervical myelopathy due to CSF overshunting have also been reported. Patients with this type of cervical myelopathy usually evolve with marked clinical manifestations of spinal cord involvement. Materials and methods  In this article, we report a 20-year-old girl, previously given a ventriculoperitoneal shunt at age 6 years, who presented with neck pain after a whiplash injury. Results and discussion  Magnetic resonance imaging revealed a cervical extramedullary mass that mimicked a cervical extradural hematoma. Further neuroimaging studies demonstrated that it corresponded to an engorged cervical epidural venous plexus that we attributed to chronic CSF overdrainage. After expectant management, the patient experienced a total recovery of her symptoms. To our knowledge, this is the first report of this condition occurring in an asymptomatic patient. Our aim in reporting this patient is twofold: (1) to warn the clinician about these neuroimaging findings that may mimic a cervical extradural hematoma and (2) to illustrate that engorged cervical epidural plexus may occur in patients in the absence of clinical manifestations of myelopathy. Recognition of this entity is important to distinguish it from a mass lesion in which a surgical intervention might be indicated.     

Transient ventriculoperitoneal shunt malfunction after chronic constipation: case report and review of literature

Background Significant constipation in patients with shunt-dependent hydrocephalus may often be enough to bring a subclinical shunt malfunction to clinical attention or even to be the cause of temporary distal peritoneal shunt malfunction. The treatment of the constipation may address the symptomatic shunt dysfunction so as to avoid operative intervention. The pathogenesis of distal shunt malfunction and its management in such a situation are discussed, and the relevant literature is briefly reviewed. Case report A 16-year-old young boy had shunt-dependent hydrocephalus secondary to prematurity and intraventricular hemorrhage at birth. He was chronic flaccid paraplegic and had a neurogenic bladder and bowel involvement. He presented with acute dull aching intermittent headaches, nausea, and constipation of short duration. There was no underlying shunt infection. CT brain showed dilated lateral ventricles. Shunt survey revealed a convoluted course and kink in the distal peritoneal catheter. After administration of a bowel enema, the headaches and nausea resolved over the next few hours, and the posttreatment CT showed significant decrease in ventricular size. Conclusion Chronic constipation is an important predisposing factor for distal malfunction in shunt-dependent hydrocephalus and should be ascertained in evaluation of a ventriculoperitoneal shunt malfunction. Appropriate treatment of significant constipation can relieve shunt malfunction and reestablish cerebrospinal fluid circulation. A shunt exploration can be avoided in such a situation. A close neurological monitoring of the patient is essential during the course of treatment. An interdisciplinary approach between concerned medical specialities and enhanced awareness is mandatory to ensure appropriate bowel management.     

Tuberculous brain abscess: A case report with a review of the literature in English

A 69-year-old man had a tuberculous brain abscess in the right frontal lobe as well as an underlying alcoholic cirrhosis of the liver. The abscess responded well to combined surgical excision and antituberculous treatment. A review of 42 patients, including this patient who had tuberculous abscesses of the central nervous system (CNS) disclosed 54% of classical (genuine, true or typical) lesions morphologically similar to the pyogenic abscess, and 46% of atypical lesions having granulomatous changes without caseous necrosis in the abscess wall. The size of the abscesses ranged from 2 mm to 5 cm across. Some abscesses contained 3–60 mL of pus. Most tuberculous abscesses resulted from hematogenous dissemination of tubercle bacilli from primary tuberculous foci outside the CNS; a few were probably related to direct extension of tuberculosis of the ear. Approximately 58% of patients were aged in the first three decades of life and 22% of patients were children of less than 15 years of age. The mean age was 31 years for both genders. The sexual ratio was 7:6 for males and females. The frontal lobe and cerebellum were the common sites of occurrence. Approximately 19% of patients with CNS tuberculous abscesses were associated with the acquired immunodeficiency syndrome (AIDS). Combined surgical extirpation and antituberculous drugs were the treatment of choice. Needle aspiration combined with appropriate antituberculous drugs have yielded satisfactory results in some patients. An intra-operative smear and a stain of pus for acid-fast bacilli is necessary for rapidly distinguishing between a tuberculous abscess and a pyogenic abscess as well as for proper immediate postoperative treatment. Geographically, the CNS tuberculous abscesses were scattered in many countries, particularly in India and the USA. Their increased incidence is expected in relation to the present prevalence of AIDS.     

Pseudotumor cerebri complicating measles: a case report and literature review

A previously healthy 8-year-old girl patient was referred with the complaints of severe headache associated with nausea and vomiting. Three weeks prior to her admission, she had measles manifested with fever and typical skin eruptions. Fundoscopic examination revealed bilateral swollen optic discs with tortuous blood vessels. Other physical examinations were unremarkable, except for photophobia. Lumbar puncture demonstrated a cerebrospinal fluid opening pressure of 30 cm H(2)O, no cells, normal levels of glucose and protein. Serum measles immunoglobulin M level was elevated (183 AU). Our further investigations revealed that the patient had pseudotumor cerebri (PTC) following measles infection.     

颅内蛛网膜囊肿-腹腔分流术后分流管依赖二例并文献复习

目的 探讨颅内蛛网膜囊肿-腹腔分流术后并发分流管依赖的可能机制、影像学特征及治疗方法.方法 分析2例蛛网膜囊肿行囊肿-腹腔分流术后并发分流管依赖的诊治过程,并结合文献进行讨论和总结.结果 2例均表现为分流管功能丧失后继发严重颅高压症状,其中1例行侧脑室-腹腔分流术;另1例先行囊肿-腹腔分流术,1个月后分流管堵塞,改行腰大池-腹腔分流术.经治疗后2例均痊愈出院,预后良好.结论 分流管依赖是继发于分流管功能下降或丧失,临床表现呈持续进展性颅内压增高;影像学上可观察到侧脑室正常或轻度缩小,原囊肿短期内可复现增大;解除分流管梗阻或重新建立脑脊液引流渠道是安全有效的治疗方法.     

Giant meningioma of the III ventricle in a child: case report and review of the literature

We report the case of an 11-year-old girl with a giant meningioma of the III ventricle who presented with signs and symptoms of raised intracranial pressure. The tumor was removed through a transcallosal approach. A review of current literature yielded 16 previous cases of meningiomas of the III ventricle in the pediatric age group. The usual form of presentation is that of a midline syndrome with no localizing signs. In the cases that were operated on, surgical intervention was rewarding and mortality was low. A very unusual finding in the meningioma that we report was its origin in the floor of the III ventricle, a circumstance that has only once been described previously.     

脑室-腹腔分流管移位至心脏二例报告及文献复习

目的 探讨罕见的脑室-腹腔分流管移位至心脏的发病机制、临床特点、诊治方法及并发症.方法 分析2例脑室-腹腔分流管移位至心脏的诊治过程,并结合文献对本病的预防及诊治进行讨论.结果 通过临床表现及影像学检查明确诊断,手术顺利拔除了移位的分流管,术中及术后患者病情平稳.结论 首次在国内报道了脑室-腹腔分流管移位至心脏的病例;在脑室-腹腔分流术中注意通条打皮下隧道时不宜过深或过浅,通条头部不宜过尖;术后出现异常应复查头部CT、胸片及腹片;直接从头部原切口处切开拔除分流管是简单、可行、安全的手术方式.

Abstract：

Objective To discuss the mechanism, clinical features, complications, diagnosis criteria and treatment of intracardiac migration of the distal catheter of ventriculoperitoneal shunt. Method The diagnosis criteria and treatment of 2 cases of intracardiac migration of the distal catheter of ventriculoperitoneal shunt were studied, and relative literatures were reviewed. Results The migratory catheter was successfully extracted after definite diagnosis according to clinical features and imaging findings. There was no postoperative abnormality. Conclusions This is the first report of migration of the distal catheter of ventriculoperitoneal shunt into heart in China.The possible measures to minimize the incidence of the migration include avoiding deep or superficial neck tunneling and using blunt tunneling devices. Head CT, chest and abdominal x - ray are needed if postoperative abnormality is noticed. Percutaneous removal of the catheter from the retroauricular fomer incision is simple and safe.     

颅内静脉异常回流致脑积水一例及文献复习

目的 探讨先天性颅内静脉回流异常所致脑积水的临床特点和治疗方法.方法 对1例先天性颅内静脉回流异常所致脑积水患者,经CT、MRI、MRV及DSA检查明确诊断后,行脑室-腹腔体外可调压分流术治疗,对其病史结合文献进行回顾分析.结果 先天性颅内静脉回流异常导致的脑积水临床上非常罕见,患儿常有头颈部皮肤毛细血管扩张,对高颅压耐受较好,回流静脉受损可致颅内压调节失代偿,DSA检查能够明确颅内静脉回流的异常路径,体外可调压脑室-腹腔分流可随时根据患儿反应调节分流压力,分流压力一般需维持在较高水平,以保证静脉回流.结论 出生后有头颈部毛细血管扩张者需考虑先天性颅内静脉回流异常,DSA检查有助于明确诊断,体外可调压脑室-腹腔分流可安全有效地控制先天性颅内静脉回流异常所致脑积水引起的头颅进行性增大.     

软骨发育不全伴脑积水5例诊治分析并文献复习

目的 总结软骨发育不全(ACH)合并脑积水患儿的诊治经验.方法 回顾性分析经基因检测确诊的5例ACH合并脑积水的临床资料,并结合相关文献进行分析.结果 1例外院接受脑室-腹腔分流术治疗脑积水,术后随访3年,脑积水未进展,未出现分流相关并发症.另外4例均采用随访观察,随访时间2～12年,其中2例单纯合并脑积水病人的脑室大...     

儿童蛛网膜囊肿-腹腔分流术后继发裂隙脑室综合征的治疗

目的 探讨颞叶蛛网膜囊肿行囊肿-腹腔分流术后出现的裂隙脑室综合征的早期诊断依据,合理有效的治疗方法以及预防这种并发症的措施.方法 回顾性分析研究了经过本文通信作者治疗的6例颞叶蛛网膜囊肿行囊肿-腹腔分流术后出现裂隙脑室综合征患儿的影像学资料、治疗经过和治疗结果.结果 男4例,女2例.平均发病年龄57.5个月.治疗方法为使用可调压力的抗虹吸分流管泵更换原有分流管泵或联合使用脑室-腹腔分流.6例患者临床症状完全消失,平均随访30个月,未见症状复发.结论 使用可调压力的抗虹吸分流管泵更换原有分流管泵或联合脑室-腹腔分流术对于裂隙脑室综合征是一种有效的治疗措施.避免使用低压的无抗虹吸作用的分流管能够有效地预防蛛网膜囊肿-腹腔分流术后出现裂隙脑室综合征.

Abstract：

Objective To investigate early diagnosis evidences, optimal therapeutic strategies and the prophylactic methods of the slit - ventricle syndrome(SVS) in the temporal lobe arachnoid cysts patients who received the cyst - peritoneal(CP) shunting.Method Six cases of SVS in the temporal lobe arachnoid cysts patients who received the CP shunting were treated by the senior author from Jan 2005 to Jan 2009.The radiological data, treatment process and therapeutic results were reviewed retrospectively.Results There were 4 male and 2 female patients.The mean age of presentation was 57.5 months.The final treatment was to change the original shunt with the programmable valve or combined with the ventricular - peritoneal(VP)shunting.All the symptoms of the patients disappeared totally, and the mean follow - up duration was 30mouths.Conclusions To use programmable shunts to substitute for the original shunt or combined with inserting a VP shunt is an optimal therapeutic method for SVS.The use of low - pressure shunts to treat the ararchoid systs should be abandoned unless dictated by specific indications.     

Third ventriculostomy vs ventriculoperitoneal shunt in pediatric obstructive hydrocephalus: results from a Swiss series and literature review

Introduction Few series compare endoscopic third ventriculostomies (ETV) and ventriculoperitoneal shunts (VPS). To avoid the complications after a shunt insertion, there is an increased tendency to perform a third ventriculostomy. We reviewed all pediatric patients operated in the French-speaking part of Switzerland for a newly diagnosed obstructive hydrocephalus since 1992 and compared the outcome of patients who benefited from ETV to the outcome of patients who benefited from VPS. There were 24 ETV and 31 VPS. Discussion At 5 years of follow-up, the failure rate of ETV was 26%, as compared to 42% for the VPS group. This trend is also found in the pediatric series published since 1990 (27 peer-reviewed articles analyzed). Conclusion In accordance to this trend, although a statistical difference cannot be assessed, we believe that ETV should be the procedure of choice in pediatric obstructive hydrocephalus.     

Neurological outcome following neonatal post-haemorrhagic hydrocephalus: the effects of maximum raised intracranial pressure and ventriculo-peritoneal shunting

The neuromotor outcome of 33 survivors of grade 3 or 4 neonatal post-haemorrhagic hydrocephalus born between 1975 and 1988 was assessed at a mean age of 4.7 years (9 months to 13 years). Two outcomes were determined: 12 patients were either normal (10) or had neurological signs without functional impairments (2), while 21/33 were moderately (16), severely (2), or profoundly impaired (3). Intracranial pressure (ICP) was measured in 26/33 patients (4–40 mm Hg): 2 had normal pressures (<5.6 mm Hg) and were normal. Raised ICP was not significantly different between outcome groups. Twenty-seven children were shunted; 10/27 had five or more operations (up to 14) and all of these had abnormal neurological outcomes, whereas the number of children with 1–4 shunt procedures was equal in both outcome groups. The rise in morbidity after the fourth shunt procedure may be associated with the ventriculitis suffered by 9 of the 10 patients with more than four shunts (P<0.01): this compares with 4/14 cases of ventriculitis in the children with 2–4 shunts and no cases of infection in the 3/27 who were shunted once. Outcome was independent of antenatal and perinatal factors including the age at or mode of presentation, and was unrelated to grade of intraventricular haemorrhage or parenchymal changes on ultrasound or CT scanning. Conclusion: for these small numbers, adverse outcome is statistically related to more than four shunt procedures and ventriculitis but independent of maximum ICP or other perinatal factors.     

Transoral protrusion of a peritoneal catheter: a case report and literature review

Transoral protrusion of a peritoneal catheter is rare. Only two cases have been reported in the English literature. We now report the case of a 5-year-old girl who presented with a catheter that had been inserted 4 years previously, protruding from her mouth. Signs of cerebrospinal fluid infection or peri- tonitis were absent. The peritoneal catheter was cut and externalized at the chest. The distal portion, which had perforated the stomach wall, was removed using endoscopic procedures. After 3 weeks of antibiotic treatment, a new shunt was inserted. Analysis of 50 cases of bowel perforation extracted from the English literature showed that among the suggested factors such as age, gender, nutritional state, history of abdominal surgery, and length and type of the catheter, age was the only predisposing factor. In the treatment of bowel perforation by a peritoneal catheter, suspected shunt infection should be managed properly and contamination be minimized during removal of the peritoneal catheter. Received: 15 May 1999     

Ventriculovenous shunt against the direction of blood flow: a new approach for shunting the cerebrospinal fluid to the venous circulation

Fifty hydrocephalic children have been treated during the past 2 years by shunting the cerebrospinal fluid (CSF) to the internal jugular vein (IJV) against the direction of blood flow. Shunting the CSF in this way prevents the development of siphonage in the erect posture and regulates the intraventricular pressure (IVP) within normal limits. Most of the commonly encountered complications with current extracranial shunts did not occur. The ventriculomegaly regressed in patients with rigid craniums. The enormously enlarged head was reduced in size as a result of surgery in five infants. A shunting catheter with a simple unidirectional valve was used to establish the ventriculovenous (VV) connection. Shuntography was done on two patients.     

Sarcoidosis with hydrocephalus: report of a case successfully treated with a ventriculo-peritoneal shunt and methylprednisolone pulse therapy

We describe a female patient with systemic sarcoidosis and hydrocephalus. She was initially satisfyingly treated with peroral steroids. When she later deteriorated, the treatment had to be changed due to side-effects. High dose intravenous methylprednisolone pulse therapy was tried with some, but insufficient, improvement. Therefore, a ventriculoperitoneal shunt operation was performed with immediate improvement. After that she was treated with intravenous methylprednisolone and her condition has remained proper and stable for 5 years. The possibility that pulse therapy might have contributed to the favourable course in our patient is discussed.     

Delayed spontaneous pneumocephalus in ventriculoperitoneal shunting: Two case reports and literature review

Spontaneous pneumocephalus following cerebrospinal fluid shunt is a rare complication. In most cases, the air enters in the intracranial cavity via a skull base defect. We report 2 cases of delayed tension pneumocephalus, secondary to ventriculoperitoneal shunt, and review the etiopathogenesis, prevention and treatment of this condition.