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Amayiri N, Obeidat M, Laban DA, Musharbash A, Al-Hussaini M, Maraqa B, Ibrahimi A, Sarhan N, Bouffet E. BRAF/MEK inhibitors use to treat ventriculoperitoneal shunt-associated ascites in pediatric low-grade gliomas. Pediatr Blood Cancer 2024; 71:e31058. [PMID: 38753385 DOI: 10.1002/pbc.31058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Revised: 04/19/2024] [Accepted: 04/23/2024] [Indexed: 06/27/2024]
Affiliation(s)
- Nisreen Amayiri
- Department of Pediatrics, King Hussein Cancer Center, Amman, Jordan
| | - Mouness Obeidat
- Department of Surgery, King Hussein Cancer Center, Amman, Jordan
| | - Dima Abu Laban
- Department of Diagnostic radiology, King Hussein Cancer Center, Amman, Jordan
| | - Awni Musharbash
- Department of Surgery, King Hussein Cancer Center, Amman, Jordan
| | - Maysa Al-Hussaini
- Department of Pathology and Laboratory Medicine, King Hussein Cancer Center, Amman, Jordan
| | - Bayan Maraqa
- Department of Pathology and Laboratory Medicine, King Hussein Cancer Center, Amman, Jordan
| | - AhmadKh Ibrahimi
- Department of Radiation Oncology, King Hussein Cancer Center, Amman, Jordan
| | - Nasim Sarhan
- Department of Radiation Oncology, King Hussein Cancer Center, Amman, Jordan
| | - Eric Bouffet
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
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Han S, Yang Z, Wang L, Yang Y, Qi X, Yan C, Yu C. Postoperative hydrocephalus is a high-risk lethal factor for patients with low-grade optic pathway glioma. Br J Neurosurg 2024; 38:625-631. [PMID: 34240664 DOI: 10.1080/02688697.2021.1947971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 05/14/2021] [Accepted: 06/22/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To explore the prognostic factors of patients with low-grade optic pathway glioma (OPG) and the optimal treatment to reduce the incidence of postoperative hydrocephalus. PATIENTS AND METHODS This single-center study retrospectively analyzed data from 66 patients with OPGs who underwent surgery. The patients were followed, and overall survival (OS) and progression-free survival (PFS) were determined. The effects of different treatments on the hydrocephalus of patients were compared. RESULTS Postoperative hydrocephalus was identified as a factor to increase the risk of mortality by 1.99-fold (p = .028). And, 5-year survival rate was significantly lower among patients with postoperative hydrocephalus (p = .027). The main factors leading to preoperative hydrocephalus in patients are large tumor volume and invasion into the third ventricle. Gross total resections (GTR) could reduce the risk of long-term hydrocephalus (p = .046). Age younger than 4 years (p = .046) and tumor invasion range/classification (p = .029) are the main factors to reduce the five-year survival rate. Postoperative radiotherapy (RT) and chemotherapy (CT) had no significant effects on OS. Extraventricular drainage (EVD) was not associated with perioperative infection (p = .798 > .05) and bleeding (p = .09 > .05). Compared with 2 stage surgery (external ventricular drainage or ventriculoperitoneal shunt (VPS) was first placed, followed by tumor resection), 1 stage surgery (direct resection of tumor) had no complication increase. CONCLUSIONS Postoperative hydrocephalus is mostly obstructive hydrocephalus, and it is an important factor that reduces the OS of patients with low-grade OPGs. Surgery to remove the tumor to the greatest extent improves cerebrospinal fluid circulation is effective at reducing the incidence postoperative hydrocephalus. For patients whose ventricles are still dilated after surgery, in addition to considering poor ventricular compliance, they need to be aware of the persistence and progression of hydrocephalus.
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Affiliation(s)
- Song Han
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing, PR China
| | - Zuocheng Yang
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing, PR China
| | - Liguo Wang
- Department of Neurosurgery, Fuxing Hospital, Capital Medical University, Beijing, PR China
| | - Yakun Yang
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing, PR China
| | - Xueling Qi
- Department of Pathology, Sanbo Brain Hospital, Capital Medical University, Beijing, PR China
| | - Changxiang Yan
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing, PR China
| | - Chunjiang Yu
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing, PR China
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Afornali S, Beraldo RF, Maeda AK, Mattozo CA, Brito RN, Ergen A, Pereira MC, Chaurasia B. Ventriculo-gallbladder shunt: case series and literature review. Childs Nerv Syst 2024; 40:1525-1531. [PMID: 38329505 DOI: 10.1007/s00381-024-06297-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 01/17/2024] [Indexed: 02/09/2024]
Abstract
BACKGROUND The ventriculoperitoneal shunt (VPS) is the gold-standard surgical technique to treat hypertensive hydrocephalus; however, it may fail in 20 to 70% of cases. The present study shows an alternative for patients with contraindications to VPS. METHODS A case series of nine patients. The medical records of all patients under 17 years of age who underwent ventriculo-gallbladder (VGB) shunt at a pediatric hospital from January 2014 to October 2022 were reviewed. RESULTS There were 6 (66.7%) males and 3 (33.3%) females. The average age of 73.6 months or 6.1 years at the time of surgery. They had undergone, on average, 5.1 VPS reviews before the VGB shunt. Five (55.5%) had complications of VGB shunt: infection (11.1%), atony (11.1%), hypodrainage (11.1%), and ventriculoenteric fistula (22.2%); all these patients got better at surgical reapproach, and in two of them, the VGB shunt was re-implanted. CONCLUSION This case series shows a lower risk of death and a similar risk of complications compared to other alternative shunts. This article spotlighted VGB as a viable alternative when VPS fails or has contraindications.
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Affiliation(s)
- Sandrieli Afornali
- Department of Neurosurgery, Pequeno Príncipe Hospital, Curitiba, Paraná, Brazil
- Department of Neurosurgery, Pontifical Catholic University of Paraná, Curitiba, Paraná, Brazil
| | - R Fedatto Beraldo
- Department of Neurosurgery, Pontifical Catholic University of Paraná, Curitiba, Paraná, Brazil
| | - A Keijiro Maeda
- Department of Neurosurgery, Pequeno Príncipe Hospital, Curitiba, Paraná, Brazil
- Department of Neurosurgery, Pontifical Catholic University of Paraná, Curitiba, Paraná, Brazil
| | - C Alberto Mattozo
- Department of Neurosurgery, Pequeno Príncipe Hospital, Curitiba, Paraná, Brazil
- Department of Neurosurgery, Pontifical Catholic University of Paraná, Curitiba, Paraná, Brazil
| | - R Nascimento Brito
- Department of Neurosurgery, Pontifical Catholic University of Paraná, Curitiba, Paraná, Brazil
| | - Anil Ergen
- Department of Neurosurgery, Derince Research Hospital, Kocaeli, Turkey
| | - M Charles Pereira
- Department of Otolaryngology - Head and Neck Surgery, Albany Medical Centre, Albany, NY, USA
| | - Bipin Chaurasia
- Department of Neurosurgery, Neurosurgery Clinic, Birta, Birgunj, 44300, Nepal.
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Porto Junior S, Ramos JVB, da Cunha BLB, da Silva da Paz MG, de Oliveira Lima TV, Moreira LR, de Avellar LM. Ventriculo - Gallbladder shunt. J Clin Neurosci 2024; 121:83-88. [PMID: 38368659 DOI: 10.1016/j.jocn.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 01/21/2024] [Accepted: 02/05/2024] [Indexed: 02/20/2024]
Abstract
INTRODUCTION Permanent liquor diversion is associated with a high risk of failure and often requires re-intervention. The ventriculo-gallbladder shunt (VGS) has been recognized as a last-resort alternative for treating hydrocephalus when the peritoneum or other distal sites are no longer suitable for receiving shunts. This article aims to report a case from a neurosurgery referral service in Brazil and review the literature on this issue. METHODS A systematic literature review was conducted in accordance with the PRISMA statement. The PubMed, Embase, and Web of Science databases were searched for data screening and extraction. The reported case was conducted with ethical approval from the neurosurgical hospital's ethics committee. RESULTS G.B.S, male, 43 years old, no comorbidities, who has been dealing with a 12-year history of hydrocephalus, with post-surgical chronic fungal meningitis. Two years ago, he underwent a ventriculoatrial shunt (VAS) placement due to multiple ventriculoperitoneal shunt (VPS) failures. Endocarditis was suspected, and the VAS was removed. As an alternative, VGS was implanted 6 months ago, and since then, there has been no need for a new system review. The gallbladder has an absorptive capacity of 1500 cc of liquid daily, which is more than the normal daily production of cerebrospinal fluid (CSF). Therefore, it is a good alternative when the ventriculoperitoneal shunt is not feasible due to postsurgical peritoneal adhesions or when there are contraindications for ventriculoatrial shunts. CONCLUSION VGS is an alternative for patients who cannot undergo the most common surgical interventions, such as VPS.
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Affiliation(s)
- Silvio Porto Junior
- Bahiana School of Medicine and Public Health, Brazil; General Hospital Roberto Santos, Brazil.
| | - João Victor Brito Ramos
- Bahiana School of Medicine and Public Health, Brazil; General Hospital Roberto Santos, Brazil
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Hadhri MM, Souei Z, Boukhit M, Mosbahi S, Ben Nsir A, Darmoul M. Can we consider ventriculo-gallbladder shunt a first-line treatment in selected patients? Case report of a successful management. Childs Nerv Syst 2023; 39:1963-1968. [PMID: 36933013 DOI: 10.1007/s00381-023-05923-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 03/13/2023] [Indexed: 03/19/2023]
Abstract
INTRODUCTION Ventriculo-gallbladder shunt (VGS) has been recognized as a last-resort alternative to treat hydrocephalus when the peritoneum and/or other distal sites can no longer receive shunts. In some specific conditions, it may be conceded as a first-line treatment. CASE PRESENTATION We report the case of a 6-month-old girl with progressive post-hemorrhagic hydrocephalus who presented a concomitant chronic abdominal symptom. Specific investigations ruled out acute infection and led to the diagnosis of chronic appendicitis. Both problems were managed in a one-stage salvage procedure consisting of laparotomy sanctioning to treat the abdominal pathology and seize the opportunity to perform a VGS as a first option since the abdomen is prone to ventriculoperitoneal shunt (VPS) failure. CONCLUSION Only few cases have reported the use of VGS as the first option to handle uncommon complex cases due to abdominal or cerebrospinal fluid (CSF) conditions. We wish to draw attention to VGS as an effective procedure not only in children with multiple shunt failures but also as first-line management in some selected cases.
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Affiliation(s)
- Mohamed Maher Hadhri
- Department of Neurosurgery, Fattouma Bourguiba University Hospital, Avenue Farhat Hached, 5000, Monastir, Tunisia.
- Research Unity Interventional Radiology LR18SP08, University of Monastir, Monastir, Tunisia.
| | - Zohra Souei
- Department of Neurosurgery, Fattouma Bourguiba University Hospital, Avenue Farhat Hached, 5000, Monastir, Tunisia
| | - Mohamed Boukhit
- Department of Neurosurgery, Fattouma Bourguiba University Hospital, Avenue Farhat Hached, 5000, Monastir, Tunisia
| | - Sana Mosbahi
- Department of Pediatric Surgery, Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | - Atef Ben Nsir
- Department of Neurosurgery, Fattouma Bourguiba University Hospital, Avenue Farhat Hached, 5000, Monastir, Tunisia
- Research Unity Interventional Radiology LR18SP08, University of Monastir, Monastir, Tunisia
| | - Mehdi Darmoul
- Department of Neurosurgery, Fattouma Bourguiba University Hospital, Avenue Farhat Hached, 5000, Monastir, Tunisia
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Casajús Ortega A, Vázquez Míguez A, Zazpe Cenoz I, de Frutos Marcos D. Double ventriculo-gallbladder shunt in the treatment of giant suprasellar arachnoid cyst with secondary hydrocephalus. NEUROCIRUGIA (ENGLISH EDITION) 2023; 34:40-43. [PMID: 35534409 DOI: 10.1016/j.neucie.2022.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 11/07/2021] [Accepted: 11/21/2021] [Indexed: 02/01/2023]
Abstract
Ventriculo-gallbladder shunt is described as an effective alternative procedure in the treatment of hydrocephalus. We present the case of a 19-year-old patient diagnosed with suprasellar arachnoid cyst since his childhood and hydrocephalus, with a double shunt; ventriculo peritoneal and peritoneal cyst shunt. After several replacements due to peritoneal failure, he underwent ventriculoatrial shunt, with associated complications and subsequent repositioning to the peritoneum. After new valve dysfunction due to peritoneal complications, ventriculo-gallbladder shunt was proposed as an alternative treatment for this patient, which was safe and effective in resolving the patient's symptoms, and the patient was discharged, maintaining clinical stability in the follow-up more than 2 years later.
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Zima LA, Belal AM, Sandberg DI. Choroid plexus cauterization to treat inadequate abdominal cerebrospinal fluid absorption: case report. Childs Nerv Syst 2022; 38:817-820. [PMID: 34309719 DOI: 10.1007/s00381-021-05298-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 07/17/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Inadequate absorption of cerebrospinal fluid (CSF) in the setting of high CSF production is a relatively rare cause of shunt malfunction. CASE REPORT We present the unique case of a 3-year-old boy who developed sterile ascites and abdominal distension in a delayed fashion after shunt placement. The shunt was externalized, and the patient was noted to have high CSF output. Bilateral choroid plexus cauterization resulted in a significant decrease in CSF production and enabled the shunt to be re-inserted into the abdomen.
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Affiliation(s)
- Laura A Zima
- Department of Neurosurgery, McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA.
| | - Ahmed M Belal
- Departments of Pediatric Surgery and Neurosurgery, McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA
| | - David I Sandberg
- Departments of Pediatric Surgery and Neurosurgery, McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA
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Clinical and molecular characteristics of pediatric low-grade glioma complicated with ventriculo-peritoneal shunt related ascites. J Neurooncol 2022; 157:147-156. [PMID: 35122583 DOI: 10.1007/s11060-022-03956-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 01/25/2022] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Ventriculo-peritoneal shunt (VPS) related ascites is a rare complication of pediatric low grade gliomas (pLGG). Physiopathology of this complication is not fully understood and there is paucity of data regarding the molecular profile of pLGG gliomas complicating with ascites and the optimal management of this unusual event. METHODS International multi-institutional retrospective analysis of patients diagnosed with BRAF altered pLGG and ascites arising as a complication of VPS. Demographics, tumor characteristics, therapeutic approaches and outcomes were recorded. RESULTS Nineteen patients were identified. Median age at diagnosis was 14 months (R: 2-144). Most patients (17; 89.4%) presented with lesions involving the optic pathway. Mean tumor standard volume was 34.8 cm2 (R: 12.5-85.4). Pilocytic Astrocytoma was the most frequent histological diagnosis (14;7 3.7%). Eight (42.1%) tumors harbored BRAF V600-E mutation and seven (36.8%) KIAA1549 fusion. The onset of ascites was documented at a median time of 5 months following VPS insertion. Four (21%) patients were managed with paracentesis only, 7(36.8%) required both paracentesis and shunt diversion, 7(36.8%) required only a shunt diversion and 1 (5.2%) patient was managed conservatively. Chemotherapy regimen was changed in 10 patients following ascites. Eight patients received targeted therapy (4 dabrafenib/4 trametinib) and 5 were radiated. There were eleven survivors with a median OS of 69 months (R: 3-144). CONCLUSIONS Ascites is an early feature in the clinical course of young patients with midline BRAF altered pLGG, with high mortality rate observed in our cohort. The hypothesis of ascites as an adverse prognostic factor in pLGG warrants further prospective research.
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Casajús Ortega A, Vázquez Míguez A, Zazpe Cenoz I, de Frutos Marcos D. Doble derivación ventrículo y cisto biliar en el tratamiento de quiste aracnoideo gigante supraselar con hidrocefalia secundaria. Neurocirugia (Astur) 2022. [DOI: 10.1016/j.neucir.2021.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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10
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Reisner A, Smith AD, Wrubel DM, Buster BE, Sawvel MS, Blackwell LS, Laxpati NG, Brahma B, Chern JJ. Utility of ventriculogallbladder shunts in complex cases of hydrocephalus related to extreme prematurity. J Neurosurg Pediatr 2021; 27:511-517. [PMID: 33636696 DOI: 10.3171/2020.9.peds20522] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 09/03/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The management of hydrocephalus resulting from intraventricular hemorrhage related to extreme prematurity remains demanding. Given the complexities of controlling hydrocephalus in this population, less commonly used procedures may be required. The authors examined the utility of ventriculogallbladder (VGB) shunts in a series of such children. METHODS The authors retrospectively reviewed the medical records of all children who underwent surgery for hydrocephalus in the period from 2011 through 2019 at Children's Healthcare of Atlanta. Six patients who underwent VGB shunt placement were identified among a larger cohort of 609 patients who had either a new shunt or a newly changed distal terminus site. The authors present an analysis of this series, including a case of laparoscopy-assisted distal VGB shunt revision. RESULTS The mean age at initial shunt placement was 5.1 months (range 3.0-9.4 months), with patients undergoing a mean of 11.8 shunt procedures (range 5-17) prior to the initial VGB shunt placement at a mean age of 5.3 years (range 7.9 months-12.8 years). All 6 patients with VGB shunt placement had hydrocephalus related to extreme prematurity (gestational age < 28 weeks). At the time of VGB shunt placement, all had complex medical and surgical histories, including poor venous access due to congenital or iatrogenic thrombosis or thrombophlebitis and a peritoneum hostile to distal shunt placement related to severe necrotizing enterocolitis. VGB complications included 1 case of shunt infection, identified at postoperative day 6, and 2 cases of distal shunt failure due to retraction of the distal end of the VGB shunt. In all, there were 3 conversions back to ventriculoperitoneal or ventriculoatrial shunts due to the 2 previously mentioned complications, plus 1 patient who outgrew their initial VGB shunt. Three of 6 patients remain with a VGB shunt, including 1 who underwent laparoscopy-assisted distal shunt revision 110.5 months after initial VGB shunt insertion. CONCLUSIONS Placement of VGB shunts should be considered in the armamentarium of procedures that may be used in the particularly difficult cohort of children with hydrocephalus related to extreme prematurity. VGB shunts show utility as both a definitive treatment and as a "bridge" procedure until the patient is larger and comorbid abdominal and/or vascular issues have resolved sufficiently to allow conversion back to ventriculoperitoneal or ventriculoatrial shunts, if needed.
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Affiliation(s)
- Andrew Reisner
- Departments of1Pediatrics
- 2Neurosurgery, and
- Departments of4Neurosurgery and
| | - Alexis D Smith
- 3Surgery, Emory University School of Medicine, Atlanta; and
- Departments of4Neurosurgery and
| | | | | | | | | | | | | | - Joshua J Chern
- Departments of1Pediatrics
- 2Neurosurgery, and
- Departments of4Neurosurgery and
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Morosanu CO, Priscu A, Florian IS. Evaluation of the ventriculocholecystic shunt-an overview of present practice in adult and pediatric hydrocephalus. Neurosurg Rev 2021; 44:2533-2543. [PMID: 33481136 PMCID: PMC8490219 DOI: 10.1007/s10143-021-01472-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 12/30/2020] [Accepted: 01/04/2021] [Indexed: 01/14/2023]
Abstract
In the context of hydrocephalus, there are a multitude of therapeutic options that can be explored in order to improve patient outcomes. Although the peritoneum is the current elected clinical solution, various receptacles have been utilized when experiencing contraindications. Along with the ventriculoatrial or ventriculopleural, the ventriculocholecystic shunt was also described as an alternative. In order to make a decision on a place for drainage, the surgeon must be knowledgeable on details from modern literature. The main target of this review was to summarize the currently available information on this topic and assess the status of the gallbladder as a viable option for cerebrospinal fluid diversion.
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Affiliation(s)
| | - Adelina Priscu
- Department of Internal Medicine, Indiana University Health Ball Memorial Hospital, Muncie, IN, USA
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Alraee S, Alshowmer S, Alnamshan M, Azzubi M. Management of ventriculo-gallbladder shunt in the presence of gallstones. BMJ Case Rep 2020; 13:13/6/e234775. [PMID: 32587118 PMCID: PMC7319722 DOI: 10.1136/bcr-2020-234775] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Hydrocephalus is a prevalent health problem that is frequently encountered by paediatric neurosurgeons during infancy and childhood. We report a case of an 11-year-old boy with high cerebrospinal fluid protein hydrocephalus secondary to optic glioma that required a ventriculoperitoneal (VP) shunt. The patient had multiple failures of VP shunt and developed massive ascites. Alternatively, the hydrocephalus was treated by ventriculo-gallbladder (VG) shunt in the presence of sludge which was removed from the gallbladder before placement of the shunt. After VG shunt insertion, the patient expressed signs of infection with elevated liver profile, which emphasised the presence of gallstones. While the shunt was kept in its place without any complications, the gallstones were successfully removed by an endoscopic retrograde cholangiopancreatography. In conclusion, the presence of sludge is not a contraindication for VG shunt placement, and, if the VG shunt was complicated with gallstones, it could be treated without the need for cholecystectomy.
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Affiliation(s)
- Sondus Alraee
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Sahar Alshowmer
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Mohammad Alnamshan
- Department of Pediatric Surgery, National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Moutasem Azzubi
- Department of Pediatric Neurosurgery, National Guard Health Affairs, Riyadh, Saudi Arabia
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The ventriculo-cholecystic shunt: does CSF volume matter? Childs Nerv Syst 2019; 35:1557-1560. [PMID: 31350574 DOI: 10.1007/s00381-019-04317-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Accepted: 07/18/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION The management of hydrocephalus in paediatric patients where the peritoneum has failed can be challenging. One option is to perform a ventriculo-cholecystic shunt. However, little is known about the capacity of the gall bladder to accommodate cerebrospinal fluid (CSF). METHODS A retrospective case series was performed to include all paediatric patients who received a ventriculo-cholecystic shunt at a single centre, Sheffield Children's Hospital. RESULTS We identified three patients who had a ventriculo-cholecystic shunt inserted. The shunt survived past 1 year in two patients, who had pre-operative external ventricular drain (EVD) outputs of 8 and 10 ml/h respectively. One patient shunt failed at day four post-op due to distal dysfunction, his pre-operative EVD was over 30 ml/h. CONCLUSIONS When considering a patient for a ventriculo-cholecystic shunt, caution should be taken if a high CSF output is known, for example, as per an EVD measurement.
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Ignacio RC, Schermerhorn SM, Marrotte AJ, Prieto JM. Laparoscopic ventricular-cholecystic shunt. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2019. [DOI: 10.1016/j.epsc.2019.101233] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Laparoscopy-assisted placement of a ventriculobiliary shunt: a technical note. Childs Nerv Syst 2019; 35:1397-1400. [PMID: 31049668 DOI: 10.1007/s00381-019-04173-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Accepted: 04/25/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE Hydrocephalus is a common condition in pediatric neurosurgeon's clinical practice. Peritoneal and atrial shunting is the treatment of choice in the immense majority of patients. Sometimes, there are complex cases that may need innovative solutions in order to implant the distal catheter of the shunt: in these situations, the gallbladder is a well-described option and it can be safely used. METHODS We report the case of a 4-month-old baby with a wide optic-chiasmal hypothalamic glioma generating hydrocephalus with high protein values in CSF. Ventriculobiliary shunting was decided, and the distal catheter was directed by the assistance of laparoscopic surgery. RESULTS The outcome was satisfactory. CONCLUSIONS As far as we know, laparoscopic placement of a distal catheter in the gallbladder has not been described in the literature; herein, we describe the tenets and the technical tips of this approach.
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Our initial experience with ventriculo-epiplooic shunt in treatment of hydrocephalus in two centers. Neurol Neurochir Pol 2017; 51:290-298. [PMID: 28528738 DOI: 10.1016/j.pjnns.2017.04.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 02/26/2017] [Accepted: 04/26/2017] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Hydrocephalus represents impairment in cerebrospinal fluid (CSF) dynamics. If the treatment of hydrocephalus is considered difficult, the repeated revisions of ventriculo-peritoneal (VP) shunts are even more challenging. OBJECTIVE The aim of this article is to evaluate the efficiency of ventriculo-epiplooic (VEp) shunt as a feasible alternative in hydrocephalic patients. MATERIAL AND METHODS A technical modification regarding the insertion of peritoneal catheter was imagined: midline laparotomy 8-10cm long was performed in order to open the peritoneal cavity; the great omentum was dissected between its two layers; we placed the distal end of the catheter between the two epiplooic layers; a fenestration of 4cm in diameter into the visceral layer was also performed. A retrospective study of medical records of 15 consecutive patients with hydrocephalus treated with VEp shunt is also presented. RESULTS Between 2008 and 2014 we performed VEp shunt in 15 patients: 5 with congenital hydrocephalus, 8 with secondary hydrocephalus and 2 with normal pressure hydrocephalus. There were 7 men and 8 women. VEp shunt was performed in 13 patients with multiple distal shunt failures and in 2 patients, with history of abdominal surgery, as de novo extracranial drainage procedure. The outcome was favorable in all cases, with no significant postoperative complications. CONCLUSIONS VEp shunt is a new, safe and efficient surgical technique for the treatment of hydrocephalus. VEp shunt is indicated in patients with history of recurrent distal shunt failures, and in patients with history of open abdominal surgery and high risk for developing abdominal complications.
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Grigorean VT, Sandu AM, Popescu M, Strambu V. Ventriculoportal Shunt, a New Transomphalic Extraperitoneal Surgical Technique in Treatment of Hydrocephalus. Surg Innov 2017; 24:223-232. [PMID: 28193123 DOI: 10.1177/1553350617692637] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIM The aim of this article was to report a new transomphalic extraperitoneal surgical technique for treatment of hydrocephalus, called ventriculoportal shunt. MATERIALS AND METHODS We performed ventriculoportal shunt on an experimental animal (pig). The particularity of ventriculoportal shunt consists in the fact that the distal end of the catheter is inserted transomphalic extraperitoneally in the portal system through reopened umbilical vein. We present technical details regarding this new surgical technique. RESULTS AND DISCUSSION The animal had favorable outcome, without any postoperative early or late morbidity. We discuss indications, contraindications, possible complications in humans and advantages of ventriculoportal shunt compared with ventriculocardiac and ventriculoperitoneal drainages and possibilities to avoid complications specific to classic shunt procedures. CONCLUSIONS Ventriculoportal shunt is a new surgical technique for treatment of hydrocephalus. The distal end of the catheter introduced into reopened umbilical vein, drains cerebrospinal fluid into the portal system. Ventriculoportal shunt is safe and easy to perform. With ventriculoportal shunt specific complications of ventriculoperitoneal or ventriculocardiac drainages can be potentially avoided. Ventriculoportal shunt combines advantages of vascular shunt with those of having an immunological barrier for cerebrospinal fluid before entering the systemic circulation. Theoretically, indications for surgery are extended, and ventriculoportal shunt can be performed in patients former contraindicated for ventriculoperitoneal shunt. Further research is needed and this surgical technique must be performed on human subjects with hydrocephalus.
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Affiliation(s)
- Valentin Titus Grigorean
- 1 Emergency Clinical Hospital Bagdasar-Arseni, University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania
| | - Aurelia Mihaela Sandu
- 2 Emergency Clinical Hospital Bagdasar-Arseni, Fourth Department of Neurosurgery, Bucharest, Romania
| | - Mihai Popescu
- 3 University Pitesti, Emergency County Hospital Arges, Pitesti, Romania
| | - Victor Strambu
- 4 Clinical Nephrology Hospital Carol Davila, University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania
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Johnson JA, O'Halloran PJ, Crimmins D, Caird J. Thinking outside the shunt-sterile CSF malabsorption in pilocytic astrocytomas: case series and review of the literature. Childs Nerv Syst 2016; 32:2255-2260. [PMID: 27193012 DOI: 10.1007/s00381-016-3112-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Accepted: 05/06/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Ventriculoperitoneal (VP) shunt insertion is the most common cerebrospinal fluid (CSF) diversionary procedure used for the treatment of chronic hydrocephalus. Sterile CSF ascites is a rare complication of VP shunt insertion. This can arise from either an overproduction of CSF or inadequate filtration of CSF at the level of the peritoneum. By either mechanism, the development of CSF ascites requires an intact VP shunt. OBJECTIVE The authors discuss two paediatric cases diagnosed with suprasellar pilocytic astrocytomas treated with platinum-based chemotherapy, who subsequently developed sterile CSF ascites. We review the literature with regard to CSF malabsorption and discuss it as a contributing factor to shunt malfunction. CONCLUSION CSF malabsorption with resultant ascites is a rare complication of VP shunting with many etiologies. Two common predisposing factors included the use of platinum-based chemotherapeutic agents, as well as the specific neuropathology. Further analysis of these two entities is needed in order to elucidate their role in contributing to the development of CSF ascites in this patient cohort.
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Affiliation(s)
- J A Johnson
- Department of Neurological Surgery, Cork University Hospital, Corcaigh, Ireland
| | - P J O'Halloran
- Department of Neurological Surgery, Cork University Hospital, Corcaigh, Ireland.
| | - D Crimmins
- Department of Paediatric Neurosurgery, Children's University Hospital, Temple Street, Dublin 1, Ireland
| | - J Caird
- Department of Paediatric Neurosurgery, Children's University Hospital, Temple Street, Dublin 1, Ireland
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Hasslacher-Arellano JF, Arellano-Aguilar G, Funes-Rodríguez JF, López-Forcén S, Torres-Zapiain F, Domínguez-Carrillo LG. Ventriculo-gallbladder shunt: An alternative for the treatment of hydrocephalus. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/j.circen.2016.04.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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20
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Hasslacher-Arellano JF, Arellano-Aguilar G, Funes-Rodríguez JF, López-Forcén S, Torres-Zapiain F, Domínguez-Carrillo LG. [Ventriculo-gallbladder shunt: An alternative for the treatment of hydrocephalus]. CIR CIR 2015; 84:225-9. [PMID: 26259740 DOI: 10.1016/j.circir.2015.01.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 01/13/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND In the management of hydrocephalus, the ventriculo-gallbladder shunt is justified in situations where the ventriculo-peritoneal shunt is not useful due to peritoneal involvement and/or when the ventriculo-auricular and ventriculo-pleural shunts are contraindicated. CLINICAL CASE A 27 year-old female with hydrocephalus at birth, managed with ventricle-peritoneal shunt, modified 3 times throughout her life due to repeated infections and other different reasons. She was admitted due to colitis caused by Clostridium difficile, presenting concomitant signs of intracranial hypertension and neurological impairment. This led to a review and change of the ventriculo-peritoneal shunt system, with distal dysfunction due to peritoneal thickening. Atrial and pleural shunts were not indicated because the risk of infection. As an alternative, it was decided to place the distal end of the catheter in the gallbladder. The patient recovered her neurological functions after the surgery. CONCLUSIONS Drainage alternatives may be needed in 5% of patients with valvular shunt dysfunction. The ventriculo-gallbladder is a good and viable option because it has an absorptive capacity of 1500cc liquid daily, besides being an excellent drainage through the bile duct. The abdominal surgery is easy to perform, and it is an alternative option in the failure of the ventriculo-peritoneal shunt.
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Affiliation(s)
| | | | | | | | - Fernando Torres-Zapiain
- Servicio de Neurocirugía, Instituto Mexicano del Seguro Social, Unidad Medica de Alta Especialidad T1 León, Guanajuato, México
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Rivero-Garvía M, Pancucci G, Morcillo J, Millán A, Márquez-Rivas J. Ventriculobiliary Shunts, Another Option. Pediatr Neurosurg 2015; 50:152-6. [PMID: 25925012 DOI: 10.1159/000381030] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Accepted: 02/14/2015] [Indexed: 11/19/2022]
Abstract
The basic management of hydrocephalus includes shunts to the peritoneum and atrium. However, there are particularly complex patients in whom it is necessary to look for atypical places for implanting the distal catheter. Since 2000, 1,325 shunts have been implanted in pediatric patients. Only 3 patients required a ventriculobiliary shunt. We report 3 cases: a 7-year-old boy with a surgically treated complex heart disease, a 16-month-old girl with hydrocephalus secondary to a brain tumor and multiple bacteremias secondary to an infection of the central venous reservoir, and a 4-year-old girl with nonreabsorptive hydrocephalus caused by intraventricular bleeding due to premature birth, necrotizing enterocolitis and shunt infections with abdominal pseudocysts, which caused multiple abdominal septations and, finally, a nonreabsorptive peritoneum. At present, cases 1 [45 months after ventriculobiliary shunt (VBS)] and 3 (27 months after VBS) are symptom free, while case 2 (14 months after VBS) died of infectious respiratory complications. The gold standard for the treatment of nonreabsorptive hydrocephalus is a ventriculoperitoneal shunt, the second option is a ventriculoatrial shunt, and the third option is uncertain. In our short experience, a ventriculo-gallbladder shunt is a good option when there is no abdominal hypertension.
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Recurrent ascites in a patient with low-grade astrocytoma and ventriculo-peritoneal shunt treated with the multikinase inhibitor sorafenib. J Pediatr Hematol Oncol 2014; 36:e533-5. [PMID: 24351969 DOI: 10.1097/mph.0000000000000094] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
This report describes a 6-year-old boy with disseminated low-grade astrocytoma and ventriculo-peritoneal shunt, who developed recurrent ascites while receiving sorafenib on a clinical trial. Laboratory analysis of the peritoneal fluid showed no elevation of protein content and no evidence of underlying infection or tumor dissemination. This report highlights ascites as a previously unrecognized adverse reaction to sorafenib in a patient with a ventriculo-peritoneal shunt. We conclude that such patients should be closely monitored for this complication when treated with sorafenib.
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Abstract
OBJECTIVE The objective of this article is to describe an approach to imaging CSF shunts. Topics reviewed include the components and imaging appearances of the most common types of shunts and the utility of different imaging modalities for the evaluation of shunt failure. Complications discussed include mechanical failure, infection, ventricular loculation, overdrainage, and unique complications related to each shunt type. CONCLUSION This article reviews the imaging features of common CSF shunts and related complications with which radiologists should be familiar.
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Demetriades AK, Haq IZ, Jarosz J, McCormick D, Bassi S. The ventriculocholecystic shunt: two case reports and a review of the literature. Br J Neurosurg 2013; 27:505-8. [PMID: 23445328 DOI: 10.3109/02688697.2013.771135] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
We describe the re-siting of ventriculoperitoneal shunts to the gallbladder in two children. The first child had a rare case of hydrocephalus associated with plasminogen deficiency. She had had multiple VP shunt revisions due to non-absorption of CSF from the peritoneum. The second had craniopharyngioma-related hydrocephalus with once again a non-absorbing peritoneum. We report no surgical complications in the revisions for both the cases, and there has been a subsequent follow-up of 46 and 28 months, respectively, without incident. A review of the relevant literature describing the use and the performance of ventriculocholecystic shunts in comparison with other ventricular shunts is considered.
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Affiliation(s)
- A K Demetriades
- Department of Neurosurgery, King's College Hospital , Denmark Hill, London , UK
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O'Halloran PJ, Kaliaperumal C, Caird J. Chemotherapy-induced cerebrospinal fluid malabsorption in a shunted child: case report and review of the literature. BMJ Case Rep 2013; 2013:bcr-2012-008255. [PMID: 23396932 DOI: 10.1136/bcr-2012-008255] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Ventriculoperitoneal (VP) shunt insertion is one of the most common neurosurgical procedures for the treatment of chronic hydrocephalus. Although regarded as a relatively benign procedure, several complications including obstruction, infection and mechanical failure can be seen during the postoperative stage. Symptomatic sterile cerebrospinal fluid (CSF) ascites and hydrothoracies are rare complications of VP shunt surgery. The paucity of cases makes identifying the aetiological factors difficult, particularly without catheter tip migration. It is most likely that several factors interact to reduce the absorption of CSF. The authors discuss the case of a 5-year-old girl who developed CSF ascites and a pleural effusion after starting chemotherapy for a suprasellar pilocytic astrocytoma, 2 years post-VP shunt insertion, due to a secondary obstructive hydrocephalus. After the initial management of the presenting symptoms, the child's VP shunt was subsequently changed to a ventriculo-atrial shunt and the patient made an unremarkable recovery. We also review the literature pertaining to this rare complication, assessing identifiable risk factors and surgical management options.
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Tripathi AK, Agrawal D, Sedain G. Hydrocephalic holoprosencephaly: An oxymoron? Insights into etiology and management. J Pediatr Neurosci 2011; 4:41-3. [PMID: 21887175 PMCID: PMC3162837 DOI: 10.4103/1817-1745.49108] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Holoprosencephaly is usually associated with microcephaly, although macrocephaly is not uncommonly seen. However, the cause of hydrocephalus in holoprosencephaly remains ill-defined. Here, the authors report a case of CSF ascites following ventriculoperitoneal shunt placement in a five month-old child with alobar holoprosencephaly, and hypothesize that the excessive CSF production which occurs in this condition may be responsible for the formation of CSF ascites. Further research is required to assess whether the gene responsible for holoprosencephaly is also responsible for upregulating CSF production in patients with concomitant hydrocephalus.
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Affiliation(s)
- Anuj Kumar Tripathi
- Department of Neurosurgery, Neurosciences and Gamma-knife Center, All India Institute of Medical Sciences, New Delhi-110 029, India
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Girotti ME, Singh RR, Rodgers BM. The Ventriculo-Gallbladder Shunt in the Treatment of Refractory Hydrocephalus: A Review of the Current Literature. Am Surg 2009. [DOI: 10.1177/000313480907500819] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The ventriculo-gallbladder (VGB) shunt has been reported on several occasions for the alleviation of ventriculo-peritoneal (VP) –shunt-refractory hydrocephalus. There is little data regarding VGB shunts and a need for delineating appropriate surgical therapy when cerebrospinal fluid drainage to the peritoneum becomes infeasible. We report our experience with VGB shunt placement in three patients with chronic hydrocephalus. All three had a history of prior VP-shunt placements and revisions due to distal obstruction or infection, or contraindications to alternative forms of ventricular drainage. In one patient, the VGB shunt functioned well for 9 years but was revised due to contamination during an unrelated operation. Neither of the other two patients have experienced VGB shunt-related complications. VP shunts are presently regarded as the standard of care for uncomplicated hydrocephalus. When VP shunts fail, the most common alternatives have been ventriculo-atrial and ventriculo-pleural shunts. In five case series involving 59 patients with VGB shunts, the long-term success rate was 62.7 per cent. Infection (10.2%) and obstruction (10.2%) were the most common complications. Based on durability and a low incidence of complications, it is the current consensus that VGB shunts are a viable alternative with good outcomes in the case of failed VP shunts.
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Abstract
OBJECT The authors report a clinical protocol for the application of ventriculogallbladder (VGB) shunts in children who may be unable to maintain or receive ventriculoperitoneal (VP) shunts. METHODS Eighteen patients underwent placement of VGB shunts as an alternative to VP shunt therapy for the following reasons: malfunction of the VP shunt due to suspected failure of the peritoneum to absorb cerebrospinal fluid (17 cases) and multiple intraabdominal general surgical procedures (1 case). The patients ranged in age from 4 months to 17 years (mean 6.5 +/- 6.1 years [standard deviation {SD}]). All patients underwent preoperative imaging of the gall-bladder either by ultrasonography or computed tomography scanning. A team consisting of a pediatric neurological surgeon and a pediatric general surgeon performed all operative procedures. The procedures were conducted by open laparotomy to precisely place the appropriate length of distal catheter and to anchor it to the gallbladder wall. RESULTS There were 2 early shunt malfunctions, both obstructions due to "sludge" (1 in the biliary duct and 1 in the common bile duct). A late-onset (5-year) malfunction occurred secondary to gallbladder stones. In all 3 cases of malfunction, the devices were successfully converted to VP shunts. In 1 patient a conversion to a VP shunt was chosen following a general surgical intervention. There were 2 shunt infections (Staphylococcus epidermidis and Haemophilus influenzae). These were successfully treated. Two patients underwent conversion to a VGB shunt on 2 occasions. Thirteen patients had functional VGB shunts at the time of their last follow-up assessment. The follow-up for these 13 patients ranged from 1 to 8 years (mean 2.1 +/- 2.0 years [SD]). CONCLUSIONS Ventriculogallbladder shunts may be considered for the treatment of hydrocephalus in children when the peritoneal cavity cannot be used as a distal terminus.
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Affiliation(s)
- Philipp R Aldana
- Department of Neurosurgery, University of Florida Health Science Center, Jacksonville, Florida, USA
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Massimi L, Tufo T, Di Rocco C. Management of optic-hypothalamic gliomas in children: still a challenging problem. Expert Rev Anticancer Ther 2008; 7:1591-610. [PMID: 18020927 DOI: 10.1586/14737140.7.11.1591] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Optic pathway-hypothalamic gliomas (OPHGs) are rare, often unresectable tumors that mostly occur in childhood. Their biological behavior is unpredictable, although they tend to follow an aggressive clinical course in infants and a benign course in children with neurofibromatosis type 1. Optimal management is still controversial. Nonprogressing OPHGs are usually followed by surveillance alone. Surgery is advocated for progressing tumors to decompress the optic pathways, obtain a quick relief from intracranial hypertension and allow histologic examination (when needed). The current trend is in favor of conservative surgical behavior, except for resectable tumors. Chemotherapy is increasingly used in the management of OPHGs, especially in infants, to delay radiotherapy. Carboplatin and vincristine are the most frequently used drugs, although several chemotherapeutic agents in different combinations are currently employed with good results. Radiotherapy is utilized in children over 5 years of age as an adjuvant or as an alternative to surgery. The prognosis of OPHGs is quite good, with regard to the overall survival rate (70-100% at 5 years), but less favorable in terms of late morbidity.
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Affiliation(s)
- Luca Massimi
- Catholic University Medical School, Pediatric Neurosurgery, Institute of Neurosurgery, Largo A Gemelli 8, 00168, Rome, Italy.
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Kariyattil R, Steinbok P, Singhal A, Cochrane DD. Ascites and abdominal pseudocysts following ventriculoperitoneal shunt surgery: variations of the same theme. J Neurosurg 2007; 106:350-3. [PMID: 17566200 DOI: 10.3171/ped.2007.106.5.350] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Ascites and abdominal pseudocysts are two complications that can occur following placement of a ventriculoperitoneal (VP) shunt. Although various factors have been implicated, the exact pathogenesis of the two conditions remains elusive. To the authors' knowledge, there are no studies in which these two obviously related conditions have been compared. METHODS The authors retrospectively reviewed the cases of children with abdominal complications caused by a VP shunt. There were 15 patients who developed a pseudocyst and five patients who developed ascites. The cases were analyzed to identify common and distinguishing factors that may help in identifying the mechanism involved. Abdominal symptoms were the mode of presentation for patients with ascites, whereas shunt malfunction was the mode of presentation in 60% of those with pseudocysts. Culture-proven infection, abdominal surgery, and the number of revisions seemed to be more common in cases with pseudocysts than in ascites. The fluid in ascites was found to be a transudate irrespective of the origin of hydrocephalus. Alternative drainage sites were required in the treatment of patients with ascites, and reimplantation in the peritoneum was possible in 66.7% of those with pseudocysts. In the long-term, however, peritoneal reimplantation was possible in three of the five patients with ascites. CONCLUSIONS Abdominal pseudocysts and ascites, after VP shunt treatment, are distinct conditions with different modes of presentation and findings during examination of fluid, and therefore they require different management strategies.
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Affiliation(s)
- Rajeev Kariyattil
- Division of Pediatric Neurosurgery, Department of Pediatric Surgery, British Columbia Children's Hospital, Children's and Women's Health Centre, Vancouver, British Columbia, Canada
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Aszites und Abmagerung bei intrakranieller Raumforderung. Monatsschr Kinderheilkd 2007. [DOI: 10.1007/s00112-007-1554-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Fountas KN, Kassam MA, Grigorian AA. A rare, delayed complication of a ventriculogallbladder shunt. Neurosurg Focus 2007; 22:E12. [PMID: 17613190 DOI: 10.3171/foc.2007.22.4.14] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
✓The use of the gallbladder as an alternative cerebrospinal fluid diversion site has been previously described in cases in which all other body cavities, such as the peritoneal cavity, right atrium, or pleural cavity, have been exhausted. Various ventriculogallbladder (VG) shunt complications have been described as well. In the present paper, the authors report on a rare, delayed VG shunt complication. A distal obstruction developed in a previously inserted VG shunt because of a large, radiolucent bile calculus. The presence of the VG shunt could be implicated in the pathogenetic mechanism of the bile calculus formation. The authors also review the pertinent literature.
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