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Qin G, Liang Y, Xu K, Xu P, Ye J, Tang X, Lan S. Neuroendoscopic lavage for ventriculitis: Case report and literature review. Neurochirurgie 2020; 66:127-132. [PMID: 32087178 DOI: 10.1016/j.neuchi.2019.12.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 12/03/2019] [Accepted: 12/15/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Ventriculitis, one of the difficulties in neurosurgical treatment, is a significant cause of death and morbidity in patients with hydrocephalus. Neuroendoscopy is widely used in the treatment of non-communicable hydrocephalus. The advantages of neuroendoscopy may play a decisive role in the treatment of ventriculitis. CASE REPORT AND METHODS We report a 34-year-old male patient with refractory fever and rapid progressive disturbance of consciousness due to ventriculitis caused by intraventricle rupture in a left colliculus abscess. He received intravenous (IV) antibiotics and saline neuroendoscopic lavage (NEL) combined with septostomy and endoscopic third ventriculostomy leading to rapid recovery and remission of symptoms. We also reviewed the use of NEL for ventriculitis in PubMed from 1970 to January 20, 2019. RESULTS In our review, 93 cases (including the present report) were treated with NEL; 91 cases of infection subsided, and 7 patients died. CONCLUSION NEL may be an effective method for the treatment of ventriculitis.
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Affiliation(s)
- G Qin
- Department of Neurosurgery, People's Hospital of Guangxi Zhuang Autonomous Region, 06 Taoyuan Road, 530021 Nanning, China.
| | - Y Liang
- Department of Neurosurgery, People's Hospital of Guangxi Zhuang Autonomous Region, 06 Taoyuan Road, 530021 Nanning, China.
| | - K Xu
- Department of Neurosurgery, People's Hospital of Guangxi Zhuang Autonomous Region, 06 Taoyuan Road, 530021 Nanning, China.
| | - P Xu
- Department of Neurosurgery, People's Hospital of Guangxi Zhuang Autonomous Region, 06 Taoyuan Road, 530021 Nanning, China.
| | - J Ye
- Department of Neurosurgery, People's Hospital of Guangxi Zhuang Autonomous Region, 06 Taoyuan Road, 530021 Nanning, China.
| | - X Tang
- Department of Neurosurgery, People's Hospital of Guangxi Zhuang Autonomous Region, 06 Taoyuan Road, 530021 Nanning, China.
| | - S Lan
- Department of Neurosurgery, People's Hospital of Guangxi Zhuang Autonomous Region, 06 Taoyuan Road, 530021 Nanning, China.
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Guan F, Peng WC, Huang H, Ren ZY, Wang ZY, Fu JD, Li YB, Cui FQ, Dai B, Zhu GT, Xiao ZY, Mao BB, Hu ZQ. Application of neuroendoscopic surgical techniques in the assessment and treatment of cerebral ventricular infection. Neural Regen Res 2019; 14:2095-2103. [PMID: 31397347 PMCID: PMC6788251 DOI: 10.4103/1673-5374.262591] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Cerebral ventricular infection (CVI) is one of the most dangerous complications in neurosurgery because of its high mortality and disability rates. Few studies have examined the application of neuroendoscopic surgical techniques (NESTs) to assess and treat CVI. This multicenter, retrospective study was conducted using clinical data of 32 patients with CVI who were assessed and treated by NESTs in China. The patients included 20 men and 12 women with a mean age of 42.97 years. NESTs were used to obliterate intraventricular debris and pus, fenestrate or incise the intraventricular compartment and reconstruct cerebrospinal fluid circulation, and remove artificial material. Intraventricular irrigation with antibiotic saline was applied after neuroendoscopic surgery (NES). Secondary hydrocephalus was treated by endoscopic third ventriculostomy or a ventriculoperitoneal shunt. Neuroendoscopic findings of CVI were used to classify patients into Grade I (n = 3), Grade II (n = 13), Grade III (n = 10), and Grade IV (n = 6) CVI. The three patients with grade I CVI underwent one NES, the 23 patients with grade II/III CVI underwent two NESs, and patients with grade IV CVI underwent two (n = 3) or three (n = 3) NESs. The imaging features and grades of neuroendoscopy results were positively related to the number of neurosurgical endoscopic procedures. Two patients died of multiple organ failure and the other 30 patients fully recovered. Among the 26 patients with secondary hydrocephalus, 18 received ventriculoperitoneal shunt and 8 underwent endoscopic third ventriculostomy. There were no recurrences of CVI during the 6- to 76-month follow-up after NES. Application of NESTs is an innovative method to assess and treat CVI, and its neuroendoscopic classification provides an objective, comprehensive assessment of CVI. The study trial was approved by the Institutional Review Board of Beijing Shijitan Hospital, Capital Medical University, China.
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Affiliation(s)
- Feng Guan
- Department of Neurosurgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Wei-Cheng Peng
- Department of Neurosurgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Hui Huang
- Department of Neurosurgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Zu-Yuan Ren
- Department of Neurosurgery, Peking Union Medical College Hospital, Beijing, China
| | - Zhen-Yu Wang
- Department of Neurosurgery, Peking University Third Hospital, Peking University, Beijing, China
| | - Ji-Di Fu
- Department of Neurosurgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Ying-Bin Li
- Department of Neurosurgery, the Second Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Feng-Qi Cui
- Department of Neurosurgery, Beijing Liangxiang Hospital, Beijing, China
| | - Bin Dai
- Department of Neurosurgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Guang-Tong Zhu
- Department of Neurosurgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Zhi-Yong Xiao
- Department of Neurosurgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Bei-Bei Mao
- Department of Neurosurgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Zhi-Qiang Hu
- Department of Neurosurgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
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Guan F, Huang H, Ren ZY, Wang ZY, Fu JD, Li YB, Cui FQ, Peng WC, Dai B, Zhu GT, Xiao ZY, Mao BB, Hu ZQ. Neuroendoscopic Evaluation and Treatment for Cerebral Ventricular Infection. Chin Med J (Engl) 2018; 131:2114-2116. [PMID: 30127223 PMCID: PMC6111679 DOI: 10.4103/0366-6999.239319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Feng Guan
- Department of Neurosurgery, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
| | - Hui Huang
- Department of Neurosurgery, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
| | - Zu-Yuan Ren
- Department of Neurosurgery, Peking Union Medical College Hospital, Beijing 100032, China
| | - Zhen-Yu Wang
- Department of Neurosurgery, Peking University Third Hospital, Peking University, Beijing 100191, China
| | - Ji-Di Fu
- Department of Neurosurgery, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Ying-Bin Li
- Department of Neurosurgery, The Second Affiliated Hospital of Nanjing Medical University, Nanjing 210000, China
| | - Feng-Qi Cui
- Department of Neurosurgery, Beijing Liangxiang Hospital, Beijing 102401, China
| | - Wei-Cheng Peng
- Department of Neurosurgery, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
| | - Bin Dai
- Department of Neurosurgery, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
| | - Guang-Tong Zhu
- Department of Neurosurgery, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
| | - Zhi-Yong Xiao
- Department of Neurosurgery, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
| | - Bei-Bei Mao
- Department of Neurosurgery, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
| | - Zhi-Qiang Hu
- Department of Neurosurgery, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
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Satyarthee GD. Expanding Horizon of Neuroendoscopic Procedure from Endoscopic-Assisted Tumor Resection, Vascular Surgery, and Management of Hydrocephalus to Diagnostic and Therapeutic Management of Pyogenic Ventriculitis. World Neurosurg 2017; 104:1024-1025. [PMID: 28732418 DOI: 10.1016/j.wneu.2017.03.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 03/08/2017] [Indexed: 10/19/2022]
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Yang NR, Hong KS, Seo EK. Acute Cholecystitis as a Cause of Fever in Aneurysmal Subarachnoid Hemorrhage. Korean J Crit Care Med 2017; 32:190-196. [PMID: 31723633 PMCID: PMC6786720 DOI: 10.4266/kjccm.2016.00857] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 02/27/2017] [Accepted: 04/03/2017] [Indexed: 11/30/2022] Open
Abstract
Background Fever is a very common complication that has been related to poor outcomes after aneurysmal subarachnoid hemorrhage (aSAH). The incidence of acalculous cholecystitis is reportedly 0.5%–5% in critically ill patients, and cerebrovascular disease is a risk factor for acute cholecystitis (AC). However, abdominal evaluations are not typically performed for febrile patients who have recently undergone aSAH surgeries. In this study, we discuss our experiences with febrile aSAH patients who were eventually diagnosed with AC. Methods We retrospectively reviewed 192 consecutive patients who underwent aSAH from January 2009 to December 2012. We evaluated their characteristics, vital signs, laboratory findings, radiologic images, and pathological data from hospitalization. We defined fever as a body temperature of >38.3°C, according to the Society of Critical Care Medicine guidelines. We categorized the causes of fever and compared them between patients with and without AC. Results Of the 192 enrolled patients, two had a history of cholecystectomy, and eight (4.2%) were eventually diagnosed with AC. Among them, six patients had undergone laparoscopic cholecystectomy. In their pathological findings, two patients showed findings consistent with coexistent chronic cholecystitis, and two showed necrotic changes to the gall bladder. Patients with AC tended to have higher white blood cell counts, aspartame aminotransferase levels, and C-reactive protein levels than patients with fevers from other causes. Predictors of AC in the aSAH group were diabetes mellitus (odds ratio [OR], 8.758; P = 0.033) and the initial consecutive fasting time (OR, 1.325; P = 0.024). Conclusions AC may cause fever in patients with aSAH. When patients with aSAH have a fever, diabetes mellitus and a long fasting time, AC should be suspected. A high degree of suspicion and a thorough abdominal examination of febrile aSAH patients allow for prompt diagnosis and treatment of this condition. Additionally, physicians should attempt to decrease the fasting time in aSAH patients.
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Affiliation(s)
- Na Rae Yang
- Department of Neurosurgery, Ewha Womans University Mokdong Hospital, Ewha Womans University School of Medicine, Seoul, Korea.,Graduate School of Medicine, Ewha Womans University, Seoul, Korea
| | - Kyung Sook Hong
- Department of Surgery and Critical Care Medicine, Ewha Womans University Mokdong Hospital, Ewha Womans University School of Medicine, Seoul, Korea
| | - Eui Kyo Seo
- Department of Neurosurgery, Ewha Womans University Mokdong Hospital, Ewha Womans University School of Medicine, Seoul, Korea.,Graduate School of Medicine, Ewha Womans University, Seoul, Korea
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Management of Pyogenic Cerebral Ventriculitis by Neuroendoscopic Surgery. World Neurosurg 2017; 98:6-13. [DOI: 10.1016/j.wneu.2016.10.103] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 10/20/2016] [Accepted: 10/21/2016] [Indexed: 11/18/2022]
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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: 14] [Impact Index Per Article: 1.3] [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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Eap C, Blauwblomme T, Dupuy L, Bennis S, Faber B, Mireau E, Aldea S, Frileux P, Gaillard S. [Migration of a ventriculoperitoneal shunt in the liver: A rare complication]. Neurochirurgie 2012; 58:391-3. [PMID: 22769025 DOI: 10.1016/j.neuchi.2012.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2012] [Accepted: 05/31/2012] [Indexed: 11/26/2022]
Abstract
We report on a case of migration inside the liver of the distal end of a ventriculoperitoneal shunt catheter in an adult patient. A simple laparotomy permitted the surgical removal with no haemorrhagic complication. We discuss the other cases reported in the literature and we outline the need to perform an abdominal CT scan in patients carrying a VP shunt with digestive symptoms.
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Affiliation(s)
- C Eap
- Service de neurochirurgie, hôpital Foch, 40, rue Worth, 92150 Suresnes, France.
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Martínez-Lage JF, Girón Vallejo O, López López-Guerrero A, Martínez-Lage Azorín L, Roqués JL, Almagro MJ. Acute cholecystitis complicating ventriculo-peritoneal shunting: report of a case and review of the literature. Childs Nerv Syst 2008; 24:777-9. [PMID: 18365208 DOI: 10.1007/s00381-008-0617-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2008] [Indexed: 01/20/2023]
Abstract
CASE A 3-year-old boy underwent emergency external ventricular drainage and excision of a fourth ventricle anaplastic ependymoma. A week later, the child was given a ventriculo-peritoneal shunt. Fourteen days after shunting, the child developed a subphrenic abscess and acute cholecystitis that required surgery. RESULTS A Staphylococcus epidermidis was isolated both from the ventricular catheter and CSF and from the subphrenic abscess and the gallbladder. To our knowledge, this is the first report of cholecystitis evolving as a descending shunt infection. The current literature related with this unique complication is briefly reviewed.
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Affiliation(s)
- Juan F Martínez-Lage
- Regional Service of Neurosurgery, Virgen de la Arrixaca University Hospital, El Palmar, 30120 Murcia, Spain.
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