Endoscopic third ventriculostomy (ETV) has now become an accepted mode of hydrocephalus treatment in children. Varying degrees of success for the procedure have been reported depending on the type and etiology of hydrocephalus, age of the patient and certain technical parameters. Review of these factors for predictability of success, complications and validation of success score is presented.
Cerebrospinal Fluid Shunts ; Child ; Humans ; Hydrocephalus ; Ventriculostomy*

No abstract available.
Candida* ; Cerebrospinal Fluid Shunts ; Meningitis*

Although the Codman-Hakim programmable valve is one of most popular shunt systems used in the clinical practice for the treatment of hydrocephalus, malfunctions related with this system have been also reported which lead to underdrainage or overdrainage of the cerebrospinal fluid. While obstruction of the ventricular catheter by tissue materials or hematoma and catheter disconnection are relatively common, the malfunction of the valve itself is rare. Herein, we report on a rare case of shunt overdrainage caused by displacement of the pressure control cam after pressure adjustment. A 57-year-old female, who underwent a ventriculoperitoneal shunt eight years ago, experienced aggravating symptoms of shunt overdrainage after pressure adjustment. Displacement of the pressure control cam was revealed on the X-ray, and a shunt revision was performed. The purpose of this report is to provide a working knowledge of the valve structure and to enhance the ability to interpret the valve setting on an X-ray for diagnosis of valve malfunction.
Catheters ; Cerebrospinal Fluid ; Cerebrospinal Fluid Shunts ; Diagnosis ; Equipment Failure ; Female ; Hematoma ; Humans ; Hydrocephalus ; Middle Aged ; Ventriculoperitoneal Shunt

OBJECTIVE: Infantile posthemorrhagic hydrocephalus (IPHH) is the most common cause of infantile acquired hydrocephalus. We present and discuss our experience of treatment of six IPHH patients treated by a ventriculo-peritoneal (VP) shunt. METHODS: Six preterm infants treated by a VP shunt due to germinal matrix hemorrhage and hydrocephalus were included in our study. External ventricular drainage (EVD) was performed in patients with symptomatic ventricular dilatation, and a VP shunt was placed in the case of no improvement of the ventricular index despite several rounds of EVD. Radiographic findings and surgical outcomes were analyzed retrospectively. RESULTS: Four patients were male and two were female. Mean gestational age was 25 weeks and mean weight at birth was 868.3 g. One patient had a Papile grade II (16.7%) hemorrhage, three had a grade III (50%) hemorrhage, and two had a grade IV (33.3%) hemorrhage. EVD complications (one case of ventriculitis and one case of a ventricular abscess) occurred in two patients. VP shunt complications occurred in two patients (33.3%). Three cases had an isolated 4th ventricle; two of these cases had a VP shunt placed whereas the other case had a VP shunt placed in addition to aqueductoplasty using a neuroendoscope. At the last follow-up, three of the six patients had severe neurodevelopmental delay, two had mild neurodevelopmental delay, and one had normal development status. CONCLUSION: In our study, although it is difficult to present the significant result for management of IPHH, we think that varied efforts are required to treat IPHH patients.
Cerebrospinal Fluid Shunts ; Dilatation ; Drainage ; Female ; Follow-Up Studies ; Gestational Age ; Hemorrhage ; Humans ; Hydrocephalus* ; Infant ; Infant, Newborn ; Infant, Premature ; Male ; Neuroendoscopes ; Parturition ; Retrospective Studies ; Ventriculoperitoneal Shunt*

OBJECTIVE: To explore the treatment and pathophysiology of extra-axil cerebrospinal fluid accumulation aft er skull surgery. METHODS: The treatment of 46 cases of pineal regional tumor was retrospectively studied. RESULTS: The CT showed that all patients had postoperative extra-axil cerebrospinal fluid accumulation in 6 hours after operation. 5 cases displayed symptomatic accumulation of extra-axil cerebrospinal fluid. 1 died 30 days aft er discharge, 4 performed S-P shunt and 3 of them switched to V-P shunt after S-P shunt failed. CONCLUSION Much more attention should be paid to postoperative accumulation of extra-axil cerebrospinal fluid. Both V-P and S-P are the effective strategies of therapy.
Cerebrospinal Fluid Shunts ; Humans ; Pinealoma ; cerebrospinal fluid ; surgery ; Postoperative Period ; Retrospective Studies ; Skull ; surgery

Shunting of cerebrospinal fluid into the peritoneal cavity is a well established procedure which has, over the years, enjoyed increasing popularity. A slit valve at the distal end elminated the insinuation of the omentum into the shunting tube and a spring catheter prevented kinking of the shunt tubing. However, the most common cause of failure of the shunting is from the separation, or pulling apart, of the various components of the shunt system with subsequent infection. A one piece spring catheter is sufficient to the necessity. Surgical details are illustrated for installing a one piece spring catheter for hydrocephalus. Four basic steps of surgical procedure using a subcutaneous guide, a leader, a cannula and a cuff are described; firstly passing the guide and the one piece shunt from McBurney's point to the supraclavicular space, secondly passing the guide from the parietal eminence to the supraclavicular space to thread the one piece shunt cephalad. Thirdly, inserting the cannula into the lateral ventricle and threading the ventricular end of the one piece shunt through the cuff into the lateral ventricle and fourthly inserting the peritoneal end into the peritoneal cavity.
Adolescent ; Adult ; Catheterization/methods ; Cerebrospinal Fluid Shunts/instrumentation* ; Cerebrospinal Fluid Shunts/methods ; Child, Preschool ; Human ; Hydrocephalus/surgery ; Infant ; Infant, Newborn ; Peritoneal Cavity

The cerebrospinal fluid tap test (CSFTT) is recommended as a key step in the diagnosis of idiopathic normal pressure hydrocephalus (iNPH). While there is no generally accepted evaluation period for ascertaining a CSFTT responder, a substantial number of patients are evaluated only once within 24 hours of the test for improvement in gait. We report an iNPH patient with a favorable response to shunt surgery, who was first judged a non-responder by this standard, though subsequently was judged a responder in virtue of repetitively testing gait over 7 days. A 68-year-old man presented with progressive impairment of gait, balance, and memory. He was diagnosed as iNPH with an Evans' ratio of 0.35. At first hospitalization, change in gait was evaluated 24 hours after the CSFTT. He didn't show any significant improvement and was judged as a non-responder. However, at the second CSFTT, we repetitively tested his change in gait over seven days. Forty-eight hours after the tap, he showed significant improvement in his gait. He was then confirmed as a responder. After the operation, the gait difficulties were almost fully resolved. Further studies developing the standard procedure of the CSFTT should be considered.
Aged ; Cerebrospinal Fluid ; Cerebrospinal Fluid Shunts ; Diagnosis ; Gait ; Hospitalization ; Humans ; Hydrocephalus, Normal Pressure* ; Memory ; Predictive Value of Tests ; Virtues

The cerebrospinal fluid container is a device for storage of medicaments. By means of surgical operation, a ventricle catheter can be embedded in the ventricle of the brain. This safe and reliable device provides for neurosurgeons a new method of intracranical therapy and reestablishment of the circulating passage of the cerebrospinal fluid.
Brain Diseases ; surgery ; Catheters, Indwelling ; Cerebrospinal Fluid ; Cerebrospinal Fluid Shunts ; instrumentation ; Equipment Design ; Humans ; Neurosurgical Procedures ; instrumentation

Amenorrhea is rarely presented as a manifestation of endocrinological disturbances in patients of chronic hydrocephalus. We describe two cases of secondary amenorrhea caused by hydrocephalus due to aqueductal stenosis. Two female patients of age 30 and 20 yr presented with amenorrhea and increasing headache. Magnetic resonance images revealed marked, noncommunicating hydrocephalus without any tumorous lesion. In one patient, emergent extraventricular drainage was necessary because of progressive neurological deterioration. Each patient underwent surgical intervention for the hydrocephalus-ventriculoperitoneal shunt and endoscopic third ventriculostomy. Both resumed normal menstruation continuing so far with further normal menstrual bleeding. These two cases and others reported in the literature indicated that the surgical intervention for hydrocephalus resolves amenorrhea in all the cases of amenorrhea due to hydrocephalus. The suspected role of the surgery is the correction of increased intracranial pressure, which is an important pathogenetic factor in the development of amenorrhea.
Adult ; Amenorrhea/*etiology ; *Cerebral Aqueduct ; Cerebrospinal Fluid Shunts ; Female ; Gonadorelin/deficiency ; Human ; Hydrocephalus/*complications

OBJECTIVETo observe the therapeutic effect of Ommaya reservoir implantation on hydrocephalus in premature infants following intraventricular hemorrhage (IVH) and to investigate factors influencing the therapeutic effect.

METHODSAn ambispective cohort study was conducted on the clinical and follow-up data of 20 premature infants (gestational age <32 weeks, birth weight <1500 g) who received Ommaya reservoir implantation because of hydrocephalus following IVH. The therapeutic effect of Ommaya reservoir implantation was observed. These patients were divided into cure and treatment failure groups according to their treatment outcomes. The factors influencing therapeutic effects were investigated by univariate analysis.

RESULTSHydrocephalus was relieved significantly at 30 days after Ommaya reservoir implantation. However, some patients showed significantly decreased therapeutic effects since 3 months after operation: during 3-6 months after operation, 7 cases underwent ventriculoperitoneal shunt, 4 cases discontinued treatment because of economic reasons, and 1 case underwent endoscopic third ventriculostomy due to scalp hematoma with skin necrosis. The ventricles of the remaining 8 cases returned to normal size at 12-18 months after operation. As for postoperative complications, secondary IVH was seen in 8 cases, intracranial infection in 2 cases, and scalp hematoma with skin necrosis in 1 case. The univariate analysis revealed significant differences in gestational age, birth weight and duration of hydrocephalus before Ommaya reservoir implantation between the cure and the treatment failure groups (P<0.05).

CONCLUSIONSOmmaya reservoir implantation has a remarkable short-term therapeutic effect on hydrocephalus in premature infants following IVH, but later the effect decreases in some patients. Low gestational age, low birth weight and long duration of hydrocephalus may be the main factors influencing therapeutic effects of Ommaya reservoir implantation.

Cerebral Hemorrhage ; complications ; Cerebrospinal Fluid Shunts ; instrumentation ; Cohort Studies ; Female ; Humans ; Hydrocephalus ; surgery ; Infant, Newborn ; Infant, Premature ; Male