Comparison of techniques for ventriculoperitoneal shunting in 523 patients with subarachnoid hemorrhage

Chalouhi, Nohra; Whiting, Alexander C; Anderson, Eliza C.; Witte, Samantha; Zanaty, Mario; Tjoumakaris, Stavropoula; Gonzalez, L. Fernando; Hasan, David; Starke, Robert M.; Hann, Shannon; Ghobrial, George M.; Rosenwasser, Robert H.; Jabbour, Pascal

doi:10.3171/2014.6.jns132638

Cited by 11 publications

(10 citation statements)

References 17 publications

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“…A recent study identified higher Hunt and Hess grade and surgical clipping in patients suffering from SAH as independent predictors of VPS infection (3). This again might overrule potential advantages of avoiding a second operation in patients with simultaneous CP and VPS.…”

Section: Discussionmentioning

confidence: 97%

Cranioplasty and Ventriculoperitoneal Shunt Placement after Decompressive Craniectomy: Staged Surgery Is Associated with Fewer Postoperative Complications

et al. 2015

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Section: Discussionmentioning

confidence: 97%

Cranioplasty and Ventriculoperitoneal Shunt Placement after Decompressive Craniectomy: Staged Surgery Is Associated with Fewer Postoperative Complications

et al. 2015

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“…A recently published study suggested that the use of the ventriculostomy site for VP shunt placement may not add morbidity (infection or need for revision) as compared with the use of a fresh contralateral site. 30 However, the study was performed in subarachnoid hemorrhage patients with an existing ventriculostomy and no specific data were reported for infected cases. It has been reported that the mean duration of externalization is about 2 weeks.…”

Section: Discussionmentioning

confidence: 99%

Complete Intestinal Obstruction and Necrosis as a Complication of a Ventriculoperitoneal Shunt in Children

Zhao

Wei

et al. 2015

Medicine

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Ventriculoperitoneal (VP) shunt complications are common, but abdominal complications are rare. The objective of this report is to present 2 cases of intestinal obstruction due to a VP shunt and review the literature for data on this rare occurrence.A 4-month-old boy received surgical resection of a medulloblastoma and a VP shunt was inserted to manage progressive hydrocephalus. Two months later, he was admitted with intermittent vomiting, and plain abdominal radiography showed complete intestinal obstruction. Emergency laparotomy revealed an adhesive intestinal obstruction around the catheter, and approximately 5 cm of necrotic ileum was resected. His recovery was uneventful. In the second case, a 6-year-old boy was diagnosed with a primary nongerminomatous malignant germ cell tumor and a VP shunt was place to treat hydrocephalus. Two weeks after the first course of chemotherapy, he went into a coma; computed tomography demonstrated enlargement of the tumor and gross total resection was performed. Two weeks later, he developed abdominal distention; plain radiography showed intestinal obstruction and laparotomy revealed adhesive intestinal obstruction around the catheter with 15 cm of necrotic ileum. The necrotic bowel was resected. Unfortunately, the patient developed sepsis and despite treatment remained in a vegetative state.Medline, Central, Embase, and Google Scholar databases were searched up to May 9, 2014, using the terms VP shunt, shunting, and/or intestinal obstruction. Only cases involving children or adolescents were included. Eleven reports involving patients with abdominal complications resulting from a VP shunt for hydrocephalus were identified. The dates of the reports spanned from 1971 to 2014. Volvulus was the most common cause of VP shunt-related obstruction, and mechanical obstruction due to twisting of the catheter the second most common. Only 1 case in the literature review was related to intestinal adhesions. Treatment in most cases was laparotomy.Although intestinal obstruction is a rare complication of a VP shunt, it should be considered in the presence of abdominal symptoms and prompt treatment provided to have a good outcome.

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“…Most importantly a likely complication of subarachnoid hemorrhage is cerebral vasospasm (51). A common treatment option for hemorrhagic change that infiltrates the ventricles is a ventriculostomy followed by ventriculoperitoneal shunt placement (28). In severe cases of TBI with subarachnoid hemorrhage where herniation is anticipated, decompressive craniectomy can be performed (90).…”

Section: Vasospasms Subarachnoid Hemorrhage Edema and Ischemic Hypoxiamentioning

confidence: 99%

Role of Microvascular Disruption in Brain Damage from Traumatic Brain Injury

Logsdon

Lucke‐Wold

Turner

et al. 2015

Comprehensive Physiology

127

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Traumatic brain injury (TBI) is acquired from an external force, which can inflict devastating effects to the brain vasculature and neighboring neuronal cells. Disruption of vasculature is a primary effect that can lead to a host of secondary injury cascades. The primary effects of TBI are rapidly occurring while secondary effects can be activated at later time points and may be more amenable to targeting. Primary effects of TBI include diffuse axonal shearing, changes in blood brain barrier (BBB) permeability, and brain contusions. These mechanical events, especially changes to the BBB, can induce calcium perturbations within brain cells producing secondary effects, which include cellular stress, inflammation, and apoptosis. These secondary effects can be potentially targeted to preserve the tissue surviving the initial impact of TBI. In the past, TBI research had focused on neurons without any regard for glial cells and the cerebrovasculature. Now a greater emphasis is being placed on the vasculature and the neurovascular unit following TBI. A paradigm shift in the importance of the vascular response to injury has opened new avenues of drug treatment strategies for TBI. However, a connection between the vascular response to TBI and the development of chronic disease has yet to be elucidated. Long-term cognitive deficits are common amongst those sustaining severe or multiple mild TBIs. Understanding the mechanisms of cellular responses following TBI is important to prevent the development of neuropsychiatric symptoms. With appropriate intervention following TBI, the vascular network can perhaps be maintained and the cellular repair process possibly improved to aid in the recovery of cellular homeostasis.

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Comparison of techniques for ventriculoperitoneal shunting in 523 patients with subarachnoid hemorrhage

Cited by 11 publications

References 17 publications

Cranioplasty and Ventriculoperitoneal Shunt Placement after Decompressive Craniectomy: Staged Surgery Is Associated with Fewer Postoperative Complications

Cranioplasty and Ventriculoperitoneal Shunt Placement after Decompressive Craniectomy: Staged Surgery Is Associated with Fewer Postoperative Complications

Complete Intestinal Obstruction and Necrosis as a Complication of a Ventriculoperitoneal Shunt in Children

Role of Microvascular Disruption in Brain Damage from Traumatic Brain Injury

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