Disconnection and fracture are two significant mechanical VP shunt dysfunctions and must be adequately researched and understood even during routine follow-ups. A disconnected or fractured shunt may be working and it is not safe to state that the shunt is no longer needed.
Hepatic pseudocyst formation is a rare intra-abdominal complication of ventriculoperitoneal shunts. The presence of an intracranial tumor and a history of central nervous system infection are major risk factors for the development of this complication. Hepatic pseudocysts secondary to ventriculoperitoneal shunts can be classified as intra- and extra-axially growing cysts. On abdominal computed tomography images, extra-axially growing pseudocysts are typically surrounded by a fine annulus that shows continuity to hepatic parenchyma. For treatment of extra-axially growing hepatic pseudocysts, surgical unroofing of the cyst and repositioning of the catheter is an effective method if there is no shunt infection and/or dysfunction.
Although many patients with LBP benefit from conservative treatment methods such as short-term bed rest, medical therapy, lifestyle changes, and physical therapy and exercise, approximately 7% experience chronic pain (16). Moreover, 15% of those with chronic LBP require surgery (4). Although microdiscectomy, the most effective method for surgical treatment of lumbar herniated discs, provides satisfactory results, it can result in several complications such as recurrence, █ INTRODUCTION I n industrialized countries, approximately 80% of the population experiences an episode of low back pain (LBP) at least once in their lifetime (5). There are many pathologies and specific anatomic locations that may lead to LBP, but intervertebral disc herniation is recognized as one of the most common causes (7). AIM:To describe the intra-and postoperative results of patients who received a transforaminal anterior epidural steroid injection (TAESI) prior to lumbar microdiscectomy. MATERIAL and METHODS:Sixty-four patients who did not improve after minimally invasive techniques (MIT) for lumbar radiculopathy were evaluated. Thirty-two of them treated with techniques other than TAESI and those receiving thrombolytic or anticoagulant drugs before microdiscectomy were excluded. We recorded the type of MIT, numbers of levels and injections, time interval between the last MIT and microdiscectomy, duration of surgery, amount of intraoperative blood loss, rate of incidental durotomy, postoperative infection, and visual analogue scale (VAS) scores for leg pain before and after microdiscectomy at 24 hours, and the 1 st and 3 rd months (Group 1). A total of 35 patients with no history of MIT or lumbar surgery who had undergone unilateral, single-level lumbar microdiscectomy at our clinic were randomly selected to be included in the control group (Group 2) and same parameters were recorded for the comparison of both groups. RESULTS:The mean duration of lumbar discectomy was 140 minutes, and the amount of average intraoperative blood loss was 227 cc in the study group (Group 1), and 65 minutes and 73 cc, respectively in the control group (Group 2)(p>0.05). The comparison of VAS scores revealed that lumbar discectomy was still effective after TAESI (p=0.00). CONCLUSION:Although epidural steroid injection is an effective modality for the management of chronic pain, these patients should be informed preoperatively about the relatively long duration of surgery and the possible requirement for blood transfusion.
Summary: Proximal migration of the distal end of a ventriculoperitoneal shunt has been observed much more rarely than other numerous shunt-related complications. Subgaleal migration of the peritoneal end is one of the samples. In the preset report we have discussed a case of subgaleal migration of the peritoneal end detected as a result of the examinations performed for shunt dysfunction. There was ventricular dilatation on CT scan of the brain. X-ray examinations confirmed proper ventricular catheter and shunt valve placement but a complete migration of distal (peritoneal) catheter into the subgaleal space. Then the patient's shunt was revised. When our case and the literature were examined, we observed that this complication was frequently encountered during the first postoperative months, in the pediatric ages and in patients with advanced hydrocephalus. Besides, we have detected that the peritoneal catheters had tendency to migration into the subgaleal tissues similar to pre-insertion forms of the preoperatively original packages.
Summary: an eight -month -old male child was admitted with weakness and swelling in the feet. paraparesis and bilateral lower extremity edema were present in the neurological examination. thoracic MRi showed an intradural intramedullary mass 61 × 11 mm in size in the t5-t10 levels. laminotomy between the t5-t10 vertebrae was performed. a mass with smooth borders was separated from most of the neural tissue. in the postoperative MRi, we observed a contrast enhancing area, considered a residual fragment, only 5 × 4 mm in size. histopathological properties were compatible with the intermixed subtype of ganglioneuroblastoma. only a limited number of thoracic cord ganglioneuroblastoma reports have been previously published. although very rare in children and young adults, ganglioneuroblastoma should be included in the differential diagnosis of thoracic cord tumors. It is difficult to obtain a preoperative diagnosis with clinical features and radiological investigations. diagnosis depends on histopathological examinations. curative treatment should be in the form of a complete resection of the tumor. in partially resected cases, adjuvant radiotherapy may become necessary, along with close follow -up.
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