Complications of subduroperitoneal shunting

Erşahin, Yusuf; Tabur, Ender; Kocaman, Sevgül; Mutluer, Saffet

doi:10.1007/pl00007288

Cited by 25 publications

(25 citation statements)

References 19 publications

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“…This complication is a mechanism of the infection spreading to upper parts of the brain as a result of colonic perforation. However, it is reported that deferred or undertreated shunt infections result in abscess more often than colonic perforation does [6]. In our case, there were predisposing factors such as a low birth weight (2,250 g) and premature birth (28 weeks), numerous repetitive VPS or shunt revision surgeries, and undergoing immunosuppression; however, there was no sign of colonic perforation.…”

Section: Discussionmentioning

confidence: 49%

Pediatric Giant Cerebral Candida Abscess: A Case Report

et al. 2019

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Fungal infections of the central nervous system and pediatric brain abscess are rare but serious conditions in terms of morbidity and mortality that need immediate diagnosis and treatment. It can be seen in congenital or acquired immunosuppressed patients as opportunistic infections as well as in low-birth-weight, premature infants with ventriculoperitoneal shunt, external ventricular drainage, or with a history of craniotomy. Our aim is to emphasize the giant cerebral Candida abscess of a 13-month-old female infant who previously had eight ventriculoperitoneal shunt operations due to hydrocephalus. The patient was taken to pediatric emergency care with complaints of feeding difficulty and discomfort and was hospitalized due to the detection of an intracranial mass by contrast-enhanced brain tomography. After total excision of the mass with its capsule, the patient was pathologically diagnosed with Candida abscess, and the treatment was started. The patient was discharged by the end of the 6th week.

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Section: Discussionmentioning

confidence: 49%

Pediatric Giant Cerebral Candida Abscess: A Case Report

et al. 2019

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“…12 It has the lowest rate of failure, with several studies reporting a 0% failure rate, but comes with numerous well-known short-and long-term complications. 8,13,30 In some cases, the shunt may be removed after resolution of the CSC. 8,12,13,17,25 Craniotomy for CSC is a relatively infrequent procedure and is typically reserved for cases in which the CSC is loculated.…”

Section: 25mentioning

confidence: 99%

“…8,13,30 In some cases, the shunt may be removed after resolution of the CSC. 8,12,13,17,25 Craniotomy for CSC is a relatively infrequent procedure and is typically reserved for cases in which the CSC is loculated. In the series reported by Caldarelli et al, 4 only 3 (4%) of 72 children underwent a craniotomy with resection of neomembranes.…”

Section: 25mentioning

confidence: 99%

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Minicraniotomy versus bur holes for evacuation of chronic subdural collections in infants—a preliminary single-institution experience

Klimo

Matthews

Lew

et al. 2011

PED

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Object Various surgical interventions have been described to evacuate chronic subdural collections (CSCs) of infancy. These include transfontanel percutaneous aspiration, subdural drains, placement of bur hole(s) with or without a subdural drain, and shunting. Shunt placement typically provides good long-term success (resolution of the subdural fluid), but comes with well-known early and late complications. Recently, the authors have used a mini–osteoplastic craniotomy technique with the goal of definitively treating these children with a single surgery while avoiding the many issues associated with a shunt. They describe their procedure and compare it with the traditional bur hole technique. Methods In this single-institution retrospective study, the authors evaluated 26 cases involving patients who underwent treatment for CSC. Preoperative, intraoperative, and postoperative data were reviewed, including radiographic findings (density of the subdural fluid and ventricular and subarachnoid space size), neurological examination findings, and intraoperative fluid description. The primary outcome was treatment failure, defined as the patient requiring any subsequent surgical intervention after the index procedure (minicraniotomy or bur hole placement). Results Fifteen patients (10 male and 5 female; median age 5.1 months) collectively underwent 27 minicraniotomy procedures (each procedure representing a hemisphere that was treated). In the bur hole group, there were 11 patients (6 male and 5 female; median age 4.6 months) with 18 hemispheres treated. Both groups had subdural drains placed. The average follow-up for each treatment group was just over 7 months. Treatment failure occurred in 2 patients (13%) in the minicraniotomy group compared with 5 patients (45%) in the bur hole group (p = 0.09). Furthermore, the 2 patients who had treatment failure in the minicraniotomy group required 1 subsequent surgery each, whereas the 5 in the bur hole group needed a total of 9 subsequent surgeries. Eventually, 80% of the patients in the minicraniotomy group and 70% of those in the bur hole group had resolution of the subdural collections on the last imaging study. Conclusions The minicraniotomy technique may be a superior technique for the treatment of CSCs in infants compared with bur hole evacuation. The minicraniotomy provides greater visualization of the subdural space and allows more aggressive evacuation of the fluid, better irrigation of the space, the ability to fenestrate any accessible membranes safely, and continued egress of fluid into the subgaleal space. Although this preliminary report has obvious limitations, evaluation of this technique may be worthy of a prospective, multiinstitutional collaborative effort.

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“…I would like to comment on the removal of SP shunts. Subdural empyema developed following bowel perforation in 1 of our 97 patients with an SP shunt who was brought to the hospital 2 days after the mother had seen the shunt tip extruding through the anus [6]. Dan and Spiegelmann [7] also reported mixed bacterial subdural empyema in a 9-month-old boy with an SP shunt.…”

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confidence: 93%