Factors influencing shunt malfunction in patients with tuberculous meningitis

Ambekar, Sudheer; Srinivas, Dwarakanath; Pandey, Paritosh; Somanna, Sampath; Bangalore, C.; Indira, Devi B

doi:10.4103/2277-9167.118121

Cited by 8 publications

(24 citation statements)

References 20 publications

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“…It predisposes to develop a shunt block leading to shunt revision. 33 Based on Jamjoom et al, 34 catheters left in situ for over 8 days had a higher risk of EVD-related infection (ERI) compared with those removed at 7 days or less (odds ratio = 2.54 [95% confidence interval: 1.14–5.7]; p = 0.02). The other studies also have proven that prolonged catheterization duration plays an essential role in ERI.…”

Section: Discussionmentioning

confidence: 99%

Challenges and Controversies in the Management of Tuberculous Meningitis with Hydrocephalus: A Systematic Review and Sarawak Institution's Experience

Yiek

Wong

2022

Asian J Neurosurg

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Introduction To date, there are no standard practice guidelines available and no universal consensus regarding treatment protocol in management of tuberculous meningitis (TBM) with hydrocephalus. Over the years, diverse views have existed in neurosurgical management of TBM with hydrocephalus. Some authors advocate ventriculo-peritoneal (VP) shunt, while others suggest that external ventricular drainage (EVD) may be the preferable neurosurgical procedure for a poor-grade patient. Method We systematically reviewed published literature and presented our institution's experience. We performed a retrospective case study in our Sarawak neurosurgical center from 2018 to 2020. We tabulated the outcome according to preoperative classifications, which were Vellore Grading (VG), Modified Vellore Grading (MVG), British Medical Research Council Classification (MRC), and others: author-defined. Result In our center, there were 20 cases of TBM with hydrocephalus treated by EVD and VP shunt from 2018 to 2020. We systematically searched published medical literature, and 23 articles were retrieved and analyzed. Poor outcomes were observed in poor-grade patients, especially VG/MVG 3/4 and MRC 3, from both institution and systemic review data. Shunt complication rate was lower in our center as compared with published literature. Conclusion Unfortunately, morbidity and mortality were approximately twofold higher in poor-grade as compared with good-grade patients. However, about one-third of poor-grade patients achieved a good outcome. Cerebrospinal fluid (CSF) diversion would be an unavoidable treatment for hydrocephalus. Poor-grade patients tend to have cerebral infarcts in addition to hydrocephalus. An extended duration of EVD placement could be a potential measure to assess Glasgow coma scale recovery and monitor serial CSF samples.

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Section: Discussionmentioning

confidence: 99%

Challenges and Controversies in the Management of Tuberculous Meningitis with Hydrocephalus: A Systematic Review and Sarawak Institution's Experience

Yiek

Wong

2022

Asian J Neurosurg

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“…26 But to recommend the routine use navigation system for the insertion shunt, we need a multicentric study with large sample size. Ambekar et al 27 and Kamat et al 28 showed in their study that patients with increased protein levels in CSF are at a high risk of VP shunt blockage. In our study, we found more complications in the patients with elevated CSF protein of more than 40 mg per deciliter.…”

Section: Discussionmentioning

confidence: 95%

“…Ambekar et al 27 and Kamat et al 28 showed in their study that patients with increased protein levels in CSF are at a high risk of VP shunt blockage. In our study, we found more complications in the patients with elevated CSF protein of more than 40 mg per deciliter.…”

Section: Discussionmentioning

confidence: 95%

A Prospective Study and Analysis of Ventriculoperitoneal Shunt Surgery: Their Indication and Complication in a Single Tertiary Care Center

Pal

Dhar

Sahu

et al. 2021

Indian Journal of Neurosurgery

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Background Ventriculoperitoneal (VP) shunt insertion is routinely performed for the treatment of hydrocephalus due to different indications like congenital, infective, tumor, posttraumatic, and normal pressure hydrocephalus (NPH). A lot of common and rare complications following this procedure have been reported. Objectives To analyze the clinical profile, indications, anesthetic, and postoperative complications for VP shunt surgery in our center. Materials and Methods This prospective clinical review study was conducted in the Department of Neurosurgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, between October 2018 to January 2020 and included 454 cases of hydrocephalus who underwent VP shunt surgery. The data was compiled and analyzed. Results A total of 454 patients with male predominance were studied. Pediatric and adolescent patients were 48.9% (222/454). Obstructive hydrocephalus due to tumors was the etiology of 48.7% (221/454) cases. The incidence of overall shunt complications was 9.7% (44/454), of which obstruction and infection was 5.9% (27/454) and 3.1% (14/454), respectively. Factors associated with increased shunt complications include redo and infective etiology and cases having higher protein in perioperative cerebrospinal fluid (CSF) analysis. Neuronavigation, antibiotic-impregnated shunt and biventricular shunt are associated with lower complications. Conclusion Obstructive hydrocephalus due to tumors happened to be the most common cause of VP shunt, and shunt obstruction is most common complication, especially in infective and redo cases.

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“…We also found that CSF cell count, protein and sugar levels did not have a signicant effect over revision of shunt as reported in other studies. [6] Ambekar et al [20] suggested patients with pre-operative hyponatremia and high CSF protein concentration have a higher incidence of shunt malfunction. In our study mean value of ventricular size (FH/ ID ratio) was reduced from 60.89% to 43.7% and this reduction in ventricular size was statistically signicant.…”

Section: Discussionmentioning

confidence: 99%

Shunt Malfunction in Tuberculous Meningitis- Whether Grade and CSF Picture Affect Outcome

Sobti

Singh

et al. 2020

Global Journal for Research Analysis

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BACKGROUND Tuberculosis remains a major global problem and a public health issue of considerable magnitude. The World Health Organisation (WHO) estimates that one third of the world’s population is infected with mycobacterium tuberculosis, with the highest prevalence of tuberculosis in Asia. Shunt surgery for hydrocephalus associated with tuberculous meningitis has proven to be highly efficacious. Few studies have addressed the issue of outcome of shunt surgery and impact of CSF (Cerebrospinal fluid) picture in post tuberculous meningitis hydrocephalus shunt surgery. MATERIAL AND METHODS The study was a prospective study conducted in Department of Neurosurgery, PGIMER, Dr. RML Hospital, New Delhi. The duration of follow up was of 6 months. 70 patients were enrolled in the study. All patients who underwent ventriculo-peritoneal shunt surgery for hydrocephalus with tuberculous meningitis in Neurosurgery department at PGIMER & Dr.RML hospital were included in the study. All the patients who had hydrocephalus following tuberculous meningitis were evaluated using Modified Vellore grading of TBM and hydrocephalus. All the patients who underwent ventriculo-peritoneal shunt surgery had have their CSF analysis (cytology, protein, sugar, Gram stain, ZN stain, India ink and aerobic culture) done. Outcome of the surgery were evaluated based on Glasgow outcome score (GOS), radiological parameters and complications. Statistical analysis was performed by the SPSS program for Windows, version 17.0. RESULTS The age of patients enrolled into the study varied from 2 months to 87 years with 44.3% of patients in 1-5 years age group. Patients were divided into 4 grades according to Modified Vellore Grading. Grades at the time of admission were compared with the final Glasgow outcome scale. At the time of admission 6 patients were in Grade I, 13 patients in Grade II, 45 patients in Grade III and 6 patients in Grade IV. GOS was 5 in Grade I, 4.69 +/- in Grade II, 4.50 +/- IN Grade III and 2.17+/- in Grade IV. Outcome was compared according to Cerebrospinal fluid (CSF) cell count, sugar and protein levels but none was found to be significant. Number of shunt revisions were compared to CSF cell count and sugar level but none was found to be significant. Mean FH/ID ratio before surgery was 60.89% which was reduced to 43.70% after 6 months follow up. CONCLUSION Ventriculo-peritoneal shunt surgery is a safe and effective treatment modality to treat tuberculous meningitis with hydrocephalus in all grades of patients except in Grade IV. CSF protein, sugar levels and cell count neither affect the outcome nor increase the risk of shunt malfunction

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Factors influencing shunt malfunction in patients with tuberculous meningitis

Cited by 8 publications

References 20 publications

Challenges and Controversies in the Management of Tuberculous Meningitis with Hydrocephalus: A Systematic Review and Sarawak Institution's Experience

Challenges and Controversies in the Management of Tuberculous Meningitis with Hydrocephalus: A Systematic Review and Sarawak Institution's Experience

A Prospective Study and Analysis of Ventriculoperitoneal Shunt Surgery: Their Indication and Complication in a Single Tertiary Care Center

Shunt Malfunction in Tuberculous Meningitis- Whether Grade and CSF Picture Affect Outcome

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