Necrotizing enterocolitis complicating the management of posthemorrhagic hydrocephalus

Pierro, Agostino; Manalang, L.R.; May, Paul; Cooke, R W; Cudmore, R.E.

doi:10.1016/0022-3468(93)90497-9

Cited by 19 publications

(12 citation statements)

References 20 publications

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“…In such patients, constipation can result in significantly elevated intra-abdominal pressure that decreases CSF outflow through a distal catheter, resulting in shunt failure 9) . Surgery due to abdominal problems such as necrotizing enterocolitis can decrease intra-abdominal absorption and result in shunt malfunction 11) . In addition, abdominal distension from overproduction of CSF from choroid plexus hypertrophy has also been reported to affect shunt function 6) .…”

Section: Discussionmentioning

confidence: 99%

“…Although it is rarely considered as a first-line treatment because of cardiopulmonary and renal complications, VA shunting is a valid alternative in patients who have experienced multiple previous intra-abdominal VP shunt failures or had contraindications to abdominal catheter placement 14) . Recently, there are some reports that show no significant differences in mortality between patients with VP shunts and VA shunts, so in circumstances where it is difficult to perform a VP shunt, a VA shunt may be considered as an alternative 11) .…”

Section: Discussionmentioning

confidence: 99%

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Shunt Revision to Ventriculoatrial Shunt Due to Long-Term Abdominal Distension Complicated by Neonatal Necrotizing Enterocolitis and Cerebrospinal Fluid Overproduction after Ventriculoperitoneal Shunt for the Management of Post-Hemorrhagic Hydrocephalus: A Case Report

Park

Lim

Yoon

2019

Nerve

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A cerebrospinal fluid (CSF) shunt is the most common treatment known to date in the treatment of hydrocephalus. A ventriculoperitoneal (VP) shunt is one of the most commonly favored procedures for CSF diversion. We present a case of shunt revision from a VP shunt to a ventriculoatrial (VA) shunt. The patient was diagnosed with germinal matrix hemorrhage with intraventricular hemorrhage shortly after birth with a history of ileostomy surgery for neonatal necrotizing enterocolitis 10 days after birth. The patient began to develop hydrocephalus around 7 weeks after birth and she had VP shunt surgery at 6 months old for post-hemorrhagic hydrocephalus. After the VP shunt surgery, the patient experienced several months of vomiting and constipation along with worsening of the abdominal distension. Distal abdominal catheter externalization was temporarily performed, and 20 to 30 mL/kg of CSF was drained daily. Abdominal distension was still not resolved after 2 weeks and VA shunting was performed. The patient was discharged with improved abdominal distension and was followed for 3 years without any complications. We report a relatively rare case of a shunt revision to VA shunt due to long-term abdominal distension complicated by neonatal necrotizing enterocolitis and CSF overproduction after VP shunting.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Shunt Revision to Ventriculoatrial Shunt Due to Long-Term Abdominal Distension Complicated by Neonatal Necrotizing Enterocolitis and Cerebrospinal Fluid Overproduction after Ventriculoperitoneal Shunt for the Management of Post-Hemorrhagic Hydrocephalus: A Case Report

Park

Lim

Yoon

2019

Nerve

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“…Ultimately, 16 studies involving 4.304 patients were included in the final analysis. 1,[26][27][28][29][30][31][32][33][34][35][36][37][38][39][40] The search process is visually represented in Figure 1.…”

Section: Study Selectionmentioning

confidence: 99%

“…Among the 3311 reasons for shunt placement available, idiopathic normal pressure hydrocephalus (NPH) was the most common, with 664 cases (20.0%), followed by tumors with 367 cases (11.0%) and aqueductal stenosis with 234 cases (7.0%), in the company of other types of etiologies. Among the included studies, 5 focused exclusively on adult patients, 27,[32][33][34]39 9 focused on children, 1,26,30,31,[35][36][37][38]40 and 2 had both. 28,29 More information regarding baseline characteristics is depicted in Table 2.…”

Section: Baseline Characteristics Of Included Studiesmentioning

confidence: 99%

Ventriculoatrial Shunt Versus Ventriculoperitoneal Shunt: A Systematic Review and Meta-Analysis

Oliveira,

Hakim,

Semione

et al. 2023

Neurosurgery

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BACKGROUND AND OBJECTIVES: Ventriculoperitoneal shunt (VPS) is usually the primary choice for cerebrospinal fluid shunting for most neurosurgeons, while ventriculoatrial shunt (VAS) is a second-line procedure because of historical complications. Remarkably, there is no robust evidence claiming the superiority of VPS over VAS. Thus, we aimed to compare both procedures through a meta-analysis. METHODS: Following Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, the authors systematically searched the literature for articles comparing VAS with VPS. The included articles had to detail one of the following outcomes: revisions, infections, shunt-related mortality, or complications. In addition, the cohort for each shunt model had to encompass more than 4 patients. RESULTS: Of 1872 articles, 16 met our criteria, involving 4304 patients, with 1619 undergoing VAS and 2685 receiving VPS placement. Analysis of revision surgeries showed no significant difference between VAS and VPS (risk ratio [RR] = 1.10, 95% CI: 0.9-1.34; I2 = 84%, random effects). Regarding infections, the analysis also found no significant difference between the groups (RR = 0.67, 95% CI: 0.36-1.25; I2 = 74%, random effects). There was no statistically significant disparity between both methods concerning shunt-related deaths (RR = 2.11, 95% CI: 0.68-6.60; I2 = 56%, random effects). Included studies after 2000 showed no VAS led to cardiopulmonary complications, and only 1 shunt-related death could be identified. CONCLUSION: Both methods show no significant differences in procedure revisions, infections, and shunt-related mortality. The literature is outdated, research in adults is lacking, and future randomized studies are crucial to understand the profile of VAS when comparing it with VPS. The final decision on which distal site for cerebrospinal shunting to use should be based on the patient's characteristics and the surgeon's expertise.

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“…Shunt placement in small premature infants carries the risk of considerable morbidity, secondary to various shunt-related complications, such as, ulceration of scalp, ventriculitis, sepsis, and necrotizing enterocolitis, and the need for frequent revision 3,9,21) . Various temporary procedures have been used to delay ventriculo-peritoneal shunt placement, for example, subcutaneous reservoir embedment surgery, a ventriculo-subgaleal shunt, external ventricular drainage, and repeated lumber puncture; however, success rates vary 4,21,22) .…”

Section: Case Reportmentioning

confidence: 99%

Intraparenchymal Pericatheter Cyst as a Complication of a Ventriculo-Peritoneal Shunt in a Premature Infant

Rim

Hwang

Kwon

et al. 2011

J Korean Neurosurg Soc

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He was born at gestation week 28 to a 30-year-old multipara at our hospital by Cesarean section delivery due to premature rupture of the maternal membrane. His birth weight was 1,450 g and his Apgar scores were 6 and 9 at 1 and 5 minutes, respectively. After birth, he was provided positive pressure ventilation and intubated. He also suffered respiratory distress and was treated with surfactant and by mechanical ventilation. On the 24th day after birth, he was presented with fontanel bulging with slight activity reduction. Moro reflex was partial but symmetric, and his pupils were of equal size and reactive to light bilaterally. Ultrasonography and MRI of the brain revealed severe hydrocephalus (Fig. 1). External ventricular drainage was performed, and 8 days later at a body weight of 1,600 mg, a ventriculo-peritoneal shunt was inserted using contoured-shape ultrasmall PS Medical vlave. Two months after shunt surgery, follow-up CT and MRI showed pericatheter ventricular cyst formation (Fig. 2). Burr hole drainage of the pericatheter cyst was performed, and 80 cc of a yellowish translucent fluid was aspirated. Fluid analysis revealed, a cell count of 6/uL (polymorphous nuclear cells 17%), glucose 36 mg/dL, protein 2633 mg/dL, and gram stain negativity, and culture showed no growth of bacteria and fungus. The drain catheter was removed on the 9th day after insertion and a follow up CT scan revealed near total cyst disappearance. Two months later, head enlargement and a tense fontanel were noted, and follow up MRI revealed intraparenchymal cyst regrowth with normally sized ventricle. Because reinsertion of the new proximal catheter into the ventricle was considered difficult without direct visualization, craniotomy and shunt revision was planned.Craniotomy and opening of the cyst revealed a pseudocyst INTRODUCTIONSince the introduction of cerebrospinal fluid (CSF) shunting procedures, they have been one of the main methods of managing hydrocephalus. However, complications of shunt surgery may impede the management of hydrocephalus, and have been reported to affect about 20 to 30 percent of cases during long term follow up 11,12) . Infection and obstruction are the most common complications, though improvements in shunt valve design have diminished complication rates caused by nonphysiologic hydrodynamics of the shunt system. The spread of CSF into brain parenchyma is a rare complication of a ventriculoperitoneal shunt 2,5,10,14,18) , and can take the form of CSF edema or a reversible porencephalic cyst 13) . Pericatheter cysts have been described in relation to a blocked shunt in children and adults, but it has not been previously reported in a premature infant. The authors present a case of an intraparenchymal CSF cyst in a premature infant who happens to be the youngest patient ever reported with this condition. CASE REPORTAn one-day-old male infant was admitted to our neonatal intensive care unit due to weak crying and whole body cyanosis. A ventriculo-peritoneal shunt is a standard surgical management for hydroc...

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Necrotizing enterocolitis complicating the management of posthemorrhagic hydrocephalus

Cited by 19 publications

References 20 publications

Shunt Revision to Ventriculoatrial Shunt Due to Long-Term Abdominal Distension Complicated by Neonatal Necrotizing Enterocolitis and Cerebrospinal Fluid Overproduction after Ventriculoperitoneal Shunt for the Management of Post-Hemorrhagic Hydrocephalus: A Case Report

Shunt Revision to Ventriculoatrial Shunt Due to Long-Term Abdominal Distension Complicated by Neonatal Necrotizing Enterocolitis and Cerebrospinal Fluid Overproduction after Ventriculoperitoneal Shunt for the Management of Post-Hemorrhagic Hydrocephalus: A Case Report

Ventriculoatrial Shunt Versus Ventriculoperitoneal Shunt: A Systematic Review and Meta-Analysis

Intraparenchymal Pericatheter Cyst as a Complication of a Ventriculo-Peritoneal Shunt in a Premature Infant

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