Ventriculoperitoneal shunt occlusion and cranioplasty

Abstract

Decompressive craniectomy (DC) is an urgent neurosurgical procedure, effective in the reduction of intracranial pressure (ICP) in patients with elevated ICP and in complications of brain infarction that do not respond to clinical treatment; traumatic brain injury (TBI); intracerebral haemorrhage (ICH) and aneurysmal intracerebral haemorrhage. Symptomatic hydrocephalus is present in 2 to 29% of patients who undergo craniectomy. They may require a ventriculoperitoneal shunt (VPS). The literature does not yet show standard management of cranioplasty in patients who have previously undergone a shunt, showing evidence of sinking skin flap syndrome. This case shows parenchymal expansion after VPS occlusion and cranioplasty in the patient’s profile. The 23-year-old male patient, right-handed, went to the hospital in January 2017 due to severe traumatic brain injury following multiple traumas. The patient underwent urgent DC surgery for the management of elevated ICP. The patient developed hydrocephalus. hydrocephalus. It was decided to perform the VPS implant. After 2 years, and with quite a sunken flap, the patient was submitted to cranioplasty procedure after shunt occlusion was performed. The patient left the hospital receiving outpatient care with no more complaints. In spite of the favourable outcome, new studies are fundamental to decide upon the best approach.

Simultaneous Cranioplasty and External Ventricular Drain Implantation in Patients with Hydrocephalus: Case Series and Literature Review

“…As for the material adopted in the plastic surgery, the customized PMMA prosthesis was chosen, by 3D printingdue to the accessibility and reproducibility of the technique, in addition to the therapeutic and aesthetic results -, according to the experience with these operations of our center. [6][7][8][9] There is also no consensus on the appropriate time for CP intervention. On the one hand, there are a number of studies that associate late reconstruction with unfavorable results.…”

“…The reconstruction of the skullcap was guided by a customized three-dimensional (3D) technique, using polymethylmethacrylate (PMMA). [6][7][8][9] After CP, the EVD was closed and removed in an interval of 24 to 48 hours, with the patient still in the intensive care unit (ICU).…”