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Abstract Background A ventriculoperitoneal (VP) shunt is a cerebral shunt that diverts excess cerebrospinal fluid (CSF).Obstruction in the normal outflow or decreased absorption of the fluid is the usual cause. Hydrocephalus is treated by cerebral shunts.In paediatric patients, untreated hydrocephalus can be lethal and leads to many adverse effects including increase irritabilities, chronic headaches, learning difficulties, visual disturbances, and, in more advanced cases, severe mental retardation. Malfunction of the shunt with excess CSF accumulated can increase the intracranial pressure resulting in cerebral oedema and ultimately herniation. Objective To study and evaluate the mechanical causes of shunt failure and their surgical remedies and reduce the preventable morbidity, cost and mortality associated with shunt failure. Methods We conducted a prospective observational study including 70 patients who developed pure mechanical shunt failure for the first time from 2017 to 2020 in the Department of Neurosurgery Sher-i-kashmir Institute of Medical Sciences. Patients with previous shunt surgeries which include VP shunting and shunt revision or failure and shunt infections were excluded. Identity of all the patients has been kept anonymus. Written informed consent was obtained from all patients or their guardians in case of minors. Shunt malfunction was in the form of catheter misplacement, kinking, displacement from the ventricle or peritoneal cavity, disconnection, migration,inadvertent suturing of the catheter, air in shunt bulb. Results We found kinking at the proximal end in 25 (35%) patients as the most common cause of shunt failure. It was mostly as a result of inadequate and less spacious tunnelling made for the reservoir. Inadvertant suturing of shunt while closing abdomen in 7 (10%), shunt disconnection in 6 (8.5%), air in shunt bulb in 2 (2.8%), wrong placement at ventricular end in 10 (14.2%), shunt migration into the brain parenchyma in 5 (7.1%), shunt migration through the anal canal in 1(1.4%), pseudomeningocele around catheter valve in 3 (4.2%), placement of lower end into the preperitoneal space in 4 (5.7%) patients. Conclusions Shunt surgery is seemingly a straightforward operation for neurosurgeons. But considering the incidence of shunt failure and its associated morbidity and mortality, it should always be done with trepidation and extreme caution. Exclusive mechanical shunt malfunction is a major concern and leads to great deal of morbidity in the shunt operations. However, there are trivial remedies and technical nuances which needs to be followed during surgery to avoid these complications.

Abstract Background Epidural hematomas have been treated with urgent surgical evacuation to prevent catastrophic neurological sequelae and death. Brain Trauma Foundation recommends EDH volume greater than 30 cm3 and warrants surgical evacuation irrespective of GCS. However, due to increase in number of patients undergoing brain CTs following head injuries, more patients have been detected with EDH causing minimal symptoms. Aims and objectives To study factors influencing patients being treated conservatively for head injury with supratentorial epidural hematomas. Material and methods Our study is a retrospective analysis of supratentorial epidural hematoma treated conservatively from august 2018 to July 2020 at Sher-i-Kashmir institute of medical sciences, Srinagar, Jammu and Kashmir. Results A total of 19 patients with EDH were treated conservatively and fulfilled the inclusion criteria.(GCS of 13–15 with no neurological deficit, mild signs of elevated ICP, EDH thickness 13 on admission. 8 patients were hospitalised for a week, whilst 2 patients stayed in the hospital for 20 and 25 days, respectively, due to problems not related to EDH. One patient in whom conservative treatment had to be changed to surgical evacuation after 6 days of observation because of worsening headache, impaired alertness repeated imaging showed slight increase in EDH. Conclusions EDH can be managed conservatively in carefully selected patients of minor head injury with radiological surveillance and close neurological monitoring. Patients with GCS on admission more than 13, midline shift of less than 5 mm, location and volume of EDH less than 30 ml. Thus, leading to optimal utilisation of hospital resources. So, we conclude that even a dreaded entity like extradural haemorrhage can be managed conservatively in selected cases with strict clinical and radiological surveillance. We have called them ‘’Benign extradural haemorrhages’’.

Background and Importance: Spinal Subdural Hematoma (SSH) is a rare condition with an unknown incidence in the general population. Iatrogenic spinal subdural hematoma radiologically mimicking a prolapsed dorsolumbar disc has not been published in the literature. Case Presentation: A 65-year-old female presented with altered sensorium and generalized weakness for 3 days evaluated by a neurologist who diagnosed it as a metabolic encephalopathy with Syndrome of Inappropriate Antidiuretic Hormone secretion (SIADH) with severe anemia and hypothyroidism. She underwent a diagnostic lumbar puncture and following which, within 24 hours, she developed weakness of both the lower limbs. MRI of dorsolumbar spine was done which revealed D12-L1 extruded disc causing severe compression to the conus medullaris with D12-L2 subarachnoid lesion and cord edema. On opening the dura, a large organized hematoma on the anterior aspect of the conus was seen and evacuated. Conclusion: Spinal subdural hematoma presents with a spectrum of signs and symptoms. Although MRI is the investigation of choice but SSH presenting like a prolapsed intervertebral disc on MRI is one of its kinds and should be kept in mind since it carries a grave prognosis if not treated early with emergency decompression.