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Like any other surgical intervention, ventriculoperitoneal shunt (VPS) insertion is associated with multiple complications including bleeding, shunt infection, and shunt malfunction. Additionally, other complications involve the gastrointestinal tract, such as CSF pseudocyst or abdomen pseudocyst (APC) formation, have also been reported. The APC inhibits cerebrospinal fluid (CSF) absorption and causes shunt malfunction. Differential diagnosis might be difficult since APC can mimic other cystic abdominal diseases. This article aims to provide an updated review that summarize the most relevant findings available in the literature. This review can help clinicians in better understanding the clinical characteristics of this complication in order to develop a comprehensive approach that is associated with a lower incidence and recurrence rate of APC. Accurate history taking, precise clinical examination of signs and symptoms, abdominal imaging, and a high index of suspicion are key components of an APC diagnosis. Therefore, understanding predisposing factors and clinical features of such distinctive complication is essential for the adequate management of patients. Abdominal pseudocyst formation at the distal end of VPS can result in both features of shunt malfunction and abdominal signs and symptoms. Post-VPS APC, whenever suspected, should be assessed appropriately by imaging. The treatment of APC ranges from shunt removal and external drainage to various forms of shunt repositioning or conversion, and treatment decisions often depend on individual patient characteristics and surgeon preference. [ABSTRACT FROM AUTHOR]

Leber hereditary optic neuropathy (LHON) is characterized by vision loss due to the degeneration of retinal ganglion cells. LHON‐Plus refers to LHON with additional extraocular findings. Neurological conditions observed in LHON‐Plus include seizures, encephalopathy, movement disorders, neuropathy, and myopathy. Herein, we present a case with atypical LHON‐Plus caused by a novel DNAJC30 disease‐causing gene variant. A 15‐year‐old boy presented with acute headache, and blurred and decreased vision in both eyes. Although initial evaluation pointed toward idiopathic intracranial hypertension, the subsequent diagnostic process revealed unusual features like area postrema syndrome and T2 hyperintensity in brain magnetic resonance imaging. Consequently, antibody‐negative neuromyelitis optica spectrum disorder (NMOSD) was diagnosed and treatment was commenced. Recurrent episodes of elevated intracranial pressure necessitated the insertion of a ventriculoperitoneal shunt. Exome sequencing (ES) revealed a novel homozygous variant in the DNAJC30 gene 2 years after symptom onset. Atypical LHON presentations due to nuclear gene mutations may mimic other neuroinflammatory conditions like NMOSD, necessitating thorough clinical evaluation and genetic testing. ES plays a crucial role in diagnosing complex neurological cases, enabling the identification of novel genetic variants associated with LHON and related disorders. [ABSTRACT FROM AUTHOR]

Waardenburg syndrome is an uncommon autosomal dominant condition that presents with varying ocular and systemic features. Although rare, research has also shown that these patients are at higher risk of neural tube defects including spina bifida which may lead to further neurological and neuro-ophthalmological complications. In many cases ventriculoperitoneal shunts are required to prevent and manage these complications. This case details a presentation of papilledema secondary to shunt failure in Waardenburg syndrome associated spina bifida. Neurosurgery and shunt revision resulted in resolution of the papilledema. This case underscores the need of eye physicians to monitor their patients with Waardenburg syndrome associated spina bifida, especially those with prior neurosurgical procedures, for complications such as papilledema as they might be ultimately involved in their diagnosis and management. [ABSTRACT FROM AUTHOR]

Objective: Communicating hydrocephalus (CH) is an uncommon complication that can affect patients with glioblastoma (GBM). Due to its clinical and radiological findings, it presents as a chronic hydrocephalus. The mechanisms underlying its occurrence and impact on the prognosis of the disease are poorly known, but some studies have suggested that shunting can have a positive impact on the quality of life of these patients. Methods: The authors performed a systematic literature review and meta-analysis to identify the possible risk factors that could help to identify CH cases in glioblastoma, using the MEDLINE/PubMed and Cochrane Database of Systematic Reviews databases. The Joanna Briggs Institute critical appraisal tool was used to assess the risk of bias. Results: Our search yielded 273 studies, but only 9 records were included in the final quantitative analysis. CH in glioblastoma patients was found to be very uncommon (proportion 0.04 out of 1; range 0.03–0.05, p < 0.01, CI:95%) and its occurrence was associated with a previous ventricular opening (0.85 out of 1; range 0.66–0.94, p < 0.01, CI:95%). Conclusion: CH in glioblastoma should be suspected in patients with GBM who have undergone accidental ventricular opening during tumor resection and presenting with chronic hydrocephalus symptoms. [ABSTRACT FROM AUTHOR]

Background In pediatrics, shunt infection is considered the most common complication of ventriculoperitoneal (VP) shunt insertion and the main cause of shunt failure. Careful surgical technique and hygienic skin preparations are highly important for prevention of shunt infections. Our objective was to assess the significance of using preoperative chlorhexidine/alcohol as a skin antiseptic in reducing the infection rate in pediatric VP shunts surgery. Methods We conducted a retrospective, case control study of 80 pediatric patients with active hydrocephalus. The control group (a single step of preoperative skin antisepsis using povidone-iodine and isopropyl alcohol) comprised 40 patients who underwent a shunt surgery between January 2019 and June 2020 and the study group (two steps of preoperative skin antisepsis using 2% chlorhexidine gluconate in 70% isopropyl alcohol as a first step followed by povidone-iodine as a second step) comprised 40 patients who underwent a shunt surgery between July 2020 and January 2022. Results Shunt infection was encountered in 11 (13.7%) patients. It was significantly higher in preterm babies (p = 0.010), patients with a previous shunt revision (p < 0.001), and those with a previous shunt infection (p < 0.001). The incidence of infection was 22.5% in the control group and 5% in study group, with a statistically significant difference (p = 0.023). Conclusions Two steps of preoperative skin antisepsis, first using chlorhexidine/alcohol and then povidone-iodine scrub solution, may significantly reduce the infection rate in pediatric VP shunt surgeries. [ABSTRACT FROM AUTHOR]

Purpose: We hypothesize that distal shunt catheters fully impregnated with barium are more prone to failure compared to distal catheters with only a barium stripe. We sought to evaluate this distinction using a matched case–control study. Methods: Patient records over an 8-year period were queried for distal shunt revisions for fracture or disconnection (cases). A control group of patients with confirmed functioning distal catheters was queried from the same period and matched based on patient age at exploration/revision. Data were collected via chart review, including demographics, hydrocephalus etiology, distal catheter type, and patient age at revision. Independent T-test, chi-squared, and binomial logistic regression analyses were performed. Results: There were 194 patients included in the study: 97 patients with distal shunt revision and 97 controls with a functional distal shunt system. The mean patient age at distal catheter revision was 12.87 ± 4.59 years, and the mean patient age of the control group was 12.81 ± 4.59 years. The most common etiology was premature intraventricular hemorrhage (32%). Of the distal failures, 41.2% had fully impregnated barium catheters, while 58.8% had striped barium catheters. Of the control group, 76/97 (78%) patients had barium-striped distal shunt catheters and 21/97 (22%) had fully impregnated catheters. Logistic regression analysis showed that fully impregnated catheters were more likely than striped barium to fail, p = 0.004 (OR = 2.54, 95% CI 1.35–4.77). Conclusion: In a matched case–control format, odds of failure of fully impregnated distal catheters were 2.54 greater than striped barium catheters. [ABSTRACT FROM AUTHOR]

Introduction: Endoscopic Third Ventriculostomy (ETV) is a well-established treatment for pediatric hydrocephalus, particularly in cases of aqueductal stenosis. The ETV Success Score (ETVSS) is a predictive tool widely used to estimate the likelihood of ETV success based on factors like age. Its accuracy, especially in infants under 3 months, is still debated. Patients and methods: This study evaluates the age-dependency of ETV success in 54 pediatric patients compared to ETVSS predictions. Patients were divided into age and pathology groups according to Kulkarni. Success was defined according the ETVSS criteria. Minimum follow-up was 12 months and included MRI to demonstrate a flow void at the floor or the third ventricle. Results: Our institutional data revealed a higher overall success rate SR (88%) compared to the ETVSS-predicted rate of 73%. Despite small numbers within subgroups, especially in very young children < 1 month, the success rate was higher than predicted by ETVSS. Discussion: Our results show significantly higher actual SR across all age groups compared to ETVSS predictions (p = 0.035) when selected and performed by an experienced physician. The age groups > 1 year had significantly higher SR close to 100% (p < 0.0001 and p = 0.0038, respectively). This suggests that ETV may be underutilized, particularly in infants, where predicted success rates are pessimistic. Conclusion: ETVSS is a useful tool for counseling of parents, but differences in institution-specific outcomes should not be neglected. Depending on that, physicians might opt in favor of ETV as primary treatment in occlusive hydrocephalus of very young children, counterbalancing risks and sequalae of VP-shunting. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to evaluate the effectiveness of two prophylactic strategies in preventing shunt infections in pediatric patients undergoing ventriculoperitoneal shunt surgery. Methods: This retrospective study included pediatric patients who underwent ventriculoperitoneal shunt surgery between 2017 and 2024. Patients were divided into two groups based on the prophylactic method used: Group 1 (VS) where the shunt was washed with vancomycin solution before placement, and Group 2 (TVP) where vancomycin powder was applied to the subgaleal and subcutaneous tissues after shunt placement. Data collected included age, gender, preoperative CRP values, operation length, hospitalization duration, wound site problems, and rates of early (within 3 days) and late (within 36 months) postoperative infections and shunt revisions. Results: Data from 56 pediatric patients were analyzed. The TVP group had significantly lower rates of early postoperative infections compared to the VS group (3.3% vs. 26.9%, p < 0.05). Late postoperative infections were also lower in the TVP group (3.3% vs. 30.7%, p < 0.05). Shunt revision was required in 26.9% of patients in the VS group, but none in the TVP group (p < 0.05). Wound site problems were a critical factor, with all patients experiencing wound site infections also developing early postoperative infections (p < 0.05). Conclusion: The use of subgaleal topical vancomycin powder is a promising prophylactic method in ventriculoperitoneal shunt surgery, particularly for pediatric patients who are prone to skin problems, as it effectively avoids systemic toxic effects while reducing infection rates and the need for shunt revisions. [ABSTRACT FROM AUTHOR]

Introduction: Idiopathic intracranial hypertension (IIH) is a rare clinical entity in the paediatric population. Clinical presentation is mostly similar to adult counterpart and can include headaches, vomiting, papilloedema, deterioration in visual acuity or fields, and 6th cranial nerve palsy, leading to significant morbidity. Therapeutic lumbar puncture and medical treatment with acetazolamide are usually the first-line treatments. In a minority of refractory cases, particularly where visual function is threatened, CSF diversion has been traditionally used in clinical practice. CSF diversion in IIH patients can be associated with high rate of shunt malfunction and revision due to small ventricular size leading to repeated procedures. We describe our experience with cranial vault expansion as a method of treatment of paediatric IIH cases refractory to medical treatment as a CSF diversion sparing method. Methods: Following review of IIH cases undergoing surgical treatment in our unit over 15 years (years 2009–2024), cases receiving cranial vault expansion as primary surgical treatment were selected and further analysed. Inclusion criteria were paediatric cases (age < 16) undergoing vault expansion as first surgical treatment for IIH refractory to pharmacological treatment for vision-threatening papilloedema. All cases were discussed within multidisciplinary meeting and selected following consideration of all management options. Results: Over the studied period, we identified two cases of refractory IIH with severe papilloedema undergoing cranial vault expansion as primary shunt-sparing surgery. Both patients presented with symptoms of headaches, vomiting, and blurred vision with ophthalmological confirmation of severe papilloedema despite pharmacological therapy. Following multidisciplinary discussions, both underwent successful supratentorial vault expansion. Pharmacological treatment was discontinued in both cases following surgery. Evaluation at latest follow-up showed resolution of symptoms and papilloedema with no need for subsequent cerebrospinal fluid diversion at the latest follow-up. Conclusion: Cranial vault expansion is a viable and safe alternative surgical option in paediatric IIH cases refractory to medical treatment obviating the need for repeated shunt procedures. In cases with extremely small ventricles or where parental choice precludes CSF diversion, cranial vault expansion can be considered. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to evaluate the demographic, clinical, laboratory, and microbiological features of ventriculoperitoneal shunt (VPS) infections through a 13-year retrospective study. VPS bacterial agents and their antibiotic susceptibility were also investigated through the occurrence of single VPS (SVPS) and recurrent VPS (RVPS) infections. Methods: This study included 110 patients with SVPS infections and 55 patients with RVPS infections. Results: In patients who developed multiple infections, Gram-negative organisms were found to be the most predominant (60%, 54/90). The resistance rates were 85.2% for third-generation cephalosporins (3GCs), 83.3% for piperacillin–tazobactam, and 10.4% for carbapenem. Of the patients in the SVPS infection group, 49% were treated with combinations with carbapenem; of the patients in the RVPS infection group, 84.4% were treated in the same way. Central nervous system (CNS) tuberculosis as the etiology of hydrocephalus; short duration of antibiotics used for treatment; high cerebrospinal fluid (CSF) protein and blood C-reactive protein (CRP) levels; and prolonged use of prophylactic antibiotics were found to be related to an increased rate of recurrent infection occurrence. A two-stage shunt change approach decreased the risk of recurrent infections. Conclusions: Based on the findings of our study, it is essential to closely monitor patients with independent risk factors for RVPS infection development, due to the high rates of resistant Gram-negative bacterial growth and the initiation of empirical antimicrobial treatment with glycopeptide plus carbapenem. Certain treatment options, such as 3GCs plus glycopeptide, should be revised based on clinical progress and microbiological culture results. [ABSTRACT FROM AUTHOR]

Aim Methods Results Conclusion Hydrocephalus surgery with a ventriculoperitoneal shunt is a life‐saving treatment, but it has been associated with a high risk of dysfunction and complications. We investigated whether infants who received a ventriculoperitoneal shunt below 12 months of age had a reduced risk of acute shunt dysfunction if they were included in a structured follow‐up programme.A population‐based, retrospective chart review was performed at Uppsala University Children's Hospital, Sweden. Patients were identified by International Classification of Diseases, Tenth Revision codes and surgical codes from 1 January 2005 to 31 December 2019. Those who received the structured follow‐up programme from April 2012 were compared with historical controls.We identified 95 patients (66% male): 47 in the follow‐up group and 48 controls. Their mean age was 2.6 (range 0–12) months. There was a high 44% acute shunt dysfunction rate during the first year after primary surgery: 38% in the follow‐up group and 50% in the control group (p = 0.25). The difference was not significant.The structured follow‐up programme was not associated with a significant reduction in acute shunt dysfunction. Predictive models could help to identify patients at risk for shunt dysfunction and complications and improve surveillance and follow‐up programmes. [ABSTRACT FROM AUTHOR]

Objective: To observe the outcome of surgical clipping in anterior circulation aneurysm in a modestly resourced hospital. Methods: A retrospective cross-sectional study was conducted at Punjab Institute of Neurosciences Lahore, from August 2022 to July 2023. Seventy five patients meeting the inclusion criteria of age <65, saccular aneurysm of anterior circulation, and Hunt and Hess grade one or two were enrolled through non-probability convenience sampling. Data were collected from patient records, and surgeries were performed by experienced neurosurgeons using pterional and sub-frontal approaches. SPSS version 26 was utilized for data analysis. Results: Mean age 49.3733 ± 2.56 (Mean ± SD) years, 60% female. Most common aneurysm location: anterior communicating artery (37.33%). Post-operative complications: vasospasm (17.33%), hydrocephalus (6.66%), fits (5.33%), mortality (2.66%). About 91% patients had no complications or recovered within three months. Conclusion: Surgical clipping of anterior circulation aneurysms is a safe and effective treatment, yielding favorable angiographic outcomes. Despite occasional complications, most patients achieved satisfactory results, especially in a setting having limited endovascular facilities or when coiling is not feasible. Future comparative studies with endovascular methods will further refine patient selection and surgical techniques. [ABSTRACT FROM AUTHOR]

Introduction: Cryptococcal meningitis (CM) combined with intracranial hypertension is associated with a poor prognosis. This study aimed to investigate the therapeutic efficacy and prognostic factors of ventriculoperitoneal (VP) shunt in non-human immunodeficiency virus (HIV) CM patients with intracranial hypertension. Methodology: A total of 136 non-HIV CM patients with intracranial hypertension treated in our hospital from July 2010 to December 2019 were retrospectively included. 57 patients underwent VP shunt placement (shunt group) and 79 patients received conservative therapy (conservative group). The clinical symptoms after treatment, cerebrospinal fluid (CSF) test results, and therapeutic outcomes were compared between the groups. Results: VP shunt significantly reduced the incidences of headache, vomiting, cranial nerve injury, intracranial pressure, and CSF leukocyte level in CM patients (all p < 0.05). The shunt group had a significantly higher curative rate, shorter seroconversion time, hospitalization time, and disease duration (all p < 0.001). However, no significant difference in the survival outcome was observed between the groups (p = 0.163). Cox proportional-hazard regression analysis showed that seroconversion time was the only independent factor associated with the survival outcome. Conclusions: Our results suggested that the VP shunt is an effective and safe treatment for non-HIV CM patients combined with intracranial hypertension. Seroconversion time was the only independent factor associated with the survival outcome. [ABSTRACT FROM AUTHOR]

Background: The accepted treatment for idiopathic normal pressure hydrocephalus (iNPH) is the insertion of a ventriculoperitoneal shunt (VPS). Recently, some studies examined endoscopic third ventriculostomy (ETV) for the treatment of iNPH with controversial results. The aim of this systematic review and meta-analysis was to compare ETV to VPS regarding complications and outcome for the treatment of iNPH. Methods: We searched Medline, Embase and Scopus. Due to the scarcity of data, we did not include only randomized controlled trials, but also retro- and prospective studies. The primary outcome was failure of cerebrospinal fluid diversion method. Secondary endpoints were clinical postoperative improvement rate, morbidity and mortality. Results: Out of 311 screened studies, three were included in the quantitative analysis including one RCT and two retrospective cohort studies. No statistically significant difference concerning failure rate of CSF diversion method (ETV 27.5% vs. VPS 33.2%, RR 1.19, 95% CI [0.69–2.04], p = 0.52) or postoperative improvement was found (68% for ETV vs. 72.8% for VPS, RR 0.81, 95% CI [0.57–1.16], p = 0.26). ETV showed a significantly lower complication rate compared to VPS (7.5% vs. 51.1%, RR 0.25, 95% CI [0.08–0.76], p = 0.02). Conclusion: ETV and VPS did not differ significantly regarding their failure rate for iNPH, while ETV showed a significantly lower complication rate than VPS. However, the data available is scarce with only one RCT investigating this important matter. Further well-designed trials are necessary to investigate the clinical outcome of ETV in iNPH. Trial registration number: PROSPERO (ID: CRD42020199173) [ABSTRACT FROM AUTHOR]

Objective Our aim was to assess the efficacy of ventriculoperitoneal shunt (VPS) for treating postoperative central nervous system infection (PCNSI) complicated with hydrocephalus and to identify factors associated with treatment failure. Materials and Methods We conducted a retrospective analysis of PCNSI patients with hydrocephalus treated by VPS at the Department of Neurosurgery, the First Affiliated Hospital, College of Medicine, Zhejiang University, between December 2012 and January 2020. Functional recovery was evaluated during follow-up using the Glasgow Outcome Scale. Results A total of 29 patients (21 males, 8 females) were enrolled in the study (mean age: 56.4 ± 12.0 years, range: 18.0–77.0 years). Seventeen patients were treated successfully by VPS (58.6%). Among the 11 patients with shunt complications (37.9%), 8 (27.6%) presented with fever, 3 (10.3%) with shunt infection, and 3 (10.3%) with shunt obstruction. Univariate analysis identified low Glasgow Coma Scale (GCS) score (3–8) at the time of VPS and post-treatment fever as predictive of shunt failure. Conclusion VPS was effective for treating PCNSI complicated with hydrocephalus. However, patients with low GCS score at the time of VPS or fever post-treatment were at greater risk of shunt failure and poor outcome. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the safety study of percutaneous gastroscopic gastrostomy in patients after ventriculoperitoneal shunt. Methods: We conducted a retrospective analysis of neurosurgical patients who underwent VPS and PEG at our hospital between January 2012 and November 2023. Patients were divided into 2 groups: VPS group and VPS followed by PEG gruop. Patients received routine antibiotic prophylaxis before the procedure, continued for 48 hours. Follow-up included monitoring immediate complications, particularly wound infection, intracranial infection, neurologic status deterioration, and shunt dysfunction. Routine follow-up visits were conducted post-discharge. Results: In the VPS group (n = 778), the incidence of intracranial infection was 3.08%. Among patients with PEG after VPS, the time interval between procedures ranged from 13 to 685 days. The mean follow-up period was 22 (1-77) months, with no deaths or further complications. Conclusion: Performing PEG more than 13 days after VPS does not significantly increase the risk of intracranial infections or PEG-associated infections, making it a relatively safe procedure. [ABSTRACT FROM AUTHOR]

Hydrocephalus is a common diagnosis worldwide that is treated with shunts and is associated with potential life-threatening risks of shunt dysfunction and infection. We investigated differences in rates of shunt revisions and infections including various factors in patients with different causes of hydrocephalus. We also studied causes of infections and efficacy of perioperative antibiotic regimens. Our objective was to identify patients at risk of higher revision and infection rates after shunt treatment. We conducted a retrospective single-center cohort study including 728 adult patients who underwent shunt surgery between 2013 and 2019 at our center. Overall revision rate was 20.1%, and infection rate was 4.8%. Infection was detected in 24% of all revisions. The main location for a positive culture was cerebrospinal fluid (67.5%), frequently caused by Cutibacterium acnes (60%). Younger age and prior shunts were the only predictors confirmed in multivariate Cox regression as significantly increasing the risk of revision surgery. Multivariate Cox regression analysis of infection risk factors showed that obstructive hydrocephalus, prior shunt, and cloxacillin significantly increased risk of shunt infection. We found revision and infection rates in accordance with other studies. We showed a significantly increased risk in younger patients. Previous shunts also increased the risk of revisions and infections. We showed a small but significant effect of perioperative prophylaxis with broader-spectrum antibiotics compared with cloxacillin. Our study identified a group of younger patients with congenital hydrocephalus and prior implants with an increased risk of shunt infection in whom additional preventive measures should be employed. [ABSTRACT FROM AUTHOR]

Purpose: Ventriculoperitoneal shunt (VPS) insertion is the gold standard treatment for congenital hydrocephalus, but there is little data about the cost of this procedure in developing countries. We aimed to determine the in-hospitalization cost of initial VPS insertion and its complications (malfunction and infection) and identify predictors of increased cost. Methods: We performed a retrospective cohort study by reviewing the medical and financial records of pediatric patients with congenital hydrocephalus and underwent shunt surgery at our institution between 2015 and 2019. We also performed multivariable linear regression analysis to determine clinical characteristics that were predictive of cost. Results: A total of 230 cerebrospinal fluid diversion procedures were performed on 125 patients. The mean age during index VPS insertion was 9.8 months (range: 7 days–8 years). Over a median follow-up of 222 days, 15 patients (12%) developed shunt malfunction while 25 (20%) had a shunt infection. The mean in-hospitalization cost for all patients was PHP 94,573.50 (USD 1815). The predictors of higher cost included shunt infection (p < 0.001), shunt malfunction (p < 0.001), pneumonia (p = 0.006), sepsis (p = 0.004), and length of hospital stay (p = 0.005). Patients complicated by shunt infection had a higher mean cost (PHP 282,631.60; USD 5425) than uncomplicated patients (PHP 40,587.20 or USD 779; p < 0.001) and patients who had shunt malfunction (PHP 87,065.70 or USD 1671; p < 0.001). Conclusion: The study provided current data on the in-hospitalization cost of VPS insertion in a public tertiary hospital in a developing country. Shunt infection, malfunction, pneumonia, sepsis, and length of hospital stay were significant predictors of cost. [ABSTRACT FROM AUTHOR]

Introduction: To evaluate the demographic, clinical, diagnostic, and treatment data of pediatric patients with ventriculoperitoneal shunt infection and risk factors for ventriculoperitoneal shunt infection and recurrence of ventriculoperitoneal shunt infection. Methods: Patients aged 0–18 years who were diagnosed with ventriculoperitoneal shunt infection at Cukurova University Faculty of Medicine Hospital between 2016 and 2021 were included in the study. Demographic, clinical, laboratory, and treatment data of the patients were evaluated retrospectively. Risk factors for the development and recurrence of ventriculoperitoneal shunt infection were evaluated. Patients who underwent ventriculoperitoneal shunt but did not develop any shunt infection were selected as the control group. Results: Eighty-five patients with a diagnosis of ventriculoperitoneal shunt infection were included in the study. Fever (58.8%), anorexia (58.8%), vomiting (56.5%), and altered consciousness (54.1%) were the most common complaints at admission. The control group consisted of 48 patients. The number of shunt revisions was statistically significantly higher in the group that developed ventriculoperitoneal shunt infection compared to the control group (p < 0.001). In patients with ventriculoperitoneal shunt infection, C-reactive protein and cerebrospinal fluid protein values before shunt insertion were found to be statistically significantly higher than the control group (p < 0.001). Conclusion: Ventriculoperitoneal shunt infection occurs most frequently in the first months after shunt application. Therefore, it is extremely important to prevent colonization and contamination during surgery in preventing the development of ventriculoperitoneal shunt infection. In the present study, cerebrospinal fluid protein elevation and C-reactive protein elevation before shunt application were found to be significant in terms of the development and recurrence of ventriculoperitoneal shunt infection. [ABSTRACT FROM AUTHOR]

Objective To compare the clinical effect and prognosis of hydrocephalus underwent ventriculoperitoneal (VP) shunt at different time. Methods The clinical data of 130 patients with secondary hydrocephalus admitted to the Department of Neurosurgery, The First Affiliated Hospital of Nanjing Medical University from September 2022 to August 2023 were analyzed retrospectively. The improvement of Glasgow coma scale (GCS), Barthel index (BI), and mini mental state examination (MMSE) before and after surgical treatment at different times were studied. Results The GCS, BI and MMSE of all groups after VP shunt were significantly increased (P<0.05). Among them, there was no significant statistical difference in clinical effect between the 0-3 months group and the 3-6 months group, but it was better than the group above 6 months. Conclusions For the patients with secondary hydrocephalus after craniocerebral injury, cerebral hemorrhage, intracranial tumor and intracranial aneurysm surgery, the treatment of VP shunt can effectively improve the neurological function, daily living ability and intelligent mental state of the patients. The operation time should be within 6 months. [ABSTRACT FROM AUTHOR]

Ventriculoperitoneal (VP) shunts, used to treat hydrocephalus, can sometimes cause hypersensitivity reactions to silicone, necessitating repeated surgical interventions. Traditional management involves replacing silicone with alternatives like polyurethane, which have limitations. This study presents a novel approach using Teflon (PTFE) sheets to cover the silicone valve surface. A 22-year-old male with a history of multiple shunt surgeries and wound revisions was admitted for wound dehiscence, suspected to be due to a late hypersensitivity reaction to silicone. The shunt valve and cranial entry point were wrapped in Teflon PTFE felt sheets, and the wound was closed with propylene sutures. The patient was treated with methylprednisolone and discharged after three days. Follow-up showed complete wound healing within a month, and the patient remained revision-free for ten years. This case suggests that Teflon sheets may offer a promising approach for managing silicone hypersensitivity in VP shunts, though further studies are needed to determine its broader applicability. [ABSTRACT FROM AUTHOR]

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Abstract To explore techniques, advantages and disadvantages of 3D Slicer reconstruction and 3D printing localization technology combined with transcranial neuroendoscopy in ventriculoperitoneal shunt surgery. Retrospective analysis of clinical data of patients with hydrocephalus treated by ventriculoperitoneal shunt surgery using 3D Slicer reconstruction and 3D printing positioning technology combined with transcranial neuroendoscopy in our hospital from October 2021 to March 2023. A total of 33 patients with complete data were collected, including 19 males and 14 females, aged 10–81 years. Pre operative use of 3D Slicer reconstruction and 3D printing localization, and intraoperative use of neuroendoscopy assisted catheterization to complete ventriculoperitoneal shunt surgery. The drainage tube position was confirmed by brain CT and 3D Slicer reconstruction after operation, of which 30 cases were located in the frontal horn or center of the ipsilateral lateral ventricle, and 3 cases were located in the frontal horn or center of the contralateral lateral ventricle. All patients were successfully catheterized and well positioned. According to the unique ventricular system characteristics of each hydrocephalus patient, the 3D Slicer reconstruction technology was used to determine the individualized puncture point and direction, measure the puncture depth, accurately locate the puncture through the 3D printing guide plate, and accurately send the tip of the ventricular catheter into the frontal or central part of the lateral ventricle with the assistance of neuroendoscopic visualization, which improved the success rate of the operation and reduced the risk of tube blockage. At the same time, our team has newly developed a puncture point (“Cai’s point”), which has a puncture path in a non-vascular area and can reduce the risk of puncture bleeding. However, further prospective clinical research is needed to determine its routine location.

With advancements in medical devices and imaging techniques, endovascular treatment using stent grafts has emerged as a viable and aggressive therapeutic option for traumatic subclavian artery injuries, including iatrogenic cases. Existing literature suggests that endovascular treatment is less invasive and offers hemostatic success rates comparable to traditional surgical methods. However, there is a paucity of case reports, necessitating further investigation into treatment indications and procedural challenges. We report the case of a 50-year-old woman who sustained a right subclavian artery injury during ventriculoperitoneal shunt placement, a rare occurrence of iatrogenic subclavian artery injury. In our approach, we utilized both the right common femoral artery and right radial artery to attempt a pull-through technique, although this was abandoned owing to radial artery spasm. Ultimately, a stent graft was successfully implanted by traversing the injury site with a micro-guidewire via the right common femoral artery. This case highlights the feasibility of endovascular treatment, even in rare injury mechanisms, provided that thorough preoperative and intraoperative imaging evaluations are performed.

Intracranial epidermoid cyst originating from abnormal migration of neuroectodermal cells during embryogenesis. It is a slow-growing tumor commonly found in cerebellopontine angle, fourth ventricle, and sellar/parasellar region. This is a case series of five cases to know the effectiveness of Omaya in pre-operative and early post-operative period followed by ventriculoperitoneal shunt after 2 weeks. This is a prospective observational study done in premier institute of central India from April 2023 to April 2024. A total five cases of different age groups and clinical presentations are included. There is no ventriculoperitoneal shunt blockage when it was followed by early pre- and post-operative period large reservoir Omaya insertion.

Abstract Background The aim of this study was to compare the efficacy of ventriculoperitoneal shunt (VPS) and endoscopic third ventriculostomy (ETV) for the treatment of hydrocephalus after thalamic hemorrhage (TH) where external ventricular drainage (EVD) could not be removed after hematoma absorption, and to provide a theoretical basis for the clinical treatment of hydrocephalus after TH. Methods The clinical data of patients with hydrocephalus after TH whose EVD could not be removed after hematoma absorption were retrospectively analyzed. According to the patients’ surgical methods, the patients were divided into the VPS group and ETV group. The operative time, length of hospital stay, complications, and reoperation rates of the two groups were compared. Results There was no statistically significant difference in intraoperative bleeding, length of hospital stay between the two groups. The EVD tubes were successfully removed in all patients after surgery. There were 4 (9.5%) complications in the ETV group and 3 (6.7%) complications in the VPS group, with no statistically significant difference in postoperative complications between the two groups. During the 1-year follow-up, 7 patients (16.7%) in the ETV group and 3 patients (6.7%) in the VPS group required reoperation. In the subgroup analysis of TH combined with fourth ventricular hemorrhage, 6 patients (14.3%) in the ETV group and 1 patient (2.2%) in the VPS group required reoperation, and the difference between the two groups was statistically significant. Conclusions ETV had good efficacy in treating hydrocephalus caused by TH and TH that broke into the lateral ventricle and the third ventricle. However, if hydrocephalus was caused by TH with the fourth ventricular hematoma, VPS was a better surgical method because the recurrence rate of hydrocephalus in ETV was higher than that in VPS. Therefore, the choice of surgical method should be based on the patient’s clinical features and hematoma location.

Abstract Background Tuberculous peritonitis often presents with nonspecific symptoms that can lead to diagnostic challenges, particularly when manifesting as peritoneal pseudocysts. This study highlights the clinical complexity and diagnostic approach of tuberculous peritonitis presented as a pseudocyst in an immunocompetent adult, an atypical scenario that is rarely documented. Case presentation We report a detailed case of a 41-year-old man presenting with abdominal distension, pain, and significant weight loss over four months. Abdominal CT showed a peritoneal pseudocyst, initially misdiagnosed due to its resemblance to more common abdominal pathologies. The diagnosis of tuberculous peritonitis was confirmed through histopathological analysis. Additionally, a systematic literature review was conducted to identify and analyse similar cases, focusing on clinical presentations, diagnostic methods, and patient outcomes. Our patient exhibited classic symptoms of abdominal TB but was unique due to the absence of prior ventriculoperitoneal shunting, a common factor in similar cases. Our literature review found that such presentations typically result in diagnostic delays averaging five months, complicating patient management and outcomes. This review also underscores the importance of considering tuberculosis in the differential diagnosis of peritoneal pseudocysts, particularly in TB-endemic regions. Conclusion This case and review emphasize the need for high clinical suspicion and prompt investigation of tuberculosis in patients presenting with atypical abdominal symptoms and pseudocysts. Improved diagnostic strategies, including early use of imaging and pathological evaluations, are essential for timely diagnosis and management, thereby improving patient outcomes in suspected cases of extrapulmonary tuberculosis.

Objective: Cerebrospinal fluid (CSF) shunting has become the standard treatment for idiopathic normal pressure hydrocephalus (NPH). Nevertheless, there is still disagreement on diagnostic criteria for selecting patients for surgery and optimal shunt management. The primary aim of the present study was to provide an update on the status of best practice, the use of different diagnostic algorithms and therapeutic management of idiopathic NPH in an European country. Methods : A standardized questionnaire with sections on the assessment of clinical symptoms and signs of NPH, diagnostic work-up, therapeutic decision making, and operative techniques was sent to 135 neurosurgical clinics in Germany that regularly perform shunt surgeries. Results: Overall, responses were received from 114/135 (84.4%) clinics. Most responders considered gait disturbance to be the hallmark clinical sign of idiopathic NPH (96%). A lumbar tap test was utilized always/ mostly by 97 centers (86%). In 43% of the centers, 30–40 ml CSF were removed with the spinal tap test. Spinal dynamic CSF studies were used by 12 centers only occasionally, and only by 1 center always for diagnostic purposes. Ventriculo-peritoneal shunting was the most frequent type of CSF diversion (> 90%). Pressure-controlled valves were used by the majority of units (95%) Overall 102 centers (93%) always/mostly used adjustable valves, and antisiphon devices were used always/ mostly in 50% of units. Conclusion: The present survey demonstrates that there has been a remarkable change of practice and opinions on the diagnosis and treatment of idiopathic NPH over the past two decades in Germany. Remarkably, variabilities in practice among different centers are less common than previously and recommendations according to scientific publications and guidelines have been implemented more readily. [ABSTRACT FROM AUTHOR]

Follow-up of previously healthy patients surviving cryptococcal meningitis found that cryptococcal antigen could be detected for >1 year in serum from 38 of 44 (86%) patients and in cerebrospinal fluid (CSF) from 20 of 31 patients (67%), far beyond the time of culture conversion. The speed of titer decline, measured as the number of days for a 2-fold drop in titer to occur, was slower in serum than in CSF. The speed of decline of antigen titers was much slower in serum and CSF for patients infected with Cryptococcus gattii than Cryptococcus neoformans. The speed of decline in CSF and serum titers was also much slower in patients who had received a ventriculoperitoneal shunt for increased intracranial pressure. The variable and extraordinarily slow rate of clearance in our patients did not appear to reflect differences in disease control but rather differences in species and shunting for increased intracranial pressure. [ABSTRACT FROM AUTHOR]

Intracranial epidermoid cyst originating from abnormal migration of neuroectodermal cells during embryogenesis. It is a slow-growing tumor commonly found in cerebellopontine angle, fourth ventricle, and sellar/parasellar region. This is a case series of five cases to know the effectiveness of Omaya in pre-operative and early post-operative period followed by ventriculoperitoneal shunt after 2 weeks. This is a prospective observational study done in premier institute of central India from April 2023 to April 2024. A total five cases of different age groups and clinical presentations are included. There is no ventriculoperitoneal shunt blockage when it was followed by early pre- and post-operative period large reservoir Omaya insertion. [ABSTRACT FROM AUTHOR]

Germinomas frequently cause hydrocephalus, and ventriculoperitoneal shunts (VPS) have been commonly used for their management. Although VPS can potentially serve as a route for peritoneal dissemination of germinomas, the abdominal imaging characteristics of this rare yet important complication remain unknown. In this article, we report the computed tomography imaging findings of diffuse peritoneal dissemination of intracranial germinoma. [ABSTRACT FROM AUTHOR]

Idiopathic normal pressure hydrocephalus (iNPH) is a disease characterized by gait disturbance, cognitive impairment, and urinary incontinence. For those patients who do not respond to shunt surgery, it lacks objective radiologic findings for the diagnosis of shunt malfunction. Here we aimed to evaluate whether the Evans index and callosal angle change during a prospective long-term follow-up of patients with iNPH submitted to shunt surgery. Clinical (NPH Japanese Scale) and radiologic (Evans index and callosal angle) data were collected pre- and postoperatively (3, 6, 12 and months) in 19 patients with iNPH. Imaging tests were evaluated by the same neuroradiologist during the follow-up. Patients had lower scores on the NPH Japanese Scale over time (P < 0.001). There was no significant difference among Evans index values during the follow-up (P = 0.24). Preoperative average callosal angle was 72 ± 15, which increased to 91 ± 18 in 6 months (P = 0.003). In this sample, patients with iNPH submitted to a programmable valve shunt had an increase in callosal angle concomitant to neurologic improvement. The Evans index did not change during follow-up. [ABSTRACT FROM AUTHOR]

Idiopathic normal pressure hydrocephalus (iNPH) typically presents with gait disturbances, cognitive decline, and urinary incontinence. Symptomatic improvement generally occurs following shunt placement, but limited evidence exists on the quality of life (QOL) metrics in iNPH. Therefore, we conducted a prospective study of the effect of shunt placement on QOL in iNPH patients, using Quality of Life in Neurologic Disorders (Neuro-QOL) metrics. Eligible patients underwent shunt placement after evidence of symptomatic improvement following temporary cerebrospinal fluid diversion via inpatient lumbar drain trial. Patients were administered short- and long-form Neuro-QOL assessments prior to shunt placement and at 6-month and 1-year postoperative timepoints to evaluate lower extremity mobility, cognitive function, and social roles and activities participation. Changes in QOL measures were analyzed using a repeated-measures linear mixed effects model. There were 48 patients with a mean age of 75.4 ± 6.3 years. Average short-form mobility scores improved by 3.9 points (14.6%) at 6-month follow-up and by 6.2 points (23.2%) at 1-year follow-up compared with preoperative baseline (P = 0.027 and P = 0.0002, respectively). Short-form cognition scores increased by 5.2 points (22.4%) at 6 months and 10.9 points (47.0%) at 1 year postoperatively (P = 0.007 and P < 0.0001, respectively). On long-form assessment, social roles and activity participation scores improved by 29.3 points (23.4%) at 6 months and 31.6 points (25.2%) at 1 year after surgery compared to baseline (P = 0.028 and P = 0.02, respectively). Our findings demonstrate that shunt placement leads to improved QOL in iNPH patients across multiple domains. Significant improvements in mobility, cognition, and social roles and activity participation are realized within the first 6 months and are sustained on 1-year follow-up. [ABSTRACT FROM AUTHOR]

Further study is needed to determine the safest mode of delivery and anesthetic management for parturients with ventriculoperitoneal shunts (VP). Prior recommendation for delivery in women with ventriculoperitoneal shunts was cesarean delivery. However, both vaginal delivery and neuraxial anesthesia have been shown to be safe in women with appropriately functioning VP shunts. We present a case series of parturients with VP shunt. Parturients with VP shunts were identified and VP shunt placement indications, neurologic symptoms during pregnancy, delivery mode, anesthetic type, and postpartum complications were reviewed. Forty patients were identified, and fifteen women with twenty deliveries were included. Two women experienced neurological symptoms during pregnancy and one required postpartum shunt revision for blurry vision and ataxia. There were ten cesarean deliveries and ten vaginal deliveries (eight normal spontaneous, one vacuum assisted, and one forceps assisted). Assisted vaginal deliveries were performed to decrease Valsalva including the patient with neurological symptoms related to shunt malfunction. Of the vaginal deliveries, six (60%) had epidural analgesia. Anesthesia for cesarean delivery included neuraxial anesthesia (n = 5) and general anesthesia (n = 5). In our cohort, women with VP shunt received neuraxial blockade without complication. Neuraxial techniques should be offered to women with appropriately functioning VP shunt. [ABSTRACT FROM AUTHOR]

Infantile hydrocephalus considerably impacts neurodevelopment, warranting attention to potential long-term consequences on visuomotor functions. The current study investigated the impact of infantile hydrocephalus on functional connectivity within the posterior cortex. Fourteen patients, who were treated for infantile hydrocephalus, were matched for age and sex with 14 typically-developing controls. Both groups had a mean age of 9 years old. Resting-state functional MRI was used to conduct a functional connectivity analysis within the visuomotor integration network, including the inferior frontal occipital fasciculus, superior longitudinal fasciculus, and frontal aslant tract. Patients had reduced functional connectivity in visuomotor pathways compared to typically-developing children with notable impact on the left and right fusiform gyrus and precuneus. Children with infantile hydrocephalus also performed significantly lower in tasks involving visuomotor integration, visual processing, visuospatial skills, motor coordination, and fine motor manipulation. This study enhances our understanding of the multifaceted impact of infantile hydrocephalus on both neural connectivity and considering behavioral outcomes. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to compare the efficacy of ventriculoperitoneal shunt (VPS) and endoscopic third ventriculostomy (ETV) for the treatment of hydrocephalus after thalamic hemorrhage (TH) where external ventricular drainage (EVD) could not be removed after hematoma absorption, and to provide a theoretical basis for the clinical treatment of hydrocephalus after TH. Methods: The clinical data of patients with hydrocephalus after TH whose EVD could not be removed after hematoma absorption were retrospectively analyzed. According to the patients' surgical methods, the patients were divided into the VPS group and ETV group. The operative time, length of hospital stay, complications, and reoperation rates of the two groups were compared. Results: There was no statistically significant difference in intraoperative bleeding, length of hospital stay between the two groups. The EVD tubes were successfully removed in all patients after surgery. There were 4 (9.5%) complications in the ETV group and 3 (6.7%) complications in the VPS group, with no statistically significant difference in postoperative complications between the two groups. During the 1-year follow-up, 7 patients (16.7%) in the ETV group and 3 patients (6.7%) in the VPS group required reoperation. In the subgroup analysis of TH combined with fourth ventricular hemorrhage, 6 patients (14.3%) in the ETV group and 1 patient (2.2%) in the VPS group required reoperation, and the difference between the two groups was statistically significant. Conclusions: ETV had good efficacy in treating hydrocephalus caused by TH and TH that broke into the lateral ventricle and the third ventricle. However, if hydrocephalus was caused by TH with the fourth ventricular hematoma, VPS was a better surgical method because the recurrence rate of hydrocephalus in ETV was higher than that in VPS. Therefore, the choice of surgical method should be based on the patient's clinical features and hematoma location. [ABSTRACT FROM AUTHOR]

Objective: The ventriculoperitoneal shunt (VPS) is an established approach in treating normal pressure hydrocephalus (NPH). This study aims to examine the long-term effects of VPS regarding clinical and radiological outcomes, to explore interdependencies with comorbidities and medication, and to determine a suitable opening pressure of the programmable valve. Methods: 127 patients with VPS were retrospectively evaluated. The Hakim triad along with Evans index (EI) and callosal angle (CA) were examined preoperatively and postoperatively at various time points up to over thirty-six months. Preexisting comorbidities and medication were considered. Adjustments to valve settings were documented along with symptom development and complications. Wilcoxon and paired-sample t-tests were used to analyze postoperative change. Chi-square, Eta-squared, and Pearson coefficients were used in correlation analyses. Results: Relief from individual symptoms was most prominent within the first 6 months (p < 0.01). EI and CA significantly decreased and increased, respectively (p < 0.05). Postoperative clinical and radiological improvement was largely maintained over the follow-up period. Diabetes mellitus and apoplexy correlated with surgical outcomes (p < 0.05). The median opening pressure as a function of overall symptom management was determined to be 120 mmH2O for women and 140 mmH2O for men. Conclusion: VPS is effective in treating NPH with respect to both clinical and radiological outcomes, although these two components are independent of each other. Improvement is most pronounced in short-term and maintained in the long-term. Comorbidities have significant influence on the course of NPH. The valve setting does not forecast change in radiological findings; consequently, priority should be placed on the patient's clinical condition. [ABSTRACT FROM AUTHOR]

The use of the peritoneal cavity for cerebrospinal fluid (CSF) absorption was introduced in 1905. Since then, the ventriculoperitoneal shunt has been one of the most commonly performed surgeries to treat hydrocephalus. Abdominal pseudocysts are relatively rare abdominal complications due to the insertion of a ventriculoperitoneal shunt. Their incidence varied between 0.33 and 6.8%. We report a young boy with a history of hydrocephalus treated by ventriculoperitoneal shunt he admitted to our department presenting with abdominal pseudocyst revealed by abdominal pain and headache. He underwent surgery, where shunt was externalized and the pseudocyst was excision. The shunt was reinserted after the infection was eradicated in the atrium. [ABSTRACT FROM AUTHOR]

Pediatric hydrocephalus is a significant health burden globally, particularly in low- and middle-income countries. Data from specific regions such as KwaZulu-Natal, South Africa, are lacking. This study aimed to investigate pediatric hydrocephalus by comparing 4 distinct 5-year periods. Data were collected retrospectively (2003–2007, 2008–2012, and 2013–2017) and prospectively (2018–2022). Children (≤18 years old) treated for hydrocephalus were included. Data on demographics, referral patterns, etiology, treatment modalities, and outcomes were collected and analyzed. A total of 3325 children were treated. The peak period was 2008–2012 (35.3%). Most children (51.4%) were from rural areas (P = 0.013), and 47.9% were referred from regional hospitals (P < 0.001). Boys (56.4%) and infants (60.2%) were predominant groups (P < 0.001). Postinfectious etiology (32.7%) was predominant (P < 0.001), particularly tuberculous meningitis (54.1%). Ventriculoperitoneal shunts were the mainstay treatment (84.2%), with notable complication rates (20.4%), including infections (9.6%). Human immunodeficiency virus co-infection was diagnosed in 2.5% of cases. Weekend procedures were associated with ventriculoperitoneal shunt complications (hazard ratio [HR] = 1.3, 95% confidence [CI]1.03–1.66, P = 0.03). Mortality rate was 7.9%, and age ≥1 year (HR = 2.43, 95% CI 1.87–3.17, P < 0.001), tertiary hospital referral (HR = 1.48, 95% CI 1.06–2.04, P = 0.019), ventriculoperitoneal shunt infection (HR = 3.63, 95% CI 2.66–4.95, P < 0.001), acute abdomen (HR = 2.17, 95% CI 1.11–4.25, P = 0.024), and pneumonia (HR = 7.32, odds ratio = 4.84–11.06, P < 0.001) were associated with mortality. This study provides comprehensive insights into pediatric hydrocephalus in KwaZulu-Natal. Monitoring temporal trends and predictors of outcomes will guide future interventions to mitigate the burden of pediatric hydrocephalus in the region. [ABSTRACT FROM AUTHOR]

Hydrocephalus, a major complication in tuberculous meningitis (TBM) patients, often necessitates treatment via ventriculoperitoneal shunt (VPS). However, post-VPS, some patients develop a complication called contralateral isolated lateral ventricle (CILV), leading to persistent hydrocephalus symptoms. This study aims to evaluate cerebrospinal fluid (CSF) parameters in predicting CILV occurrence post-VPS in adult TBM patients. A retrospective analysis was conducted, focusing on the relationship between preoperative CSF parameters and the development of CILV in 40 adult TBM patients who underwent VPS. The study compared CSF parameters from lumbar puncture after admission with those from ventricular CSF post-external ventricular drainage tube insertion. CILV was observed in 6 of the 40 patients following VPS. Statistical analysis showed no significant difference between the CSF parameters obtained via lumbar and ventricular punctures. Notably, the mean CSF glucose level in patients with CILV was significantly lower (1.92 mmol/L) compared to the non-CILV group (3.03 mmol/L). Conversely, the median adenosine deaminase (ADA) level in the CILV group was higher (5.69 U/L) compared to the non-CILV group (3.18 U/L). The optimal cutoff values for CSF glucose and ADA levels were 1.90 mmol/L and 4.80 U/L, respectively, with a sensitivity of 66.67% and 83.33% and a specificity of 88.24% and 79.41%. The study identified elevated ADA levels and decreased glucose levels in CSF as potential risk factors for CILV development in adult TBM patients post-VPS. These findings suggest the necessity for more tailored surgical approaches, in patients with altered CSF parameters to mitigate the risk of CILV. [ABSTRACT FROM AUTHOR]

Introduction: Chronic subdural hematoma (CSDH) often occurs 3 weeks to 3 months after brain injury, which is mainly caused by bleeding of the bridging vein. For patients with ventriculoperitoneal (V-P) shunt, excessive drainage can also cause CSDH. We present a rare case of CSDH caused by shunt valve breakdown in brain injury. Case Report: We report a 68-year-old man with V-P shunt for 8 years. He presented with bilateral CSDH with disappearance of lateral ventricles nearly 1 month after a brain injury caused by being hit with a stick. After burr hole drainage (BHD), the patient's symptoms improved and lateral ventricles reappeared, but disappeared rapidly with CSDH recurrence within a short time. We considered the cause to be medium pressure shunt valve breakdown caused by hitting with a stick, which was confirmed by the engineer's test after the operation and excessive drainage of cerebrospinal fluid. BHD replaced the adjustable pressure shunt valve, and the patient recovered. Conclusion: V-P shunt is a common operation in neurosurgery, and postoperative shunt valve breakdown may lead to poor outcome. We report a rare case of CSDH caused by shunt valve breakdown due to excessive external forces, suggesting that patients after V-P shunt should pay attention to the protection of the shunt valve. [ABSTRACT FROM AUTHOR]

The objective of this pilot study was to assess the reliability of superb microvascular ultrasound (SMI) for the measurement of the cerebrospinal fluid (CSF) flow within VPS systems as an indirect sign for shunt dysfunction. Asymptomatic hydrocephalus patients, with a VPS system implanted between 2017 and 2021, were prospectively enrolled in the study. Using SMI, the CSF flow within the proximal and distal catheters were analysed. Before and after pumping the shunt reservoir, intraabdominal free fluid, optical nerve sheath diameter (ONSD), and papilla diameter (PD) were evaluated and correlated with the amount of valve activation. Nineteen patients were included. A flow was detectable in 100% (N = 19) patients in the proximal and in 89.5% (N = 17) in the distal catheter. The distal catheter tip was detectable in 27.7% (N = 5) patients. Free intraabdominal fluid was initially detected in 21.4% (N = 4) patients and in 57.9% (N = 11) at the end of the examination (P = 0.049). ONSD was significantly lower after pump activation (4.4 ± 0.9 mm versus 4.1 ± 0.8 mm, P = 0.049). Both peak velocity and flow volume per second were higher in proximal compared to distal catheters (32.2 ± 45.2 versus 5.6 ± 3.7 cm/sec, P = 0.015; 16.6 ± 9.5 ml/sec versus 5.1 ± 4.0 ml/sec, P = 0.001, respectively). No correlation was found between the number of pump activations and the changes in ONSD (P = 0.975) or PD (P = 0.820). SMI appears to be a very promising non-invasive diagnostic tool to assess CSF flow within the VPS systems and therefore affirm their function. Furthermore, appearance of free intraperitoneal fluid followed by repeated compression of a shunt reservoir indicates an intact functioning shunt system. [ABSTRACT FROM AUTHOR]