Factors influencing shunt malfunction in patients with tuberculous meningitis (original) (raw)
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Asian journal of neurosurgery
The objective of this study was to compare safety and efficacy of endoscopic third ventriculostomy (ETV) versus ventriculoperitoneal (VP) shunt in the treatment of hydrocephalus in tuberculous meningitis (TBM) and to assess clinical and radiological profiles of patients with TBM that would be better suited to either VP shunt or ETV. This study was a single-center randomized prospective study on 52 patients with TBM hydrocephalus in the pediatric age group (<18 years of age). Patients included in the study were randomized into undergo either VP shunt or ETV. Both groups were followed up for a minimum of 5 months and assessed for success and failure rates as well as procedural complications and neurologic sequelae. Twenty-six patients underwent ETV with a success rate of 65.4% with six of nine failures occurring within the first 16 days after surgery (median time to failure - 3 days). In the VP shunt group, there was a success rate of 61.54% and a median time to failure of 50 days....
Shunting in tuberculous meningitis: a neurosurgeon's nightmare
Child's Nervous System, 2008
Objective In a developing country like India, tuberculosis is very common in spite of a mass vaccination programme. Meningitis, progressive arteritis, adhesive arachnoiditis and tuberculomas represent the wide spectrum of this potentially lethal disease. Hydrocephalus occurs in about one third of the patients with central nervous system tuberculosis. Majority of patients have large fourth ventricles with adhesive obstructions in the basal cerebrospinal fluid (CSF) cisterns. Aggressive CSF diversion does not always alter the course of the disease. Endoscopic procedures are rarely, if ever, successful. Ventriculo-peritoneal shunting is fraught with complications like high rate of infection and shunt tube blockage. So there is clearly a need to explore methods of CSF diversion. Methods In our series of 32 patients, we present the indications, prognostic indicators and types of shunt with the clinical outcome of childhood tuberculous meningitis. Conclusions Even though the results are far from satisfactory, early shunting still remains the best option to prevent long-term neurological sequelae.
Clinical Chronicle: The Use of Ventriculo-Atrial Shunt in Tuberculous Hydrocephalus Treatment
Indonesian Journal of Case Reports, 2023
Tuberculous meningitis (TBM) is the predominant bacterial meningitis form in children under 13, with an incidence of 8.6 per 100,000 before age 15. Tuberculous Hydrocephalus (TH), often presenting with hydrocephalus, poses a significant challenge in Indonesia for both children and adults. The commonly used Ventriculo-peritoneal (VP)-shunt procedure for TH, though prevalent, is associated with multiple complications. As an alternative, the Ventriculo-atrial (VA)-shunt procedure has been explored, but reports on its use in TH in Indonesia are lacking. This case report details a 1-year-old girl with TH who initially underwent a VP-shunt procedure, which proved unsuccessful. Subsequently, the VAshunt procedure was employed, leading to a complete recovery. Our findings contribute valuable insights into the potential effectiveness of the VA-shunt as an alternative intervention for TH, especially in the Indonesian medical landscape.
A study of VP shunt in management of hydrocephalus
International Surgery Journal, 2017
Background: Hydrocephalus a neurological disorder common in both children and adults. VP shunt placement is considered the mainstay of management. The aim was to study complications of VP Shunt and factors influencing shunt malfunction and prognosis.Methods: This study was conducted in the Department of Surgery, Gandhi Medical College Bhopal, Madhya Pradesh, India between January 2013 to August 2016 and included all patients of hydrocephalus who underwent VP shunt surgery. We performed a retrospective and prospective data review which was subjected to statistical analysis, frequency determination, determination of mean and standard deviation, Pearson’s Chi-square test for studying associations between variables.Results: A total of 198 patients were studied. The predominant etiologies being congenital hydrocephalus, aqueduct stenosis, spina bifida/MMC, intracranial space occupying lesions and tuberculous meningitis. The incidence of overall shunt complications was 28.8%, incidence of...
Endoscopic third ventriculostomy for chronic hydrocephalus after tuberculous meningitis
Surgical Neurology, 2005
Background: Cerebrospinal fluid diversion procedures are indicated in patients with hydrocephalus after tuberculous meningitis (TBM). We present 2 patients with hydrocephalus after TBM who were successfully treated with endoscopic third ventriculostomy (ETV). Methods: Two patients had been diagnosed with hydrocephalus after TBM and had undergone ventriculoperitoneal shunt surgery for the same. They presented with multiple episodes of shunt dysfunction. Endoscopic third ventriculostomy was performed (twice for one patient), and the patients were evaluated clinically and radiologically after the procedure. Results: On long-term clinical follow-up (3 and 2 years, respectively), both patients were asymptomatic after the ETV. The first patient was radiologically evaluated 7 months after the procedure and the second patient 2 years after the procedure. The first patient showed a decrease in ventricular size. The second patient did not show any significant change in the ventricular size. Conclusion: Endoscopic third ventriculostomy can be considered as a safe and long-lasting solution for hydrocephalus after chronic TBM. D
Role of endoscopic third ventriculostomy in tuberculous meningitis with hydrocephalus
Asian Journal of Neurosurgery, 2014
alternative to shunt procedures is an established treatment for obstructive hydrocephalus in TBM. [7,9-20] Role of ETV is controversial in communicating hydrocephalus and in acute phase of disease. The present article is aimed to review the role of ETV in TBM hydrocephalus. Indications of ETV in TBM hydrocephalus ETV is indicated in obstructive hydrocephalus in TBM. Most of the researchers prefer lumbar peritoneal shunt in communicating hydrocephalus, [21,22] although there are reports of ETV being performed in communicating hydrocephalus. [13,15] Endoscopic third ventriculostomy procedure ETV is technically difficult in post-infective hydrocephalus, especially in acute phase of disease due to presence of inflammation, thick and opaque floor of third ventricle. [7,10,17] It is comparatively simple in chronic phase of disease. There is an increased risk of hemorrhage and neurovascular injury, especially in acute phase. [10] Difficult cases in acute stage can be managed by water jet dissection. [10] Simple cases, in chronic phase, can be dealt by blunt perforation of the floor of third ventricle. Although ETV is technically possible in almost all cases of TBM hydrocephalus, proper case selection
ETV in tuberculous meningitis with hydrocephalus and allergic reaction to VP shunt: a case report
International Journal of Research in Medical Sciences
Hydrocephalus is one of the most common complications of tuberculous meningitis (TBM) occurring in up to 85% of patients with the disease. The placement of a ventriculoperitoneal (VP) shunt is the most common form of treatment for hydrocephalus in tuberculous meningitis (TBM). Although allergic reactions to the silicone in shunt device are very rare, the authors describe a case of silicone allergy causing multiple VP shunt revisions. Alternative choice is endoscopic third ventriculostomy (ETV), but it is debatable. ETV has variable success in these patients and is generally not advisable in patients in the acute stages of the disease. A 19-year-old woman with hydrocephalus in tuberculous meningitis, who had undergone multiple VP shunt revisions, presented with shunt malfunction caused by allergic reaction of the tissue surrounding the shunt tubing. Laboratory examination demonstrated high level IgE, high level ESR, and PCR-TBC Positive, related to the allergic reaction. Patient with...
Early shunt complications in 46 children with hydrocephalus
Arquivos de Neuro-Psiquiatria, 2009
OBJECTIVE: To determine the causes of early shunt complications in 46 children with hydrocephalus. METHOD: A retrospective study was conducted on 46 children submitted to ventriculoperitoneal shunt surgery between February 2005 and February 2007. RESULTS: Thirteen (28%) patients presented complications, which were due to infection in 9 (69%) and to malfunction of the shunt system in 4 (31%).The mean number of surgical procedures performed on patients who presented complications was 2.8 per patient, with a total of 46 surgeries in this group. All patients with infectious complications were identified during their hospital stay. CONCLUSIONS: Infection was the most common complication. The infection rate was proportional to the length of hospital stay. All patients with hydrocephalus due to tumors or myelomeningocele presented complications. A higher incidence of infections was observed in children older than 2 years.