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Fulltext The risk factors of external ventricular drainage-related infection at hospital kuala lumpur: an observational study

Omar MA, Mohd Haspani MS

Malays J Med Sci, 2010 Jul;17(3):48-54.
PMID: 22135549 MyJurnal

External ventricular drainage (EVD) has been widely used for the purpose of cerebrospinal fluid (CSF) diversion at Hospital Kuala Lumpur (HKL).

Matched MeSH terms: Cerebrospinal Fluid Shunts
Fulltext Proximal migration of the Hakim's valve into a porencephalic cyst

Chee Pin Chee

Med J Malaysia, 1987 Dec;42(4):309-13.
PMID: 3331410

An unusual case of proximal migration of a Hakim's valve intracranially into a porencephalic cyst two years after insertion of the ventriculo-peritoneal shunt in a neonate is reported. The underlying cause is discussed. It is recommended that all shunt should be anchored with nonabsorbable suture material properly on to the pericranium.

Matched MeSH terms: Cerebrospinal Fluid Shunts/adverse effects; Cerebrospinal Fluid Shunts/instrumentation*
Fulltext Per rectal extrusion of a ventriculo peritoneal shunt catheter. A case report

Ali J, Cheah FKC

Med J Malaysia, 1987 Sep;42(3):201-3.
PMID: 3333537

A rare complication of per rectal extrusion of a ventricule peritoneal shunt catheter occuring in a four-month old Chinese baby boy with hydrocephalus is described. Perforation of the bowel by the shunt occurred without any peritonitis or retrograde infection of the shunt system. Its pathogenesis and diagnosis are discussed.

Matched MeSH terms: Cerebrospinal Fluid Shunts/adverse effects*
Choroid plexus papilloma five years after shunting for hydrocephalus

Pyn CC, Arumugasamy N

Med J Malaysia, 1976 Sep;31(1):65-8.
PMID: 1023016
Matched MeSH terms: Cerebrospinal Fluid Shunts/adverse effects*
Fulltext Comparison between Ventriculosubgaleal Shunt and Extraventricular Drainage to Treat Acute Hydrocephalus in Adults

Nee LS, Harun R, Sellamuthu P, Idris Z

Asian J Neurosurg, 2017 Oct-Dec;12(4):659-663.
PMID: 29114279 DOI: 10.4103/ajns.AJNS_122_16

Context: Hydrocephalus, due to subarachnoid or intraventricular hemorrhage (IVH), meningitis, or tumor compression, is usually transient and may resolve after treatment. There are several temporary methods of cerebrospinal fluid (CSF) diversion, none of it is superior to the other, and the decision is based on its various etiologies and factors. Ventriculosubgaleal shunt (VSGS) is one of those temporary measures, which is a simple and rapid CSF decompression method without causing electrolyte and nutritional losses.

Aims: The aim is to study the efficacy of VSGS for temporary CSF diversion, compared to extraventricular drainage (EVD) in adult hydrocephalus patients; to evaluate the outcome in terms of avoiding a permanent shunt, and to look for incidences of their complications.

Settings and Design: This was a retrospective observational study.

Subjects and Methods: The data were acquired from case notes of fifty patients with acute hydrocephalus: 26 secondary to IVH, 10 from aneurysm rupture, 8 posttrauma, and 6 from infection. All these patients had undergone CSF diversion in Hospital Queen Elizabeth II, Sabah, Malaysia, between 2013 and 2015. The patients were followed up from the date of treatment until the resolution of hydrocephalus, where parameters such as shunt dependency and complications were documented.

Statistical Analysis Used: All analyses were carried out using Statistical Packages for the Social Sciences Version 22.0. Chi-squared test or Fisher's exact test is used for univariate analysis of categorical variables.

Results: A total of 21 (42%) patients underwent EVD insertion and 29 (58%) underwent VSGS insertion. Thirty-seven (74%) patients did not require a permanent shunt; 24 (64.8%) of them were from the VSGS group (P = 0.097). EVD had more intracranial complications (44.1%) compared with VSGS (23.5%), with a statistically significant P = 0.026.

Conclusions: VSGS is a safe and viable option for adult hydrocephalus patients, with the possibility of continuation of the treatment for such patients in nonneurosurgical centers, as opposed to patients with EVDs. Furthermore, even though this method had no statistical difference in avoiding a permanent ventriculoperitoneal shunt, VSGS has statistically significant less intracranial complications compared with EVD.

Matched MeSH terms: Cerebrospinal Fluid Shunts
Hydrocephalic children presenting to a Malaysian community-based university hospital over an 8-year period

Abdullah J, Naing NN

Pediatr Neurosurg, 2001 Jan;34(1):13-9.
PMID: 11275782

There are few local statistics on the incidence of hydrocephalus and the outcome of hydrocephalic shunts in the South East Asian region. We report a retrospective study on 285 hydrocephalic patients who underwent shunting procedures between 1990 and 1998 at the University Hospital Science Malaysia, a regional referral center. Multiple logistic regression analysis was applied to predict determinants of outcome in relation to the timing of diagnosis, other congenital abnormalities associated with the hydrocephalus, timing of surgery and cortical thickness from CT scan. The relationship of shunt infection was correlated to the age of the patient and surgical procedure. The predictors for developmental outcome reported by this study were age at diagnosis, type of brain abnormalities and gender. Time of operation and cortical thickness did not contribute to the outcome.

Matched MeSH terms: Cerebrospinal Fluid Shunts*
Fulltext Coma due to malplaced external ventricular drain

Chai FY, Farizal F, Jegan T

Turk Neurosurg, 2013;23(4):561-3.
PMID: 24101284 DOI: 10.5137/1019-5149.JTN.5724-12.1

Ventriculostomy or external ventricular drain (EVD) placement by free-hand technique has a high malplacement rate. It is a blind procedure that often requires multiple attempts and revisions. To date, no neurological complication due to EVD malplacement has been reported in the literature. In this report, we present the first case of coma induced by a malplaced EVD and the patient regained consciousness after the drain was adjusted. Our discussion focused on various techniques that can improve the accuracy of EVD insertion. EVD insertion under image guidance provides better accuracy with limited disadvantages. We hypothesized that the patient's coma was due to the mass effect and irritation of the malplaced EVD exerted onto the ventral periaqueductal grey matter and the ascending neurons from upper brainstem.

Matched MeSH terms: Cerebrospinal Fluid Shunts/adverse effects
Recent Advances in Rational Diagnosis and Treatment of Normal Pressure Hydrocephalus: A Critical Appraisal on Novel Diagnostic, Therapy Monitoring and Treatment Modalities

Zhang L, Hussain Z, Ren Z

Curr Drug Targets, 2019;20(10):1041-1057.
PMID: 30767741 DOI: 10.2174/1389450120666190214121342

BACKGROUND: Normal pressure hydrocephalus (NPH) is a critical brain disorder in which excess Cerebrospinal Fluid (CSF) is accumulated in the brain's ventricles causing damage or disruption of the brain tissues. Amongst various signs and symptoms, difficulty in walking, slurred speech, impaired decision making and critical thinking, and loss of bladder and bowl control are considered the hallmark features of NPH.
OBJECTIVE: The current review was aimed to present a comprehensive overview and critical appraisal of majorly employed neuroimaging techniques for rational diagnosis and effective monitoring of the effectiveness of the employed therapeutic intervention for NPH. Moreover, a critical overview of recent developments and utilization of pharmacological agents for the treatment of hydrocephalus has also been appraised.
RESULTS: Considering the complications associated with the shunt-based surgical operations, consistent monitoring of shunting via neuroimaging techniques hold greater clinical significance. Despite having extensive applicability of MRI and CT scan, these conventional neuroimaging techniques are associated with misdiagnosis or several health risks to patients. Recent advances in MRI (i.e., Sagittal-MRI, coronal-MRI, Time-SLIP (time-spatial-labeling-inversion-pulse), PC-MRI and diffusion-tensor-imaging (DTI)) have shown promising applicability in the diagnosis of NPH. Having associated with several adverse effects with surgical interventions, non-invasive approaches (pharmacological agents) have earned greater interest of scientists, medical professional, and healthcare providers. Amongst pharmacological agents, diuretics, isosorbide, osmotic agents, carbonic anhydrase inhibitors, glucocorticoids, NSAIDs, digoxin, and gold-198 have been employed for the management of NPH and prevention of secondary sensory/intellectual complications.
CONCLUSION: Employment of rational diagnostic tool and therapeutic modalities avoids misleading diagnosis and sophisticated management of hydrocephalus by efficient reduction of Cerebrospinal Fluid (CSF) production, reduction of fibrotic and inflammatory cascades secondary to meningitis and hemorrhage, and protection of brain from further deterioration.

Matched MeSH terms: Cerebrospinal Fluid Shunts