• Journal of Korean Neurosurgical Society
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• 제56권4호
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• pp.361-363
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• 2014

Percutaneous endoscopic gastrostomy tube placement is often performed in patients with a ventriculoperitoneal shunt and it has been accepted as a safe procedure. The authors report a case of a 50-year-old male who developed acute exacerbation of the hydrocephalus immediately after the percutaneous endoscopic gastrostomy tube placement without any signs of shunt infection, which has not been reported until now. After revision of the intraperitoneal shunt catheter, the sizes of the intracranial ventricles were normalized.

• Journal of Korean Neurosurgical Society
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• 제64권1호
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• pp.120-124
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• 2021

Objective : Infection is one of most devastating complications in ventriculoperitoneal (VP) shunt surgery. Preoperative hair removal has traditionally been performed to reduce infectious complications. We performed VP shunt surgeries and evaluated the prevalence of infection in patients who were shaved and those who were unshaven. Methods : A retrospective analysis was conducted of 82 patients with hydrocephalus of various pathologies who underwent VP shunt surgery, with or without having the head shaved, between March 2010 and March 2017. For patients in the non-shaved group (n=36), absorbable suture materials were used for wound closure, and Nylon sutures or staples were used in the shaved group (n=46). We evaluated the infection outcomes of patients in the two groups. Results : There was no difference in the average age of patients in the two groups. In the non-shaved group, there were no infections, while two patients in the shaved group required revision because of shunt infection. Conclusion : Non-shaved shunt surgery may be safe and effective, with no increase of infection rate. We recommend that shunt procedures could be performed without shaving the hair, which may increase patients' satisfaction without increasing infection risk.

• Clinical Endoscopy
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• 제55권1호
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• pp.146-149
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• 2022

Lumboperitoneal or ventriculoperitoneal shunt insertion is a standard therapy for hydrocephalus that diverts cerebrospinal fluid from the subarachnoid space into the peritoneal cavity. Gastrointestinal perforations due to this procedure occur rarely; however, accepted treatment strategies have not yet been established. Hence, the most common treatment approaches are open surgery or spontaneous closure without endoscopy. We report the case of a small intestinal perforation in a 73-year-old-woman that occurred after the insertion of a lumboperitoneal shunt. A positive cerebrospinal fluid culture and high cerebrospinal fluid white blood cell count indicated a retrograde bacterial infection, and computed tomography revealed that the peritoneal tip of the shunt catheter was located in the lumen of the gastrointestinal tract. We repaired the perforation endoscopically using an over-the-scope clip, and the patient's recovery was uneventful. Use of an over-the-scope clip could be an effective and minimally invasive treatment for intestinal perforations caused by lumboperitoneal or ventriculoperitoneal shunt insertion.

• Journal of Korean Neurosurgical Society
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• 제54권5호
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• pp.441-443
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• 2013

Liver abscess following ventriculoperitoneal (VP) shunting occurs very rarely. We report an unusual case of multiple liver abscesses caused by Staphylococcus capitis in a 50-year-old compromised woman due to a complicating VP shunt infection. We reviewed the nine cases of VP shunt complications reported in the English literature, and speculated that the most likely pathogenetic mechanism in our case is an infected peritoneal tip that migrated to and penetrated the liver, which subsequently caused the formation of multiple liver abscesses. The patient was successfully treated with percutaneous aspiration, drainage of the abscesses, intravenous antibiotics, and shunt revision. Awareness and vigilance of the possibility of liver abscess formation caused by VP shunt infection will help establish an early accurate diagnosis and therapeutic strategy.

• Journal of Korean Neurosurgical Society
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• 제62권1호
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• pp.123-129
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• 2019

Objective : Ventriculoperitoneal (VP) shunt surgery is a common and effective treatment for hydrocephalus and cerebrospinal fluid disorders. Infection remains a major cause of morbidity and mortality after a VP shunt. There is evidence that a deep skin flora microbiome may have a role to play in post-operative infections. In this technical note, we present a skin preparation technique that addresses the issue of the skin flora beyond the initial incision. Methods : The patient is initially prepped, as standard, with. a single layer of 2% CHG+70% isopropyl alcohol. The novel stage is the 'double incision' whereby an initial superficial incision receives a further application of povidone-iodine prior to completing the full depth incision. Results : Of the 84 shunts inserted using the double-incision method (September 2015 to September 2016), only one developed a shunt infection. Conclusion : The double incision approach to skin preparation is a unique operative stage in VP shunt surgery that may have a role to play in reducing acute shunt infection.

• Journal of Korean Neurosurgical Society
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• 제41권5호
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• pp.314-317
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• 2007

Ventriculoperitoneal [VP] shunt is a common treatment for hydrocephalic patients. However, complications, such as shunt tube occlusion, infection, intracranial hemorrhage, seizure can occur. Of these, intracranial hemorrhage may occur due to intracranial vascular injury or a rapid decrease of intracranial pressure [ICP]. Most of these hemorrhages are subdural hematomas [SDH] while a few are epidural hematomas [EDH]. It is extremely rare for an intracranial hemorrhage to occur due to an extension of the bleeding from an injured extracranial vessel. We report two cases of EDH due to occipital artery injury following VP shunt and extraventricular drainage [EVD].

• Journal of Korean Neurosurgical Society
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• 제57권5호
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• pp.359-363
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• 2015

Objective : Ventriculoperitoneal (VP) shunt complication is a major obstacle in the management of hydrocephalus. To study the differences of VP shunt complications between children and adults, we analyzed shunt revision surgery performed at our hospital during the past 10 years. Methods : Patients who had undergone shunt revision surgery from January 2001 to December 2010 were evaluated retrospectively by chart review about age distribution, etiology of hydrocephalus, and causes of revision. Patients were grouped into below and above 20 years old. Results : Among 528 cases of VP shunt surgery performed in our hospital over 10 years, 146 (27.7%) were revision surgery. Infection and obstruction were the most common causes of revision. Fifty-one patients were operated on within 1 month after original VP shunt surgery. Thirty-six of 46 infection cases were operated before 6 months after the initial VP shunt. Incidence of shunt catheter fracture was higher in younger patients compared to older. Two of 8 fractured catheters in the younger group were due to calcification and degradation of shunt catheters with fibrous adhesion to surrounding tissue. Conclusion : The complications of VP shunts were different between children and adults. The incidence of shunt catheter fracture was higher in younger patients. Degradation of shunt catheter associated with surrounding tissue calcification could be one of the reasons of the difference in facture rates.

• Journal of Korean Neurosurgical Society
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• 제53권3호
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• pp.150-154
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• 2013

Objective : To evaluate the effect of electromagnetic (EM) navigation system on ventriculoperitoneal (VP) shunt failure rate through comparing the result of standard shunt placement. Methods : All patients undergoing VP shunt from October 2007 to September 2010 were included in this retrospective study. The first group received shunt surgery using EM navigation. The second group had catheters inserted using manual method with anatomical landmark. The relationship between proximal catheter position and shunt revision rate was evaluated using postoperative computed tomography by a 3-point scale. 1) Grade I; optimal position free-floating in cerebrospinal fluid, 2) Grade II; touching choroid or ventricular wall, 3) Grade III; tip within parenchyma. Results : A total of 72 patients were participated, 27 with EM navigated shunts and 45 with standard shunts. Grade I was found in 25 patients from group 1 and 32 patients from group 2. Only 2 patients without use of navigation belonged to grade III. Proximal obstruction took place 7% in grade I, 15% in grade II and 100% in grade III. Shunt revision occurred in 11% of group 1 and 31% of group 2. Compared in terms of proximal catheter position, there was growing trend of revision rate according to increase of grade on each group. Although infection rate was similar between both groups, the result had no statistical meaning (p=0.905, chi-square test). Conclusion : The use of EM navigation in routine shunt surgery can eliminate poor shunt placement resulting in a dramatic reduction in failure rates.

• Journal of Korean Neurosurgical Society
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• 제30권11호
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• pp.1345-1347
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• 2001

Ventriculoperitoneal(VP) shunting has been associated with a variety of complications. CSF ascites secondary to VP shunting is very rare. We report a case of 68-year-old man with VP shunt in whom subclinical peritoneal infection presented with ascites. The patient was treated successfully with antibiotics and removal of the shunt. CSF ascites complicating VP shunt is reviewed and the pathogenesis of this condition is discussed.

• Journal of Korean Neurosurgical Society
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• 제42권3호
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• pp.232-234
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• 2007

We describe the extrusion of a ventriculoperitoneal shunt catheter from the anus after double perforation of the large bowel in a 3-year-old girl with hydrocephalus. She was admitted because the tip of the peritoneal catheter protruded 10 cm from the anus and clear cerebrospinal fluid dripped from the tip. Emergency laparotomy was performed. The distal peritoneal catheter perforated and penetrated the sigmoid colon and re-perforated into the rectal cavity. The distal peritoneal catheter was removed, the proximal catheter was exposed for external drainage, and intravenous broad-spectrum antibiotics were administered for 2 weeks. After control of infection, the shunt system was completely removed. Bowel perforation by a peritoneal catheter is a rare complication. Diagnosis is often difficult, delayed, and its incidence is likely underestimated. Most bowel perforation is the result of infection as opposed to technical errors.