Limits...
Shunt fracture in two children with myelomeningocele following spine surgery.

Baradaran N, Nejat F, Baradaran N, El Khashab M - Surg Neurol Int (2010)

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Neurosurgery, Children's Hospital Medical Center, Tehran University of Medical Sciences, Iran.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

Ventriculoperitoneal (VP) shunt surgery is the most frequent operation, which is used in order to treat hydrocephalus... Here, we report two children with shunted hydrocephalus and history of MMC who presented with acute shunt malfunction related to distal tube fracture shortly following the spinal surgery... On examination, resistance against shunt flushing was observed with simultaneous subcutaneous swelling on her neck... New shunt series showed the absence of radioopaque catheter tract in her chest [Figure 1] while both ends of the tube were found in the abdomen... At that time, his parents had refused MMC repair due to severe neurological deficit... His follow-up was not regular... After 4 days, he demonstrated headache and CSF collection at the place of MMC surgery... Flushing of the pump was associated with pain and swelling in his neck... The most common location for a fracture is along the distal catheter segment, often near the clavicle or over the lower ribs... In our patients with well-functioning pre-operative shunts, prone position during and after the surgery in order to decrease the risk of wound CSF leakage could be assumed as the main cause for this failure... The positioning of the patient under general anaesthesia can provide a kind of mechanical stress on the catheter that when the child is awake, it is impossible to be reproduced due to pain and probable contracture... Attentive follow-up of the shunt function after any spine surgery in the shunted patients is advised... VP shunting for hydrocephalus has come to stay as the predominant treatment, and malfunction is one of the most common clinical problems encountered in pediatric neurosurgery... Here, we describe two patients with shunted hydrocephalus who presented with acute shunt malfunction related to distal tube fracture just following a spinal surgery.

No MeSH data available.


Chest X-ray of the patient shows no catheter in this view and cut of the catheter at the neck
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC2958323&req=5

Figure 0001: Chest X-ray of the patient shows no catheter in this view and cut of the catheter at the neck

Mentions: The patient is a 6-year-old girl who was initially referred to our neurosurgical service at the age of 2 months with hydrocephalus and MMC. She underwent successful VP shunt insertion and MMC repair. She was regularly monitored for her shunt function, developmental milestones as well as urological and orthopedic problems. Six years thereafter, she developed new-onset leg and back pain and progressive worsening of her gait, which her magnetic resonance imaging (MRI) confirmed post-surgical tethered cord with spinal cord adherence to previous MMC surgery scar. Plain X-ray shunt series performed during the admission time showed no breakage of shunt catheter. She underwent an untethering procedure in the prone position with her head turned to one side on the doughnut without any operative complications; however, she was readmitted 10 days later because of a 2-day history of severe headache and vomiting leading to drowsiness without any back wound problems. On examination, resistance against shunt flushing was observed with simultaneous subcutaneous swelling on her neck. New shunt series showed the absence of radioopaque catheter tract in her chest [Figure 1] while both ends of the tube were found in the abdomen. She was urgently managed with standard procedure for new distal catheter insertion. The distal peritoneal shunt was broken at a 12-cm distance from the connection point to the pump. Her post-operative course was unremarkable.


Shunt fracture in two children with myelomeningocele following spine surgery.

Baradaran N, Nejat F, Baradaran N, El Khashab M - Surg Neurol Int (2010)

Chest X-ray of the patient shows no catheter in this view and cut of the catheter at the neck
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2958323&req=5

Figure 0001: Chest X-ray of the patient shows no catheter in this view and cut of the catheter at the neck
Mentions: The patient is a 6-year-old girl who was initially referred to our neurosurgical service at the age of 2 months with hydrocephalus and MMC. She underwent successful VP shunt insertion and MMC repair. She was regularly monitored for her shunt function, developmental milestones as well as urological and orthopedic problems. Six years thereafter, she developed new-onset leg and back pain and progressive worsening of her gait, which her magnetic resonance imaging (MRI) confirmed post-surgical tethered cord with spinal cord adherence to previous MMC surgery scar. Plain X-ray shunt series performed during the admission time showed no breakage of shunt catheter. She underwent an untethering procedure in the prone position with her head turned to one side on the doughnut without any operative complications; however, she was readmitted 10 days later because of a 2-day history of severe headache and vomiting leading to drowsiness without any back wound problems. On examination, resistance against shunt flushing was observed with simultaneous subcutaneous swelling on her neck. New shunt series showed the absence of radioopaque catheter tract in her chest [Figure 1] while both ends of the tube were found in the abdomen. She was urgently managed with standard procedure for new distal catheter insertion. The distal peritoneal shunt was broken at a 12-cm distance from the connection point to the pump. Her post-operative course was unremarkable.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Neurosurgery, Children's Hospital Medical Center, Tehran University of Medical Sciences, Iran.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

Ventriculoperitoneal (VP) shunt surgery is the most frequent operation, which is used in order to treat hydrocephalus... Here, we report two children with shunted hydrocephalus and history of MMC who presented with acute shunt malfunction related to distal tube fracture shortly following the spinal surgery... On examination, resistance against shunt flushing was observed with simultaneous subcutaneous swelling on her neck... New shunt series showed the absence of radioopaque catheter tract in her chest [Figure 1] while both ends of the tube were found in the abdomen... At that time, his parents had refused MMC repair due to severe neurological deficit... His follow-up was not regular... After 4 days, he demonstrated headache and CSF collection at the place of MMC surgery... Flushing of the pump was associated with pain and swelling in his neck... The most common location for a fracture is along the distal catheter segment, often near the clavicle or over the lower ribs... In our patients with well-functioning pre-operative shunts, prone position during and after the surgery in order to decrease the risk of wound CSF leakage could be assumed as the main cause for this failure... The positioning of the patient under general anaesthesia can provide a kind of mechanical stress on the catheter that when the child is awake, it is impossible to be reproduced due to pain and probable contracture... Attentive follow-up of the shunt function after any spine surgery in the shunted patients is advised... VP shunting for hydrocephalus has come to stay as the predominant treatment, and malfunction is one of the most common clinical problems encountered in pediatric neurosurgery... Here, we describe two patients with shunted hydrocephalus who presented with acute shunt malfunction related to distal tube fracture just following a spinal surgery.

No MeSH data available.