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Cerebrospinal fluid shunt infection

Influences on initial management and subsequent outcome

Beverly C. Walters, Harold J. Hoffman, E. Bruce Hendrick and Robin P. Humphreys

N o entity accounts for more mortality and morbidity among patients with cerebrospinal fluid (CSF) shunts than infection. Death, intellectual and neurological deficit, and astronomical costs in terms of health care funds and human suffering are the usual sequelae. For these reasons, the management of shunt infection is of great concern to the neurosurgical community. In order to gain some perspective on this matter, an examination was undertaken of efforts at the Hospital for Sick Children (HSC) in Toronto, Canada, in the treatment of CSF shunt infections

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Gerald D. Silverberg, Christina B. Harbury and Edward Rubenstein

R epair of cerebrospinal fluid (CSF) fistulas in the area of the sella and the sphenoid is technically difficult and often unsuccessful. 3, 12 There are significant rates of recurrence of leakage after both standard suture repair and free muscle and fascial grafts. Attempts to use organically synthesized glues, such as the cyanoacrylates, were at first thought promising, 8, 10, 11, 13 but have been found to induce an intense tissue reaction to the point of necrosis. 6, 7, 14 They remain experimental drugs. We are proposing the use of a physiologically

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W. J. H. Caldicott, J. B. North and Donald A. Simpson

. Bracewell A : Glucose oxidase test strips in the detection of CSF fistula. J Laryng Otol 79 : 1001 – 1004 , 1965 Bracewell A: Glucose oxidase test strips in the detection of CSF fistula. J Laryng Otol 79: 1001–1004, 1965 3. Brawley BW , Kelly WA : Treatment of basal skull fractures with and without cerebrospinal fluid fistulae. J Neurosurg 26 : 57 – 61 , 1967 Brawley BW, Kelly WA: Treatment of basal skull fractures with and without cerebrospinal fluid fistulae. J Neurosurg 26: 57–61, 1967 4

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Marek Czosnyka, Hugh K. Richards, Zofia Czosnyka, Stefan Piechnik and John D. Pickard

T he immediate effect of an increase in the volume of cerebrospinal fluid (CSF) depends on the brain's modulus of elasticity and baseline intracranial pressure (ICP). The phenomenon of pressure—volume compensation has been studied for many years. 2, 14, 19, 20, 22, 26 In conjunction with the model of CSF absorption (being proportional to the pressure difference between the CSF and the sagittal sinus, known as Davson's law 13 ), it has formed the foundation for the mathematical modeling of CSF pressure—volume compensatory mechanisms. 2, 10, 14, 22, 26, 31, 44

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Juan A. Guevara, Graciela Zúccaro, Alejandro Trevisán and Claudio D. Denoya

A t present, the most widely used and successful treatment of hydrocephalus involves shunting excess cerebrospinal fluid (CSF) into an extra-cranial body compartment. 20 Ventriculoperitoneal (VP) shunts are most commonly used; 22 they generally involve less serious complications, and surgical procedures are faster and easier than alternative routes. 31 Complications of VP shunts include mechanical malfunctions (such as disconnection, breaking, and plugging), occlusion of the abdominal tip, migration of the shunt, and perforation of the viscera. 1, 31

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Dimitris G. Placantonakis, Eric Lis and Mark M. Souweidane

) 38 : 374 – 376 , 1998 4 Cook PG , Norman PF : Case report: intradiploic leptomeningeal cyst of the frontal bone occurring as a complication of head injury in an adult . Clin Radiol 39 : 214 – 215 , 1988 5 D’Almeida ACG , King RB : Intradiploic cerebrospinal fluid fistula. Report of two cases . J Neurosurg 54 : 84 – 88 , 1981 6 Kadri H , Mawla AA : Late appearance of hydrocephalus associated with posttraumatic intradiploic arachnoid cyst . Childs Nerv Syst 20 : 494 – 495 , 2004 7 Lunardi P , Missori P , Artico M

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Joe I. Ordia, Ronald W. Mortara and Edward L. Spatz

V entriculoperitoneal (VP) shunting is the treatment of choice in most patients with hydrocephalus. Both early and late complications are well described. However, a functioning VP shunt usually does not claim the patient's attention by acting as a “noisy faucet.” We report two unusual cases in which the patients presented with audible cerebrospinal fluid (CSF) flow following VP shunting. The first patient was bothered by the head noise which initially was unexplained. The second patient was concerned that the disappearance of the noise meant that the shunt had

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Jack McCallum, Joseph C. Maroon and Peter J. Jannetta

P ostoperative cerebrospinal fluid (CSF) leaks have plagued surgeons and their patients since the beginning of intracranial surgery. From the time of Dandy's initial operative repair of a CSF fistula almost 50 years ago, surgical correction has remained the treatment of choice for these problems. It has, however, been occasionally suggested that lowering CSF pressure with serial lumbar punctures might allow spontaneous healing of CSF leaks. Vorc'h and Rougerie 3, 4 successfully used continuous drainage of lumbar spinal fluid rather than serial lumbar

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Gregg L. Williams, Michael Pollay, Thomas Seale, Brent Hisey and P. Alex Roberts

high degree of binding of the peripheral type of benzodiazepine ligands (for example, 4′-chloro analog of diazepam (Ro 5-4864)) to choroid plexus tissue suggested a possible role of these receptors in the modulation of cerebrospinal fluid (CSF) formation. In the experiments described here, the characteristics of Ro 5-4864 binding with the peripheral binding sites in rabbit choroid plexus and cerebral cortex were studied as were the pharmacological effect of this ligand on the intraventricular formation of CSF. The plexus adenosine triphosphatase (ATPase) and

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Samuel H. Greenblatt and Donald H. Wilson

I n patients with cerebrospinal fluid (CSF) rhinorrhea, occasionally the CSF will continue to leak despite many diagnostic and therapeutic procedures. 1, 3, 5 We have recently treated two such cases. The leaks were successfully stopped by lumboperitoneal shunts, after multiple cranial procedures had failed. The idea behind the use of CSF shunting procedures in these patients was to create artificial “pressure sinks,” which would divert CSF flow away from the fistulas and thereby allow them to heal. Method The patients were placed in the left lateral