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Robert F. Spetzler, Charles B. Wilson, and John M. Grollmus

T he good results of Eisenberg, et al. , 1 with lumboperitoneal (LP) shunts, in which Silastic tubing was placed into the lumbar subarachnoid space by way of hemilaminectomy, established LP shunting as an effective treatment for communicating hydrocephalus. Although percutaneous LP shunting further simplifies the procedure and reduces the complications associated with hemilaminectomy and abdominal surgery, it has not been used extensively for the treatment of communicating hydrocephalus, presumably due to its high complication rate. Jackson and Snodgrass 2

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Jacob Cherian, Robert L. Atmar, and Shankar P. Gopinath

shunting. 26 The literature remains unclear as to when each approach is indicated and how often patients require neurosurgical intervention. The present study offers a retrospective review of our experience at a single institution over a 5-year period. Methods A retrospective electronic chart review was conducted of records from a single large teaching hospital of 586 beds serving a major metropolitan area. Using ICD-9 codes, patient admission and discharge diagnoses of cryptococcal meningitis between September 2008 and February 2013 were identified. Lists of

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Jack Woodford, Richard L. Saunders, and Ernest Sachs Jr.

C onclusive assurance of ventricular shunt patency is critical to an assessment of the results of hydrocephalus treatment, and several methods have been reported for such evaluation. 2, 5, 6, 8 We have found the lumbar infusion technique described in this paper to be valuable, safe, and expedient to test shunt patency in patients with communicating hydrocephalus. It gives a dynamic profile of shunt function. The infusion tests were done to evaluate a series of adult patients with “normal” pressure hydrocephalus. In this paper, we review our experience with

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Umesh S. Vengsarkar, Venilal G. Panchal, Parimal D. Tripathi, Sushil V. Patkar, Alok Agarwal, Paresh K. Doshi, and Manmohan M. Kamat

T hecoperitoneal shunting is now a well-established technique for treating communicating hydrocephalus. It has also proved its usefulness in cases of cerebrospinal fluid (CSF) rhinorrhea, to arrest an intractable CSF leak, and in benign intracranial hypertension to prevent impending loss of vision. We have found this technique rewarding in three consecutive cases of syringomyelia treated between January and April, 1990, and would like to place our experience on record for future evaluation of the technique. All three patients presented clinically with a

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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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Diphtheroid infections of cerebrospinal fluid shunts

The changing pattern of shunt infection in Cleveland

Harold L. Rekate, Teresa Ruch, and Frank E. Nulsen

S hunt infection has been the major cause of morbidity and mortality in patients with cerebrospinal fluid (CSF) shunts. Reported rates of infection vary widely, and are as high as 22% in some series. 16 Several recent reports have shown considerable reductions in rates of infection when all shunts in the same institution are performed by the same surgeon with strict attention to asepsis, time of procedure, and the use of prophylactic antibiotics. 19 Shunt infection leads to prolonged hospital stay, numerous surgical procedures, and increased risk of

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Christina Notarianni, Prasad Vannemreddy, Gloria Caldito, Papireddy Bollam, Esther Wylen, Brian Willis, and Anil Nanda

hydrocephalus has undergone several revisions beginning with head wrapping, medication, and ultimately, CSF shunting and endoscopy. These therapies are aimed at preventing or reversing the neurological damage caused by the distortion of the brain due to this condition. 18 At present, the most popular management of hydrocephalus is CSF diversion through shunts. These devices have been shown to extend survival and lead to improved neurological outcome. Foltz et al. 8 demonstrated improved survival and a higher degree of intellectual capability with surgical arrest of

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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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Scott L. Parker, William N. Anderson, Sean Lilienfeld, J. Thomas Megerian, and Matthew J. McGirt

C erebrospinal fluid shunts have been the primary surgical option in the treatment of hydrocephalus since their introduction in the 1950s. 11 While there has been a dramatic improvement over the past several decades in surgical technique, shunt technology, and surgical experience, shunt infection remains a serious complication. 10 , 25 , 26 , 31 In children it is associated with psychomotor retardation and reduced IQ, while in adults, it is associated with meningitis, endocarditis, and prolonged hospitalization. 27 , 36 , 37 As early as the mid-1970s

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Farid Radmanesh, Farideh Nejat, Mostafa El Khashab, Syed Mohammad Ghodsi, and Hasan Eftekhar Ardebili

M ore than 90% of children with myelomeningocele (MMC) develop hydrocephalus, but only 15% manifest significant hydrocephalus at the time of MMC closure. 9 Since the aggressive treatment of children afflicted with MMC became the common practice, the issue of timing of shunt placement with regard to MMC repair has been debated. Earlier reports have supported sequential treatment due to concerns over the possibility of an increased risk of shunt infection and malfunction with the simultaneous method. 14 These studies also emphasize the need for