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Lumboperitoneal shunt insertion without fluoroscopy guidance: Accuracy of placement in a series of 107 procedures.

ABSTRACT: Background: Lumboperitoneal (LP) shunts were the mainstay of cerebrospinal fluid diversion therapy for idiopathic intracranial hypertension (IIH). The traditionally cited advantage of LP shunts over ventriculoperitoneal (VP) shunts is the ease of insertion in IIH. This needs to be placed at the level of L3/4 to be below the level of the spinal cord. The objective of this study was to analyse the position of LP shunts inserted without portable fluoroscopy guidance. Methods: A retrospective analysis of radiology was performed for patients who underwent lumboperitoneal shunts between 2006 and 2016 at the National Hospital for Neurology and Neurosurgery. Patients who had insertion of a LP shunt without fluoroscopy guidance were selected. Patients without post-procedural imaging were excluded. A retrospective analysis of the clinical notes was also performed. Results: Between 2006 and 2016, 163 lumboperitoneal shunts were inserted in 105 patients. A total of 56 cases were excluded due to lack of post-procedural imaging; therefore, 107 post-procedural x-rays were reviewed. In 17 (15.8%) cases the proximal end of the LP shunt was placed at L1/L2 level or above. Conclusions: Insertion of LP shunts without portable fluoroscopy guidance gives a 15.8% risk of incorrect positioning of the proximal end of the catheter. We suggest that x-ray is recommended to avoid incorrect level placement. Further investigation could be carried out with a control group with fluoroscopy against patients without.

SUBMITTER: Al-Rashed S

PROVIDER: S-EPMC5506531 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:Background:Postoperative communicating hydrocephalus has been described in the literature commonly associated with treatment of ruptured intracranial aneurysms; however, it is also reported to occur following other intracranial interventions such as meningioma resection and decompressive hemicraniectomy. In 2011, Burkhardt et al. reported the incidence of postoperative hydrocephalus following skull base meningioma resection was twice as high as resection of meningiomas in other regions.[1] They found that age and increased length of surgery were associated with higher rates of postoperative hydrocephalus. Our patient, a 76-year-old man, initially presented with the left-hand paresthesias and numbness before the revelation of a large sphenoid planum meningioma on workup imaging. He underwent surgical resection due to developing cranial nerve deficits and personality changes in an extensive procedure that required approximately 8 h to complete. His postoperative course, given the factors above, included the development of hydrocephalus. Case Description:He was taken to the operating room for ventriculoperitoneal shunt placement, as displayed in this video case report, which highlights our surgical and sterile techniques, intraoperative ultrasound to ensure appropriate ventricular placement, and a single-port laparoscopic technique for direct visualization of placement of the abdominal catheter. After shunt placement, his course was complicated by a small tract hemorrhage, which resolved without further treatment. He was observed to have an improvement in mental function that occurred over the following 2-3 days before being discharged to an outpatient rehabilitation facility for continued care. Conclusion:Ventriculoperitoneal shunt placement is an effective and safe procedure for the treatment of postoperative communicating hydrocephalus when performed with appropriate techniques as displayed in the associated video case report. The patient gave informed consent for surgery and video recording. Institutional Review Board approval was deemed unnecessary.

Project description:Objective:Fluoroscopy guidance is generally required for endobronchial ultrasonography with guide sheath (EBUS-GS) in peripheral pulmonary lesions (PPLs). Virtual bronchoscopic navigation (VBN) can guide the bronchoscope by creating virtual images of the bronchial route to the lesion. The diagnostic yield and safety profiles of VBN without fluoroscopy for PPLs have not been evaluated in inexperienced pulmonologist performing EBUS-GS. Methods:Between January 2016 and June 2017, consecutive patients with PPLs referred for EBUS-GS at a single cancer center were enrolled. The diagnostic yield as well as safety profiles was retrospectively analyzed, and our preliminary experience was shared. Results:A total of 109 patients with 109 lesions were included, 99 (90.8%) lesions were visible on EBUS imaging. According to the procedure time needed to locate the lesion on EBUS, 24.8% (27/109) were deemed technically difficult procedures; however, no significant relationships were identified between candidate parameters and technically difficult procedures. The overall diagnosis yield was 74.3% (81/109), and the diagnostic yield of malignancy was 83.7% (77/92). Lesions larger than 20 mm [odds ratio (OR), 2.758; 95% confidence interval (95% CI), 1.077-7.062; P=0.034] and probe of within type (OR, 3.174; 95% CI, 1.151-8.757, P=0.026) were independent factors leading to a better diagnostic yield in multivariate analysis. About 30 practice procedures were needed to achieve a stable diagnostic yield, and the proportion of technically difficult procedures decreased and stabilized after 70 practice procedures. Regarding complications, one patient (0.9%) had intraoperative hemorrhage (100 mL) which was managed under endoscopy. Conclusions:VBN without fluoroscopy guidance is still useful and safe for PPLs diagnosis, especially for malignant diseases when performed by pulmonologist without previous experience of EBUS-GS. VBN may simplify the process of lesion positioning and further multi-center randomized studies are warranted.

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Lumboperitoneal shunt insertion without fluoroscopy guidance: Accuracy of placement in a series of 107 procedures.

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