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Management and Outcome of Post-Infectious Multiloculated Hydrocephalus: A Case Series

BACKGROUND AND IMPORTANCE: Infection following ventriculoperitoneal shunt (VPS) placement is a recognized complication, with variable incidence rates worldwide. Development of post-infectious multiloculated hydrocephalus (MLH) is likely if VPS infection is improperly managed, in turn affecting the p...

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Autores principales: Alojan, Abdulrazaq A, Alotaibi, Assayl R, Alalhareth, Hussain N, Alwadei, Ali D, Ammar, Ahmed
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Wolters Kluwer - Medknow 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8473994/
https://www.ncbi.nlm.nih.gov/pubmed/34667474
http://dx.doi.org/10.4103/sjmms.sjmms_85_21
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author Alojan, Abdulrazaq A
Alotaibi, Assayl R
Alalhareth, Hussain N
Alwadei, Ali D
Ammar, Ahmed
author_facet Alojan, Abdulrazaq A
Alotaibi, Assayl R
Alalhareth, Hussain N
Alwadei, Ali D
Ammar, Ahmed
author_sort Alojan, Abdulrazaq A
collection PubMed
description BACKGROUND AND IMPORTANCE: Infection following ventriculoperitoneal shunt (VPS) placement is a recognized complication, with variable incidence rates worldwide. Development of post-infectious multiloculated hydrocephalus (MLH) is likely if VPS infection is improperly managed, in turn affecting the prognosis. There is a lack of studies from Saudi Arabia regarding patients' functional outcome in relation to different variables. OBJECTIVES: To study the causative organisms, related variables and patient outcomes in MLH after VPS infection. METHODS: This case series is a retrospective chart review of pediatric patients diagnosed with hydrocephalus from 2011 to 2019. Patients were included if they were aged <18 years, had confirmed cerebrospinal fluid/blood infection with radiological evidence of MLH, and were regularly followed-up. Functional status score was used to evaluate the outcomes. RESULTS: A total of 150 patients underwent VPS insertion during the study period, of which 12 (8%) had postinfection MLH. The mean age at diagnosis and follow-up was 9 and 19 months, respectively. Ten patients developed MLH after their first VPS infection and one each developed MLH following the second and third VPS infections. Cerebrospinal fluid cultures mostly grew only single organisms (6/12), with Staphylococcus species being the most common. All patients underwent navigated endoscopic fenestration; nine patients required VPS placement and three required redo endoscopic fenestration surgery. All patients were developmentally delayed, with the majority (75%) having a functional status score of 6–10. CONCLUSION: Development of MLH after VPS infection is debilitating and requires prompt treatment. Although the overall functional outcome is poor, evolving neuroendoscopic techniques with tailored preoperative planning may play a role in reducing the adverse effect of shunt multiplicity, shunt infections and the higher failure rate among patients with complex hydrocephalus.
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spelling pubmed-84739942021-10-18 Management and Outcome of Post-Infectious Multiloculated Hydrocephalus: A Case Series Alojan, Abdulrazaq A Alotaibi, Assayl R Alalhareth, Hussain N Alwadei, Ali D Ammar, Ahmed Saudi J Med Med Sci Case Series BACKGROUND AND IMPORTANCE: Infection following ventriculoperitoneal shunt (VPS) placement is a recognized complication, with variable incidence rates worldwide. Development of post-infectious multiloculated hydrocephalus (MLH) is likely if VPS infection is improperly managed, in turn affecting the prognosis. There is a lack of studies from Saudi Arabia regarding patients' functional outcome in relation to different variables. OBJECTIVES: To study the causative organisms, related variables and patient outcomes in MLH after VPS infection. METHODS: This case series is a retrospective chart review of pediatric patients diagnosed with hydrocephalus from 2011 to 2019. Patients were included if they were aged <18 years, had confirmed cerebrospinal fluid/blood infection with radiological evidence of MLH, and were regularly followed-up. Functional status score was used to evaluate the outcomes. RESULTS: A total of 150 patients underwent VPS insertion during the study period, of which 12 (8%) had postinfection MLH. The mean age at diagnosis and follow-up was 9 and 19 months, respectively. Ten patients developed MLH after their first VPS infection and one each developed MLH following the second and third VPS infections. Cerebrospinal fluid cultures mostly grew only single organisms (6/12), with Staphylococcus species being the most common. All patients underwent navigated endoscopic fenestration; nine patients required VPS placement and three required redo endoscopic fenestration surgery. All patients were developmentally delayed, with the majority (75%) having a functional status score of 6–10. CONCLUSION: Development of MLH after VPS infection is debilitating and requires prompt treatment. Although the overall functional outcome is poor, evolving neuroendoscopic techniques with tailored preoperative planning may play a role in reducing the adverse effect of shunt multiplicity, shunt infections and the higher failure rate among patients with complex hydrocephalus. Wolters Kluwer - Medknow 2021 2021-08-31 /pmc/articles/PMC8473994/ /pubmed/34667474 http://dx.doi.org/10.4103/sjmms.sjmms_85_21 Text en Copyright: © 2021 Saudi Journal of Medicine & Medical Sciences https://creativecommons.org/licenses/by-nc-sa/4.0/This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.
spellingShingle Case Series
Alojan, Abdulrazaq A
Alotaibi, Assayl R
Alalhareth, Hussain N
Alwadei, Ali D
Ammar, Ahmed
Management and Outcome of Post-Infectious Multiloculated Hydrocephalus: A Case Series
title Management and Outcome of Post-Infectious Multiloculated Hydrocephalus: A Case Series
title_full Management and Outcome of Post-Infectious Multiloculated Hydrocephalus: A Case Series
title_fullStr Management and Outcome of Post-Infectious Multiloculated Hydrocephalus: A Case Series
title_full_unstemmed Management and Outcome of Post-Infectious Multiloculated Hydrocephalus: A Case Series
title_short Management and Outcome of Post-Infectious Multiloculated Hydrocephalus: A Case Series
title_sort management and outcome of post-infectious multiloculated hydrocephalus: a case series
topic Case Series
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8473994/
https://www.ncbi.nlm.nih.gov/pubmed/34667474
http://dx.doi.org/10.4103/sjmms.sjmms_85_21
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