• Annals of Clinical Neurophysiology
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• v.24 no.1
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• pp.30-34
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• 2022

In cases of hyponatremia induced by brain damage, it is important to distinguish between the syndrome of inappropriate anti-diuretic hormone secretion (SIADH) and cerebral salt wasting syndrome. A ventriculoperitoneal (VP) shunt is the standard treatment for hydrocephalus, and external lumbar drainage (ELD) is an option to evaluate the effect of a VP shunt. However, ELD has potential complications, such as subarachnoid hemorrhage, meningitis, and rarely hyponatremia. Therefore, we report a case of a patient with cerebral salt-wasting syndrome resulting from ELD to treat normal-pressure hydrocephalus during the rehabilitation of acute ischemic stroke.

• Journal of Korean Neurosurgical Society
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• v.49 no.4
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• pp.217-221
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• 2011

Objective : This paper presents data from a retrospective study of endoscopic third ventriculostomy (ETV) in patients with shunt malfunction and proposes a simple and reasonable post-operative protocol that can detect ETV failure. Methods : We enrolled 19 consecutive hydrocephalus patients (11 male and 8 female) who were treated with ETV between April 2001 and July 2010 after failure of previously placed shunts. We evaluated for correlations between the success rate of ETV and the following parameters : age at the time of surgery, etiology of hydrocephalus, number of shunt revisions, interval between the initial diagnosis of hydrocephalus or the last shunt placement and ETV, and the indwelling time of external ventricular drainage. Results : At the time of ETV after shunt failure, 14 of the 19 patients were in the pediatric age group and 5 were adults, with ages ranging from 14 months to 42 years (median age, 12 years). The patients had initially been diagnosed with hydrocephalus between the ages of 1 month 24 days and 32 years (median age, 6 years 3 months). The etiology of hydrocephalus was neoplasm in 7 patients; infection in 5; malformation, such as aqueductal stenosis or megacisterna magna in 3; trauma in 1; and unknown in 3. The overall success rate during the median follow-up duration of 1.4 years (9 days to 8.7 years) after secondary ETV was 68.4%. None of the possible contributing factors for successful ETV, including age (p=0.97) and the etiology of hydrocephalus (p=0.79), were statistically correlated with outcomes in our series. Conclusion: The use of ETV in patients with shunt malfunction resulted in shunt independence in 68.4% of cases. Age, etiology of hydrocephalus, and other contributing factors were not statistically correlated with ETV success. External ventricular drainage management during the immediate post-ETV period is a good means of detecting ETV failure.

• Journal of Korean Neurosurgical Society
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• v.30 no.sup1
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• pp.99-107
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• 2001

Objective : Hydrocephalus and vasospasm are the common complications following subarachnoid hemorrhage (SAH). In spite of development of perioperative management and operative technique, hydrocephalus cause neurological deficit and poor prognosis. Usually CSF drainage procedure(external ventricular drainage(EVD) or shunt) is needed in hydrocephalus following SAH. The aim of this study was to investigate whether the need for shunting and the outcome after shunting in hydrocephaus following SAH can be related to the duration, daily and total amount of cerebrospinal fluid(CSF) drainage at EVD. Material and Method : IVH is one of several factors which cause hydrocephalus. In this retrospective study, firstly we investigated the incidence of IVH in total cases and frequency of IVH according to aneurysmal site and then prognosis of IVH following SAH. Among 629 patients with SAH, hydrocephalus was diagnosed by CT scan and symptoms. And then those 102 hydrocephalus following SAH were divided into two groups which were hydrocephalus with IVH group and without IVH group. In these two groups, we investigated and compared the incidence of hydrocephalus in all case, frequency of hydrocephalus according to aneurysmal site, the outcome according to H-H grade on admission and the need rate of shunt, etc. Of those hydrocephalus, 100 EVD procedures were done. The duration, daily and total amount of CSF drainage at EVD were investigated. Fifty cases expired during EVD was excluded. We analyzed whether the need rate of shunt and the final outcome after shunting can be related to IVH, the duration and daily and total amount of CSF drainage. Result : The incidence of hydrocephalus following SAH was 20%(with IVH group ; 64%, without IVH group ; 11%). As H-H grade on admission was better, the outcome of hydrocephalus was also better. The mortality rate of hydrocephalus with IVH was 64% which was higher than 40% that of hydrocephalus without IVH. The need rate of shunt in all cases of hydrocephalus following SAH was 20%, but those with IVH group excluding expired patients before shunt was 40%. This was very similar to 41% of the need rate of shunt in hydrocephalus without IVH. The total amount of CSF drainage was statistically related to the need rate of shunt(total amount : need rate of shunt/<1000cc : 15%, 1000-2000cc : 40%, >2000cc : 50%). The duration and daily amount of CSF drainage were not statistically related to the need rate of shunt, but as daily amount of CSF drainage was more and duration was longer, the need rate of shunt was increased(daily amount : need rate of shunt /<100cc : 16%, 100-200cc : 25%, >200cc : 40%//duration : need rate of shunt/<1week : 8%, 1-2weeks : 30%, >2weeks : 47%), and also the final outcome after shunting was poor. Especially the total amount of CSF drainage was significant related to the final outcome after shunting(total amount : GOS/<1000cc : I&II(3/4), 1000-2000cc : II(2/4), III(2/4), >2000cc : III&IV(6/7)). Conclusion : This study revealed that the incidence and mortality rate of hydrocephalus following SAH were influenced by IVH. So SAH associated IVH has the higher incidence of hydrocephalus and poor outcome. As the CSF drainage amount was more and duration of drainage was longer, the need rate of shunt was increased and the final outcome after shunting was poor. Especially the total amount of CSF drainage were strongly related to the need rate of shunt and the outcome after shunting.

• Journal of Korean Neurosurgical Society
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• v.30 no.7
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• pp.939-942
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• 2001

Thirty nine-year-old man who required urgent shunt operation due to rapidly deteriorating visual acuity suffered from ventriculitis after aneurysmal operation. Daily dose of 20mg of vancomycin and amikyn were given intraventricularly via external ventricular catheter after failure of various kinds of systemic antibiotics. The exit of the catheter was made on the upper chest wall to prevent superinfection. External ventricular drainage could finally be switched to ventriculo-peritoneal shunt and he was discharged with clinical improvement.

• Journal of Korean Neurosurgical Society
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• v.48 no.6
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• pp.480-484
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• 2010

Objective : To evaluate the role of lumbar drainage in the prevention of shunt-dependent hydrocephalus after treatment of ruptured intracranial aneurysms by coil embolization in good-grade patients. Methods : One-hundred-thirty consecutive patients with aneurysmal subarachnoid hemorrhage in good-grade patients (Hunt & Hess grades I-III), who were treated by coil embolization between August 2004 and April 2010 were retrospectively evaluated. Poor-grade patients (Hunt & Hess grades IV and V), a history of head trauma preceding the development of headache, negative angiograms, primary subarachnoid hemorrhage (SAH), and loss to follow-up were excluded from the study. We assessed the effects on lumbar drainage on the risk of shunt-dependent hydrocephalus related to coil embolization in patients with ruptured intracranial aneurysms. Results : One-hundred-twenty-six patients (96.9%) did not develop shunt-dependent hydrocephalus. The 2 patients (1.5%) who developed acute hydrocephalus treated with temporary external ventricular drainage did not require permanent shunt diversion. Overall, 4 patients (3.1%) required permanent shunt diversion; acute hydrocephalus developed in 2 patients (50%). There was no morbidity or mortality amongst the patients who underwent a permanent shunt procedure. Conclusion : Coil embolization of ruptured intracranial aneurysms may be associated with a lower risk for developing shunt-dependent hydrocephalus, possibly by active management of lumbar drainage, which may reflect less damage for cisternal anatomy than surgical clipping. Coil embolization might have an effect the long-term outcome and decision-making for ruptured intracranial aneurysms.

• Journal of Korean Neurosurgical Society
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• v.29 no.2
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• pp.231-239
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• 2000

Objectives : A postoperative hydrocephalus is compromises the clinical outcome of patients with aneurysmal clippings as one of the major complications of SAH. Subdural hygroma is often complicated after aneurysmal clippings, which subsides spontaneously as simple hygroma, or progresses to shunt-dependent hydrocephalus (SDHC). To predict development of SDHC from the hygroma, and to improve clinical outcome of patients with aneurysmal clippings, we analyzed clinical predisposing factors between 2 subgroups, simple hygroma and SDHC. Patients and Methods : A retrospective study of 232 consecutive cases of clipped aneurysmal patient was undertaken in our hospital for last two years. The 46 patients(19.8%) developed hygromas after aneurysmal clippings. There were 22 cases with simple hygroma(9.5%), and 24 patients with SDHC(10.3%). Comparison of 2 subgroups was made for various clinical and radiological factors. Results : Older age(p＝0.03), poor preoperative clinical grade(p＝0.01), high Fisher grade(p＝0.005), large amount of hygroma(p＝0.014) and increased size of lateral ventricle ipsilateral to hygroma(p＝0.001) were correlated significantly with SDHC. There was no statistical significance in sex, aneurysmal location and presence of acute preoperative ventricular dilatation between 2 subgroups. Conclusion : The clinical factors, such as older age, poor preoperative clinical grade, high Fisher grade, large amount of hygroma and increased size of lateral ventricle ipsilateral to hygroma showed statistical sinificance for differentiating SDHC from simple hygroma.

• Journal of Korean Neurosurgical Society
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• v.42 no.3
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• pp.232-234
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• 2007

We describe the extrusion of a ventriculoperitoneal shunt catheter from the anus after double perforation of the large bowel in a 3-year-old girl with hydrocephalus. She was admitted because the tip of the peritoneal catheter protruded 10 cm from the anus and clear cerebrospinal fluid dripped from the tip. Emergency laparotomy was performed. The distal peritoneal catheter perforated and penetrated the sigmoid colon and re-perforated into the rectal cavity. The distal peritoneal catheter was removed, the proximal catheter was exposed for external drainage, and intravenous broad-spectrum antibiotics were administered for 2 weeks. After control of infection, the shunt system was completely removed. Bowel perforation by a peritoneal catheter is a rare complication. Diagnosis is often difficult, delayed, and its incidence is likely underestimated. Most bowel perforation is the result of infection as opposed to technical errors.

• Journal of Korean Neurosurgical Society
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• v.29 no.5
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• pp.644-649
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• 2000

Objective : Acute hydrocephalus can be caused by many pathologic conditions such as sub- arachnoid hemorrhage, intraventricular hemorrhage, inflammatory diseases. External ventricular drainage(EVD) through trephination of the skull is essential procedure for progressing or persistent symptomatic acute hydrocephalus. If the EVD can not be removed in short period, the chance of ventriculitis increases and periodic transposition of the draining catheter should be considered. Shunt procedure can not be performed in acute hemorrhage or infectious condition because of the risk of shunt malfunction or intra-abdominal spreading of the infection, respectively. The authors replaced EVD with continuous lumbar drainage(CLD) for the purpose of controlling acute hydrocephalus and preventing ventriculitis simultaneously, or treating ventriculitis more effectively in case of infection which had already broken out. CLD has many advantages over EVD, although, it can complicate disastrous downward brain herniation in patients with elevated intracranial pressure. The authors performed CLD with EVD maintained and then tested the possibility of the brain herniation with quite simple method. If the CLD was proven as safe through the test, EVD could be replaced with it without terrible herniation. Material and Method : Between September 1998 and April 1999, 10 patients underwent CLD in replacement of EVD. Among them, 5 were patients with aneurysmal subarachnoid hemorrhage, 2 were patients with thalamic hematoma and intraventricular hemorhage and 3 were patients with traumatic intracranial hemorrhage. Results : In eight of them the replacements were successfully done and one of them died on account of medical illness. In two of them the replacement could not be performed because of the risk of herniation and all expired owing to ventriculitis. Two patients required permanent shunt operation. Conclusion : This article provides a valuable alternative method of treatment for persistent symptomatic hydrocephalus which can not be managed with shunt operation immediately.

• Journal of Korean Neurosurgical Society
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• v.39 no.4
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• pp.277-280
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• 2006

Objective : The aim of this study is to determine which patients with progressively deteriorating acute cerebellar infarction would benefit from surgical treatment and which surgical procedure would best benefit them. Methods : Seventy six patients were treated at our hospital for cerebellar infarction over the past 3 years. Sixty nine patients received conservative management in the neurological department of our hospital. Among them, 7 patients [5 males and 2 females; average age, 49 yrs] were referred to neurosurgical department because of mental deterioration and underwent emergency surgery. Five patients underwent external ventricular drainage with suboccipital craniectomy and two patients underwent suboccipital craniectomy alone. Results : Of the 7 surgically treated patients, 4 patients experienced good recovery and 2 patients experienced moderate disability [disabled but independent] and 1 patient experienced severe disability [conscious but disabled]. There was no death. Conclusion : In patients conservatively treated for cerebellar infarction and showing mental deterioration and radiologically evident brainstem compression and ventricular enlargement, we strongly recommend suboccipital craniectomy [plus optional external ventricular drainage in case of showing hydrocephalus] as a first treatment option.

• Journal of Korean Neurosurgical Society
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• v.42 no.1
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• pp.56-58
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• 2007

A 64-year-old man was admitted to our hospital in semicomatous consciousness. Brain computed tomography scans demonstrated $2.6{\times}2.5\;cm$ sized hyperdense mass in the pineal region with multiple punctate calcifications and hydrocephalus. Brain magnetic resonance imaging demonstrated a pineal mass which was heterogeneously enhanced with gadolinium. After external ventricular drainage, the patient regained consciousness. The mass was totally removed via occipital transtentorial approach. No consequent ventricular shunt was needed and the patient recovered without any neurological deficit. Final pathologic report of the tumor was ependymoma.