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Abstract Hydrocephalus is a commonly encountered pathology in the neurosurgical practice. Since the first permanent ventriculo-subarachnoid-subgaleal shunt described by Mikulicz in 1893, there were multiple attempts to find solutions for draining the excess production/less reabsorption of the cerebrospinal fluid (CSF) from the brain. Nowadays, the most common technique is the ventriculoperitoneal shunt (VPS), whereas the ventriculoatrial shunt (VAS) is applied only in some rare conditions. To date there are still no specific guidelines or strong evidence in literature that guide the surgeon in the choice between the two methods, and the decision usually relies on the confidence and expertise of the surgeon. Considering the lack of established recommendations, this systematic review and meta-analysis aims to evaluate the effectiveness and safety of these two shunting techniques. This systematic review was conducted following the PRISMA protocol (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). No chronological limits of study publications were included. Prospective and retrospective clinical studies, and reports of case series with at least five patients per group and reporting data on comparison between VAS and VPS techniques were eligible for inclusion. Nine studies reporting 3197 patients meeting the inclusion and exclusion criteria were identified and included in the quantitative synthesis. The risk of shunt dysfunction/obstruction was significantly lower in the VAS group [odds ratio (OR) 0.49, 95%-CI 0.34–0.70, I2 0%]. The risk of infection was not significantly different between the two groups (OR 1.02, 95%-CI 0.59–1.74, I2 0%). The risk of revision was not significantly different between the two groups; however, the heterogeneity between the studies was significant (OR 0.73, 95%-CI 0.36–1.49, I2 91%). Additionally, the risk of death was not significantly different between the two groups; however, the heterogeneity between the studies was high (OR 1.93, 95%-CI 0.81–4.62, I2 64%). VAS remains a safe surgical alternative for hydrocephalus. The results of this study highlight a lower risk of shunt dysfunction/obstruction variable in the VAS group, with no significant statistical differences regarding the occurrence of at least one infection-related complication. In consequence, the choice between these two techniques must be tailored to the specific characteristics of the patient. Protocol Registration: The review protocol was registered and published in Prospective Register of Systematic Reviews (PROSPERO) ( www.crd.york.ac.uk/PROSPERO ) website with registration number: CRD42023479365.

Hydrocephalus is a commonly encountered pathology in the neurosurgical practice. Since the first permanent ventriculo-subarachnoid-subgaleal shunt described by Mikulicz in 1893, there were multiple attempts to find solutions for draining the excess production/less reabsorption of the cerebrospinal fluid (CSF) from the brain. Nowadays, the most common technique is the ventriculoperitoneal shunt (VPS), whereas the ventriculoatrial shunt (VAS) is applied only in some rare conditions. To date there are still no specific guidelines or strong evidence in literature that guide the surgeon in the choice between the two methods, and the decision usually relies on the confidence and expertise of the surgeon. Considering the lack of established recommendations, this systematic review and meta-analysis aims to evaluate the effectiveness and safety of these two shunting techniques. This systematic review was conducted following the PRISMA protocol (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). No chronological limits of study publications were included. Prospective and retrospective clinical studies, and reports of case series with at least five patients per group and reporting data on comparison between VAS and VPS techniques were eligible for inclusion. Nine studies reporting 3197 patients meeting the inclusion and exclusion criteria were identified and included in the quantitative synthesis. The risk of shunt dysfunction/obstruction was significantly lower in the VAS group [odds ratio (OR) 0.49, 95%-CI 0.34–0.70, I2 0%]. The risk of infection was not significantly different between the two groups (OR 1.02, 95%-CI 0.59–1.74, I2 0%). The risk of revision was not significantly different between the two groups; however, the heterogeneity between the studies was significant (OR 0.73, 95%-CI 0.36–1.49, I2 91%). Additionally, the risk of death was not significantly different between the two groups; however, the heterogeneity between the studies was high (OR 1.93, 95%-CI 0.81–4.62, I2 64%). VAS remains a safe surgical alternative for hydrocephalus. The results of this study highlight a lower risk of shunt dysfunction/obstruction variable in the VAS group, with no significant statistical differences regarding the occurrence of at least one infection-related complication. In consequence, the choice between these two techniques must be tailored to the specific characteristics of the patient. Protocol Registration: The review protocol was registered and published in Prospective Register of Systematic Reviews (PROSPERO) (www.crd.york.ac.uk/PROSPERO) website with registration number: CRD42023479365. [ABSTRACT FROM AUTHOR]

ABSTRACT: Objectives: This study aims to evaluate the aetiology and antibiotic susceptibility pattern in children with ventriculo-peritoneal (VP) shunt infections. Methods: A retrospective investigation was conducted from March 2011 to March 2018 among 163 children, who were admitted because of VP shunt infections in a referral educational hospital in Isfahan, Iran. Results: Coagulase negative staphylococcus (CoNS) was the most common organism (49.0%), followed by Acinetobacter baumannii (10.4%) and Staphylococcus aureus (8.9%).Susceptibility of Gram-positive organisms to a different class of antibiotics was as follows: glycopeptides (82, 96%), carbapenems (78.38%), aminoglycosides (57.81%), fluoroquinolones (50.00%) and trimethoprim-sulfamethoxazole (50%). Gram-negative isolates were more susceptible to aminoglycosides (56.52%) and fluoroquinolones (52.78%), respectively. Sensitivity of Gram-negative bacteria to fluoroquinolones was significantly higher in infections that occurred in the first month of the shunt implantations compared to infections that were detected afterward (78.95% vs. 23.53%, respectively, P = 0.001). Conclusion: The highest sensitivity of Gram-positive bacteria was to glycopeptides and carbapenems. In addition, Gram-negative organisms had the best susceptibility to aminoglycosides and fluoroquinolones. A high level of resistance to studied antibiotics among Gram-negative isolates underscores the necessity of including new antibiotics such as colistin, fosfomycin, ceftazidime/avibactam, ceftolozane/tazobactam and tigecycline in susceptibility testing and empiric antibiotic therapy for VP shunt infections.

Background: Hydrocephalus is the commonest pediatric neurological disorder and usually treated by cerebrospinal fluid (CSF) diversion. This diversion accomplished by third ventriculostomy or ventriculo-peritoneal shunt. However, the optimal management is still controversial. Aim of the work: To compare the endoscopic third ventriculostomy (ETV) to ventriculo-peritoneal (VP) shunt in management of Infantile hydrocephalus. Patients and Methods:We conducted a retrospective analysis for 40 infants with hydrocephalus. The treatment used was CSF diversion by ETV or VP shunt. Results: oth treatment groups were comparable regarding age, gender, cause of hydrocephalus, incidence of postoperative re-obstruction, OFC change, hematoma, revision surgery, mortality or success rate. However, the operative time was significantly reduced among ETV when compared to VP shunt group (48.80±9.13 vs 66.75±7.65 minutes, respectively). The rate of postoperative infection was significantly decreased in ETV when compared to VP shunt groups (15.0% vs 45.0% respectively). Finally, the overall mortality during postoperative one year follow up duration was 42.5% with no significant difference between ETV and VP shunt groups (35.0% vs 50.0% respectively). In addition, the overall failure rate was 50.0%, which was lower among ETV when compared to V shunt groups (35.0% vs 65.0% respectively) with no significant difference. Conclusion: Endoscopic third ventriculostomy is effective and safe intervention for treatment of infantile hydrocephalus (for infants between 6 and 3 years of age). It is superior to VP shunt as it is associated with lower postoperative infection and shorter operation time, when compared to shunt.

Cerebrospinal fluid (CSF) shunt infection is a serious and potentially devastating complication of CSF shunt placement. Younger age, previous CSF shunt infection or revision, and the type of the shunt are important risk factors for shunt infection. More than half of the cases are caused by Staphylococcus aureus and coagulase-negative staphylococci. The biofilm plays a central role in its pathogenesis. CSF cultures remain the gold standard for diagnosis of CSF shunt infection. The most effective way to prevent CSF shunt infection is optimization of sterile protocols and use of proper and timely antibiotic prophylaxis. Management of CSF shunt infection frequently requires removal of all shunt components, placement of a temporary external device, and administration of intravenous antibiotics, followed by reshunting at a later time. This review summarizes and analyses the results of previous reports of CSF shunt infection and assesses the prevention and management of this important entity. [ABSTRACT FROM AUTHOR]

Ventriculo-peritoneal shunting is a surgical treatment for hydrocephalus. Complications of this procedure are not well described in dogs. The most common complication in humans is infection, which can be fatal if not diagnosed and treated quickly. We describe the magnetic resonance ( MR) imaging characteristics of a shunt-associated cerebral infection in a dog. The MR features of the infection included hyperintensity of the lining of the ventricular system visible on a T2-weighted FLAIR sequence and marked linear contrast enhancement of the ependymal layer on T1-weighted sequences, similar to that described in people. [ABSTRACT FROM AUTHOR]

Migration of the peritoneal end of the ventriculo-peritoneal shunt through the patent processus vaginalis has been described in preterm male infants with 26 such cases in the literature. The occurrence of this rare complication in the female preterm infants has not yet been reported. We report a 3-month-old premature female infant who presented with a gradual increase in head size since birth. Computed tomography revealed obstructive hydrocephalous secondary to the aqueductal stenosis and ventriculo-peritoneal shunt was performed. Ten days following the procedure she presented with swelling and other signs of inflammation over the right vulvar region. X-ray abdomen confirmed the migration of the peritoneal end into the vulva. Surgical obliteration of the patent processus vaginalis and replacement of the peritoneal end was performed. The patient had no recurrence at 6 months of follow-up. This report presents the unusual complication of a common procedure in a female infant with a review of the current literature. [ABSTRACT FROM AUTHOR]

Oral physicians frequently encounter medically compromised patients in their everyday practice and a sizable number of these patients are in urgent need of specialized care. One such medically specialized category is that of patients suffering from hydrocephalus. A large number of medical reports and citations in support of surgical care of the hydrocephalic disorder are available in literature. However, reports on dental studies offer contradictory statements on the relationship between hydrocephalic shunts and oral manoeuvres. The present narrative review aims to delineate the historical journey of the association between shunt infections and dental procedures, decode the existing controversies and provide updated information on antibiotic prophylaxis prior dental treatment for hydrocephalic patients.