Selected Compilation: The method of judging the fault site of the ventricular abdominal shunt device

Ventriculoperperoneal shunt (ventriculoperitoneal, VPS) is one of the most common operations in neurosurgeryThe risk of surgery is low, but the incidence of shunt failure is highVPS system failures can increase disability and mortality rates, so they must be diagnosed and repaired promptly and accuratelyThere is still no consensus guideline or recommended standardized approach to properly determine the exact site of the shunt system failure and failure, such as near-end conduits, valve devices, or remote conduitsMorgan Broggi of The Brainazione IRCCS Istituto Neurology Carlo Besta Neurosurgery in Milan, Italy, conducted a study to identify the fault diagnosis method of the VPS system, published online in February 2020 in World Neurosurgeryresearch methods
the researchers put forward the process path to determine the failure of the VPS system (Figure 1)A retrospective study of patients admitted to hospital for suspected VPS failures between 1 January 2012 and 31 December 2018 was conductedFigure 1VPS device barrier detection processvpS reservoir sac punctures in patients whose ventricles are confirmed by clinical symptoms and CT tests, and surgical replacement of the ventricles if the puncture does not have cerebrospinal fluid and the near-end catheter is highly suspected to be blocked or failedConversely, if cerebrospinal fluid is obtained, the sample is sent to culture for examination, bacteria are found in the cerebrospinal fluid for anti-infection treatment and replacement of the entire shunt system, and when there is no bacteria in the cerebrospinal fluid, the reservoir sac is selectively eliminated under x-line by injection of the reservoirWhen the near-end catheter is partially blocked, the cerebrospinal fluid can also be extracted from the reservoir sacManually close the far end catheter a few centimeters at the far end of the valve, and the puncture reservoir sac is slowly injected into the physiological saline solution (1:1) of the 3-4mL iodide contrast agent, allowing the contrast agent to fill the vents evenlyConfirm the smoothness of the near-end catheter on the X-ray screen, and if the in-brain contrast agent is not photosensitive or difficult to inject into the ventricle, the near-end catheter should be suspected of complete or partial obstructionWhen evaluating the valve and the far-end catheter, apply pressure on the valve to close the near-end catheter, and then slowly inject the valve with a 5-7mL contrast agent solution to observe whether there is an contrast agent in the abdominal cavity and "spray- into the abdominal cavity to confirm the smoothness of the far-end catheter."results102 patients, aged 1-86 years, with an average age of 41.5 years, and 56 men, were included in the VPS device disorder testThe study found 59 cases (57.8%) of VPS failures12 cases (20.3%) occurred, ventricular tube blocking or damage or shift, 11 cases (18.6%) valve damage, 17 cases (28.8%) remote conduit blocking or damage or shift, 16 cases (27.1%) valve and near-end conduit or valve and far-end conduit blocked or damaged or shifted3 cases (5.1%) VPS device is normal, but there is an infectionSelective VPS repair based on the barrier siteThe sensitivity and specificity of the above tests were 92.2% and 100%, respectively, while the positive and negative predictions were 100% and 88.4%, respectivelyConclusion
the authors point out that when the VPS device is suspected of malfunction, it is recommended to identify quicklyAccording to the judgment process proposed by the author, the fault site of the VPS device can be accurately determined, the corresponding repair is carried out, and the whole shunt system is not replacedCopyright Notice the copyright of works published byOutside InformationAPP, including but not limited to text, pictures, videos, are owned by the sponsor/original author andof the God's Information, and no one may steal any content directly or indirectly by means of adaptation, cutting, reproduction, reproduction, recording, etcwithout the express authorization of theoutside information Works authorized by the Outside Information shall be used within the scope of authorization, please indicate the source: the of the Outside Information If there is a violation, outside the information will reserve the right to further pursue the legal liability of the infringer outside the information welcome individuals to forward and share the works published by this number.