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The treatment of choice in NPH is ventriculoperitoneal shunt surgery (VPS). This treatment needs a VP shunt, which is a catheter with a valve aiming at implementing a one-way outflow of the excessive amount of CSF from the ventricles. It is obligatory to have patency control because of some possible complications such as infections and obstruction.
To evaluate the benefit of surgical shunt removal or externalization followed by removal, Wong et al. compared two groups: one with medical treatment alone, and another with medical and surgical treatment simultaneously. 28 patients with infection after ventriculoperitoneal shunt implantation over an 8-year period in their neurosurgical center ...
Fluid-attenuated inversion recovery (FLAIR) is a magnetic resonance imaging sequence with an inversion recovery set to null fluids. For example, it can be used in brain imaging to suppress cerebrospinal fluid (CSF) effects on the image, so as to bring out the periventricular hyperintense lesions, such as multiple sclerosis (MS) plaques. [ 1 ]
ShuntCheck is comparable to imaging in ruling out shunt obstruction in cases which the Attending Physician judges to be “unlikely to require shunt surgery”. Sinai Baltimore NPH Study 2012-2014 Michael A. Williams MD is conducting ShuntCheck testing on adult hydrocephalus patients undergoing radionuclide shunt patency testing.
Each of the types of shunts listed above can be composed of a tube or catheter and various types of valves, although they can just be composed of the tubing or catheter. Below is a list of valves that are used in lumbar–peritoneal shunts (LP shunts) and Cerebral shunts (for a more detailed list of the types of valves see type of valves): Delta
In CT scan, subdural hygroma will have same density as the normal CSF. Meanwhile, in MRI, subdural hygroma will have same intensity with CSF. If iodinated contrast is administered during CT scan, the hygroma will produce high density because of the contrast at 120 kVp. However, at 190 kVp, hygroma with contrast will have intermediate density.
When catheter drainage is permanent, it is usually referred to as a shunt. There are many catheter-based ventricular shunts that are named for where they terminate, for example, a ventriculoperitoneal shunt terminates in the peritoneal cavity, a ventriculoatrial shunt terminates within the atrium of the heart, etc.
The shunt can be obstructed at the catheter or the valve itself. Cases of shunt obstruction would present with similar symptoms to untreated hydrocephalus (headaches, nausea, lethargy, etc.). It can be caused by tissue, bacteria, or kinking of the catheter. Diagnosis is usually made by shunt tapping and imaging studies like CT.