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17-APRIL-2007 RAWAN TALEB ABU-THABET 22 YEARS MALFUNCTIONING
VENTRICULO-PERITONEAL SHUNT.
Anamnesis
The patient came to the emergency Al-Shmaisani
hospital with acute episode of headache, blurred
vision and vomiting for 2 days.
The patient was operated by me September-1998
for pinealocytoma followed by insertion of the
ventriculo-peritoneal shunt right side, followed
by radiotherapy. She was last seen in the clinic
24-February-1999 to stop anticonvulsant
treatment.
MRI of the brain was performed and confirmed the
presence of acute hydrocephalus.
On examination:: The patient was almost blind in
both eyes with agonizing headache. Check for
reservoir function was acceptable. Plain abdomen
and skull X-ray ruled out slippage of the shunt.
Mannitol 20 gm every 6 hours started and the
patient was taken to the operating room after 7
hours.
The old abdominal incision was refreshed and the
shunt was pulled out of its canal and checked
directly for its function. It was functioning
perfectly and it was clean. Inspection inside
the slits was normal. The distal part of the
shunt was reinserted to the same canal and
rotated several times to prevent possible
occlusion by scar or omintum inside the abdomen.
Smooth postoperative recovery and the Mannitol
was stopped and all medications. The visual
functions normalized and the patients complains
disappeared.
Comments
The patient got sudden onset hypertensive
encephalic syndrome due to unknown reasons of shunt malfunction
with deteriorating visual functions, which could lead to
complete bilateral blindness.
Direct check of the shunt function is
mandatory, to prevent further escalation of the increase
intracranial pressure.
The cause of the malfunction could be a
debris or many countless reasons, which could cause temporary or
permanent function loss of the shunt.
Despite the fact the patient is stable for
more than 12 years after surgery for pinealoma and insertion of
VPS, she was in need for the device all the time. In other
cases, the patient could accommodate and when the shunt start to
malfunction, no clinical data are observed and the incidence
undergo unnoticeable.
For more details about pinealomas click
here!
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Notice: Not all operative activities
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Notice: Head injuries and very urgent surgeries are also
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