Endoscopic Third Ventriculostomy Versus Ventriculoperitoneal Shunt In Treatment Of Hydrocephalus

Abstract

The treatment goals of hydrocephalus include control of increased intracranial pressure and avoidance of infection. Achieving these allows the preservation of maximal intellectual function and minimizes neurological deficits. Many of the congenital forms of hydrocephalus are associated with an overall good outcome. The definitive therapy for hydrocephalus is shunting the CSF from the lateral ventricles to another region where it can be absorbed. The VP shunt, first available in the 1950s, but improved after silastic tubing became available. Cerebrospinal fluid may be shunted to other locations, including the right atrium and pleura. Historically, CSF has been diverted to other areas, including the gall bladder, stomach, fallopian tube, and ureter . The most common complication of the VP shunt is the infection, Shunt infections can present in a number of ways: (a) meningitis, (b) an indolent infection with a chronic inflammatory response leading to shunt obstruction, (c) local soft tissue infection around the shunt hardware with wound breakdown and/or purulent discharge, or (d) infection within the peritoneal cavity that presents with abdominal pain, shunt obstruction and/or an accumulation of fluid within the peritoneal cavity. Approximately two-thirds of all shunt infections are caused by staphylococcal species (S.epidermidisand S. aureusbeing the most common). These bacteria probably colonize a shunt at the time of insertion, and an infection usually becomes clinically apparent within the first 6 months after insertion. The variability in time of presentation depends on the degree of colonization, virulence of the organism and host factors. Only 10% to 20% of shunt infections present more than 6 months after insertion. The presence of a shunt infection proven by CSF Gram stain or culture requires treatment with appropriat