Nazwar Tommy Alfandy, Sumarno Sumarno, Balafif Farhad, Wardhana Donny Wisnu, Parubak Ronald Aprianto, Melani Melani, Titisari Prima Putri Dyah, Panjaitan Christin, Febriani Indri
Division of Neurosurgery, Department of Surgery, Faculty of Medicine, Brawijaya University/Dr. Saiful Anwar General Hospital, Malang, East Java, Indonesia.
Department of Clinical Microbiology, Faculty of Medicine, Brawijaya University/Saiful Anwar Hospital, Malang, East Java, Indonesia.
Surg Neurol Int. 2024 Aug 30;15:313. doi: 10.25259/SNI_545_2024. eCollection 2024.
Ventriculoperitoneal shunt (VPS) is an effective intervention for managing hydrocephalus; however, various complications may arise, one of which is infection due to shunt exposure. In this study, we report the incidence, risk factors, clinical presentation, and management strategies of four cases of shunt exposure in patients with hydrocephalus.
The first case involves a 1-year-10-month-old female who underwent her initial VPS placement at 7 months old due to hydrocephalus. The second case is a 3-month-old female who had a VPS placed at 20 days old for obstructive hydrocephalus and ventriculomegaly secondary to toxoplasmosis. The third case is a 15-year-old female who received a VPS due to a cerebral abscess with a prior history of tuberculous meningoencephalopathy. The fourth case is a 38-year-old male who underwent VPS placement for hydrocephalus. Two years post-intervention, the fourth patient was diagnosed with VPS exposure and subsequently underwent shunt removal.
The identification of risk factors and clinical symptoms in patients, supported by ancillary examinations such as cerebrospinal fluid analysis, can predict the incidence of VPS infections. Bacterial VPS infections can be managed with appropriate antibiotics tailored to the specific bacterial species. However, in certain cases, surgical removal of the VPS may be considered as a measure to eradicate infectious pathogens.
脑室腹腔分流术（VPS）是治疗脑积水的一种有效干预措施；然而，可能会出现各种并发症，其中之一是分流管外露导致的感染。在本研究中，我们报告了4例脑积水患者分流管外露的发生率、危险因素、临床表现及处理策略。
第一例为一名1岁10个月大的女性，因脑积水在7个月大时首次接受VPS植入术。第二例是一名3个月大的女性，因弓形虫病继发梗阻性脑积水和脑室扩大，在20日龄时接受了VPS植入术。第三例是一名15岁的女性，因脑脓肿接受VPS治疗，既往有结核性脑膜脑炎病史。第四例是一名38岁的男性，因脑积水接受VPS植入术。干预两年后，第四例患者被诊断为VPS外露，随后接受了分流管移除术。
通过脑脊液分析等辅助检查，识别患者的危险因素和临床症状，可预测VPS感染的发生率。细菌性VPS感染可用针对特定细菌种类的适当抗生素进行治疗。然而，在某些情况下，可考虑手术移除VPS作为根除感染病原体的一种措施。
