Korean J Neurotrauma.  2015 Oct;11(2):93-99. 10.13004/kjnt.2015.11.2.93.

An Improved One-Stage Operation of Cranioplasty and Ventriculoperitoneal Shunt in Patient with Hydrocephalus and Large Cranial Defect

• Jung YT
• Lee SP
• Cho JI

• KMID: 2378265
• DOI: http://doi.org/10.13004/kjnt.2015.11.2.93

Abstract

OBJECTIVE
The risk of complications is high for patients with a large cranial defect and hydrocephalus, undergoing cranioplasty and ventriculoperitoneal (VP) shunt operation. The purpose of this study is to examine retrospectively such cases with complications and contrive an operative technique to reduce complications.
METHODS
Nineteen patients underwent cranioplasty and VP shunt operation due to large cranial defects and hydrocephalus. These patients were divided into two groups: Group A with 10 patients who underwent staged-operations, and Group B with 9 patients who underwent one-stage operation. Their complications in each group were retrospectively reviewed. Another five patients underwent a one-stage operation with temporary occlusion of the distal shunt catheter to improve on the technique and were categorized as Group C. Complications in these groups were compared and analyzed.
RESULTS
The results of the data analysis revealed that complications related to anesthesia (40%) and those related to antibiotic prophylaxis (30%) were high in Group A, while non-infectious delayed complications (45%) and perioperative complications such as intracranial hematoma (33%) were high in Group B. However, for patients in Group C, it showed less complication with the operative technique devised by these authors, as opposed to two previous procedures.
CONCLUSION
In patients with hydrocephalus and a large cranial defect, complications arising from existing one-stage operation or staged-operations can be reduced by implementing the technique of "one-stage operation with temporary occlusion of the distal shunt catheter."

Keyword

Decompressive craniectomy; Cranioplasty; Cranial defect; Ventriculoperitoneal shunt; Hydrocephalus; One-stage operation

MeSH Terms

Anesthesia
Antibiotic Prophylaxis
Catheters
Decompressive Craniectomy
Hematoma
Humans
Hydrocephalus*
Retrospective Studies
Statistics as Topic
Ventriculoperitoneal Shunt*

Figure

• 

  FIGURE 1 Photographs of occluded distal shunt catheter by using different occlusion devices. A: By making a direct tie of the shunt catheter with a black silk 4-0 suture material. B: By applying a Yasargil aneurysm clip. Note that the distal end of the clip blades is reinforced with a black silk tie to increase the ending force. C: With a bulldog clamp.

• 

  FIGURE 2 The slides of thin sections of the region, which have been occluded for 7 days, are observed under an optical microscope (×100) (A) and a surgical microscope (×13) (B). Note that there is no difference between the wall structure of the 3 differently occluded shunt catheters and that of a normal shunt catheter. N: none occluded, C: clipped, B: bulldog clamped, T: tied.

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