الفهرس يوجد فقط 14 صفحة متاحة للعرض العام
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المستخلص
It is a prospective study that included 60 patients below 14 years old with hydrocephalus randomly selected presented to ABO EL RISH Children Hospital to be operated upon in the period from October 2004 till February 2006. These patients were operated upon using two shunt systems (30 cases will be operated upon using contoured and 30 cases will be operated upon using Burr Hole V-P shunt systems, aiming to make a comparison between different ventriculo-peritoneal shunt systems used in treatment of hydrocephalus in ABO EL RISH Children Hospital to detect which system is most efficient and of less complication.
Exclusion criteria:
Patients excluded from this study if:
• They presented to the hospital already with shunt complications.
Methods:
All the cases were subjected to the following:
1- History taking:
Age, Sex, Vomiting, Seizures, Fever, rapid head growth, delayed milestone.
2- Full clinical examination:
Body temperature, neck rigidity, head circumference, anterior fontanelle, dilated scalp veins and sun setting of the eyes.
3- Investigations:
CT Brain, MRI was not performed because it is time consuming and expensive when compared to CT brain.
4- Shunt placement:
All patients will be operated upon by CSF Flow Control Shunt Systems (Contoured or Burr Hole) (in Burr Hole we will use medium pressure, size 12 mm shunt system).
5- Follow up:
All patients were followed up every two months for six months assessing shunt function.
Working shunt is the shunt that did not show any symptom or sign of complications in the follow up visits.
Results
In our study shunt obstruction occurred in 7 cases of the 60 cases under study in the first six months after shunt insertion (11.6%).
4 cases of 30 patients treated with contoured V-P shunts were obstructed (13.3%) and 3 cases of 30 patients treated with Burr-Hole V-P shunts were obstructed (10%) and there were (3) obstructed Burr-Hole V-P shunts, two were proximal and one was distal obstruction so the percentage of proximal obstruction in 30 patients treated with Burr-Hole V-P shunts.
Representing (6.6%) while the distal obstruction representing 3.3%. While there were (4) obstructed contoured V-P shunts, three were proximal and one was distal the percentage of proximal obstruction in 30 patients treated with contoured V-P shunts representing 10% while distal obstruction representing 3.3%.
In the present study shunt infection occurred in 9 case of the 60 cases under study in the first six months after shunt insertion (15%), 5 cases in the Contoured V-P shunts (16.6%) and 4 cases in the Burr-Hole V-P shunts (13.3%).
By the end of 6 months of follow up the shunt failure rate in contoured V-P shunt system used found to be 30%.
While in Burr-Hole V-P shunt system used the shunt failure rate found is 23%.
Finally we found that, by the end of six months of follow up the infection rate, obstruction rate and failure rate are higher in contoured V-P shunt than in Burr-Hole V-P shunt and working shunt rate is higher in Burr-Hole V-P shunt but these differences are found statistically insignificant (P > 0.05).