Case (2): Tumor related hydrocephalus and its related CSF diseases Websiteďźšwww.csfneurosurg.com
Case 2: “incurable ” peritoneal Shunt obstruction? • Case 1 :Male,59 years old; • April 30, 2010: surgical removal of a tumor in Forth ventricular floor(fig.1) • During radiotherapy from June 7 to July 21 ,2010: blood hypotension, olfactory hallucination , instable gait, unable to stand（astasia ） • After radiotherapy till July 29 ,2010: serious memory loss ;incontinence ; mind unconsciousness • At July 29 ,2010: MRI showed an hydrocephalus(fig.2)
Fig.1. before surgery
Fig.2 at July 29 ,2010
27 days delay of diagnosis of shunt complication after delayed first shunting 1. 2.
At 8/31/2010：a delayed V-P shunting performed after one month of treatment of his “cerebrogenic pneumonia” without significant responsive effect, During 27 days after 7th day of shunting: 1. 2. 3.
3.
Continuous fever and abdominal pain (abdominalgia); Extensive enteroparalysis (enteroplegia) plus an inflammatory mass (fig.1),and pneumonia(fig.2); Above both were irresponsible to long-term antibiotics treatment
Transferring to the China center of Neurosurgery in Beijing
At October 3,2010 after 27 days of antibiotics treatment : Pneumonia and Gastrointestinal paralysis
still be there
Continuous 6 failed shunt revisions for shunt obstructions in later approximately 100 days Every revisions because their progressive processes of from conscious response in slowness to incontinence and to coma plus ventricular enlargement: 1. 2. 3.
4. 5. 6.
1st shunt revision : (for peritoneal shunt bloc at 10/21/2010）； 2nd shunt revision : (for peritoneal shunt bloc at 10/24/2010） 3rd shunt revision by 1st laparoscopic surgery : (for peritoneal blocked shunt putted in Right iliac fossa (at 11/12/2010） 4th shunt revision by 2nd laparoscopic surgery ( for peritoneal blocked shunt putted between liver and diaphragm at 12/11/2010 ） 5th shunt revision by inserting another new V-P shunt between liver and diaphragm with the original shunt in place (for peritoneal shunt bloc too at 1/13/2011 . 6th shunt revision at 3/1/2011 by 3rd laparoscopic surgery putting both shunts in bilateral iliac fossa of pelvis ，because both shunts are already adhesive with enlarged gallbladder .
Good neuroimmaging results from CSF treatments in our hospital
3 months later
At admission
1 year later
Excellent results from neurosurgical CSF treatments 1.5 months later
At admission
3 months later
1year later