Ventriculoperitoneal Shunt Infection and Treatment in Children

Purpose: The most important complication of ventriculoperitoneal shunt (VPS) surgery is central nervous system infections developing in the postoperative period. The incidence of VPS infection in cases with VPS inserted is known to be between 6.5-23.5%. The aim of this study is to evaluate the treatment and complications relating to VPS surgery infections in pediatric patients with hydrocephalus. Material and Methods: Patients between January 2011 and January 2013 with VPS inserted for hydrocephalus and complications relating to infections after surgical intervention were included in the study. The patient files were retrospectively investigated and analyzed. Patients were evaluated based on demographic characteristics, etiology of hydrocephalus, date of shunt insertion, operation notes from the VPS insertion operation, microbiological and biochemical test results on CSF samples after diagnosis of VPS infection, surgical intervention for treatment, antibiotics administered and duration of antibiotic use. Results: Thirty-five patients monitored for VPS infection diagnosis between the ages of 3 days and 16 years were evaluated. In the 35 patients monitored for VPS infection diagnosis 19 had growth in cerebrospinal fluid (CSF) while 17 patients had no growth in CSF but inflammatory findings were present. The most frequently isolated effective pathogens were coagulase-negative staphylococci (78%). Other microorganisms isolated in the CSF of patients were Staphylococcus aureus, Enterococcus feacalis, Enterococcus gallinarium, Pseudomonas stutzeri, Candida albicans, Streptococcus mitis and ESBL (-) Klebsiella pneumonia. While one patient died during treatment, 34 patients were successfully discharged. Conclusion: We believe that early administration of antibiotic treatment and removal of the infected shunt are of vital importance. [Cukurova Med J 2015; 40(1.000): 72-79

Rapid Effect of Gamma Knife Radiosurgery on Clivus Metastasis: A Case Report

Breast cancer may cause distant metastasis even though there is no local recurrence. Disease can spread to any part of body via lymphoid and hematogenous way, and clivus is one of the most common locations. Total excision of clival lesions carries a significant risk of neurologic damage due to proximity to cranial nerves. We present 62-year-old woman who has a previously known breast cancer history. She admitted to our clinic with unilateral sixth nerve palsy and diplopia. Imaging studies revealed clivus metastasis. Patient was treated with gamma knife radiosurgery. In the next 2 months, sixth nerve palsy recovered along with diplopia. In this case report we would like to emphasize the importance of gamma knife radiosurgery at the deeply located breast cancer metastasis