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A technique for the insertion of Holter ventriculo-atrial shunt for infantile hydrocephalus
358
ABSTRACTS
standing unlikely. The rationale of the operation is that it provides sufficient laxity for both equinus and varus deformities to be corrected without tension. Forty-one operations were performed in 23 children, with five unilateral and 18 bilateral procedures. Of these, 25 operations were on arthrogryposis and 16 on spina bifida patients. Thirty-two feet had a good result, six residual equinus only, and three were failures needing further operation. The author concludes from this work that the operation has a useful place in management of these cases. -John Aitkel
NERVOUS
SYSTEM
Frontobasal Skull Fractures in Childhood. E. Deisenhammer and A. Gund. Wien. Med. Wschr. 121:510-512 (June), 1971. Though frontobasal skull fractures are comparatively rare in children, correct treatment is mandatory in these cases. Even without signs of a nasal liquorrhea, rhinogenous meningitis can occur. To prevent this, operation is recommended in all cases. Diagnosis is improved by means of a cysternoscintiscan using RIHSA iodine-131. In testing the secretions for its contents of radioisotopes an external fistula can be demonstrated. Localized disturbances of the C.S.F. circulation on the brain surface without fistula formation, showing a stasis of liquor in porencephalic cysts or around. scar formations, can indicate a necessary operation. The authors’ experience is based on a series of 129 frontobasal skull fractures, 16 of them in children. -G. Brancfesky A Technique for the Insertion of Holter Ventriculo-atrial Shunt for Infantile Hydrocephalus. S. Tsingoglou and D. M. Forrest. Brit. J. Surg. 58:367-372 (May), 1971. The operative technique, pre- and postoperative management, of Holter ventriculoatria1 shunt for infantile hydrocephalus is described. To minimize postoperative septicemia, which is the major cause of morbidity and mortality following valve insertion, a
technique is developed to shorten the operative time and minimize contact with the skin, prolonged exposure of wound, and excessive handling of the shunt. Operative time is saved by insertion of the distal catheter blindly and the length of the distal catheter is determined by a preoperative chest X ray using a lead shot marker placed at the right sterna edge along the nipple line. An A-type distal catheter is used and the optimal position aimed at is the lower right atrium. In the 6 yr 1962-1967, 330 hydrocephalic children, 221 of whom also had spina bifida, were operated on using this technique. The operative mortality was three. One had a cardiac arrest during skin closure and autopsy revealed no cause of death. Two children died following bperation. In one, a subdural hematoma was found on the side of the operation, and in the second there was intraventricular and subarachnoid hemorrhage. The incidence of septicemia was 4.4% in the hydrocephalus-only group and 5.8% in those who also had spina bifida. These results are favorable when compared with other published results, although they are often not directly comparable; 6.8% (Becker and Nielsen, 1968), 7.8% (Eckstein and Cooper, 1968). Postoperative chest X rays to determine the position of the distal catheter using this method in 356 shunt operations showed the following results. Lower right atrium 253 (71.0%). Midright atrium 27 (7.6%). High right atrium seven (2%). Right atrium/inferior vena cava ten (2.8%). Inferior vena cava 23 (6.4%). Right ventricle 23 (6.4%). Low superior vena cava six (1.6%). Others seven (2%). The authors believe that although their method of insertion of distal catheter may lead to more cases of unsatisfactory position of the catheter compared with radiographic or electrocardiographic control techniques, it has the advantage of making the operation simple and short and cuts down the incidence of septicemia compared with other reported series. -7. Lari
Complications from Holter Ventriculo-atrial Shunts. S. Tsingoglou and D. M. Forrest. Brit. J. Surg. 58:372-377 (May), 1971.
ABSTRACTS
standing unlikely. The rationale of the operation is that it provides sufficient laxity for both equinus and varus deformities to be corrected without tension. Forty-one operations were performed in 23 children, with five unilateral and 18 bilateral procedures. Of these, 25 operations were on arthrogryposis and 16 on spina bifida patients. Thirty-two feet had a good result, six residual equinus only, and three were failures needing further operation. The author concludes from this work that the operation has a useful place in management of these cases. -John Aitkel
NERVOUS
SYSTEM
Frontobasal Skull Fractures in Childhood. E. Deisenhammer and A. Gund. Wien. Med. Wschr. 121:510-512 (June), 1971. Though frontobasal skull fractures are comparatively rare in children, correct treatment is mandatory in these cases. Even without signs of a nasal liquorrhea, rhinogenous meningitis can occur. To prevent this, operation is recommended in all cases. Diagnosis is improved by means of a cysternoscintiscan using RIHSA iodine-131. In testing the secretions for its contents of radioisotopes an external fistula can be demonstrated. Localized disturbances of the C.S.F. circulation on the brain surface without fistula formation, showing a stasis of liquor in porencephalic cysts or around. scar formations, can indicate a necessary operation. The authors’ experience is based on a series of 129 frontobasal skull fractures, 16 of them in children. -G. Brancfesky A Technique for the Insertion of Holter Ventriculo-atrial Shunt for Infantile Hydrocephalus. S. Tsingoglou and D. M. Forrest. Brit. J. Surg. 58:367-372 (May), 1971. The operative technique, pre- and postoperative management, of Holter ventriculoatria1 shunt for infantile hydrocephalus is described. To minimize postoperative septicemia, which is the major cause of morbidity and mortality following valve insertion, a
technique is developed to shorten the operative time and minimize contact with the skin, prolonged exposure of wound, and excessive handling of the shunt. Operative time is saved by insertion of the distal catheter blindly and the length of the distal catheter is determined by a preoperative chest X ray using a lead shot marker placed at the right sterna edge along the nipple line. An A-type distal catheter is used and the optimal position aimed at is the lower right atrium. In the 6 yr 1962-1967, 330 hydrocephalic children, 221 of whom also had spina bifida, were operated on using this technique. The operative mortality was three. One had a cardiac arrest during skin closure and autopsy revealed no cause of death. Two children died following bperation. In one, a subdural hematoma was found on the side of the operation, and in the second there was intraventricular and subarachnoid hemorrhage. The incidence of septicemia was 4.4% in the hydrocephalus-only group and 5.8% in those who also had spina bifida. These results are favorable when compared with other published results, although they are often not directly comparable; 6.8% (Becker and Nielsen, 1968), 7.8% (Eckstein and Cooper, 1968). Postoperative chest X rays to determine the position of the distal catheter using this method in 356 shunt operations showed the following results. Lower right atrium 253 (71.0%). Midright atrium 27 (7.6%). High right atrium seven (2%). Right atrium/inferior vena cava ten (2.8%). Inferior vena cava 23 (6.4%). Right ventricle 23 (6.4%). Low superior vena cava six (1.6%). Others seven (2%). The authors believe that although their method of insertion of distal catheter may lead to more cases of unsatisfactory position of the catheter compared with radiographic or electrocardiographic control techniques, it has the advantage of making the operation simple and short and cuts down the incidence of septicemia compared with other reported series. -7. Lari
Complications from Holter Ventriculo-atrial Shunts. S. Tsingoglou and D. M. Forrest. Brit. J. Surg. 58:372-377 (May), 1971.