Third ventriculostomy vs ventriculoperitoneal shunt in pediatric obstructive hydrocephalus: results from a Swiss series and literature review
ABSTRACT Few series compare endoscopic third ventriculostomies (ETV) and ventriculoperitoneal shunts (VPS). To avoid the complications after a shunt insertion, there is an increased tendency to perform a third ventriculostomy. We reviewed all pediatric patients operated in the French-speaking part of Switzerland for a newly diagnosed obstructive hydrocephalus since 1992 and compared the outcome of patients who benefited from ETV to the outcome of patients who benefited from VPS. There were 24 ETV and 31 VPS.
At 5 years of follow-up, the failure rate of ETV was 26%, as compared to 42% for the VPS group. This trend is also found in the pediatric series published since 1990 (27 peer-reviewed articles analyzed).
In accordance to this trend, although a statistical difference cannot be assessed, we believe that ETV should be the procedure of choice in pediatric obstructive hydrocephalus.
Article: Chapter 9 The Aldan terrain
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ABSTRACT: Introduction: Hydrocephalus is the most common congenital abnormality of the central nervous system in infants. Many cases of hydrocephalic children are described since ancient times. It is characterized by excessive accumulation of cerebrospinal fluid in the ventricles of the brain. Its symptomatology during infanthood or early childhood is characterized by swelling of the head, protrusion of the forehead and brain atrophy. All these symptoms appear due to increased cerebrospinal fluid volume, increased intracranial pressure and dilatation of the ventricular walls. Aim: The aim of this paper is to describe the ventriculoperitoneal shunt complications in pediatrics patients and to point out the role of nursing stuff in the prevention of them. Methods: This include literature search on the database Medline and relevant with that issue international hydrocephalus organizations to identify studies regarding the complications of ventriculoperitoneal shunt and the nursing care for each complication. Results: Ventriculoperitoneal shunt is the treatment of hydrocephalic infants, rather than endoscopic third ventriculostomy. Although the success of the ventriculoperitoneal shunt's placement, the patients usually suffer from its afterwards complications. The complications involves postoperative shunt infection, shunt placement failure, shunt obstruction – malfunction, abdominal complications – peritonitis, valve complications, slit-ventricle syndrome and seizures. The role of the nursing stuff is vital, particularly in the postoperative weeks. Conclusion: A proper nursing assessment includes valid identification of complications and their prompt treatment. Also, nurses had to implement accurate nursing care, in order to prevent any complication. Finally, parental teaching from the nurses is crucial in the process of health outcomes for pediatric patient.
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ABSTRACT: Achieving high distribution reliability levels and concurrently minimizing capital costs can be viewed as a problem of optimization. Assuming given outage rates and repair times, distribution system design is the remaining factor in determining customer reliability. Including customer value of reliability in an economic analysis allows for optimization of the major components of distribution system design. Using mathematical models and simulations, a comparison of design concepts can be performed to compute the optimal feeder section length, feeder loading level, and distribution substation transformer loading level. The number of feeder ties and feeder tie placement are also optimized through the models. The overall outcome of this analysis is that capital costs can then be directed towards system improvements that will be most cost-effective in improving system reliability. This paper presents a value-based probabilistic approach to designing urban distribution systems. The value-based reliability methodology is illustrated using a practical urban distribution system of MidAmerican Energy Company.International Journal of Electrical Power & Energy Systems 01/2004; DOI:10.1016/j.ijepes.2005.08.006 · 3.43 Impact Factor