| Hydrocephalus refers to the imbalance between CFS production and absorption and/or the obstruction of its pathways,causing disturbance in cerebrospinal fluid(CSF)dynamics and abnormal accumulation of excess cerebrospinal fluid in either the ventricle or subarachnoid space,and resulting in the associated dilatation of their parts.The incidence of hydrocephalus in the general population is 1%～1.5%and increases with the increase of population.Hydrocephalus,a common disease in neurosurgery occurs in patients ranging from newborns to adults.It can be divided into primary and acquired hydrocephalus according to etiology.Acquired hydrocephalus is known as common sequelae in patients with post-hemorrhagic conditions,including brain trauma,intracranial hemorrhage,brain tumors,intracranial infection,etc.The clinical manifestations are the symptoms of increased intracranial pressure,such as headache,vomiting,papillary edema,diplopia,vertigo,etc.,or the triple symptoms of gait instability,dementia,urinary incontinence,or the patients with improved consciousness after the treatment of the primary onset of intracranial gradually aggravate the consciousness disorder.Ventriculoperitoneal shunt is the most common and effective method for treatment of hydrocephalus.Early shunt surgery in patients with hydrocephalus leads to a better prognosis.Therefore,early treatment is of positive significance.However,postoperative infection is an important factor in the failure of ventriculoperitoneal shunt,especially the most important reason for the recent failurePreoperative intracranial infection is considered an absolute contraindication for ventriculoperitoneal shunt.However,it is difficult to be diagnosed,especially occult intracranial infection.CSF bacterial culture is the gold standard for diagnosis of intracranial infection in clinical practice,but the low positive rate and time-consuming procedure of CFS bacterial culture restrain its role.Clinically,most patients with hydrocephalus cannot be guided by objective CSF bacterial culture results because they usually need prompt surgical treatment.For the vast majority of patients with negative CSF bacterial culture,leukocyte count,chlorine glucose and protein levels in CSF combined with clinical symptoms(fever)and signs(meningeal irritation sign)should be synthetically measured to determine an intracranial infection is present.Therefore,the clinical diagnosis of intracranial infection can be challenging since issues such as lacking an unified standard as well as false negative/positive rate.Fever is common after neurosurgery,which is also a crucial indicator for the diagnosis of intracranial infection.Currently,there are few reports on the correlation between the change of body temperature after ventriculoperitoneal shunt and postoperative intracranial infection.ventriculoperitoneal shunt is urgently needed for most patients with hydrocephalus to improve symptoms;the presence of intracranial infection directly affects the treatment plan and prognosis of patients.In real clinical situation,ventriculoperitoneal shunt operation is still carried out though the indicators of leukocyte,Cl,Glu and Pro in CSF are not within the normal range,and no intracranial infection occurs postoperativelyTherefore,the aim of this study was to identify the relationship between cerebrospinal fluid(CSF)leukocyte count,chloride levels,glucose levels,and protein levels and ventriculoperitoneal shunt infection,to guide the appropriate operation time for patients with hydrocephalus with abnormal cerebrospinal fluid.This study also studied the relationship between fever and postoperative infection after ventriculoperitoneal shunt,aiming to provide some guidance for early diagnosis and timely anti-infection treatment of intracranial infection after ventriculoperitoneal shunt.Section 1 Overview of hydrocephalus and bacterial central nervous system infectionsObjective Summary of hydrocephalus and bacterial central nervous system infections.Methods Through literature investigation,this paper summarizes hydrocephalus and bacterial central nervous system infection.Results The literature review mainly discusses the following aspects,including the classification,clinical manifestations,diagnosis,differential diagnosis and treatment of hydrocephalus.Epidemiological characteristics,etiology,distribution of etiology,clinical manifestations,laboratory examination,diagnosis and treatment of bacterial CNS infection.Conclusion Hydrocephalus is a common disease in neurosurgery Early surgical treatment can improve the prognosis of patients.There is no uniform standard for the diagnosis of bacterial CNS infection.Section 2 A clinical study of abnormal cerebrospinal fluid parameters before ventriculoperitoneal shunt related topostoperative intracranial infectionObjective To identify the relationship between preoperative cerebrospinal fluid(CSF)leukocyte,chloride,glucose,and protein levels and ventriculoperitoneal shunt infection.Methods Records of 272 consecutive patients who underwent ventriculoperitoneal-shunt surgery for the treatment of hydrocephalus in Zhujiang Hospital affiliated to Southern Medical University from January 2010 to December 2018 were reviewed.According to the postoperative infection or not,the patients were divided into the infection group and the non-infection group,who were analyzed the relationship between age,gender,primary disease,preoperative CSF leukocyte,chloride,glucose and protein levels and postoperative infection.Results A total of 272 patients were included,25(9.19%)were infected within 6 months after the operation,and the remaining 247(90.81%)were not infected.Low age(OR=1.019,P=0.063,95%CI:0.999-1.039)and low preoperative CSF glucose(OR=2.185,P=0.035,95%CI:1.055-4.522)were risk factors for ventriculoperitoneal shunt infection.ROC analysis revealed that the area under the curve after the combination of the above two factors was 0.688(95%CI:0.578-0.798).There was no statistical relationship between shunt infection and the CSF levels of leukocyte,chlorine and protein before shunt insertion.Conclusions Surgical treatment of young hydrocephalus patients should pay special attention to aseptic operation to avoid postoperative infection.Ventriculoperitoneal shunt should be performed after CSF glucose levels return to normal.Section 3 A Clinical study on the relationship between temperature change and intracranial infection after ventriculoperitoneal shuntObjective To observe the trend of temperature change after ventriculoperitoneal shunt and its correlation with postoperative infection.Methods A retrospective cohort study was conducted on 272 patients who underwent ventriculoperitoneal shunt from 2010 to 2018 in zhujiang hospital of southern medical university.Temperature levels of all patients were monitored on the surgery day,on 1st,3rd,5th and 7th days after surgery,and were divided into infected group and uninfected group according to whether infective extubation occurred after surgery.According to the time of postoperative intracranial infection,the infected patients were divided into early infection group and delayed infection group,and the temperature and fever of the two groups were compared on the surgery day and on the 1st,3rd,5th and 7th day after surgery.Results Among 272 patients,intracranial infection occurred in 25(9.19%),including 21 cases of early infection and 4 cases of delayed infection,and uninfected in 247(90.81%).Compared with the uninfected group,the fever rate and body temperature of the infected group were higher on the 3rd,5th and 7th day after surgery(P<0.05).There was no significant difference in fever rate and body temperature on the surgery day and on the 1st,3rd,5th and 7th day after surgery between the early infection group and the delayed infection group(P>0.05).Conclusions The fever rate was higher and the body temperature decreased faster after ventriculoperitoneal shunt.The fever after the third day of surgery is closely related to postoperative infection,which has a certain predictive significance for postoperative infection,so we should consider anti infection treatment in time. |
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