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Torkildsen procedure is a ventriculo-cisternal shunt the diverts the cerebrospinal fluid flow from among the lateral ventricles, via a ventricular catheter, to the cisterna magna that the posterior fossa. That is the first described procedure of CSF diversion because that the treatment of hydrocephalus <1> (Scarff, 1963).
Presentation that case
We existing the instance of a premature birth infant who presented with short article hemorrhagic hydrocephalus that underwent several failed CSF diversion surgeries before Torkildsen shunt procedure. The patient overcame the person that is abnormal of CSF circulation that were observed prior to the operation and his post-operative course to be uneventful, in terms of CSF –related complications.
We summary the historic data and also the technical elements of the procedure, and also we existing a brief literature review of the indications and also limitations associated with it.
Torkildsen shunt deserve to be reliable in selected patients with hydrocephalus even in the contemporary era the computed tomography and magnetic resonance imaging. The procedure allows one to protect against a traditional ventriculoperitoneal shunt, especially in situations it is no technically feasible.
Abbreviations: VP shunt, ventriculo-peritoneal shunt; CSF, cerebrospinal fluid; CT, computed tomography; MRI, magnetic resonance imaging; EVD, outside ventricular drainage; T2 GRE, T2 gradient echo sequence; VCS, ventriculocisternostomy; VA shunt, ventriculo-atrial shunt; CNS, main nervous system
We state the he work has actually been report in line with the scare criteria, as sited in our recommendations <2>
The Torkildsen shunt was very first performed in 1937 through Dr. Arne Torkildsen, a Norwegian neurosurgeon, and also reported in 1939 <1,3,4>. The is considered to it is in a kind of interior ventriculocisternal shunt the diverts the cerebrospinal fluid (CSF) flow from one of the lateral ventricles, specific the occipital horn, come the cisterna magna the the posterior fossa.
Although it appears that initially had actually been widely embraced as efficient surgical procedure for treating hydrocephalus, introducement of the VA shunt and later of the VP shunt procedure, to be the reason that that was greatly abandoned.
In this paper, us report our endure using this historical procedure come a situation of infantile hydrocephalus that appeared to it is in untreatable with contemporary therapeutic strategies.
2. Presentation of case
We describe a premature infant, 26 main of gestational period at birth, who was born via cesarean incision through sciatic projection. Amniocentesis was executed 3 days prior to birth in stimulate to inspection the possibility of short extremities stature, ~ which mommy suffered placental abruption. The infant’s gestational weight was 760 g and also he was hospitalized in an incubator.
Two days after birth, as a screening test, an initial ultrasound via the anterior fontanelle was performed, which proved the existence of intraventricular hemorrhage grade IV through accompanying porencephalic cysts the were connecting with the ventricular system. Clinical and also neurological examination known only one upcoming fullness that the anterior fontanelle and a left posterior plagiocephaly.
From the patient clinical history, we have to cite that he experienced from necrotic enterocolitis and also he to be operated on and 10 cm of the little intestine, in ~ a street of 15 cm indigenous the ileocaecal valve to be removed. As well as that, a colostomy ~ above the ideal side was performed. Necrotic enterocolitis and also respiratory insufficiency syndrome due to the prematurity that the infant constituted the clinical co-morbidities of ours patient.
Based ~ above this findings, one initial CT scan to be performed which proved the aforementioned finding, and also an exterior ventricular drainage was inserted through the frontal horn that the ideal lateral ventricle, in stimulate to control the short article hemorrhagic ventricular dilation.
A few days after ~ the operation, a CSF leak native the surgical wound to be observed and also the ventricular catheter to be removed, the wound to be revaluated and also a new EVD to be inserted because of fullness the the anterior fontanelle and new onset opisthotonos.
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An MRI to be performed to evaluate the food of the short article hemorrhagic ventricular dilation∙ the revealed significant dilation the the 3rd, 4th, and lateral ventricles bilaterally, and also dilation that the anterior subarachnoid space, a recognize that might be explained based upon the period of the infant. Concurrently, hypoplasia of the pons and cerebellum were determined (Fig. A1, Fig. A2, Fig. A3).