Interventional procedures
edema, CSF leak, hemorrhage, CM, bipolar
HAND INFECTION, EDEMA, ANTERIOR, HEMORRHAGE
The patients were divided randomly into 2 groups. In the first group (In the second group (The entry skull point was Keen point (3–4) CM. superior and (3–4) CM posterior to the helix of the ear) on the right side. Scalp incisions were in the shape of inverted U or C caring distances from valve edges, the periosteal layer was kept for valve securing by stitching, and the dura matter was cauterized by bipolar at the site of insertion puncture which was done by 11 or 15 sized scalpels. The proximal part should target the ipsilateral body away from the choroid plexus or the frontal horn. Cerebrospinal fluid is sent for cytological analysis and culture whenever suspected for abnormality. All operations were done under general anesthesia in a supine position with head tilt to the left side, the antibiotic was administrated intra-operatively, the skin was prepped by petadine surgical solution, and the shunt was not opened until it is needed and handled with new gloves. The distal catheter was tunneled from down to up through subcutaneous tissues and secured to the valve by a knot which must face toward the skull to avoid scalp irritation and the peritoneal end was inserted after confirmation of CSF flow. All patients were operated by medium-pressure shunts of size 12 Mm.The follow-up duration was up to 3 months by:Clinical evaluation:Anterior fontanel: tense or laxValve condition: well functioning or delayed filling > 30 s or stony hardComplications: such as CSF leak and infectionHead circumferenceImaging evaluation: with computed tomography scan (CT scan) within 48 h from surgery and during the follow up including:Position of the ventricular catheterCerebral brain mantle thickness (paraventricular cerebral mantle)Frontal horn diameter changePeriventricular edema changesComplications: such as hemorrhage and infection