Pony Lara: Ask @Professor Li Xiaoyong: Hi Professor Li, what are the effective measures to prevent shunt infection? Thank you, Prof. Li Xiaoyong
: First of all, I would like to correct your point, it should be shunt infection, not shunt infection. Shunt infection was indeed defined on the website almost 20 years ago, but with the results of my extensive clinical research, I can say for sure that this concept is incorrect, and the reason for this incorrectness comes from two aspects. First, we need to clarify the exact meaning of “infection”. The definition of the word infection in Western literature, such as the United States, is not the definition in our pathology, which refers to the presence or multiplication of pathogenic microorganisms, so to say that a shunt infection is the same as saying that bacteria exist, grow and multiply on the surface or inside the shunt, which is not different from the often stated fixed value, and has nothing to do with whether the patient carrying the shunt has infectious disease (note: the second meaning of infection). However, the clinic actually refers to the latter, and the presence of bacteria on the shunt is only part of the latter situation. However, the concept of shunt infection is much larger and includes not only infection of the shunt (note: actually the concept of “contamination”), but also infection of cerebrospinal fluid from organs other than the shunt, such as brain tissue and the abdominal cavity. Because many people believe that shunt infection is the cause, some shunt manufacturers are now producing anti-infective shunts and treating shunts with preoperative blistering. The fact that we have, to date, removed many cases of still shunt infections with anti-infectious shunts is strong evidence of this. The technique of preventing shunt infection involves many aspects, especially attention to intraoperative asepsis in those who have already had a preoperative intracranial infection such as ventricular drainage or lumbar pool drainage. However, special attention should be paid to the fact that shunt infections can occur even after the most rigorous aseptic operation, so early and proper diagnosis and treatment of shunt infections is also of greater importance. The topic of prevention of shunt infection is very complex and large, we are vigorously researching and have achieved certain achievements, which will be published one after another after the summary in the future. dw263：To @Professor Li Xiaoyong
Q: After traumatic cerebral flap surgery on one side, a bedridden patient in long-term coma had 2 extraventricular drains for bloody cerebrospinal fluid, but now the protein is normal. Prof. Li Xiaoyong
It is an erroneous guideline in a large number of textbooks and especially in the Chinese literature that the normal cerebrospinal fluid protein is not the most important factor in deciding ventriculoperitoneal shunts, because shunts have failed under normal conditions and have been successful under abnormally elevated conditions. In fact, the experts who often present this view are copying from textbooks or literature from long ago and do not have a lot of personal experience themselves. Two important aspects of cerebrospinal fluid shunts deserve attention: one is the prevention of shunt infection complications, and the other is the prevention of shunt blockage complications. The former is easily understood, and many neurosurgeons have some experience with the latter. For example, hydrocephalus after traumatic brain injury or cerebral hemorrhage is not easy to perform shunts early, so ventricular drainage or lumbar pool drainage is often used to overdo it, but these overdoing methods have the risk of causing intracranial infection. Therefore, the task of cerebrospinal fluid unit is a multifaceted, procedural treatment, often requiring multiple surgeries and multiple therapeutic measures in between, with a high degree of specialization.