RESUMO
Multiple shunt revisions are a formidable challenge in neurosurgery, as the surgeon faces progressive difficulties in finding suitable distal sites for implantation. Gallbladder offers an alternative safe implantation site of distal catheter in case of repeated peritoneal failures. We describe two such cases done in our institute in this brief report. One case has long term functioning shunt, whist other had complications. Relevant literature is also briefly reviewed here.
Assuntos
Anormalidades Cardiovasculares , Hidrocefalia , Abdome , Criança , Humanos , Hidrocefalia/cirurgia , Procedimentos Neurocirúrgicos/efeitos adversos , Cavidade Peritoneal/cirurgia , Derivação Ventriculoperitoneal/efeitos adversosRESUMO
Fetal and perinatal autopsies are useful to identify the accurate cause of death and in the process recognize disorders which may require counselling for future pregnancies. Abnormalities of the CNS are an important cause of fetal loss and perinatal deaths. Most of these are structural abnormalities of the CNS, however a smaller portion show changes pertaining to prematurity, infections and even congenital tumors. In this review we evaluate CNS abnormalities of the fetus and the newborn as detected in autopsy series. We also describe our experience in a tertiary care hospital with a specialized neonatology unit over the last 8 years and discuss some of the newer methods like virtual autopsy.
Assuntos
Anormalidades Congênitas , Feto , Autopsia/métodos , Anormalidades Congênitas/patologia , Feminino , Morte Fetal/etiologia , Feto/patologia , Humanos , Recém-Nascido , GravidezRESUMO
BackgroundNeuroblastoma can arise from extra-adrenal sites in the paraspinal sympathetic chain, including the presacral region, where they must be differentiated from an immature or malignant neural lesion arising from a teratoma.Case ReportWe describe two congenital presacral neuroblastomas. The main clinical differential diagnoses were sacrococcygeal teratoma and meningomyelocele. Pathologically, they lacked teratomatous tissues, lacked germ cell serum markers, were localized without metastases, and were MYCN non-amplified. Both patients have done well without chemotherapy at 18 and 15 months of follow-up.ConclusionCongenital presacral neuroblastoma should be differentiated from teratomatous lesions, and in general have a good prognosis.
Assuntos
Meningomielocele , Neuroblastoma , Teratoma , Diagnóstico Diferencial , Humanos , Meningomielocele/patologia , Neuroblastoma/patologia , Região Sacrococcígea/patologia , Teratoma/diagnóstico , Teratoma/patologiaRESUMO
OBJECTIVE: Ventriculo-subgaleal shunt is an established treatment of hydrocephalus following germinal matrix haemorrhage in low birth weight neonates. It is also used in treatment of post-infective hydrocephalus in children. We intend to emphasise the impact of its extended use in multiple clinical conditions to reduce the number of permanent shunt implantation in infants. METHOD: Retrospective review of clinical cases in a single institution from medical records. RESULTS: VSG shunts with low-pressure valve system were useful in variety of hydrocephalus in infants (post-haemorrhagic, post-infective, post-myelomeningocele, post-shunt block, post-traumatic, hydrocephalus associated with brain tumours). A significant number of infants especially those with post-haemorrhagic and post-myelomeningocele hydrocephalus could be made free of permanent shunt placement. CONCLUSIONS: Ventriculo-subgaleal shunt is an effective, less risky temporary solution of hydrocephalus in infants and can be used in a variety of hydrocephalus in children and helps in avoiding shunt dependency in some of them.
Assuntos
Hidrocefalia , Hemorragia Cerebral/cirurgia , Derivações do Líquido Cefalorraquidiano , Criança , Humanos , Hidrocefalia/cirurgia , Lactente , Recém-Nascido de Baixo Peso , Recém-Nascido , Próteses e Implantes , Estudos Retrospectivos , Derivação VentriculoperitonealRESUMO
OBJECTIVE: In a developing country like India, tuberculosis is very common in spite of a mass vaccination programme. Meningitis, progressive arteritis, adhesive arachnoiditis and tuberculomas represent the wide spectrum of this potentially lethal disease. Hydrocephalus occurs in about one third of the patients with central nervous system tuberculosis. Majority of patients have large fourth ventricles with adhesive obstructions in the basal cerebrospinal fluid (CSF) cisterns. Aggressive CSF diversion does not always alter the course of the disease. Endoscopic procedures are rarely, if ever, successful. Ventriculo-peritoneal shunting is fraught with complications like high rate of infection and shunt tube blockage. So there is clearly a need to explore methods of CSF diversion. METHODS: In our series of 32 patients, we present the indications, prognostic indicators and types of shunt with the clinical outcome of childhood tuberculous meningitis. CONCLUSIONS: Even though the results are far from satisfactory, early shunting still remains the best option to prevent long-term neurological sequelae.
Assuntos
Hidrocefalia/cirurgia , Complicações Pós-Operatórias , Tuberculose Meníngea/cirurgia , Derivação Ventriculoperitoneal , Criança , Pré-Escolar , Feminino , Humanos , Hidrocefalia/microbiologia , Masculino , Estudos Retrospectivos , Tuberculose Meníngea/complicações , Derivação Ventriculoperitoneal/efeitos adversosRESUMO
We describe our experience with the previously described technique of preservation of the bone flap in a subgaleal pocket created over the intact side of the calvaria, discuss our experience of this method and review the literature to compare this method with other alternative techniques.