Comparison between use of a pleural drainage system with flutter valve and a conventional water-seal drainage system after lung resection: a randomized prospective study.

BACKGROUND: There is still a debate regarding the most appropriate pleural collector model to ensure a short hospital stay and minimum complications. OBJECTIVES: To study aimed to compare the time of air leak, time to drain removal, and length of hospital stay between a standard water-seal drainage system and a pleural collector system with a unidirectional flutter valve and rigid chamber. DESIGN AND SETTING: A randomized prospective clinical trial was conducted at a high-complexity hospital in São Paulo, Brazil. METHODS: Sixty-three patients who underwent open or video-assisted thoracoscopic lung wedge resection or lobectomy were randomized into two groups, according to the drainage system used: the control group (WS), which used a conventional water-seal pleural collector, and the study group (V), which used a flutter valve device (Sinapi® Model XL1000®). Variables related to the drainage system, time of air leak, time to drain removal, and time spent in hospital were compared between the groups. RESULTS: Most patients (63%) had lung cancer. No differences were observed between the groups in the time of air leak or time spent hospitalized. The time to drain removal was slightly shorter in the V group; however, the difference was not statistically significant. Seven patients presented with surgery-related complications: five and two in the WS and V groups, respectively. CONCLUSIONS: Air leak, time to drain removal, and time spent in the hospital were similar between the groups. The system used in the V group resulted in no adverse events and was safe. REGISTRATION: RBR-85qq6jc (https://ensaiosclinicos.gov.br/rg/RBR-85qq6jc).

Comparison between use of a pleural drainage system with flutter valve and a conventional water-seal drainage system after lung resection: a randomized prospective study

ABSTRACT BACKGROUND: There is still a debate regarding the most appropriate pleural collector model to ensure a short hospital stay and minimum complications. OBJECTIVES: To study aimed to compare the time of air leak, time to drain removal, and length of hospital stay between a standard water-seal drainage system and a pleural collector system with a unidirectional flutter valve and rigid chamber. DESIGN AND SETTING: A randomized prospective clinical trial was conducted at a high-complexity hospital in São Paulo, Brazil. METHODS: Sixty-three patients who underwent open or video-assisted thoracoscopic lung wedge resection or lobectomy were randomized into two groups, according to the drainage system used: the control group (WS), which used a conventional water-seal pleural collector, and the study group (V), which used a flutter valve device (Sinapi® Model XL1000®). Variables related to the drainage system, time of air leak, time to drain removal, and time spent in hospital were compared between the groups. RESULTS: Most patients (63%) had lung cancer. No differences were observed between the groups in the time of air leak or time spent hospitalized. The time to drain removal was slightly shorter in the V group; however, the difference was not statistically significant. Seven patients presented with surgery-related complications: five and two in the WS and V groups, respectively. CONCLUSIONS: Air leak, time to drain removal, and time spent in the hospital were similar between the groups. The system used in the V group resulted in no adverse events and was safe. REGISTRATION: RBR-85qq6jc (https://ensaiosclinicos.gov.br/rg/RBR-85qq6jc).

Anorexia as the first clinical manifestation of von Hippel-Lindau syndrome.

Hemangioblastomas (HBs) of the brain may present without neurological symptoms over a long period of time due to their benignity and slow growth. We herein present the case of a female patient who developed a HB of the fourth ventricle presenting only with severe weight loss and anorexia. The patient was screened for mutations in all 3 exons of the VHL gene using Sanger sequencing, and was found to have a nonsense mutation in the VHL gene (single-nucleotide change causing a premature stop codon: c.481C>T; p.Arg161*), causing formation of a truncated protein, consistent with von Hippel-Lindau syndrome (VHLs). The patient was first misdiagnosed with anorexia nervosa (AN) due to the lack of other symptoms. Molecular diagnosis allows further investigation of other VHLs-related tumors and timely, appropriate treatment. However, misdiagnosing anorexia nervosa may lead to poor prognosis and even death; thus, differential diagnosis is crucial in all such cases. The present case report provides evidence that fourth ventricular lesions may affect food intake control and satiety, and highlights the importance of accurate molecular diagnosis.

Alcohol use, abuse and dependence among elderly in outpatient treatment through the application of AUDIT

SUMMARY OBJECTIVE To identify or use alcohol abuse and abuse in the IAMSPE elderly, through the application of AUDIT, socioeconomic characterization of the elderly, and problems associated with drinking and weight, if there is a relationship between depression and alcohol abuse. METHODS This is a cross-sectional, exploratory, and descriptive study with a quantitative approach. One hundred elderly patients were interviewed to apply a socioeconomic form and to assess alcohol consumption from AUDIT. RESULTS correlation between alcohol consumption and female gender (p = 0.021). Most of the participants were between 60 and 79 years old, were female, had a partner, had completed elementary school, had income and selected house, were retired and unemployed. CONCLUSION In the present study, we found no correlation between alcohol abuse and depression; Only one correlation was found between male gender and higher alcohol abuse. However, a significant prevalence of moderate use of high alcohol was found (3.9% in women and 21.7% in men), i.e., it poses a risk to the health of the elderly.

RESUMO OBJETIVO Identificar o uso, abuso e dependência de álcool em idosos do ambulatório do Iamspe, por meio da aplicação do Audit, através da caracterização socioeconômica dos idosos e dos problemas associados pelo consumo e pesar se há relação entre depressão e uso abusivo ou dependência de álcool. MÉTODOS Trata-se de um estudo de corte transversal, exploratório e descritivo de abordagem quantitativa. Foram entrevistados cem pacientes idosos para aplicação de um formulário socioeconômico e de avaliação do consumo de álcool, a partir da Audit. RESULTADOS Verificou-se correlação entre o consumo de álcool e sexo feminino (p=0,021). A maioria dos participantes estava na faixa etária entre 60 e 79 anos, era do sexo feminino, tinha companheiro(a), com ensino fundamental completo, renda e casa próprias, era aposentada e desocupada. CONCLUSÃO No presente estudo não verificamos correlação entre abuso de álcool e depressão; somente foi encontrada a correlação entre sexo masculino e maior uso abusivo de álcool. No entanto, encontrou-se prevalência significativa de uso moderado a alto de álcool (3,9% em mulheres e 21,7% em homens), o que, por si, traz risco para a saúde de idosos.

Clinical performance of fixed-pressure Sphera Duo® hydrocephalus shunt.

INTRODUCTION: Cerebral hydrodynamics complications in shunted patients are due to the malfunction of the system. The objective of this retrospective, single-center, single-arm cohort study is to confirm the safety and performance of Sphera® Duo when used in adult patients suffering from hydrocephalus, pseudotumor cerebri or arachnoid cysts. METHODS: Data were generated by reviewing 112 adult patient's charts, who were submitted to a ventriculoperitoneal shunt surgery and followed for one year after surgery. RESULTS: The results show us that 76% of patients had their neurological symptoms improved and that the reoperation rate was 15% in the first year following surgery. DISCUSSION: Sphera Duo® shunt system is an applicable shunt option in routine neurosurgical management of hydrocephalus by several causes. It has presented good results while mitigating effects of overdrainage. Overdrainage is especially important in adults with non-hypertensive hydrocephalus and can cause functional shunt failure, which causes subnormal ICP (particularly in the upright position) and is associated with characteristic neurological symptoms, such as postural headache and nausea. CONCLUSION: Sphera Duo® shunt system is safe when used in adult patients suffering from hydrocephalus, pseudotumor cerebri or arachnoid cyst.

Clinical performance of fixed-pressure Sphera Duo® hydrocephalus shunt / Performance clínica da válvula de pressão fixa Sphera Duo®

Abstract Introduction: Cerebral hydrodynamics complications in shunted patients are due to the malfunction of the system. The objective of this retrospective, single-center, single-arm cohort study is to confirm the safety and performance of Sphera® Duo when used in adult patients suffering from hydrocephalus, pseudotumor cerebri or arachnoid cysts. Methods: Data were generated by reviewing 112 adult patient's charts, who were submitted to a ventriculoperitoneal shunt surgery and followed for one year after surgery. Results: The results show us that 76% of patients had their neurological symptoms improved and that the reoperation rate was 15% in the first year following surgery. Discussion: Sphera Duo® shunt system is an applicable shunt option in routine neurosurgical management of hydrocephalus by several causes. It has presented good results while mitigating effects of overdrainage. Overdrainage is especially important in adults with non-hypertensive hydrocephalus and can cause functional shunt failure, which causes subnormal ICP (particularly in the upright position) and is associated with characteristic neurological symptoms, such as postural headache and nausea. Conclusion: Sphera Duo® shunt system is safe when used in adult patients suffering from hydrocephalus, pseudotumor cerebri or arachnoid cyst.

Resumo Introdução: As complicações da hidrodinâmica cerebral em pacientes com derivação ventriculoperitoneal são frequentemente relacionadas ao malfuncionamento do sistema. O objetivo deste estudo retrospectivo de coorte de centro único é avaliar a segurança e performance clínica do Sistema Sphera® Duo quando utilizado em adultos com hidrocefalia, pseudotumor cerebral ou cistos aracnoides. Métodos: Avaliamos os prontuários de 112 pacientes adultos submetidos a cirurgia de derivação ventriculoperitoneal e acompanhados por 1 ano após a cirurgia. Resultados: O resultado mostra que 76% dos pacientes melhoraram dos sintomas neurológicos e a taxa de reoperação foi de 15% no primeiro ano após a cirurgia. Discussão: O sistema de derivação Sphera Duo® é uma opção de shunt adequada a ser usada no tratamento neurocirúrgico da hidrocefalia por causas diversas. Ele demonstrou bons resultados clínicos enquanto reduziu riscos de hiperdrenagem. A hiperdrenagem é especialmente preocupante e mórbida em pacientes adultos com hidrocefalia não hipertensiva e pode levar a prejuízo clínico e disfunção da válvula, com sintomas de hipotensão craniana, como cefaléia ortostática e náuseas. Conclusão: O sistema de derivação Sphera Duo® é seguro para tratamento da hidrocefalia, pseudotumor cerebri ou cistos aracnóides em adultos.

Home physical exercise program: analysis of the impact on the clinical evolution of patients with normal pressure hydrocephalus / Programa de exercícios físicos domiciliares: análise do impacto na evolução clínica de pacientes com hidrocefalia de pressão normal

ABSTRACT Objective: To present a program of home physical exercises for patients with normal pressure hydrocephalus (NPH) and to evaluate adherence, acceptance and applicability; to verify possible changes in patients with NPH in the home physical exercise program, comparing patients with, and without, a ventriculoperitoneal shunt, regarding gait, quality of life, activities of daily living, static and dynamic balance and its impact on the risks of falling. Methods: This was a controlled clinical trial, with assessments in three moments (0, 10 and 18 weeks) at the home, from October 2015 to November 2017. Fifty-two patients (30 women and 22 men) participated in the study. Results: There was a statistically significant improvement with 10 weeks of home physical exercises for the groups with and without ventriculoperitoneal shunt, respectively, in the sub-items: activities of daily living p = 0.032*, p = 0.003*; static balance p < 0.001*, p < 0.001*; functional capacity p < 0.001*, p = 0.027*; and dynamic balance and gait p = 0.009*, p < 0.001*. There was no statistically significant difference for the subitems: quality of life p = 0.695, p = 1.000; and NPH grading scale p = 0.695, p = 1.000, respectively. Conclusion: The developed program of home physical exercise was easily applied and there was good acceptance by most patients with NPH included in the research. There was a statistically significant improvement with the 10 weeks of home physical exercises in the sub-items: activities of daily living, static balance and functional capacity, for both groups. In the sub-item dynamic balance and gait, there was a statistically significant improvement for both groups, but with a higher score for the group with a ventriculoperitoneal shunt. There was no statistically significant difference for the sub-items: quality of life, NPH grading scale and risk of falls, based on the Berg scale.

RESUMO Objetivo: Apresentar um programa de exercícios físicos domiciliares para pacientes com hidrocefalia de pressão normal e avaliar a adesão, aceitação e sua aplicabilidade; verificar possíveis alterações nos pacientes com HPN com o programa de exercícios físicos domiciliares, comparando os pacientes com e sem derivação ventriculoperitoneal, no que diz respeito à marcha, qualidade de vida, atividades de vida diária, equilíbrio estático e dinâmico e sua repercussão nos riscos de queda. Métodos: Trata-se de um Ensaio clínico controlado, com avaliações em três momentos (0.10 e 18 semanas) em nível domiciliar, no período de outubro/2015 a novembro/2017 Participaram do estudo 52 pacientes (30 mulheres e 22 homens). Resultados: Houve melhora estatisticamente significante com as dez semanas de exercícios físicos domiciliares para os grupos sem e com derivação ventriculoperitoneal respectivamente, nos subitens: atividades de vida diária p = 0,032* p = 0.003*, equilíbrio estático p < 0.001*, p < 0.001*; capacidade funcional p < 0.001*, p = 0,027*; equilíbrio dinâmico e marcha p = 0.009*, p < 0.001*. Não houve diferença estatística significante para os subitens: qualidade de vida p = 0,695, p = 1,000 e escala de graduação de HPN p = 0,695, p = 1,000. Conclusão: O programa de exercícios físicos domiciliares desenvolvido mostrou-se de fácil aplicabilidade e houve boa aceitação para a maioria dos pacientes com Hidrocefalia de Pressão Normal inseridos na pesquisa. Houve melhora estatisticamente significante com as dez semanas de exercícios físicos domiciliares nos subitens: atividades de vida diária, equilíbrio estático e capacidade funcional para ambos os grupos. No subitem equilíbrio dinâmico e marcha houve melhora estatisticamente significante para ambos os grupos, mas com escore maior para o grupo com derivação ventriculoperitoneal. Não houve diferença estatisticamente significante para os subitens: qualidade de vida, escala de graduação de Hidrocefalia de Pressão Normal e risco de quedas baseado na escala de Berg.

Development of the Brazilian Portuguese version of the "Grading scale for idiopathic normal pressure hydrocephalus": cross-cultural adaptation, reliability and validity / Validação da escala de hidrocefalia de pressão normal idiopática para o português brasileiro: aplicação, confiabilidade e validade

ABSTRACT Objective: The current study translated to Portuguese and validated the normal pressure hydrocephalus (NPH) scale originally developed in English as the Grading Scale for Idiopathic Normal Pressure Hydrocephalus. Methods: Following Guillemin's validation protocol, the last version of the Portuguese NPH scale was applied to 121 consecutive patients with a diagnosis of normal pressure hydrocephalus (73 men and 48 women) from the Group of Cerebral Hydrodynamics from July 2010 to March 2012. Results: The mean age was 71.09 years old, ranging from 35 to 92 years. The rate of agreement and reproducibility was high, as confirmed by Cohen's Kappa coefficient, with excellent intraobserver correlation for the NPH scale items individually evaluated: gait (0.80), dementia (0.90) and incontinence (0.87). Conclusions: The Portuguese version of the Grading Scale for Idiopathic Normal Pressure Hydrocephalus was successfully translated and validated for use in Brazilian patients.

RESUMO Objetivos: o presente estudo valida para a língua portuguesa a escala de hidrocefalia de pressão normal (HPN) desenvolvida em língua inglesa como "Escala de classificação para hidrocefalia de pressão normal idiopática". Métodos: Usando o método de Guillemin, uma versão traduzida da escala foi aplicada em 121 pacientes consecutivos com diagnóstico de hidrocefalia de pressão normal (73 homens e 48 mulheres) no Grupo de Hidrodinâmica Cerebral do Hospital das Clínicas da FMUSP de julho de 2010 a março de 2012. Resultados: a média de idade foi de 71,09 anos, variando de 35 a 92 anos. A taxa de concordância e reprodutibilidade foi alta, conforme confirmado pelo coeficiente Kappa, com excelente correlação intraobservador para itens de escala HPN que avaliou a marcha (0,80), demência (0,90) e incontinência (0,87). Conclusões: a versão em português da escala de graduação para pacientes com HPN foi traduzida e validada com sucesso para uso em pacientes brasileiros de ambos os sexos.

Cholangiocarcinoma Seeding along a Ventriculoperitoneal Shunt Catheter: A Rare Initial Manifestation

Cholangiocarcinoma accounts for less than 2% of all malignant neoplasms. Its cutaneous metastases are extremely rare, accounting for 0.0002% of all cases. The ventriculoperitoneal (VP) shunt has been considered a potential route for tumor dissemination. This type of tumor proliferation has been well documented in patients with intra-abdominal metastases secondary to brain tumors and, less frequently, brain metastases secondary to intra-abdominal tumors. In spite of that, there are few reports of cutaneous metastases along the VP shunt catheter trajectory. We present the case of a cholangiocarcinoma cutaneous metastasis at the VP shunt trajectory as the first clinical sign of this type of tumor. The patient had undergone the shunt insertion 4 years earlier due to a hydrocephaly secondary to a subarachnoid hemorrhage. After diagnosis, she was referred to chemotherapy and oncology follow-up. In the literature, 30 cases of cutaneous metastasis of cholangiocarcinoma were reported. Dissemination has been described involving percutaneous biliary drainage and distant sites. However, the case presented in this study alerts us about the possibility of cutaneous metastasis of intra-abdominal tumors in the trajectory of VP shunt catheters.

O colangiocarcinoma representa menos de 2% das neoplasias malignas. Sua metástase cutânea é extremamente rara, representando 0.0002% dos casos. A derivação ventrículo-peritoneal (DVP) tem sido considerada uma via potencial para a disseminação dos tumores. Essa propagação tumoral já foi bem descrita em pacientes com tumores do sistema nervoso central e metástases intra-abdominais e, menos frequentemente, em metástases cerebrais secundárias a tumores intra-abdominais. Apesar disso, a presença de metástases cutâneas ao longo da trajetória do cateter de DVP é pouco relatada. Apresentamos o caso de uma paciente portadora de DVP há quatro anos devido a uma hidrocefalia secundária à hemorragia subaracnoide e que apresentou metástases cutâneas de colangiocarcinoma na trajetória do cateter de derivação como o primeiro sinal clínico do tumor. Após o diagnóstico, ela foi encaminhada para quimioterapia e acompanhamento com oncologia. Na literatura, foram relatados 30 casos de metástases cutâneas de colangiocarcinoma. Em geral, a disseminação pode envolver locais distantes ou cateteres de drenagem biliar percutânea. No entanto, o caso descrito neste estudo nos alerta sobre a possibilidade de metástases cutâneas de tumores intra-abdominais na trajetória de cateteres de DVP.

The Timed Up and Go Test as a Diagnostic Criterion in Normal Pressure Hydrocephalus.

INTRODUCTION: Normal-pressure hydrocephalus (NPH) is a disease characterized by gait disturbance, urinary incontinence, and dementia. Our objectives were to define an average value of the test for the population, check the specificity and test sensitivity as evaluation criteria and diagnostic testing, and correlate with other already used more frequently. METHODS: A study conducted at the Neurosurgery Division of the Hospital do Servidor Público Estadual de São Paulo in which a group of 30 patients with NPH was submitted to the Mini-Mental State Test Examination, Time Up and Go (TUG), test and Japanese scale for NPH before the Tap Test 3 hours and 72 hours after the Tap Test. After being subjected to ventriculoperitoneal shunt, patients were evaluated 3 months, 6 months, and 12 months after surgery. A control group was used composed of 30 individuals of the same age and who had no diagnosis of NPH who were submitted to the TUG test to determine an average, which was compared with that of patients with NPH. RESULTS: TUG did not show good correlation with other tests used, but there was excellent specificity (0.967) and sensitivity (0.933) for cut-off value of 16.5 seconds for the diagnosis of NPH. CONCLUSIONS: TUG is a good test for the diagnosis of NPH because there is very good specificity and sensitivity, with a mean value of 16.5 seconds as the cut-off.

Revisiting Retrograde Ventriculosinus Shunt as an Alternative for Treating Hydrocephalus in Children

Introduction Retrograde ventriculosinus shunt (RVSS) is a useful option in the daily routine of neurosurgeons dealing with hydrodynamics. The objective of this manuscript is to review the main data about RVSS. Methods We performed a critical review. The keywords used were hydrocephalus, shunt, venous sinus, ventriculosinus shunt, retrograde ventriculosinus shunt, and sagittal sinus. The search was performed in the Medline (Pubmed) and EMBASE databases. Results Van Canneyt et al (2008) and Pinto et al (2016) performed experimental studies confirming the effectiveness of RVSS. El Shafei et al (1985, 1987, 2001) authors reported several cases treated with efficacy and few complications. Oliveira et al (2015, 2016) compared RVSS and ventriculoperitoneal shunt (VPS) in the treatment of hydrocephalus after myelomeningocele repair in infants, with similar functional results. Oliveira et al (2015, 2016) also described the applicability of RVSS in situations when VPS is not feasible, or when the peritoneum is not useful. Discussion Retrograde ventriculosinus shunt is a safe and more physiological option, which requires the use of less prosthetic material. It is feasible and applicable. Especially in children, it generates a normotensive state after shunting, allowing centrifugal head growth, once there is no intracranial hypotension due to overdrainage, which may reflect in long-term better psychomotor development. Conclusions The surgical technique of RVSS is feasible. The clinical results are comparable with those of the VPS.

Introdução A derivação ventriculosinusal retrógrada (DVSR) deve ser uma opção na rotina de neurocirurgiões que trabalham com hidrodinâmica. O objetivo deste estudo é revisar os principais dados sobre DVSR. Métodos Realizamos uma revisão crítica. As palavras-chave usadas foram hydrocephalus shunt, venous sinus, ventriculosinus shunt, retrograde ventriculosinus shunt, e sagittal sinus. A busca foi feita nas bases de dados Medline (Pubmed) e EMBASE. Resultados Van Canneyt et al (2008) e Pinto et al (2016) realizaram estudos experimentais confirmando a eficiência do DVSR. El Shafei et al (1985, 1987, 2001) relataram vários casos tratados com eficiência e poucas complicações. Oliveira et al (2015, 2016) compararam DVSR e derivação ventriculoperitoneal (DVP) no tratamento de hidrocefalia após reparo de mielomeningocele em crianças, obtendo resultados funcionais similares. Oliveira et al (2015, 2016) também descreveram a aplicabilidade do DVSR em situações em que o DVP não é possível, ou o peritônio é hostil. Discussão A DVSR é uma opção segura e mais fisiológica, que requer menos material protético; é factível e aplicável. Particularmente em crianças, gera um estado normotenso após o shunt, permitindo crescimento cefálico centrífugo, uma vez que não há mais hipotensão intracraniana devido à hiperdrenagem, o que pode refletir em melhor desenvolvimento psicomotor em longo prazo. Conclusões A técnica cirúrgica DVSR é viável. Os resultados clínicos se são comparáveis à DVP.

Endoscopic view of an internal carotid artery aneurysm presenting with hydrocephalus.

Giant aneurysms (>25 mm) represent approximately 5-10% of all intracranial aneurysms. In this paper it's reported a giant calcified aneurysm presenting with hydrocephalus. It's highlighted the pre-operative images and intra-operative endoscopic findings.

Performance of the fixed pressure valve with antisiphon device SPHERA® in the treatment of normal pressure hydrocephalus and prevention of overdrainage / Efeito da válvula de pressão fixa com antisifão SPHERA®no tratamento da hidrocefalia de pressão normal e prevenção de hiperdrenagem

ABSTRACT Normal pressure hydrocephalus (NPH) is characterized by the triad of gait apraxia, dementia and urinary incontinence associated with ventriculomegaly and normal pressure of cerebrospinal fluid. Treatment is accomplished through the implantation of a ventricular shunt (VPS), however some complications are still frequent, like overdrainage due to siphon effect. This study analyses the performance of a valve with anti-siphon device (SPHERA®) in the treatment of patients with NPH and compares it with another group of patients with NPH who underwent the same procedure without anti-siphon mechanism (PS Medical® valve). 30 patients were consecutively enrolled in two groups with 15 patients each and followed clinically and radiologically for 1 year. Patients submitted to VPS with SPHERA® valve had the same clinical improvement as patients submitted to VPS with PS Medical®. However, complications and symptomatology due to overdrainage were significantly lower in SPHERA® group, suggesting it as a safe tool to treat NPH.

RESUMO A hidrocefalia de pressão normal (HPN) é caracterizada pela tríade de sintomas de apraxia de marcha, demência e incontinência urinária. O tratamento padrão é realizado através de implantação de derivação ventricular, porém várias complicações são frequentes, como a hiperdrenagem secundária ao efeito sifão. Este estudo avaliou o resultado da válvula SPHERA® no tratamento desses pacientes em comparação com um grupo controle (PS Medical®). 30 pacientes foram consecutivamente alocados em dois grupos de 15 e seguidos por 1 ano. Pacientes com a válvula SPHERA® tiveram o mesmo grau de melhora clínica em comparação ao grupo controle, no entanto as complicações diagnósticadas e sintomatologia secundária à hiperdrenagem foi significativamente inferior no grupo da válvula SPHERA® group, sugerindo-a como uma ferramenta segura e aplicável.

Application of a 980-nanometer diode laser in neuroendoscopy: a case series.

OBJECTIVE: Ventricular neuroendoscopy represents an important advance in the treatment of hydrocephalus. High-power (surgical) Nd:YAG laser and low-level laser therapy (using 685-nm-wavelength diode laser) have been used in conjunction with neuroendoscopy with favorable results. This study evaluated the use of surgical 980-nm-wavelength diode laser for the neuroendoscopic treatment of ventricular diseases. METHODS: Nine patients underwent a neuroendoscopic procedure with 980-nm diode laser. Complications and follow-up were recorded. RESULTS: Three in-hospital postoperative complications were recorded (1 intraventricular hemorrhage and 2 meningitis cases). The remaining 6 patients had symptom improvement after endoscopic surgery and were discharged from the hospital within 24-48 hours after surgery. Patients were followed for an average of 14 months: 1 patient developed meningitis and another died suddenly at home. The other patients did well and were asymptomatic until the last follow-up consultation. CONCLUSIONS: The 980-nm diode laser is considered an important therapeutic tool for endoscopic neurological surgeries. This study showed its application in different ventricular diseases.

Performance of the fixed pressure valve with antisiphon device SPHERA® in the treatment of normal pressure hydrocephalus and prevention of overdrainage.

Normal pressure hydrocephalus (NPH) is characterized by the triad of gait apraxia, dementia and urinary incontinence associated with ventriculomegaly and normal pressure of cerebrospinal fluid. Treatment is accomplished through the implantation of a ventricular shunt (VPS), however some complications are still frequent, like overdrainage due to siphon effect. This study analyses the performance of a valve with anti-siphon device (SPHERA®) in the treatment of patients with NPH and compares it with another group of patients with NPH who underwent the same procedure without anti-siphon mechanism (PS Medical® valve). 30 patients were consecutively enrolled in two groups with 15 patients each and followed clinically and radiologically for 1 year. Patients submitted to VPS with SPHERA® valve had the same clinical improvement as patients submitted to VPS with PS Medical®. However, complications and symptomatology due to overdrainage were significantly lower in SPHERA® group, suggesting it as a safe tool to treat NPH.

Surgical technique of retrograde ventricle-sinus shunt is an option for the treatment of hydrocephalus in infants after surgical repair of myelomeningocele / A derivação ventrículo-sinusal retrógrada é uma opção para o tratamento de hidrocefalia em lactentes após correção de mielomeningocele

ABSTRACT Introduction Treatment of hydrocephalus is accomplished primarily through a ventricular-peritoneal shunt (VPS). This study aims to describe the application of retrograde ventricle-sinus shunt (RVSS) in patients with hydrocephalus after surgical treatment of myelomeningocele. Method A prospective, randomized and controlled pilot study. We consecutively enrolled 9 patients with hydrocephalus after surgical repair of myelomeningocele from January 2010 to January 2012. These patients underwent elective RVSS or VPS. Five underwent RVSS and 4 underwent VPS. Patients were followed for one year with quarterly evaluations and application of transcranial Doppler. Results RVSS group showed outcomes similar to those of VPS group. Doppler revealed significant improvement when comparing preoperative to postoperative period. RVSS group had significantly higher cephalic perimeter than VPS group. Neuropsychomotor development, complications and subjective outcomes did not differ between groups. Conclusion RVSS shunt is viable; it is an alternative option for the treatment of hydrocephalus.

RESUMO O tratamento da hidrocefalia é realizado principalmente através de uma derivação ventrículo-peritoneal (DVP). Nosso objetivo é descrever a aplicação da derivação ventrículo-sinusal retrógrada (DVSR) em pacientes com hidrocefalia após o tratamento cirúrgico de mielomeningocele. Método Estudo prospectivo, randomizado e controlado. Selecionados consecutivamente 9 pacientes com hidrocefalia após correção cirúrgica de mielomeningocele de janeiro de 2010 a janeiro de 2012. Eles foram submetidos à DVSR ou DVP. Cinco foram submetidos à DVSR e 4 à DVP. Foram seguidos por 1 ano com realização trimestral de avaliações e aplicação do Doppler transcraniano. Resultados O grupo DVSR apresentou desfechos semelhantes ao grupo DVP. O Doppler mostrou melhora significativa quando comparado o pré-operatório com o pós-operatório. O grupo DVSR apresentou perímetro cefálico significativamente maior que o grupo DVP. O desenvolvimento neuropsicomotor e complicações não diferiram entre os grupos. Conclusão A derivação ventrículo-sinusal retrógrada é viável; ela é uma opção para o tratamento de hidrocefalia.

Evidences in the treatment of idiopathic normal pressure hydrocephalus.

INTRODUCTION: idiopathic normal pressure hydrocephalus (INPH) is characterized by gait apraxia, cognitive dysfunction and urinary incontinence. There are two main treatment options: ventriculoperitoneal shunt (VPS) and endoscopic third ventriculostomy (ETV). However, there are doubts about which modality is superior and what type of valve should be applied. We are summarizing the current evidence in INPH treatment. METHODS: an electronic search of the literature was conducted on the Medline, Embase, Scielo and Lilacs databases from 1966 to the present to obtain data published about INPH treatment. RESULTS: the treatment is based on three pillars: conservative, ETV and VPS. The conservative option has fallen into disuse after various studies showing good results after surgical intervention. ETV is an acceptable mode of treatment, but the superiority of VPS has made the latter the gold standard. CONCLUSION: well-designed studies with a high level of appropriate evidence are still scarce, but the current gold standard for treatment of INPH is conducted using VPS.

Effect of volume replacement during combined experimental hemorrhagic shock and traumatic brain injury in prostanoids, brain pathology and pupil status / Efeito da reposição volêmica durante o choque hemorrágico combinado com traumatismo craniencefálico sobre prostanóides, patologia cerebral e status pupilar

Traumatic brain injury (TBI) is the main cause of trauma-related deaths. Systemic hypotension and intracranial hypertension causes cerebral ischemia by altering metabolism of prostanoids. We describe prostanoid, pupilar and pathological response during resuscitation with hypertonic saline solution (HSS) in TBI. Method Fifteen dogs were randomized in three groups according to resuscitation after TBI (control group; lactated Ringer’s (LR) group and HSS group), with measurement of thromboxane, prostaglandin, macroscopic and microscopic pathological evaluation and pupil evaluation.Result Concentration of prostaglandin is greater in the cerebral venous blood than in plasma and the opposite happens with concentration of thromboxane. Pathology revealed edema in groups with the exception of group treated with HSS.Discussion and conclusion There is a balance between the concentrations of prostaglandin and thromboxane. HSS prevented the formation of cerebral edema macroscopically detectable. Pupillary reversal occurred earlier in HSS group than in LR group.

O traumatismo cranioencefálico (TCE) é a principal causa de morte relacionada ao trauma. O choque hemorrágico e hipertensão intracraniana causam isquemia cerebral alterando o metabolismo de prostanóides. Neste estudo, relatamos o comportamento dos prostanóides, resposta pupilar e patologia durante a reposição volêmica com solução salina hipertônica (SSH) no TCE. Método Quinze cachorros foram randomizados em três grupos (controle, grupo de Ringer lactato e grupo de SSH) e foram avaliados tromboxane, prostaglandina, avaliação patológica macroscópica e microscópica e status pupilar.Resultado A concentração de prostaglandina é maior no sangue cerebral em comparação ao plasma, e o inverso ocorre com o tromboxane. A patologia revelou edema em todos os grupos, com exceção do grupo tratado com SSH.Discussão e conclusão Existe um equilíbrio entre concentrações cerebrais e plasmáticas de prostaglandina e tromboxane. A SSH protegeu o cérebro da formação de edema pós traumático.