[Assessment of computed tomographic angiographysinus development combined with occipitalbone marks for the location of transverse sigmoid sinus junction].

Objective: To introduce and evaluate a technique to precisely localize the transverse-sigmoid sinus junction (TSSJ) in retrosigmoid craniotomy. Methods: This was a single-center prospective randomized controlled study. Sixty-three patients, 29 male and 34 female, who would undergo retrosigmoid craniotomy admitted to Department of Neurosurgery, the First Affiliated Hospital of Xinjiang Medical Universityfrom March to October 2019 were enrolled in the study and were divided into trial group and control group according to the computer-generated random numbers. Preoperative venous computed tomographic angiography (CTA) combined with 3-dimensional computed tomography computed tomography (3D CT) was randomly given to the patients(n=32). Asterion was used for identification of the TSSJ in the controls (n=31). The main outcome measures as postoperative complications and relevant intraoperative indicators were compared. Results: Incision length, craniotomy time, bone window sizein trial group were shorter or smaller than those of the controls, as(6.8±0.5) cm vs (8.0±1.5) cm, (37±8) min vs (45±15) min, (8.7±1.2) cm(2) vs (10.2±2.4) cm(2) respectively, with statistical significance (all P<0.05). No statistical significance was found in bleeding amount, incidence of sinus injury and cerebrospinal fluid leakage. While incidence of neck pain was lower in case group (15.63% vs 38.71%; P=0.04) and the remission time of incisional pain in case group was shorter [(6±1) d vs (9±2) d; P=0.01]. Conclusion: While the technique is used, the center of the keyhole should be located at transitional place of the lateral part of the occipitomastoid suture, the retromastoid ridge and the superior nuchal line. Compared with the traditional craniotomy method marked by asterion, it has great advantages in reducing incidence of postoperative complications, craniotomy time, and the remission time of incisional pain.

Timing of endoscopic third ventriculostomy in pediatric patients with congenital obstructive hydrocephalus: assessment of neurodevelopmental outcome and short-term operative success rate.

The purpose of this study was to determine the impact of early (⩽6 months old), midterm (6-12 months old) and late (>12 months old) endoscopic third ventriculostomy (ETV) on the operative success rate and postoperative neurodevelopmental outcome of children with congenital obstructive hydrocephalus. We divided 63 children into three groups according to whether they underwent early, midterm or late ETV. Their preoperative developmental quotient (DQ) was assessed using the Gesell developmental diagnosis schedule (GDDS). Three and 6months after the initial procedure, GDDS was used to obtain postoperative DQ from two assessments (blinded and non-blinded). Meanwhile, two observers studied the operative success rate of initial ETV. There were no substantial differences between blinded and non-blinded assessments. The success rate of early ETV was only 20.8%. By contrast, this rate was 55% and 73.7% for midterm and late ETV, respectively. Before operation, we observed severe developmental abnormalities in all children (DQ score<40). However, children in midterm and late ETV groups achieved improvement after the operation, which was particularly remarkable in late ETV group. Six months after the first surgery, 16 (84.2%) children in the late ETV group, nine (45%) in the midterm ETV group and four (16.7%) in the early ETV group had moderate developmental disability. Nevertheless, overall prognosis for the three groups was not optimistic. There were no children with mild neurodevelopmental disability or normal function. Our data confirmed that age is a determinant for ETV effectiveness and overall prognosis.