Endoscopic Third Ventriculostomy for the Management of Obstructive Hydrocephalus in Pregnancy: A Case Report and Review of the Literature.

Introduction Hydrocephalus is a condition characterized by the abnormal accumulation of cerebrospinal fluid within the brain's ventricular system. It can stem from obstructive and nonobstructive causes. Pregnancy introduces physiopathological changes that may heighten the risk of developing or worsening symptomatic hydrocephalus. Nevertheless, comprehensive reports on this aspect, especially regarding surgical interventions, remain scarce. Case Report A young woman with a history of recurrent headaches experienced a worsening of her symptoms at the onset of her pregnancy. A magnetic resonance imaging (MRI) in the first trimester revealed increased ventricular dilation, indicating an obstructive cause due to aqueduct stenosis. During a neurosurgical board meeting, treatment options were discussed, considering the identifiable obstruction, the heightened intra-abdominal pressure associated with pregnancy, and the risk of ventricular shunt dysfunction. The patient underwent an endoscopic third ventriculostomy (ETV) without complications, leading to both symptom relief and a successful conclusion to the pregnancy. Discussion Neurosurgical procedures in pregnant women are uncommon due to the increased risks to both the mother and the fetus. However, when performed by a qualified multidisciplinary team, they can lead to positive outcomes. In cases of hydrocephalus during pregnancy, ETV appears to be a viable alternative for surgical intervention, particularly when hydrocephalus becomes symptomatic and an obstructive cause is identified, whether in patients with existing shunts or those with newly developed hydrocephalus.

Factores biomecánicos asociados al resultado clínico de pacientes tratados con artrodesis lumbar en un centro de alta complejidad en Colombia / Biomechanical factors related to surgical outcomes on patients treated with lumbar arthrodesis in a high complexity center in Colombia

INTRODUCCIÓN: La importancia del manejo del dolor lumbar radica en su recurrencia y en las manifestaciones tanto para el paciente como para la sociedad. Se hace necesario establecer qué factores llevan al éxito en términos de dolor y funcionalidad al momento de realizarse una artrodesis lumbar. MATERIALES Y MÉTODOS: Se realizó un estudio descriptivo retrospectivo que buscó determinar qué parámetros espinopélvicos de balance sagital y sus valores en términos de incidencia pélvica (PI), inclinación pélvica (PT), inclinación sacra, lordosis lumbar (LL), eje sagital vertical (SVA) y la diferencia entre la PI y LL (PI-LL), pueden tener una potencial relación con desenlaces posquirúrgicos favorables. Se incluyeron 44 pacientes tratados en el Hospital Universitario San Ignacio entre enero de 2016 y diciembre de 2017. Se tomaron en cuenta desenlaces de dolor y funcionalidad en términos la escala visual analógica y el Oswestry Disability Index (ODI). Se realizó un seguimiento prequirúrgico, y 2 posquirúrgicos a los 3 y 6 meses. Debido al tamaño de la muestra, los autores no pudieron encontrar una significancia estadística, sin embargo, los resultados son concordantes con lo publicado anteriormente en el área. RESULTADOS: El mayor cambio porcentual se encontró en el grupo de pacientes que tuvieron una PI-LL > 10° con un aumento del 50 % en el grupo de pacientes con buena funcionalidad (ODI: 0-20). En SVA > 5 cm, el rango de pacientes con una buena funcionalidad tuvo un aumento del 44,6 %. El rango de buena funcionalidad en pacientes con una PT < 20° aumentó 54,1 puntos porcentuales. CONCLUSIONES: En la presente cohorte se encontró que los parámetros radiológicos que condicionaron un mayor cambio porcentual en la funcionalidad de los pacientes después de ser llevados a cirugía de columna fueron: SVA de base > 5 cm y una PI-LL base > 10° y PT < 20°

INTRODUCTION: The importance of lumbar pain management lies in its recurrence and manifestations for both the patient and society. It is necessary to establish what factors lead to success in terms of pain and functionality at the time of a lumbar arthrodesis. MATERIAL AND METHODS: A retrospective descriptive study was conducted that sought to determine which spinopelvic parameters and their values in terms of pelvic incidence (PI), pelvic tilt (PT), sacral slope, lumbar lordosis (LL), sagittal vertical axis (SVA), and mismatch (PI-LL) might have a potential relationship with favorable postoperative outcomes. We included 44 patients who underwent MIS spinal approaches in our center between January 2016 to December 2017. Surgical outcomes of pain and functionality were assessed using visual analogue scale and Oswestry Disability Index (ODI). Follow up was conducted through three evaluations: one before surgical intervention and 2 at 3 and 6 months postop. Due to the sample size, the authors were unable to get statistically significant results. RESULTS: In our descriptive retrospective study on 44 patients, we found a big positive functional change in the group of patients who had a PI-LL > 10° with an increase of 50 percentage points in the group of patients with good functionality (ODI: 0-20). In SVA > 5 cm, the range of patients with good functionality had an increase of 44.6 percentage points. The range of good functionality in patients with a PT < 20° increased 54.1 percentage points. CONCLUSIONS: In the present cohort, it was found that the radiological parameters that conditioned greater percentage change in the functionality of the patients after being taken to spine surgery were SVA of base > 5 cm and a PI-LL base > 10° and PT < 20°

Factores pronósticos para artrodesis lumbar / Prognostic factors for lumbar arthrodesis

El dolor de espalda es uno de los síntomas más frecuentes en las instituciones de salud. La neurocirugía desempeña un papel importante en el diagnóstico y tratamiento del dolor de espalda que a menudo resulta en intervenciones quirúrgicas que incluyen la fusión intersomática lumbar entre otras alternativas terapéuticas. Sin embargo, la funcionalidad y los índices de calidad de vida esperados no siempre demuestran una mejora completa, a pesar del tratamiento médico y quirúrgico adecuado. Por lo tanto, los autores realizaron una revisión de la literatura no sistemática para evaluar los elementos más importantes involucrados en las evaluaciones diagnósticas que incluyen: anatomía lumbosacra, procesos patológicos de la columna vertebral que causan dolor de espalda e indicaciones de fusión intersomática lumbar Finalmente, el papel relevante que tienen los parámetros espinopélvicos en un adecuado planeamiento quirúrgico. Esta revisión de la literatura no sistemática tiene como objetivo establecer la evaluación más contribuyente de los factores espinopélvicos antes de la cirugía para mejorar la selección de pacientes que se someten a tratamiento quirúrgico y, por lo tanto, mejorar su funcionalidad y los índices de calidad de vida.

Back pain is one of the most frequent presenting symptoms in healthcare institutions. Neurosurgery plays a major role on diagnosis and treatment of back pain that often results in surgical interventions that ineludes lumbar interbody fusión among other therapeutic alternatives. Nevertheless, functionality and expected quality of Iife indexes do not always demónstrate full improvement despite adequate medical and surgical treatment. Therefore, the authors made a non-systematic literature review in order to assess the most important elements involved on diagnostic assessments that inelude: lumbosacral anatomy, spine pathological processes that result in back pain, indications for lumbar interbody fusión and finally, the relevant part that spinopelvic balance parameters plays for adequate planning for surgery treatment. This non-systematic literature review aims to establish the most contributing assessment spinopelvic factors prior surgery in order to improve selection of patients that undergo surgical treatment and therefore, improve their functionality and quality of Iife indexes.