Endoscopic third ventriculostomy with choroid plexus cauterization outcome: distinguishing success from failure.

OBJECTIVE Endoscopic third ventriculostomy with choroid plexus cauterization (ETV/CPC) offers an alternative to shunt treatment for infantile hydrocephalus. Diagnosing treatment failure is dependent on infantile hydrocephalus metrics, including head circumference, fontanel quality, and ventricle size. However, it is not clear to what degree these metrics should be expected to change after ETV/CPC. Using these clinical metrics, the authors present and analyze the decision making in cases of ETV/CPC failure. METHODS Infantile hydrocephalus metrics, including bulging fontanel, head circumference z-score, and frontal and occipital horn ratio (FOHR), were compared between ETV/CPC failures and successes. Treatment outcome predictive values of metrics individually and in combination were calculated. RESULTS Forty-four patients (57% males, median age 1.2 months) underwent ETV/CPC for hydrocephalus; of these patients, 25 (57%) experienced failure at a median time of 51 days postoperatively. Patients experiencing failure were younger than those experiencing successful treatment (0.8 vs 3.9 months, p = 0.01). During outpatient follow-up, bulging anterior fontanel, progressive macrocephaly, and enlarging ventricles each demonstrated a positive predictive value (PPV) of no less than 71%, but a bulging anterior fontanel remained the most predictive indicator of ETV/CPC failure, with a PPV of 100%, negative predictive value of 73%, and sensitivity of 72%. The highest PPVs and specificities existed when the clinical metrics were present in combination, although sensitivities decreased expectedly. Only 48% of failures were diagnosed on the basis all 3 hydrocephalus metrics, while only 37% of successes were negative for all 3 metrics. In the remaining 57% of patients, a diagnosis of success or failure was made in the presence of discordant data. CONCLUSIONS Successful ETV/CPC for infantile hydrocephalus was evaluated in relation to fontanel status, head growth, and change in ventricular size. In most patients, a designation of failure or success was made in the setting of discordant data.

Cierre nasal como tratamiento definitivo de las epistaxis en la enfermedad de Rendu-Osler-Weber / Nasal closure as definitive treatment for epistaxis in Rendu-Osler-Weber disease

Objetivo: Conocer las posibilidades terapéuticas que supone esta técnica quirúrgica en el tratamiento de las epistaxis en la enfermedad de Rendu-Osler-Weber. Método: No siendo muy fácil conseguir el consentimiento para su realización y quedando dentro del arsenal terapéutico como medida final, exponemos su desarrollo técnico en un caso de larga evolución, con muchos y frecuentes síntomas que, por obligar a multitud de ingresos hospitalarios, motivaba problemas sociales, familiares, laborales y psicológicos a la paciente. Resultados: Tras 14 meses de practicada la intervención, la paciente no ha vuelto a padecer epistaxis. Antes, la paciente ingresaba en el hospital por este motivo una media des iete veces al año, de modo que la intervención ha producido una notable disminución de las consultas digestivas y psicológicas. Los parámetros sanguíneos evaluados han mejorado ostensiblemente. Conclusiones: Se trata de una técnica eficaz y bien tolerada, que evita otros trastornos a los pacientes y supone eliminación de gastos (AU)

Objective: To show the result of this surgical technique for the treatment of nasal bleeding in Rendu-Osler-Weber disease. Method: After great efforts to obtain informed consent for the procedure, considered as a final therapeutic attempt, we present here the surgical technique used in a severe long-standing case with frequent symptoms that required a large number of admissions to our hospital and caused our patient considerable social, family and work-related psychological problems. Results: The surgical procedure was performed 14 months ago, with no further epistaxis since then, thus bringing to an end the emergency admissions, rated at 7 per year, and reducing consultations at the digestive and psychological clinics. The laboratory studies (haematocrit, complete blood count, bleeding time) have improved greatly. Conclusions: This is a safe technique, well tolerated by the patient,that avoids additional pathologies and reduces costs (AU)