Endoscopic resection of colloid cysts: indications, technique, and results during a 13-year period.

OBJECTIVE: Questions of recurrence and inadequacy of follow-up length persist regarding endoscopic treatment of colloid cysts. In this retrospective review, we report our long-term follow-up during a 13-year period in 35 patients who underwent endoscopic resection of colloid cysts. METHODS: The 19 males and 16 females (age range 14 to 58 years, mean 35.9 years) who had symptomatic colloid cysts that ranged in size from 5 mm to 4 cm underwent endoscopic resection in the period from 1991 to 2004. RESULTS: Of 2 patients who developed recurrences at 5.9 years and 4.3 years (1 and 6 mm, respectively) both remain asymptomatic. The rate of late asymptomatic recurrence in this series is 6.3%. Three endoscopic resections were converted to an open craniotomy. Three operative complications occurred (i.e., introducer tract hemorrhage, thalamic stroke secondary to thermal injury, epidural hematoma that required evacuation). Four patients noted minimal short-term memory loss without interference in daily living. Of 3 patients with shunts preoperatively, all have no evidence of hydrocephalus after shunt removal. Two patients have asymptomatic ventriculomegaly. Prophylactic anticonvulsants were not prescribed and no seizures were reported. No infections were recorded with antibiotic administration preoperatively, and 24 hours postoperatively. CONCLUSIONS: Our series represents the longest follow-up (mean of 7.8 years) of colloid cysts after endoscopic resection. We now use this technique as the first line of treatment for colloid cysts. The risk of recurrence is minimal with gross total resection and/or coagulation of the cyst wall.

Gradual formation of an operative corridor by balloon dilation for resection of subependymal giant cell astrocytomas in children with tuberous sclerosis: specialized minimal access technique of balloon dilation.

BACKGROUND: Major sources of morbidity and mortality in patients with tuberous sclerosis who develop subependymal giant cell astrocytomas (SEGAs) relate to tumor growth and resultant hydrocephalus. We describe a modification of a specialized minimal access resection technique in which an operative corridor is formed with balloon dilation over the course of a week prior to tumor resection. METHODS: Three patients with tuberous sclerosis who had an enlarging SEGA and concomitant hydrocephalus underwent surgical resection with this modified technique. A frontal craniotomy was performed and the optimal trajectory for tumor resection was confirmed by image guidance. After initial insertion of the deflated balloon into the ventricle and removal of the peel-away sheath, inflation of the balloon with a 1-mL saline injection sealed the tract. Additional 1-mL saline injections were continued during the next week until the balloon reached a 15-mm diameter, thus creating the operative corridor. One week after the first operation, the balloon was deflated and removed, and the patient underwent tumor resection via the newly formed operative corridor. RESULTS: Three patients with tuberous sclerosis underwent gross total resections of SEGAs and experienced subsequent resolution of ventricular dilation. Postoperative imaging confirmed minimal cortical disruption. CONCLUSIONS: Use of balloon dilation for the gradual formation of an operative corridor eliminated the need for additional retraction during SEGA resection, potentially decreasing injury to the surrounding neural tissue. In our three patients, the dilation tract retained its integrity during the operation and had sealed completely on postoperative imaging.

Skills training with supporters of the demented.

This study examined the effects of Supporter Endurance Training (SET) on family supporters of elderly demented patients. Single case methodology was used in evaluating the outcome of providing eight supporters with eight weekly training sessions in meditative relaxation and assertiveness. Four such supporters received no special training. A videotape dramatizing typical problem situations encountered with a demented family member was used to elicit information about supporters' coping styles. Post-training and six-month follow-up evaluation indicated improvements among trained individuals on measures related to assertiveness, problem solving, and stress reduction. Trained subjects' estimates of the length of time they would be able to cope with problems involved in caring for their relatives also increased. Few such improvements occurred among untrained subjects. These results suggest the usefulness of brief structured skills training programs in helping supporters to improve their coping abilities.

Existential issues in the management of the demented elderly patient.

Four major existential themes are explored, as they relate to the predicament of the relative supporting a demented elderly dependent at home. These issues, namely, death, isolation, freedom, and meaning are discussed with respect to their dynamic impact on the stressed supporter as well as their implications for anxiety management.

Coping with dementia: a pilot study.

Ten supporters of demented elderly dependents were studied in order to examine their coping behavior in the context of caring for their relatives at home. Coping skills were described with respect to programs, solutions, and cognitive aspects of motivation and stress tolerance. The observations made suggested the hypothesis that tolerance of debility in a demented relative is related not only to the number and type of problems in the dependent but also to the availability and quality of coping skills in the supporter. This hypothesis was explored through the elaboration of a skills training program (Supporter Endurance Training), which was designed and employed to improve and expand the coping skills of a supporter. Supported Endurance Training may prove to be a useful approach to the maintenance of the demented elderly person at home as a possible alternative to institutionalization.