Real-time ultrasound-guided external ventricular drain placement: technical note.

In the United Kingdom, ultrasound-guided external ventricular drain (EVD) insertion is becoming the standard of care to mitigate the morbidity associated with catheter malposition and multiple passes. Many neurosurgeons routinely use ultrasound to check the preinsertion trajectory, although real-time visualization of ventricular cannulation is preferable since minor deviations can be significant in patients with smaller ventricles, and live visualization further enables the catheter tip to be adjusted away from the choroid plexus. Such real-time ultrasound navigation has traditionally been limited by technical factors including the challenge of simultaneously manipulating the probe and inserting the catheter within the same image plane. The authors here describe a simple technique for precise EVD placement using a readily available bur hole ultrasound transducer attached to a 10-gauge needle guide channel (principally used for biopsy procedures) to accommodate a ventriculostomy catheter. The anticipated trajectory line is then projected onto the display and followed into the ipsilateral lateral ventricle. This is illustrated with a representative case and video demonstrating this rapid, user-friendly, and reliable technique. The authors invite others to consider this useful technique to minimize the risks of catheter misplacement or multiple cannulation attempts, which can be of particular benefit to junior neurosurgeons performing difficult cases under pressured conditions.

Bariatric Surgery or Non-surgical Weight Loss for Idiopathic Intracranial Hypertension? A Systematic Review and Comparison of Meta-analyses.

BACKGROUND: Idiopathic intracranial hypertension (IIH) is associated with obesity and weight loss by any means is considered beneficial in this condition. OBJECTIVES: This study aims to appraise bariatric surgery vs. non-surgical weight-loss (medical, behavioural and lifestyle) interventions in IIH management. METHODS: A systematic review and meta-analyses of surgical and non-surgical studies. RESULTS: Bariatric surgery achieved 100% papilloedema resolution and a reduction in headache symptoms in 90.2%. Non-surgical methods offered improvement in papilloedema in 66.7%, visual field defects in 75.4% and headache symptoms in 23.2%. Surgical BMI decrease was 17.5 vs. 4.2 for non-surgical methods. CONCLUSIONS: Whilst both bariatric surgery and non-surgical weight loss offer significant beneficial effects on IIH symptomatology, future studies should address the lack of prospective and randomised trials to establish the optimal role for these interventions.

Spontaneous mesenteric hematoma complicating an exacerbation of Crohn's disease: report of a case.

CASE PRESENTATION: Spontaneous mesenteric haematoma is a rare condition that occurs due to localized bleeding in the mesenteric vascular tree of a bowel segment in the absence of an identifiable cause. Here we report a case of spontaneous mesenteric haematoma during an inflammatory exacerbation of Crohn's disease. The patient underwent surgical management for small bowel obstruction secondary to Crohn's disease, however the concurrent presence of a spontaneous mesenteric haematoma in the mid-jejunal mesentery was successfully managed conservatively. CONCLUSION: This case identifies the first association of spontaneous mesenteric haematoma with an exacerbation of Crohn's disease and highlights the need to consider rare differential diagnoses such as SMH when performing radiological assessment of unexplained symptoms in inflammatory bowel disease patients.