RESUMO
We treated recurrent hydrocephalus in a previously shunted patient by neuroendoscopic third ventriculostomy. A tear was noted in the septum pellucidum. As the foramen of Monro was found to be occluded, we first fenestrated the floor of the lateral ventricle and then performed third ventriculostomy through the fenestration. A tough membrane believed to be Liliequist's membrane isolated the space immediately beneath floor of the third ventricle from the cistern below. Cerebrospinal fluid pulsation appeared after fenestration of this membrane. These obstructions presumably resulted from congenital and/or inflammatory causes. In cases such as this, successful neuroendoscopic third ventriculostomy presents a challenge to surgical judgment.
Assuntos
Ventrículos Cerebrais/cirurgia , Endoscopia/métodos , Hidrocefalia/cirurgia , Ventriculostomia/métodos , Adolescente , Ventrículos Cerebrais/patologia , Ventrículos Cerebrais/fisiopatologia , Humanos , Hidrocefalia/diagnóstico , Hidrocefalia/fisiopatologia , Imageamento por Ressonância Magnética , MasculinoRESUMO
Eleven subjects with filariasis were investigated for the relationship between the microfilarial migration and the changes of sleep stage with special reference to REM sleep. Tests on ten patients except one case revealed that the sleep of each case showed a highly consistent pattern from the viewpoint of the first night. Microfilariae were counted every hour and at each REM stage. From these data, the characteristic findings were observed as follows: 1) Microfilarial migration reached the maximum peak around midnight, showing a Poisson type distribution, even though, one case slept only 47 minutes throughout the night, having no REM sleep. 2) Suppression of microfilarial migration during REM sleep was noted in 72%, which was independent of the slow wave sleep. Finally, suppression of microfilarial migration during REM sleep is discussed from the point of view of Hawking's pendulum model and physiological phenomena of REM sleep.