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1.
Zhonghua Er Ke Za Zhi ; 59(6): 459-465, 2021 Jun 02.
Artigo em Chinês | MEDLINE | ID: mdl-34102818

RESUMO

Objective: To analyze the clinical features, genetic characteristics, treatment and follow-up results of patients with hydrocephalus caused by methylmalonic acidemia combined with homocysteinuria, and to discuss the optimal strategies for assessing and treating such patients. Methods: From January 1998 to December 2020, 76 patients with hydrocephalus due to methylmalonic acidemia combined with homocysteinuria in the Department of Pediatrics in 11 hospitals including Peking University First Hospital were diagnosed by biochemical, genetic analysis and brain imaging examination. The patients were divided into operation-group and non-operation-group according to whether they underwent ventriculoperitoneal shunt. The clinical features, laboratory examinations, genotype, and follow-up data were retrospectively analyzed. Data were compared between the two groups using rank sum test, and categorical data were compared using χ2 test. Results: Among the 76 patients (51 male, 25 female), 5 were detected by newborn screening, while 71 were diagnosed after clinical onset, 68 cases (96%) had early-onset, 3 cases (4%) had late-onset. The most common clinical manifestations of 74 cases with complete data were psychomotor retardation in 74 cases (100%), visual impairment in 74 cases (100%), epilepsy in 44 cases (59%), anemia in 31 cases (42%), hypotonia or hypertonia in 21 cases (28%), feeding difficulties in 19 cases (26%) and disturbance of consciousness in 17 cases (23%). Genetic analysis was performed in 76 cases, all of whom had MMACHC gene variations, including 30 homozygous variations of MMACHC c.609G>A. The most common variations were c.609G>A (94, 62.7%), followed by c.658_660del (18, 12.0%), c.567dupT (9, 6.0%) and c.217C>T (8, 5.3%). Therapy including cobalamin intramuscular injection, L-carnitine and betaine were initiated immediately after diagnosis. A ventriculoperitoneal shunt operation was performed in 41 cases (operation group), and 31 patients improved after metabolic intervention (non-operation group). There was no significant difference in the age of onset, the age of diagnosis, the blood total homocysteine, methionine, and urinary methylmalonic acid concentration between the two groups (all P>0.05). The symptoms of psychomotor development, epilepsy, and visual impairments improved gradually after a long-term follow-up in the operation group. Conclusions: Hydrocephalus is a severe complication of methylmalonic acidemia combined with homocysteinuria. The most common clinical manifestations are psychomotor retardation, visual impairment, and epilepsy. It usually occurs in early-onset patients. Early diagnosis and etiological treatment are very important. Hydrocephalus may improve after metabolic intervention in some patients. For patients with severe ventricular dilatation, prompt surgical intervention can improve the prognosis.


Assuntos
Erros Inatos do Metabolismo dos Aminoácidos , Hidrocefalia , Erros Inatos do Metabolismo dos Aminoácidos/complicações , Erros Inatos do Metabolismo dos Aminoácidos/genética , Criança , Feminino , Humanos , Hidrocefalia/genética , Hidrocefalia/cirurgia , Recém-Nascido , Masculino , Ácido Metilmalônico , Oxirredutases , Estudos Retrospectivos
2.
J Clin Neurosci ; 88: 63-69, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33992206

RESUMO

The presented retrospective analysis has evaluated the optimal timing and safety of external ventricular drainage (EVD) for acute hydrocephalus after aneurysmal subarachnoid hemorrhage (aSAH). The study cohort comprised 102 patients, 49 of whom underwent EVD at 3-120 h (mean, 16 h) after the clinical onset of aSAH, either before (N = 27) or after (N = 22) ruptured aneurysm coiling. Among those treated with EVD, favorable and fair outcomes at discharge (modified Rankin Scale [mRS] scores 0-3) were noted in 14 (29%) and unfavorable (mRS scores 4-6) in 35 (71%). The former was more common among women (P = 0.019) and patients without chronic arterial hypertension (P = 0.028). The cut-off value for optimal timing of EVD was defined at 13 h after the onset of aSAH. Favorable and fair outcomes were more frequent after early (≤13 h; N = 30) than late (>13 h; N = 19) EVD (40% vs. 11%; P = 0.026), whereas did not differ significantly between those in whom such procedure was done before or after ruptured aneurysm coiling (19% vs. 41%; P = 0.083). In the entire study cohort, 2 patients had re-rupture of the aneurysm, and while both of them were treated with EVD, neither case of complication was directly associated with the procedure and, in fact, preceded it. In conclusion, EVD for management of acute hydrocephalus in patients with high-grade aSAH should be preferably applied within 13 h after the clinical onset of stroke, which may be considered sufficiently safe regardless whether it is performed before or after ruptured aneurysm coiling.


Assuntos
Derivações do Líquido Cefalorraquidiano/métodos , Embolização Terapêutica/métodos , Procedimentos Endovasculares/métodos , Hemorragia Subaracnóidea/terapia , Adulto , Idoso , Aneurisma Roto/complicações , Estudos de Coortes , Feminino , Humanos , Hidrocefalia/etiologia , Hidrocefalia/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Hemorragia Subaracnóidea/complicações
3.
Acta Neurochir Suppl ; 131: 303-306, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33839862

RESUMO

INTRODUCTION: In patients with noncommunicating hydrocephalus, dilation of the ventricles stresses white matter fibers and alters the cerebral blood flow (CBF) and cerebrospinal fluid (CSF) dynamics. The purpose of this work was to investigate, non-invasively, how endoscopic third ventriculostomy (ETV) impacts white matter, CSF oscillations, and CBF. METHODS: Eleven patients presenting with chronic headaches and noncommunicating hydrocephalus due to aqueductal stenosis were treated by ETV. Phase Contrast-MRI (PCMRI) and Diffusion Tensor Imaging (DTI) were performed before and after surgery to evaluate CSF and CBF as well as white matter stresses in the Corpus Callosum (CC) and Corona Radiata (CR). ETV success was confirmed by quantification of the CSF oscillations through the aperture in the third ventricle. RESULTS: All patients improved after surgery. CSF stroke volume was five times greater than normal ventricular stroke volume. Decrease in cervical CSF oscillations and increase in CBF were observed after ETV. In CR, fiber anisotropy decreased, while water diffusion increased. In CC, anisotropy did not vary, while water diffusion also increased. CONCLUSION: Even if static ICP typically do not increase, CSF and blood flow are impacted. PCMRI and DTI can provide useful information to help neurosurgeons select patients with good chance to improve after ETV.


Assuntos
Hidrocefalia , Terceiro Ventrículo , Imagem de Tensor de Difusão , Humanos , Hidrocefalia/diagnóstico por imagem , Hidrocefalia/cirurgia , Imageamento por Ressonância Magnética , Terceiro Ventrículo/diagnóstico por imagem , Terceiro Ventrículo/cirurgia , Resultado do Tratamento , Ventriculostomia
4.
Acta Neurochir Suppl ; 131: 343-347, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33839872

RESUMO

INTRODUCTION: Challenges in diagnosing post-traumatic hydrocephalus (PTH) have created a need for an accurate diagnostic tool. We aim to report CSF dynamics in PTH and atrophy, along with differences before and after cranioplasty. METHODS: We retrospectively analyzed traumatic brain injury patients with ventriculomegaly who had infusion studies. We divided patients depending on CSF dynamics into two groups: 'likely PTH' (A) and 'likely atrophy' (B). A group of idiopathic normal pressure hydrocephalus shunt-responsive patients was used for comparison (C). RESULTS: Group A consisted of 36 patients who were non-decompressed or had a cranioplasty in situ for over 1 month. Group B included 16 patients with low Rout, AMP, and dAMP, 9 of whom were decompressed. Rout and dAMP were significantly higher in Group A than B, but significantly lower than Group C (45 iNPH patients). RAP change during infusion in group A indicated depleted compensatory reserve compared to ample reserve in group B. Repeat studies in five decompressed patients post-cranioplasty showed all parameters increased. CONCLUSIONS: Infusion tests are not useful in decompressed patients, whilst cranioplasty allowed differentiation between possible PTH and atrophy. Rout and AMP were significantly lower in PTH compared to iNPH and did not always reflect the degree of hydrocephalus reported on imaging.


Assuntos
Hidrocefalia , Atrofia , Derivações do Líquido Cefalorraquidiano , Descompressão , Humanos , Hidrocefalia/etiologia , Hidrocefalia/cirurgia , Estudos Retrospectivos
6.
BMJ Case Rep ; 14(4)2021 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-33795276

RESUMO

We report the case of a 48-year-old man with spina bifida and history of previous ventriculoperitoneal (VP) shunt placement for hydrocephalus. On attempted removal of the shunt 2 years prior to presentation at a neurosurgical unit, the peritoneal component was left in situ due to difficulties with removal. He presented acutely to our general surgical department with an enterocutaneous fistula precipitated by the retained fragment discharging to the right upper abdominal quadrant that required urgent surgical intervention. Although abdominal complications of VP shunts are documented, there is minimal literature as to the risks of remnant catheters being left in situ. This case demonstrates the possible risks with retained VP shunt catheters and the necessity to remove any redundant foreign bodies to prevent significant delayed complications.


Assuntos
Hidrocefalia , Fístula Intestinal , Disrafismo Espinal , Cateteres , Humanos , Hidrocefalia/etiologia , Hidrocefalia/cirurgia , Fístula Intestinal/etiologia , Fístula Intestinal/cirurgia , Masculino , Pessoa de Meia-Idade , Disrafismo Espinal/complicações , Derivação Ventriculoperitoneal/efeitos adversos
7.
BMJ Case Rep ; 14(4)2021 Apr 08.
Artigo em Inglês | MEDLINE | ID: mdl-33832938

RESUMO

Brain injury with ventricle puncture is a well-known complication of ventriculoperitoneal (VP) shunting. However, parenchymal injuries caused by a shunt tunneller are rare. Herein, we present a case of penetrating brain injury caused by a shunt tunneller during VP shunting. An 83-year-old woman with brainstem glioma underwent VP shunting to control hydrocephalus due to tumour growth. She underwent brainstem tumour biopsy with a lateral suboccipital approach. After the shunting, CT showed a linear haematoma in the left occipital lobe far from the site of the ventricular puncture. MRI revealed a small contusion in the left cerebellar hemisphere, disconnection of the left tentorial membrane and linear haematoma on a straight line. These facts suggested that the shunt tunneller had penetrated the skull through the craniotomy of the posterior fossa. This is a rare complication of VP shunting, with limited cases reported in the literature.


Assuntos
Glioma , Traumatismos Cranianos Penetrantes , Hidrocefalia , Idoso de 80 Anos ou mais , Ventrículos Cerebrais , Feminino , Humanos , Hidrocefalia/etiologia , Hidrocefalia/cirurgia , Derivação Ventriculoperitoneal/efeitos adversos
8.
Neurosciences (Riyadh) ; 26(2): 212-215, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33814376

RESUMO

Meningiomas are benign, slow-growing tumors originating from arachnoid gap cells. They constitute 15%-20% of all intracranial tumors in adults and 04%-4% in the pediatric age group. Meningiomas in the posterior fossa in the pediatric period do not initially come to mind. In the case presented here, there was a cystic meningioma showing heterogenous contrast and obstructive hydrocephaly was observed associated with 4th ventricle pressure. the tumor was totally removed, then the ventriculo peritoneal shunt was applied.


Assuntos
Hidrocefalia/diagnóstico por imagem , Neoplasias Infratentoriais/diagnóstico por imagem , Meningioma/diagnóstico por imagem , Derivação Ventriculoperitoneal , Criança , Humanos , Hidrocefalia/etiologia , Hidrocefalia/cirurgia , Neoplasias Infratentoriais/complicações , Neoplasias Infratentoriais/cirurgia , Imageamento por Ressonância Magnética , Masculino , Meningioma/complicações , Meningioma/cirurgia , Resultado do Tratamento
9.
Sensors (Basel) ; 21(5)2021 Mar 03.
Artigo em Inglês | MEDLINE | ID: mdl-33802445

RESUMO

Hydrocephalus is a medical condition characterized by the abnormal accumulation of cerebrospinal fluid (CSF) within the cavities of the brain called ventricles. It frequently follows pediatric and adult congenital malformations, stroke, meningitis, aneurysmal rupture, brain tumors, and traumatic brain injury. CSF diversion devices, or shunts, have become the primary therapy for hydrocephalus treatment for nearly 60 years. However, routine treatment complications associated with a shunt device are infection, obstruction, and over drainage. Although some (regrettably, the minority) patients with shunts can go for years without complications, even those lucky few may potentially experience one shunt malfunction; a shunt complication can require emergency intervention. Here, we present a soft, wireless device that monitors distal terminal fluid flow and transmits measurements to a smartphone via a low-power Bluetooth communication when requested. The proposed multimodal sensing device enabled by flow sensors, for measurements of flow rate and electrodes for measurements of resistance in a fluidic chamber, allows precision measurement of CSF flow rate over a long time and under any circumstances caused by unexpected or abnormal events. A universal design compatible with any modern commercial spinal fluid shunt system would enable the widespread use of this technology.


Assuntos
Derivações do Líquido Cefalorraquidiano , Hidrocefalia , Adulto , Derivações do Líquido Cefalorraquidiano/efeitos adversos , Criança , Humanos , Hidrocefalia/diagnóstico , Hidrocefalia/cirurgia , Próteses e Implantes
10.
Prague Med Rep ; 122(1): 14-24, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33646938

RESUMO

There are reports that in patients with aSAH (aneurysmal subarachnoid hemorrhage), LTF (lamina terminalis fenestration) reduces the rate of shunt-needed hydrocephalus via facilitation of CSF (cerebrospinal fluid) dynamic, diminished leptomeningeal inflammation, and decreased subarachnoid fibrosis. Regarding the conflicting results, this study was conducted to evaluate the effects of LTF on decreased shunt-needed hydrocephalus in patients with aSAH. A cross-sectional retrospective study was carried out to survey all patients with confirmed aSAH operated from March 2011 to September 2016 in an academic vascular center (Rasool Akram Hospital in Tehran, Iran). Of a total of 151 patients, 72 patients were male and 79 were female. The mean age of the participants was 51 years. A transiently CSF diversion (EVD - external ventricular drainage) was performed (the acute hydrocephalus rate) on 21 patients (13.9%). In 36 patients (23.8%), aneurysm occlusion with LTF and in 115 patients (76.2%) only aneurysm occlusion surgery was performed. In hydrocephalus follow-up after surgery, 13 (12%) patients needed shunt insertion (the rate of shunt-needed hydrocephalus). The statistical analysis demonstrated no significant relation between LTF and shunt-needed hydrocephalus. Confirmation of the hypothesis that LTF may decrease the rate of shunt-needed hydrocephalus can significantly decrease morbidity, mortality, and treatment costs of shunting (that is a simple, but a potentially dangerous procedure). So, it is advised to plan and perform an RCT (randomized controlled trial) that can remove the confounding factors, match the groups, and illustrate the exact effect of LTF on shunt-needed hydrocephalus.


Assuntos
Hidrocefalia , Hemorragia Subaracnóidea , Ventriculostomia , Estudos Transversais , Feminino , Humanos , Hidrocefalia/etiologia , Hidrocefalia/cirurgia , Hipotálamo/cirurgia , Irã (Geográfico) , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Hemorragia Subaracnóidea/complicações , Hemorragia Subaracnóidea/cirurgia
11.
Comput Methods Programs Biomed ; 204: 106049, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33780891

RESUMO

OBJECTIVE: The comparison of the efficiency of shunt placement and endoscopic third ventriculostomy (ETV) in treating of adult hydrocephalus patients with various intensities and different obstruction intensities in the aqueduct of Sylvius (AS). METHODS: In vitro models with separated ventricles were simulated and implemented for modeling shunt and ETV surgeries in one healthy subject and hydrocephalus patients with various intensities, as well as three different obstruction intensities in AS and under two cerebrospinal fluid (CSF) dynamic conditions. The fluid-structure interaction simulation was also carried out to validate in vitro results. RESULTS: The efficiency of both methods in reducing the maximum CSF pressure in the subarachnoid space (MCPS) decreased by an increase in the patient's intensities. Contrary to shunting, the efficiency of ETV in reducing MCPS demonstrated a decline (8.3-16.4%) by an increase in obstruction levels in AS. Based on the findings, shunt efficiency in decreasing MCPS in patients with low intensity was more remarkable compared to ETV. However, ETV was more efficient than shunt in the patient with intracranial hypertension. Further, shunt placement and ETV led to a significant reduction in the amplitude of CSF pressure in the SAS (ACPS) in patients with sneezing, coughing, Valsalva maneuver, and exercising effects in contrast to other patients. Moreover, ACPS reduction was not related to the intensity of the disease in both treatment methods. In contrast to shunt, an increase in the obstruction level in AS led to a reduction in ACPS in ETV in both CSF dynamic conditions. CONCLUSIONS: The noises from irregular disorders increased the discharging of CSF after shunt placement, and activities such as sneezing, coughing, Valsalva maneuvers, and exercising increased the risk of shunt overdrainage by 10.4~47.8%, especially in the patient with intracranial hypertension. Based on the proposed in vitro ETV and shunt models, an increase of head compliance was higher in ETV compared to the shunt. Eventually, an increase in the obstruction level of AS after ETV led to a decline in head compliance in contrast to shunt.


Assuntos
Hidrocefalia , Terceiro Ventrículo , Adulto , Derivações do Líquido Cefalorraquidiano , Humanos , Hidrocefalia/cirurgia , Hidrodinâmica , Resultado do Tratamento , Ventriculostomia
12.
No Shinkei Geka ; 49(2): 317-327, 2021 Mar.
Artigo em Japonês | MEDLINE | ID: mdl-33762452

RESUMO

Hydrocephalus is caused by excessive accumulation of cerebrospinal fluid(CSF)in the ventricles or the skull. Unlike acute hydrocephalus presenting with elevated intracranial pressure, chronic hydrocephalus is called normal-pressure hydrocephalus(NPH). Because the CSF volume increases slowly, the brain compressively deforms without increasing intracranial pressure. NPH should be diagnosed and treated according to the following three categories: idiopathic NPH(iNPH), secondary NPH(sNPH), and congenital NPH(cNPH). The intracranial CSF distribution in iNPH differed from that in sNPH or cNPH. In iNPH, the Sylvian fissure and basal cistern were conspicuously enlarged, whereas the convexity subarachnoid space was severely decreased. CSF distribution in the subarachnoid space specific to iNPH is known as "disproportionately enlarged subarachnoid space hydrocephalus(DESH)," which might be due to direct CSF communication between the lateral ventricles and the basal cistern at the inferior choroidal point of the choroidal fissure. After shunt surgery in a patient with NPH, the lateral ventricles and Sylvian fissure shrank from top to bottom, while the convexity subarachnoid space expanded. In NPH, except for obstructive hydrocephalus, the flow void sign on spin-echo T2-weighted images is usually observed around the aqueduct, which reflects the increased CSF movement.


Assuntos
Hidrocefalia de Pressão Normal , Hidrocefalia , Ventrículos Cerebrais/diagnóstico por imagem , Ventrículos Cerebrais/cirurgia , Derivações do Líquido Cefalorraquidiano , Humanos , Hidrocefalia/diagnóstico por imagem , Hidrocefalia/cirurgia , Hidrocefalia de Pressão Normal/diagnóstico por imagem , Hidrocefalia de Pressão Normal/cirurgia , Imageamento por Ressonância Magnética , Proteínas de Membrana , Proteínas do Tecido Nervoso , Espaço Subaracnóideo/cirurgia
13.
BMC Surg ; 21(1): 154, 2021 Mar 21.
Artigo em Inglês | MEDLINE | ID: mdl-33743657

RESUMO

BACKGROUND: Abdominal cerebrospinal fluid (CSF) pseudocyst is an uncommon but important complication of ventriculoperitoneal (VP) shunts. While individual articles have reported many cases of abdominal CSF pseudocyst following VP shunts, no case of a hemorrhagic abdominal pseudocyst after VP shunts has been reported so far. CASE PRESENTATION: This article reports a 68-year-old woman with a 4-month history of progressive abdominal pain and distention. She denied any additional symptoms. A VP shunt was performed 15 years earlier to treat idiopathic normal pressure hydrocephalus and no other abdominal surgery was performed. Physical examination revealed an elastic palpable mass in her right lower abdomen, which was dull to percussion. Abdominal computed tomography (CT) scan indicated a large cystic collection of homogenous iso-density fluid in the right lower abdominal region with clear margins. The distal segment of the peritoneal shunt catheter was located within the cystic mass. Abdominal CSF pseudocyst was highly suspected as a diagnosis. Laparoscopic cyst drainage with removal of the whole cystic mass was performed, 15-cm cyst which found with thick walls and organized chronic hematic content. No responsible vessel for the cyst hemorrhage was identified. No further shunt revision was placed. Histological examination showed that the cyst wall consisted of outer fibrous tissue and inner granulation tissue without epithelial lining, and the cystic content was chronic hematoma. The patient had an uneventful postoperative course and remained asymptomatic for 8-mo follow-up. CONCLUSION: To the best of our knowledge, this is the first report of hemorrhagic onset in the abdominal pseudocyst following VP shunt. Such special condition can accelerate the appearance of clinical signs of the abdominal pseudocyst after VP shunts, and its mechanisms may be similar to the evolution of subdural effusion into chronic subdural hematoma (CSDH).


Assuntos
Abdome/diagnóstico por imagem , Cistos/etiologia , Hemorragia/etiologia , Hidrocefalia/cirurgia , Derivação Ventriculoperitoneal/efeitos adversos , Idoso , Líquido Cefalorraquidiano , Cistos/diagnóstico por imagem , Cistos/cirurgia , Drenagem , Feminino , Humanos , Laparoscopia , Complicações Pós-Operatórias , Tomografia Computadorizada por Raios X
14.
Acta Neurochir (Wien) ; 163(4): 1087-1095, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33587185

RESUMO

BACKGROUND: The Miethke Sensor Reservoir sits within a ventriculoperitoneal shunt system to give a reading of the pressure within the shunt. This information can guide the management of hydrocephalus patients who present frequently with headaches. METHODS: We reviewed a cohort of 12 patients who underwent implantation of a Sensor Reservoir to assess how the management of their symptoms changed over a 4-year period. RESULTS: When comparing the group before the Sensor Reservoir and after the Sensor Reservoir insertion, there was a 75% reduction in number of CT head scans (P<0.05), 100% reduction in episodes of ICP monitoring (P<0.05), 55% reduction in number of X-ray shunt series, and a 50% reduction in acute presentation to hospital with shunt-related symptoms. The number of clinic attendances increased by 44%. In addition, cost analysis showed a saving of £6952 per patients over the 2-year period following Sensor Reservoir insertion as a result of reduced admissions and investigations. Complications were seen in 3 patients-two patients developed shunt-related infections, and 1 patient underwent shunt revision due to a proximal shunt obstruction. Seventy-five percent of patients showed an improvement in their symptoms at the end of the 4-year period. CONCLUSION: Implantation of a Sensor Reservoir in shunt patients with chronic headaches can reduce the number of investigations and hospital admissions and guide management resulting in a clinical improvement.


Assuntos
Pressão Intracraniana , Monitorização Fisiológica/efeitos adversos , Derivação Ventriculoperitoneal/efeitos adversos , Estudos de Coortes , Feminino , Cefaleia/etiologia , Humanos , Hidrocefalia/cirurgia , Masculino , Monitorização Fisiológica/instrumentação , Monitorização Fisiológica/métodos , Estudos Retrospectivos , Derivação Ventriculoperitoneal/instrumentação , Derivação Ventriculoperitoneal/métodos
15.
Acta Neurochir (Wien) ; 163(4): 1103-1112, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33587186

RESUMO

INTRODUCTION: The accurate placement of the ventricular catheter (VC) is critical in reducing the incidence of proximal failure of ventriculoperitoneal shunts (VPSs). The standard freehand technique is based on validated external anatomical landmarks but remains associated with a relatively high rate of VC malposition. Already proposed alternative methods have all their specific limitations. Herein, we evaluate the accuracy of our adapted freehand technique based on an individualized radio-anatomical approach. Reproducing the preoperative imaging on the patient's head using common anatomical landmarks allows to define stereotactic VC coordinates to be followed at surgery. MATERIAL AND METHODS: Fifty-five consecutive patients treated with 56 VPS between 11/2005 and 02/2020 fulfilled the inclusion criteria of this retrospective study. Burr hole coordinates, VC trajectory, and length were determined in all cases on preoperative computed tomography (CT) scan and were accurately reported on patients' head. The primary endpoint was to evaluate VC placement accuracy. The secondary endpoint was to evaluate the rate and nature of postoperative VC-related complications. RESULTS: Our new technique was applicable in all patients and no VC-related complications were observed. Postoperative imaging showed VC optimally placed in 85.7% and sub-optimally placed in 14.3% of cases. In all procedures, all the holes on the VC tip were found in the ventricular system. CONCLUSIONS: This simple individualized technique improves the freehand VC placement in VPS surgery, making its accuracy comparable to that of more sophisticated and expensive techniques. Further randomized controlled studies are required to compare our results with those of the other available techniques.


Assuntos
Cateterismo/métodos , Ventrículos Cerebrais/anatomia & histologia , Neuronavegação/métodos , Derivação Ventriculoperitoneal/métodos , Cateterismo/efeitos adversos , Cateteres/normas , Ventrículos Cerebrais/diagnóstico por imagem , Feminino , Humanos , Hidrocefalia/cirurgia , Imageamento Tridimensional/métodos , Masculino , Pessoa de Meia-Idade , Neuronavegação/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Tomografia Computadorizada por Raios X/métodos , Trepanação/efeitos adversos , Trepanação/métodos , Derivação Ventriculoperitoneal/efeitos adversos
16.
Neurosciences (Riyadh) ; 26(1): 31-35, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33530041

RESUMO

OBJECTIVES: To determine the prevalence of shunt malfunction without change in ventricle size in imaging modalities, and its clinical presentation. METHODS: A cross-sectional study conducted at King Abdulaziz Medical City, Riyadh, from June 2015 to May 2019. Patient's demographics, clinical presentation and changes in ventricle size were collected. Statistical analysis was done using SPSS version 23. RESULTS: The study included 42 patients who underwent shunt revision. Imaging showed no change in size in 10 (24%) patients, mild enlargement in 8 (19%), and obvious enlargement in 24 (57%). The mean age of diagnosis was 22±16.7. 55% of the patients were males, 45% females. The cause of the malfunction was ventricular catheter occlusion in 14 (34%) patients, 10 (24%) patients had valve-related malfunction, and peritoneal catheter occlusion was present in 6 (14%) patients, and 12 (28%) patients had a combination of the previously mentioned causes. Analysis of the association between ventricular size and headache, vomiting, seizure, confusion, and loss of consciousness in patients with unchanged ventricular size and those with increased ventricular size has shown no statistical significance. CONCLUSION: Shunt malfunction without ventricular size change was observed in 24% of all shunt malfunction patients. In addition, there was no relationship between ventricular size and patient symptoms.


Assuntos
Ventrículos Cerebrais/cirurgia , Falha de Equipamento/estatística & dados numéricos , Hidrocefalia/cirurgia , Derivação Ventriculoperitoneal/efeitos adversos , Adolescente , Ventrículos Cerebrais/diagnóstico por imagem , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Hidrocefalia/diagnóstico por imagem , Lactente , Masculino , Estudos Retrospectivos , Arábia Saudita , Tomografia Computadorizada por Raios X , Adulto Jovem
17.
Neurosciences (Riyadh) ; 26(1): 97-102, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33530051

RESUMO

Ventriculoperitoneal (VP) shunts are commonly used in neurosurgical procedures to treat hydrocephalus. Although shunt-associated abdominal complications are well documented, extrahepatic pseudocysts are a rare shunt complication in adult patients. Therefore, we herein report the case of a 54-year-old male patient who presented with a bulging mass around the previous surgical site at the right upper quadrant of the abdomen. He had a 4-year history of VP shunt surgery for posthemorrhagic hydrocephalus. A computed tomographic scan revealed a large extrahepatic pseudocsyt. Our case represented a rare entity of extrahepatic pseudocyst in adult patients underwent VP shunt surgery. The clinical presentation, diagnostic tools, and treatment methods were discussed.


Assuntos
Abdome/diagnóstico por imagem , Encéfalo/diagnóstico por imagem , Cistos/etiologia , Hidrocefalia/cirurgia , Doenças Peritoneais/etiologia , Derivação Ventriculoperitoneal/efeitos adversos , Abdome/cirurgia , Cistos/diagnóstico por imagem , Cistos/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Peritoneais/diagnóstico por imagem , Doenças Peritoneais/cirurgia , Tomografia Computadorizada por Raios X , Resultado do Tratamento
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