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1.
Medicine (Baltimore) ; 99(5): e18654, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32000370

RESUMO

INTRODUCTION: Acute hydrocephalus is a common complication of spontaneous or traumatic intracranial bleeding with extensive subarachnoid hemorrhage (SAH) or ventricular extension. However, it has never been reported to be secondary to pneumocephalus. PATIENT CONCERNS: A 32-year-old man was admitted following a motorcycle accident. Head computed tomography (CT) performed right after the accident revealed a skull base fracture and mild perimesencephalic SAH. Three days later, repeated CT revealed delayed perimesencephalic pneumocephalus and an evident enlargement of the ventricular system. DIAGNOSIS: The patient was diagnosed with acute obstructive hydrocephalus, which was secondary to pneumocephalus and traumatic SAH. INTERVENTIONS: The patient was treated with temporary external ventricular drainage (EVD). OUTCOMES: The patient experienced an unremarkable recovery process. At follow-up 3 months later, he showed no recurrence of the hydrocephalus and the score of Glasgow Outcome Scale was 5. CONCLUSION: Transient mechanical obstruction of CSF circulation and disturbance of CSF physiology might conjointly lead to the acute obstructive hydrocephalus.


Assuntos
Hidrocefalia/etiologia , Pneumocefalia/complicações , Fratura da Base do Crânio/complicações , Hemorragia Subaracnóidea/complicações , Acidentes de Trânsito , Adulto , Humanos , Masculino , Pneumocefalia/diagnóstico por imagem , Fratura da Base do Crânio/diagnóstico por imagem
2.
World Neurosurg ; 133: e492-e497, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31542439

RESUMO

BACKGROUND: Colloid cysts are the most common third ventricular tumor and may present with symptoms related to obstructive hydrocephalus. Although definitive endoscopic or microsurgical resection is the standard of care, patients may receive temporizing ventriculoperitoneal shunts when definitive management is deferred. Subsequent definitive treatment can be challenging because of the ventricular collapse and narrowing of the operative corridor. There is currently no literature evaluating the feasibility of definitive colloid cyst resection in patients with preexisting ventriculoperitoneal shunts. METHODS: We retrospectively reviewed records for patients undergoing colloid cyst resection between 2009 and 2019 to identify patients with preexisting shunts prior to surgery. RESULTS: Three patients had preexisting ventriculoperitoneal shunts. Two patients had been shunted at outside institutions where microsurgical or endoscopic resection was not available. One patient received a shunt from an outside surgeon when she was deemed a poor surgical candidate because of cardiac instability. All 3 patients underwent successful gross total colloid cyst resection via the transcallosal approach without recurrences during a mean follow-up of 4.2 years. All patients had intact cognitive and memory function and returned to work. CONCLUSIONS: Surgical resection of colloid cysts is possible despite a preexisting ventriculoperitoneal shunt. Because the ventricular space may be collapsed postoperatively because of cerebrospinal fluid diversion, a transcortical route (either endoscopic or microscopic) can be complicated by a small operative corridor with reduced visibility. The transcallosal approach was safe and feasible in these cases for providing midline access with adequate visualization for complete resection despite ventricular collapse.


Assuntos
Cistos Coloides/cirurgia , Procedimentos Neurocirúrgicos/métodos , Derivação Ventriculoperitoneal , Adulto , Feminino , Humanos , Hidrocefalia/etiologia , Hidrocefalia/cirurgia , Masculino , Microcirurgia/métodos , Estudos Retrospectivos
3.
World Neurosurg ; 133: 80-83, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31574329

RESUMO

BACKGROUND: Bobble-head doll syndrome is a rare neurological syndrome presenting with repetitive anteroposterior head movements. It is usually associated with expansile cystic lesions in the third ventricular region. CASE DESCRIPTION: An 8-year-old boy presented with involuntary bobbling head movements. Magnetic resonance imaging of the brain revealed an extensive suprasellar cyst resulting in obstructive hydrocephalus. Endoscopic ventriculo-cysto-cisternostomy resulted in improved clinical outcome. CONCLUSIONS: Endoscopic ventriculo-cysto-cisternostomy is an effective, less-invasive technique in the treatment of suprasellar cysts that results in resolution of the bobbling head movements.


Assuntos
Cistos Aracnóideos/etiologia , Cistos do Sistema Nervoso Central/complicações , Discinesias/etiologia , Hidrocefalia/etiologia , Terceiro Ventrículo/anormalidades , Ventriculostomia/métodos , Cistos Aracnóideos/diagnóstico por imagem , Cistos Aracnóideos/cirurgia , Cistos do Sistema Nervoso Central/diagnóstico por imagem , Cistos do Sistema Nervoso Central/cirurgia , Criança , Discinesias/diagnóstico por imagem , Discinesias/cirurgia , Humanos , Hidrocefalia/diagnóstico por imagem , Hidrocefalia/cirurgia , Imagem por Ressonância Magnética , Masculino , Terceiro Ventrículo/diagnóstico por imagem , Terceiro Ventrículo/cirurgia , Resultado do Tratamento
4.
J Craniofac Surg ; 30(7): 2171-2173, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31574785

RESUMO

OBJECTIVE: Choroid plexus cysts are the most common neuro-epithelial cysts. METHODS: The authors describe 2 cases. The first case is a 1-year-old child presenting with hydrocephalus and cyst of the choroid plexus. The child was treated with endoscopic fenestration of the cysts. RESULTS: The histological examination of the cyst wall was consistent with choroid epithelium and water-filled vesicles. The second case is a 63 year old male with a highly vascularized tumor extending to choroid plexus. A quaductus Silvius was obstructed by the tumor. The histopathologic examination of choroid plexus showed a low number, water-vesicles. CONCLUSIONS: According to our knowledge, there are no previous reports of water-filled vesicles with choroid plexus cyst causing hydrocephalus. The first case is a good example of over secretion of cerebrospinal fluid (CSF) with the water-filled vesicle. The second case with low number of water filled vesicle shows that the cause of hydrocephalus is not over production of CSF, it is blockage of the CSF pathway in Aquaductus Silvius by the tumor itself. These 2 cases are illustrative and more importantly highlight the need to study for water-filled vesicles in these kind of cases.


Assuntos
Neoplasias do Plexo Corióideo/patologia , Cistos do Sistema Nervoso Central/diagnóstico por imagem , Neoplasias do Plexo Corióideo/complicações , Neoplasias do Plexo Corióideo/diagnóstico por imagem , Neoplasias do Plexo Corióideo/cirurgia , Humanos , Hidrocefalia/etiologia , Lactente , Masculino , Pessoa de Meia-Idade , Neuroendoscopia
6.
Medicine (Baltimore) ; 98(42): e17568, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31626123

RESUMO

BACKGROUND: The aim of this study was to investigate the risk and peak time of post-traumatic hydrocephalus (PTH) in traumatic brain injury (TBI) patients with traumatic subarachnoid hemorrhage (SAH), compared to TBI patients without traumatic SAH. METHODS: In this retrospective population-based cohort study, the data was extracted from Longitudinal Health Insurance Database from 2000 to 2010 in Taiwan. A total of 23,775 TBI patients who had a first event TBI during 2000 to 2010 were included and divided into TBI with SAH (TBI-S) group and TBI without SAH (TBI-NS) group. We focused on analyzing the PTH in both groups within 2 years after brain injury. Competing risk regression models were performed to assess the risk of developing PTH in the TBI-S group compared to the TBI-NS group. RESULTS: Comparing to the TBI-NS group, there was a significantly higher cumulative incidence of PTH in the TBI-S group during the 2-year follow-up period. The adjusted hazard ratio (HR) of PTH in TBI-S group within 2 years was between 2.90-3.47, and the highest estimates were obtained within 6 months after injury (HR = 3.47, 95% CI: 2.43-4.94). The occurrence percentage of PTH was highest during 0-3rd month follow-up periods (1.95% in TBI-S group; 0.48% in TBI-NS group). CONCLUSIONS: The peak time of PTH occurrence was noted during 0-3rd month post brain injury. Traumatic SAH patients had an approximate 3-fold risk of developing PTH, comparing to TBI patients without traumatic SAH.


Assuntos
Lesões Encefálicas Traumáticas/complicações , Hidrocefalia/epidemiologia , Vigilância da População/métodos , Medição de Risco/métodos , Adolescente , Adulto , Idoso , Feminino , Seguimentos , Humanos , Hidrocefalia/etiologia , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Taiwan/epidemiologia , Adulto Jovem
7.
Plast Reconstr Surg ; 144(4): 932-940, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31568307

RESUMO

BACKGROUND: Patients with syndromic craniosynostosis have an increased incidence of progressive hydrocephalus and Chiari malformations, with few data on the relative benefit of various surgical interventions. The authors compare the incidence and resolution of Chiari malformations and hydrocephalus between patients undergoing posterior vault distraction osteogenesis (PVDO) and patients undergoing conventional cranial vault remodeling. METHODS: Patients with syndromic craniosynostosis who underwent cranial vault surgery from 2004 to 2016 at a single academic hospital, with adequate radiographic assessments, were reviewed. Demographics, interventions, the presence of a Chiari malformation on radiographic studies and hydrocephalus requiring shunt placement were recorded. Mann-Whitney U and Fisher's exact tests were used as appropriate. RESULTS: Forty-nine patients underwent PVDO, and 23 patients underwent cranial vault remodeling during the study period. Median age at surgery (p = 0.880), sex (p = 0.123), and types of syndrome (p = 0.583) were well matched. Patients who underwent PVDO had a decreased incidence of developing Chiari malformations postoperatively compared with the cranial vault remodeling cohort (2.0 percent versus 17.4 percent; p = 0.033). Not surprisingly, no significant difference was found between the groups with regard to the incidence of postoperative hydrocephalus requiring shunt placement (PVDO, 4.1 percent; cranial vault remodeling, 4.3 percent; p = 0.999). CONCLUSIONS: As expected, PVDO did not significantly affect intracranial hydrodynamics to the extent that hydrocephalus shunting rates were different for patients with syndromic craniosynostosis. However, PVDO was associated with a reduced risk of developing a Chiari malformation; however, prospective evaluation is needed to determine causality. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.


Assuntos
Malformação de Arnold-Chiari/etiologia , Craniossinostoses/complicações , Craniossinostoses/cirurgia , Hidrocefalia/etiologia , Osteogênese por Distração/métodos , Crânio/cirurgia , Feminino , Humanos , Lactente , Masculino , Indução de Remissão , Estudos Retrospectivos , Síndrome
8.
World Neurosurg ; 132: 208-210, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31505278

RESUMO

A 76-year-old man presented with progressive dementia, gait disturbance, and urinary incontinence for 1 year. Computed tomography scan revealed nonobstructive hydrocephalus, but abnormal papillary structures at the ventricular wall were noted. Before cerebrospinal fluid (CSF) diversion surgery for hydrocephalus, we performed magnetic resonance angiography and magnetic resonance venography, which revealed multiple engorged vessels over the ventricular wall and bilateral hemispheres. Digital subtraction angiography revealed 2 dural arteriovenous fistulas (DAVFs) at the left transverse-sigmoid sinus and superior sagittal sinus. Signs of angioarchitecture characteristic of cerebral venous hypertension (CVH) were noted, including cortical vein regurgitation and severe pseudophlebitic pattern. DAVFs with CVH might be a factor contributing to acquired hydrocephalus. DAVFs should be considered when patients with hydrocephalus exhibit abnormal papillary structures at the ventricular wall. Performing CSF diversion surgery for hydrocephalus before downgrading or curing such aggressive DAVFs may lead to major complications.


Assuntos
Malformações Vasculares do Sistema Nervoso Central/complicações , Ventrículos Cerebrais/patologia , Hidrocefalia/etiologia , Idoso , Angiografia Digital , Malformações Vasculares do Sistema Nervoso Central/patologia , Malformações Vasculares do Sistema Nervoso Central/cirurgia , Ventrículos Cerebrais/cirurgia , Humanos , Hidrocefalia/patologia , Hidrocefalia/cirurgia , Hipertensão/etiologia , Imagem por Ressonância Magnética , Masculino , Procedimentos Neurocirúrgicos/métodos , Tomografia Computadorizada por Raios X , Resultado do Tratamento
9.
World Neurosurg ; 132: 135-137, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31479793

RESUMO

We report a case of headache due to a hydrocephalus with associated syringomyelia. Magnetic resonance imaging showed a fourth ventricular outlet obstruction. An endoscopic third ventriculostomy (ETV) was performed with successful clinical and radiologic outcome. Fourth ventricular outlet obstruction is an uncommon cause of obstructive hydrocephalus, but it must be kept in mind. As far as we know, there are few reports that propose ETV as treatment. Therefore our case supports that ETV could be a successful option for the management of this condition.


Assuntos
Quarto Ventrículo/cirurgia , Hidrocefalia/cirurgia , Terceiro Ventrículo/cirurgia , Ventriculostomia/métodos , Adulto , Feminino , Cefaleia/etiologia , Humanos , Hidrocefalia/etiologia , Siringomielia/complicações , Siringomielia/cirurgia , Resultado do Tratamento
10.
No Shinkei Geka ; 47(8): 893-900, 2019 Aug.
Artigo em Japonês | MEDLINE | ID: mdl-31477633

RESUMO

Endoscopic third ventriculostomy(ETV)is the first-line treatment for fourth ventricle outlet obstruction(FVOO)-associated hydrocephalus. However, because FVOO is difficult to diagnose in the acute stage, ventriculoperitoneal shunt(VPS)is also used. Herein, we report two cases of shunted FVOO resulting in overdrainage or slit ventricle syndrome(SVS)that were treated successfully with the shunt-clamp system. In addition, we discuss the efficacy of the shunt-clamp system for FVOO-associated hydrocephalus. CASE 1:A 79-year-old man complained of severe postural headaches. One year earlier, he underwent VPS for secondary hydrocephalus associated with hemorrhagic cerebellar infarction. CT revealed that the ventricle had become slit-like. Although the shunt valve adjusted the maximum pressure, his complaint and the ventricle shape did not improve. After the on-off valve was inserted in the shunt system and clamped, his symptoms were resolved and the ventricle size was normalized. CASE 2:A 21-year-old man who complained of drowsiness, diplopia, and severe intermittent retroocular pain was admitted to our hospital. One year earlier, he underwent VPS with the shunt-clamp system for a secondary hydrocephalus after surgery for medulloblastoma. CT on admission revealed ventricle dilatation;however, the shape of the ventricle became slit-like 3 days after admission. We made a diagnosis of SVS and planned ETV. Owing to the difficulty in approaching the lateral ventricle, the shunt system was clamped 8 hours before the operation. After confirming ventricle dilatation, ETV was successfully performed. After the operation, the symptoms were resolved, and magnetic resonance imaging confirmed that the ventricle size was normalized.


Assuntos
Quarto Ventrículo , Hidrocefalia , Terceiro Ventrículo , Derivação Ventriculoperitoneal , Idoso , Quarto Ventrículo/patologia , Humanos , Hidrocefalia/etiologia , Hidrocefalia/terapia , Masculino , Procedimentos Neurocirúrgicos , Ventriculostomia , Adulto Jovem
11.
World Neurosurg ; 132: 173-176, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31491571

RESUMO

BACKGROUND: Epidermoid cysts of the spinal cord may rupture, resulting in keratin dissemination in the subarachnoid space, in the ventricles, and along the central canal of the spinal cord causing meningitis, myelopathic changes, or hydrocephalus. CASE DESCRIPTION: A 53-year-old woman with no past medical history presented with a 2-week history of headache located in the occipital region associated with neck pain. Brain magnetic resonance imaging demonstrated multiple fat droplets scattered throughout the subarachnoid and intraventricular spaces with significant edema of the right posterior temporoparietal lobes with trapping of the right temporal horn of the lateral ventricle and atrium. An intracranial lesion could not be observed in the study. The spinal region was suspected as the possible culprit, and spinal imaging showed a large cystic lesion at the level of the conus medullaris. The patient underwent neuronavigation endoscopic exploration of the right lateral ventricle with flushing of the keratin particles followed by a posterior lumbar decompression with resection of the epidermoid cyst. Pathology was consistent with an epidermoid cyst. Successful recovery with improvement in symptoms was quickly observed. CONCLUSIONS: When an epidermoid cyst is suspected but no intracranial lesion is found, the intraspinal area should be studied. Rupture of a spinal epidermoid cyst may cause meningitis and inflammation producing obstructive hydrocephalus. We present this rare entity and describe the diagnostic and surgical techniques used.


Assuntos
Cisto Epidérmico/complicações , Hidrocefalia/etiologia , Hidrocefalia/cirurgia , Meningite/etiologia , Procedimentos Neurocirúrgicos/métodos , Doenças da Coluna Vertebral/complicações , Ventrículos Cerebrais/metabolismo , Ventrículos Cerebrais/patologia , Descompressão Cirúrgica , Endoscopia , Feminino , Humanos , Queratinas/metabolismo , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Neuronavegação , Ruptura , Espaço Subaracnóideo/metabolismo , Espaço Subaracnóideo/patologia , Resultado do Tratamento
12.
Rinsho Shinkeigaku ; 59(9): 584-588, 2019 Sep 25.
Artigo em Japonês | MEDLINE | ID: mdl-31474646

RESUMO

A 53-year-old man was referred to our hospital because of fever and disturbed consciousness with a left-sided toothache from 5 days ago. Neurological examinations revealed a low level of consciousness, nuchal rigidity, bilateral mydriasis, and positive Babinski sign. A lumbar puncture yielded clouded fluid with a WBC 22,698/µl (polynuclear cell 98%), 681 mg/dl of protein and 0 mg/dl of glucose. The antigen of Streptococcus pneumoniae in urine and cerebrospinal fluid (CSF) were positive. Streptococcus pneumoniae was isolated from CSF culture. Brain CT on admission showed a communicating hydrocephalus. Diagnosis of pneumococcal meningitis with hydrocephalus was made and we treated with ceftriaxone and dexamethasone. The lumbar drainage placed at L 3/4 level became occluded, thus, extra-ventricular drainage was performed. Intracranial pressure (ICP) was 20 cmH2O upon insertion of the ICP sensor. At Day 2, the ICP decreased to 10 cmH2O and never increased during his course of hospitalization. Repeat brain CT showed no hydrocephalus. He responded to antimicrobial therapy and became lucid and afebrile. At Day 4, the extra-ventricular drainage was removed because of bleeding from right choroid plexus on brain CT. We treated with antimicrobial therapy until Day 21. He was transferred to another hospital for rehabilitation with mild neurological sequelae at Day 31. The cases presenting with hydrocephalus in the acute phase of bacterial meningitis has a high mortality rate. The presence of hydrocephalus is a poor prognostic factor. Although the therapeutic value of extra-ventricular drainage for hydrocephalus has been unclear, his report represents a case for neurologists to consider performing extra-ventricular drainage for hydrocephalus.


Assuntos
Drenagem/métodos , Hidrocefalia/terapia , Meningite Pneumocócica/terapia , Antibacterianos/administração & dosagem , Ceftriaxona/administração & dosagem , Dexametasona/administração & dosagem , Humanos , Hidrocefalia/diagnóstico por imagem , Hidrocefalia/etiologia , Masculino , Meningite Pneumocócica/complicações , Meningite Pneumocócica/diagnóstico , Meningite Pneumocócica/microbiologia , Pessoa de Meia-Idade , Streptococcus pneumoniae/isolamento & purificação , Tomografia Computadorizada por Raios X , Resultado do Tratamento
13.
Med Arch ; 73(3): 187-190, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31402803

RESUMO

Introduction: Hydrocephalus (HCP) remains one of the commonest pathologies treated in developing countries. Endoscopic third ventriculostomy (ETV) has become the alternative to shunt-divergen procedures in the treatment of many pathologies of the cerebral fluid in the brain. Age has been considered a limitation to perform the procedure, we started to perform ETV In younger patients earlier than many other units. Objectives: In this study, we demonstrate the overall efficacy of ETV in infants younger than 1-year of age and to subsequently report the outcome of this procedure. Methods: From 2000 till 2016 we have performed a total of 386 cases of ETV of all ages. 71-cases were infants (below 1-year of age). Our study was undertaken to evaluate these cases. Patients were divided into two subgroups according to the cause of hydrocephalus; obstructive HCP, communicating HCP. Results: Mean time for follow up was 52 months. Mean age at surgery was 137days (7- 351days). The population included 31-females and 40-males, while10 infants were premature. Success rates were; 91.6%, 63.6% correspond to each sub-group with an overall success rate of 73.24%. Conclusion: ETV in infants is feasible, technically more demanding. Success rate justifies the procedure to be performed in such age group of patients. ETV can be used, attentively, in cases of hydrocephalus associated with MMC, morbidity and mortality does not differ from the general population.


Assuntos
Hidrocefalia/cirurgia , Ventriculostomia , Endoscopia , Feminino , Seguimentos , Humanos , Hidrocefalia/diagnóstico por imagem , Hidrocefalia/etiologia , Lactente , Recém-Nascido , Masculino , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Resultado do Tratamento
14.
J Med Case Rep ; 13(1): 243, 2019 Aug 06.
Artigo em Inglês | MEDLINE | ID: mdl-31383038

RESUMO

BACKGROUND: Pseudomeningocele or cerebrospinal fluid leakage is one of the most common complications of foramen magnum decompression with duraplasty for Chiari I malformation. Usually, cerebrospinal fluid leakage is treated with lumbar drainage and/or secondary suture. However, if hydrocephalus occurs, spinal drainage may cause brain herniation. CASE PRESENTATION: A 54-year-old Japanese woman presented to our hospital with a 10-month history of bilateral finger extension weakness and clumsiness. Magnetic resonance imaging showed displacement of her cerebellar tonsils below the foramen magnum level, with syringomyelia presenting from the C4 to T8 level. Suboccipital craniectomy and C1 laminectomy with duraplasty were performed under general anesthesia. At 1 month after discharge, she again presented to our hospital due to severe headache and nausea. Magnetic resonance imaging of her cervical spine showed pseudomeningocele compressing her cerebellum and spinal cord. Magnetic resonance imaging of her brain also showed ventriculomegaly. Pseudomeningocele aspiration was performed, with 25 ml of fluid removed under X-ray control. Immediately after aspiration her headache and nausea decreased, and she reported improvement in her symptoms with increasing bilateral finger extension strength and decreasing bilateral upper extremity numbness at her 1-year follow-up. CONCLUSIONS: Although there is a considerable risk of meningitis with the aspiration procedure of pseudomeningocele, an aspiration procedure may be an easy and effective treatment option for postoperative hydrocephalus after suboccipital craniotomy with duraplasty in a patient treated for Chiari I malformation.


Assuntos
Malformação de Arnold-Chiari/cirurgia , Craniotomia/efeitos adversos , Forame Magno/cirurgia , Hidrocefalia/etiologia , Craniotomia/métodos , Feminino , Forame Magno/diagnóstico por imagem , Forame Magno/patologia , Humanos , Hidrocefalia/cirurgia , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Siringomielia/diagnóstico por imagem
15.
BMJ Case Rep ; 12(8)2019 Aug 04.
Artigo em Inglês | MEDLINE | ID: mdl-31383680

RESUMO

Sarcoidosis is a multisystem disorder, characterised histologically by the presence of non-caseating epithelioid granulomas with exclusion of other granulomatous diseases. While the lungs and lymph nodes are affected in 90%, approximately 5% of patients have neurological involvement. The clinical manifestations of neurosarcoidosis (NS) are diverse, making diagnosis especially difficult in patients without known systemic disease. Hydrocephalus occurs in only 9% of patients with NS and although uncommon, is an important manifestation because it is associated with high morbidity and mortality. We report two cases of NS presenting with hydrocephalus, one as the first presentation of sarcoidosis and one in a patient with known multisystem sarcoidosis. The patient without systemic sarcoidosis posed the greater diagnostic challenge and followed a protracted course with multiple surgical interventions, progression of central nervous system inflammation and significant physical disability.


Assuntos
Doenças do Sistema Nervoso Central/diagnóstico , Hidrocefalia/diagnóstico , Sarcoidose/diagnóstico , Adulto , Doenças do Sistema Nervoso Central/complicações , Diagnóstico Diferencial , Feminino , Humanos , Hidrocefalia/etiologia , Masculino , Pessoa de Meia-Idade , Sarcoidose/complicações
16.
West Afr J Med ; 36(2): 172-175, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31385604

RESUMO

BACKGROUND AND OBJECTIVES: Brainstem gliomas are relatively rare tumours of the central nervous system which have varying presentations and clinical course. This study aims to analyse the clinical profile and challenges of management of these tumours in a resource-limited country. METHIODS: We retrospectively analysed the data from the records of the patients managed for briainstem glioma between January 2010 and July 2017. RESULTS: There were 11 patients in the study (7 males and 4 females). The median age at diagnosis was 9 years. Eight of the patients were less than 15 years. The duration of symptoms ranged from 1 month to 2 years. All the patients had cranial nerve deficits at presentation, while 7 patients had cerebellar signs. Hydrocephalus was present in 4 patients. The lesion was pontine in 9 patients and tectal in 2. Three of the patients with hydrocephalus had ventriculoperitoneal shunt insertion while one patient refused surgery. Only one of the patients had radiotherapy. None of the patients received chemotherapy. A patient was dishcarged against medical advice. One patient is still alive after 4 years while another patient is alive after 2 years. The other 9 patients are dead with a mean survival period of 6 months. CONCCLUSION: Most of the tumours in this series were located in the pons and ran aggressive courses. Majority of our patients did not have access to radiotherapy while none had chemotherapy.


Assuntos
Neoplasias do Tronco Encefálico/mortalidade , Nervos Cranianos/fisiopatologia , Glioma/mortalidade , Tronco Encefálico/patologia , Neoplasias do Tronco Encefálico/diagnóstico , Neoplasias do Tronco Encefálico/terapia , Criança , Feminino , Glioma/diagnóstico , Glioma/terapia , Humanos , Hidrocefalia/etiologia , Masculino , Estudos Retrospectivos
17.
World Neurosurg ; 132: 1-3, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31442637

RESUMO

BACKGROUND: This report presents a rare presentation of a ganglioglioma in the sellar/suprasellar region. On the basis of the patient's presentation and imaging characteristics, the initial diagnosis was craniopharyngioma. While gangliogliomas are already rare brain tumors that are usually found in the frontal and temporal lobes of young patients, the presentation of this tumor in the sellar region is exceedingly rare. CASE DESCRIPTION: A 25-year-old male presented to the emergency department with headache, agitation, and combativeness. A head computed tomography scan showed a sellar/suprasellar mass with mixed solid and cystic components and peripheral calcifications. The mass compressed the third ventricle and cerebral aqueduct, resulting in obstructive hydrocephalus. The patient was intubated for decline in mental status and combativeness. A ventricular drain was placed emergently. A pituitary function panel did not show endocrine dysfunction. Magnetic resonance imaging showed a 3.6 cm × 4.2 cm solid mass in the sellar/suprasellar region with a cystic component. The mass displaced the adenohypophysis and extended into the prepontine and interpedicular cisterns. The clinical presentation and radiologic characteristics led to an initial diagnosis of craniopharyngioma. The patient underwent a right pterional craniotomy and transsylvian approach for resection of mass without complication, although a subtotal resection was achieved due to adherence of the tumor to optic nerves and carotid arteries. The resected specimen was diagnosed as ganglioglioma. CONCLUSIONS: This case is a reminder of how much the field of neurosurgery relies on imaging modalities but also emphasizes the importance of histopathology in the field of brain tumors.


Assuntos
Neoplasias Encefálicas/cirurgia , Ganglioglioma/cirurgia , Sela Túrcica/cirurgia , Adulto , Neoplasias Encefálicas/complicações , Neoplasias Encefálicas/diagnóstico por imagem , Neoplasias Encefálicas/patologia , Craniofaringioma/diagnóstico , Craniotomia , Diagnóstico Diferencial , Ganglioglioma/complicações , Ganglioglioma/diagnóstico por imagem , Ganglioglioma/patologia , Humanos , Hidrocefalia/etiologia , Imagem por Ressonância Magnética , Masculino , Neoplasias Hipofisárias/diagnóstico , Sela Túrcica/diagnóstico por imagem , Sela Túrcica/patologia , Ventriculostomia
18.
World Neurosurg ; 132: 7-11, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31442659

RESUMO

BACKGROUND: The rosette-forming glioneuronal tumor (RGNT) is a rare World Health Organization grade I tumor, most often originating in the fourth ventricle and characterized by a predominant glial component, as well as a neurocytic component. Despite its benign grading, there are a few documented cases of RGNT displaying more aggressive behavior with malignant characteristics. CASE DESCRIPTION: Herein, we describe a uniquely aggressive presentation of RGNT in a 49-year-old man initially presenting with obstructive hydrocephalus with lesions in the right frontal lobe, fourth ventricle, and left lateral ventricle. The patient was found to have 2 distinct intracranial entities: a right frontal meningioma and disseminated intraventricular RGNT. He underwent an anatomically limited resection of the fourth ventricular lesion with fourth ventricle-to-subarachnoid space shunting. His disease progressed thereafter, with diffuse intracranial dissemination and drop metastases in the lumbar spine. He was treated with craniospinal radiation and remains on palliative care 5 months after completion of radiotherapy. CONCLUSIONS: This case supplements and complements the handful of published cases available documenting the evolution of a particularly aggressive case of disseminated RGNT.


Assuntos
Neoplasias do Ventrículo Cerebral/cirurgia , Glioma/cirurgia , Neoplasias Primárias Múltiplas/cirurgia , Neoplasias Encefálicas/complicações , Neoplasias Encefálicas/diagnóstico por imagem , Neoplasias Encefálicas/patologia , Neoplasias Encefálicas/cirurgia , Neoplasias do Ventrículo Cerebral/complicações , Neoplasias do Ventrículo Cerebral/diagnóstico por imagem , Neoplasias do Ventrículo Cerebral/patologia , Quarto Ventrículo/diagnóstico por imagem , Quarto Ventrículo/cirurgia , Glioma/complicações , Glioma/diagnóstico por imagem , Glioma/secundário , Humanos , Hidrocefalia/diagnóstico por imagem , Hidrocefalia/etiologia , Hidrocefalia/cirurgia , Ventrículos Laterais/diagnóstico por imagem , Ventrículos Laterais/cirurgia , Masculino , Neoplasias Meníngeas/diagnóstico por imagem , Neoplasias Meníngeas/cirurgia , Meningioma/diagnóstico por imagem , Meningioma/cirurgia , Pessoa de Meia-Idade , Neoplasias Primárias Múltiplas/diagnóstico por imagem , Doenças Raras , Neoplasias da Medula Espinal/diagnóstico por imagem , Neoplasias da Medula Espinal/secundário , Derivação Ventriculoperitoneal
19.
World Neurosurg ; 132: e535-e544, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31470163

RESUMO

BACKGROUND: Hydrocephalus is the most common complication of extraparenchymal neurocysticercosis, combining obstructive and inflammatory mechanisms that impair cerebrospinal fluid circulation. METHODS: We studied the long-term progression of neurocysticercosis-induced hydrocephalus in a rat model. We generated an experimental rat model of neurocysticercosis-induced hydrocephalus by cisternal inoculation of cysts or antigens of Taenia crassiceps and compared it with the classic model of kaolin-induced hydrocephalus. We used 52 animals divided into 4 groups: 1) control, 2) neurocysticercosis-induced hydrocephalus by cysts or 3) by antigens, and 4) kaolin-induced hydrocephalus. We studied behavioral, radiologic, and morphologic alterations at 1 and 6 months after inoculation by open field test, magnetic resonance imaging, and immunohistochemical localization of aquaporin-4 (AQP-4). RESULTS: Behavioral changes were observed later in neurocysticercosis-induced than in kaolin-induced hydrocephalic rats (P = 0.023). The ventricular volume of hydrocephalus induced by experimental neurocysticercosis progressively evolved, with the magnetic resonance imaging changes being similar to those observed in humans. Periventricular inflammatory and astrocytic reactions were also observed. AQP-4 expression was higher in the sixth than in the first month after inoculation (P = 0.016) and also occurred in animals that received antigen inoculation but did not develop hydrocephalus, suggesting that AQP-4 may constitute an alternative route of cerebrospinal fluid absorption under inflammatory conditions. CONCLUSIONS: Our neurocysticercosis-induced hydrocephalus model allows for the long-term maintenance of hydrocephalic animals, involving mild clinical performance impairments, including body weight and behavioral changes.


Assuntos
Modelos Animais de Doenças , Hidrocefalia/etiologia , Neurocisticercose/complicações , Animais , Hidrocefalia/patologia , Masculino , Neurocisticercose/patologia , Ratos , Ratos Wistar
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