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1.
World Neurosurg ; 135: 253-258, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31887463

RESUMO

BACKGROUND: Generally, enlargement of arachnoid cysts (ACs) has been found mostly in cases occurring during early childhood. Therefore, progressively enlarged ACs found to be symptomatic in elderly patients are extremely rare, and the mechanisms have remained unexplored. CASE DESCRIPTION: Our first patient was a 72-year-old woman with memory disturbance, who had presented with a large cyst beneath the right temporal convexity 9 years previously. The annual follow-up magnetic resonance imaging (MRI) studies had revealed that the cyst had progressively enlarged. In addition, her memory disturbance had become advanced. Endoscopic cyst fenestration was performed between the cyst and lateral ventricle, resulting in a reduction of her symptoms. Our second patient was a 79-year-old woman with unsteadiness, who had presented with a large cyst under the right parietal convexity 6 years previously. The annual follow-up MRI studies had shown that the cyst had gradually enlarged. She subsequently developed left hemiparesis. Because the pyramidal tract was located between the cyst and ventricle, a cyst-ventricle shunt was placed to allow the cystic fluid into the lateral ventricle, with complete resolution of her symptoms. In both cases, MRI showed obliteration of the subdural spaces around the cysts. Endoscopic observations revealed that the arachnoid membrane was lined under the surrounding brain, leading to the diagnosis of an AC. CONCLUSION: The establishment of stable communication between a cyst and the normal cerebrospinal fluid space is important to treat symptomatic ACs characterized by progressive enlargement, even in elderly patients. The 1-way entry of the cerebrospinal fluid into the cyst and the closure of the surrounding subdural space might result in AC enlargement internally.


Assuntos
Cistos Aracnóideos/cirurgia , Ventrículos Cerebrais/cirurgia , Drenagem/métodos , Neuroendoscopia/métodos , Idoso , Cistos Aracnóideos/complicações , Cistos Aracnóideos/diagnóstico por imagem , Progressão da Doença , Feminino , Humanos , Imagem por Ressonância Magnética , Transtornos da Memória/etiologia , Procedimentos Neurocirúrgicos , Paresia/etiologia , Lobo Parietal , Lobo Temporal
2.
World Neurosurg ; 135: 228-232, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31863895

RESUMO

BACKGROUND: Tension pneumoventricle is an extremely rare, but treatable, neurosurgical emergency. The prompt and accurate diagnosis of tension pneumoventricle requires vigilance for the detection of clinical signs, which should also be corroborated by the imaging findings. We have reported on the pathophysiology of tension pneumoventricle and its management. CASE DESCRIPTION: A 66-year-old woman had presented with a Rathke cleft cyst. The patient underwent transsphenoidal surgery (TSS), with no clinical cerebrospinal fluid leakage observed peri- or postoperatively. However, she developed an altered mental status 8 hours after surgery, and a computed tomography scan showed evidence of a tension pneumoventricle. The patient underwent emergent external ventricular drainage insertion and exploratory endoscopic TSS. A 1-way valve was observed during TSS, and the sella floor was packed with a fat graft for 1-way valve obliteration. The patient recovered well without neurologic deficits. No radiologic regrowth was noted at the 48-month follow-up examination. CONCLUSIONS: Tension pneumoventricle is an extremely rare, but life-threatening, complication of TSS. The development of tension pneumoventricle should be kept in mind even when the surgery has proceeded very smoothly. Sellar reconstruction will, theoretically, prevent this extremely rare complication but might increase the recurrence rate of Rathke cleft cysts. The related symptoms and signs should be recognized. Prompt recognition and treatment of this condition can be life-saving, and the long-term outcomes have generally been favorable if the condition has been recognized early.


Assuntos
Cistos do Sistema Nervoso Central/cirurgia , Ventrículos Cerebrais/cirurgia , Recidiva Local de Neoplasia/cirurgia , Neuroendoscopia , Pneumocefalia/cirurgia , Complicações Pós-Operatórias/cirurgia , Sela Túrcica/cirurgia , Idoso , Ventrículos Cerebrais/diagnóstico por imagem , Feminino , Escala de Coma de Glasgow , Humanos , Imagem por Ressonância Magnética , Pneumocefalia/diagnóstico por imagem , Complicações Pós-Operatórias/diagnóstico por imagem , Osso Esfenoide , Tomografia Computadorizada por Raios X , Ventriculostomia
3.
World Neurosurg ; 135: e447-e451, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31843723

RESUMO

BACKGROUND: Slit ventricles can be a challenging target during shunt catheter insertion. Traditionally, the frontal approach has been considered optimal for small ventricles. At this center, routine use of electromagnetic (EM) stereotactic guidance (Stealth, Medtronic, Dublin, Ireland) has enabled a parietooccipital (P-O) burr hole approach to the frontal horns. We compare shunt placement and revisions required for patients with slit ventricles who had shunts inserted via a P-O approach versus frontal shunt. METHODS: We studied a retrospective cohort of patients with slit ventricles and a ventricular shunt inserted using EM guidance between 2012 and 2018. Slitlike ventricles were defined as the widest point of the lateral ventricle <3 mm. Outcome measures included placement accuracy and survival using the Kaplan-Meier curve. Optimal final catheter tip location was considered to be the frontal horn of the ipsilateral lateral ventricle. RESULTS: Eighty-two patients (77 female, 5 male) aged 34.9 ± 10.8 years (mean ± standard deviation) had ventricular shunts inserted for idiopathic intracranial hypertension (n = 63), chiari/syrinx (n = 8), congenital (n = 10), and pseudomeningocele (n = 1). Of those identified, 35 had primary P-O shunts and 46 had frontal shunts. Overall, 94% of cases had the catheter tip sitting in the frontal horn. The P-O approach was just as accurate as the frontal approach. Eight P-O shunts and 9 frontal shunts required revision over a 60-month period. There was no significant different in shunt survival between the 2 approaches (P = 0.37). CONCLUSIONS: EM-guided placement has enabled the P-O approach to be as safe and with equivalent survival to frontal approach. The accuracy of shunt placement between the 2 approaches was similar.


Assuntos
Craniotomia/métodos , Derivação Ventriculoperitoneal/métodos , Adulto , Ventrículos Cerebrais/cirurgia , Feminino , Lobo Frontal/cirurgia , Humanos , Masculino , Lobo Occipital/cirurgia , Lobo Parietal/cirurgia , Resultado do Tratamento , Retroversão Uterina
4.
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
5.
World Neurosurg ; 132: e783-e794, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31415888

RESUMO

BACKGROUND: Numerous lesions are found in the ventricular atrium (VA). Access is gained through many white matter tracts with great relevance and specific neurologic functions. It is important to understand the configuration of the most relevant structures surrounding this zone and, thus, select the safest entry zone on the lateral cerebral surface. OBJECTIVE: We studied the white matter layers traversed in the lateral transcortical parietal approach through the intraparietal sulcus (IPS), adding a transillumination technique. With this knowledge, we selected the safest highway to improve this particular approach. METHODS: An in-depth study of the white matter tracts was performed on 24 cerebral hemispheres (12 human whole brains). The Klingler technique and microsurgical dissection techniques were used under ×6 to ×40 magnification. The transillumination technique (torch illuminating the ventricular cavity) was used to expose the layers surrounding the VA and, thus, guide the dissection. RESULTS: Taking the IPS on the cerebral surface as a reference, we identified the following white matter layers ordered from the surface to the ependyma: U fibers, superior longitudinal fascicle, arcuate fascicle, vertical occipital fascicle, sagittal stratum with the optic radiations, and tapetum fibers. The transillumination technique allowed for the easier identification of the white matter deep periventricular layers. CONCLUSIONS: Knowledge of the main fascicles in the path and neighborhood of the VA allowed us to understand how certain neurologic functions can be affected by lesions at this level and to select the most appropriate way to avoid damaging relevant fascicles.


Assuntos
Ventrículos Cerebrais/diagnóstico por imagem , Ventrículos Cerebrais/cirurgia , Procedimentos Neurocirúrgicos/métodos , Transiluminação/métodos , Substância Branca/diagnóstico por imagem , Substância Branca/cirurgia , Cadáver , Humanos , Imageamento Tridimensional , Fibras Nervosas , Lobo Parietal/diagnóstico por imagem , Lobo Parietal/cirurgia
6.
Neurocirugía (Soc. Luso-Esp. Neurocir.) ; 30(4): 193-197, jul.-ago. 2019. ilus
Artigo em Inglês | IBECS | ID: ibc-183586

RESUMO

A subependymoma is a benign primary brain tumor classified as a World Health Organization grade I tumor; it is asymptomatic in most cases. We present the case of a 66-year-old Japanese man with a complaint of recurrent vomiting that led to the discovery of a large mass with hemorrhage, peritumoral edema, and a midline shift in the posterior horn of the right lateral ventricle. The patient was pathologically diagnosed with subependymoma after undergoing total tumor resection; a year after the surgery, he was free from tumor recurrence. Although symptomatic subependymomas are rare, they tend to show hemorrhage with peritumoral edema on neuroradiological tests and tend to be confused with high-grade brain tumors. In the present case, we highlight the importance of the appropriate diagnosis for subependymomas showing neuroradiological features that mimic high-grade gliomas. This diagnosis will help in providing suitable treatment for subependymomas


Un subependimoma es un tumor cerebral primario benigno, clasificado por la Organización Mundial de la Salud como un tumor grado I. En la mayoría de los casos es asintomático. Presentamos el caso de un varón japonés de 66 años de edad que reportaba vómitos recurrentes, los que lo llevaron al descubrimiento de una gran masa con hemorragia, edema peritumoral y una desviación de la línea media del cuerno posterior del ventrículo lateral derecho. Se le realizó un diagnóstico patológico de subependimoma luego de que se le sometiera a una resección total del tumor. Un año después de la cirugía no presentaba recurrencia del tumor. Aunque los subependimomas sintomáticos son raros, en las pruebas neurorradiológicas tienden a presentar hemorragia con edema peritumoral y se tiende a confundirlos con tumores cerebrales de alto grado. En el presente caso, destacamos la importancia de un diagnóstico adecuado de los subependimomas que presentan características neurorradiológicas que imitan a gliomas de alto grado. Este diagnóstico ayudará a brindar el tratamiento adecuado para dichos subependimomas


Assuntos
Humanos , Masculino , Idoso , Glioma Subependimal/diagnóstico por imagem , Glioma Subependimal/radioterapia , Hemorragia Cerebral/complicações , Neoplasias Encefálicas/cirurgia , Neurocirurgia , Glioma Subependimal/patologia , Edema Encefálico/complicações , Edema Encefálico/diagnóstico por imagem , Imuno-Histoquímica , Diagnóstico Diferencial , Ventrículos Cerebrais/cirurgia
7.
World Neurosurg ; 130: 493-498, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31295607

RESUMO

BACKGROUND: Symptomatic slit ventricle is one of the most challenging complications of shunt surgery in children. Clinical signs and symptoms may appear with a wide range of intracranial pressure (ICP) values. We report the case of a 10-year-old girl, who did not present the classic clinical features of extremely elevated ICP, which was proven by multiple invasive ICP recordings, performed during shunt revisions. CASE DESCRIPTION: At the age of 6 months, the patient presented squeal for many hours, accompanied with sunset eyes, bulging anterior fontanel, and dilated ventricles of all 4 ventricles on computed tomography scan. Acute ventriculoperitoneal shunt insertion was performed with adjustable valve. During the following 9 years, she was regularly seen and medically treated for intermittent headache, with nausea and vomiting. From 9 years of age, she was hospitalized for severe (10/10 on the visual analog scale), unbearable headache, agitation, and screaming on multiple occasions. Altogether, we had to revise the shunt system 5 times throughout 1 year. Radiologic imaging always showed narrow ventricles. Ophthalmologic examination of the fundus never revealed signs of raised ICP. Perioperative monitoring of the ICP with intraparenchymal sensor showed unexpected high values of 40-45 mm Hg. However, repetitive shunt revisions were successful only temporarily because the symptoms always returned. Only bilateral shunting of the ventricular system was able to eliminate the symptoms permanently. CONCLUSIONS: Images of slit ventricle can be associated either with low or extremely high ICP needing urgent surgical consideration, including ICP monitoring. Bilateral shunt insertion can be effective treatment for slit ventricle syndrome.


Assuntos
Ventrículos Cerebrais/cirurgia , Síndrome do Ventrículo Colabado/diagnóstico , Síndrome do Ventrículo Colabado/cirurgia , Derivação Ventriculoperitoneal/efeitos adversos , Ventrículos Cerebrais/diagnóstico por imagem , Ventrículos Cerebrais/patologia , Criança , Feminino , Humanos , Pressão Intracraniana , Reoperação , Síndrome do Ventrículo Colabado/complicações , Resultado do Tratamento
8.
World Neurosurg ; 130: 216-221, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31302268

RESUMO

BACKGROUND: Multiloculated hydrocephalus (MH) is a challenging pathology for pediatric neurosurgeons, arising from various etiologies including intraventricular hemorrhage, infection, and overshunting. Although previous publications have discussed the potential etiology of this pathological process, including fibroglial webbing, no clear precursor has been proven. We present a case of MH developing after both intraventricular hemorrhage and intraventricular infection, with visualization of the precursor via endoscopy and a confirmed glial scar on pathological examination. CASE DESCRIPTION: Our patient is an preterm-born (at 24 weeks of gestation) male with a grade III intraventricular hemorrhage treated with reservoir placement and serial taps. He did not develop posthemorrhagic hydrocephalus but presented back at approximately 4 months of age with Escherichia coli meningitis that necessitated multiple interventions for intraventricular abscesses, including an endoscopic exploration. He ultimately developed MH requiring placement of a ventriculoperitoneal shunt. CONCLUSIONS: MH is a complex pathology with multiple risk factors. To date, only theories regarding the etiology have been proposed. Our case represents the first known direct visualization of intraventricular fibroglial webbing with magnetic resonance imaging correlation. Improved understanding of the pathophysiology of this entity may improve our ability to treat this pathology before loculations develop.


Assuntos
Hemorragia Cerebral/cirurgia , Ventrículos Cerebrais/cirurgia , Hidrocefalia/cirurgia , Derivação Ventriculoperitoneal , Adulto , Hemorragia Cerebral/diagnóstico , Derivações do Líquido Cefalorraquidiano/efeitos adversos , Feminino , Idade Gestacional , Humanos , Hidrocefalia/diagnóstico , Derivação Ventriculoperitoneal/métodos
9.
J Vet Intern Med ; 33(3): 1368-1375, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30957934

RESUMO

BACKGROUND: One of the remaining questions in treating dogs with internal hydrocephalus is the association between the decrease of ventricular volume and re-expansion of cerebral parenchyma with clinical improvement. HYPOTHESIS: A decrease in ventricular volume and re-expansion of brain tissue occur after ventriculoperitoneal shunting (VPS). Clinical improvement defined by resolution of ≥1 clinical signs is associated with decreased size of cerebral ventricles and that the extent of change in ventricular size is associated with clinical improvement. ANIMALS: Forty-five client-owned dogs with newly diagnosed communicating internal hydrocephalus. METHODS: Ventricular volume, brain volume, and clinical status of dogs that underwent VPS were measured before and 3 months after surgery. Multiple logistic regression analysis was performed to assess the influence of decrease in ventricular size in addition to the covariates "age of the animal" and "duration of clinical signs before surgery" on improvement of clinical signs. RESULTS: Decreased volume of cerebral ventricles was associated with resolution of ≥1 preoperative clinical sign (P < .003). The covariates "age of the animal" and "duration of clinical signs" were not associated with improvement of clinical signs. The percentage decrease in ventricular size was associated with resolution of ataxia (P = .008) and obtundation (P = .011). CONCLUSION AND CLINICAL IMPORTANCE: The decrease in ventricular volume and increase in brain parenchyma after VPS are associated with improvement in clinical signs.


Assuntos
Ventrículos Cerebrais/cirurgia , Doenças do Cão/cirurgia , Hidrocefalia/veterinária , Derivação Ventriculoperitoneal/veterinária , Animais , Ataxia/veterinária , Encéfalo/diagnóstico por imagem , Ventrículos Cerebrais/diagnóstico por imagem , Cães , Feminino , Hidrocefalia/cirurgia , Imagem por Ressonância Magnética/veterinária , Masculino , Estupor/veterinária
10.
World Neurosurg ; 125: e978-e983, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30763750

RESUMO

OBJECTIVE: Three-dimensional (3D), high-definition (HD) endoscopy has been recently introduced in neurosurgery, and its value has been discussed extensively in endonasal skull base surgery. Because there has been no reported clinical series on the use of a recent 3D-HD ventriculoscope, the aim of this study was to describe our initial experience with this novel device. METHODS: Patients consecutively operated on from June 2016 to June 2018 with a 3D-HD ventriculoscope were prospectively collected. The system is a 6-mm, 0-degree optic with a 105-degree field of view, with a central working channel of 2.2-mm diameter and 2 side channels of 1.3-mm diameter. Patients' demographic data, preoperative symptoms, and neurologic status; neuroradiologic data; type of surgery; operative time; intraoperative and postoperative complications, and follow-up data were prospectively recorded and retrospectively reviewed. RESULTS: Twenty-four patients (age range: 3-84 years) underwent 25 procedures including endoscopic third ventriculocisternostomy, biopsy, and cyst fenestration. The technical goal of surgery was obtained in all patients. There were no intraoperative complications, expect for 1 intraoperative epileptic seizure. Postoperative complications included asymptomatic subdural collections in 2 patients, infection, and delayed endoscopic third ventriculocisternostomy closure in 1 patient each. Relative limits of the system are its size and the availability of only a 0-degree optic. Image quality appeared satisfactory in all procedures. The lack of a dedicated introducer was resolved, exploiting a vascular "peel-away" system. CONCLUSIONS: 3D-HD technology seems to provide potential advantages in ventricular surgery. This initial experience is promising but must be confirmed by larger series.


Assuntos
Ventrículos Cerebrais/cirurgia , Imageamento Tridimensional/instrumentação , Imageamento Tridimensional/métodos , Neuroendoscopia/instrumentação , Neuroendoscopia/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
11.
Neurochirurgie ; 65(1): 14-19, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30638547

RESUMO

INTRODUCTION: Aneurysmal subarachnoid hemorrhage (SAH) is a devastating form of stroke, which often causes acute hydrocephalus requiring the insertion of an external ventricular drain (EVD). A major complication of aneurysmal SAH is delayed cerebral ischemia (DCI). As DCI is linked to the presence of blood within the subarachnoid space, it has been hypothesized that removing this blood may decrease the risk of DCI. This could be achieved by injecting a fibrinolytic agent through the EVD, a strategy called intraventricular fibrinolysis (IVF). Here, we propose to conduct a phase III trial to directly evaluate the impact of IVF after aneurysmal SAH. MATERIALS AND METHODS: We will perform an open-label randomized controlled trial comparing the standard of care, i.e. EVD alone, to the experimental treatment, i.e. IVF. We plan to include 440 patients to be able to show a 10% increase in the rate of good functional outcomes in the EVD+IVF group compared to the EVD alone group (α=0.05 and ß=0.8). To obtain such sample, a multicenter trial is required, and to date 17 research sites in France have agreed to participate. PERSPECTIVE: FIVHeMA would be the first phase III trial evaluating the relevance of IVF in aneurysmal SAH. If IVF is shown to be beneficial, then a new therapeutic tool will be available to improve the outcomes of aneurysmal SAH patients.


Assuntos
Ventrículos Cerebrais/cirurgia , Fibrinolíticos/uso terapêutico , Hidrocefalia/tratamento farmacológico , Hemorragia Subaracnóidea/tratamento farmacológico , Adolescente , Adulto , Idoso , Isquemia Encefálica/tratamento farmacológico , Drenagem/métodos , Feminino , Fibrinólise/efeitos dos fármacos , Fibrinólise/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Adulto Jovem
12.
World Neurosurg ; 122: 533-543, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30476673

RESUMO

OBJECTIVE: Craniocerebral disproportion (CCD) is a challenging disease, and several expansile procedures have been used for its treatment. This report describes the dynamic chess-table cranial expansion technique and reports on 9 patients with primary and secondary CCD treated with this procedure. METHODS: Nine patients affected by CCD were treated with chess-table cranial expansion and reviewed. Symptoms of increased intracranial pressure (ICP) and radiologic findings were analyzed. ICP was monitored using epidural or telemetric sensors. Intracranial volume was measured using computed tomography image processing tools before the surgery, 24 hours after the surgery, and 1 month later. A mathematical model was developed to explain the clinical and surgical results. RESULTS: Five patients had secondary CCD and 4 had primary CCD. The mean age for cranial expansion was 16.78 years. The most frequent symptoms were headaches, nausea/vomiting, and decreased consciousness. Slit ventricles and sutural sclerosis were observed in 33.3% and 55.6% of patients. The mean ICP before the procedure was 48.67 mm Hg. Progressive cranial expansion was seen in all patients after surgery. The mean ICP decreased to 11 mm Hg and mean intracranial volume expansion was 85.8 cm3 at 1 month after surgery. There were no serious complications after surgery. All patients improved their symptoms, and no patient needed additional cranial expansion procedures. CONCLUSIONS: Chess-table cranial expansion is a safe and effective procedure and may be used as an alternative treatment for CCD. Progressive expansion of the intracranial volume is related to a decrease in ICP recordings and an improvement of symptoms.


Assuntos
Ventrículos Cerebrais/cirurgia , Craniossinostoses/cirurgia , Hipertensão Intracraniana/cirurgia , Crânio/cirurgia , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Hipertensão Intracraniana/etiologia , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento , Adulto Jovem
13.
J Laparoendosc Adv Surg Tech A ; 29(1): 82-87, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30312141

RESUMO

INTRODUCTION: Ventriculoperitoneal shunts (VPSs) are the mainstay of treatment of hydrocephalus but frequently need revision. We sought to directly compare the impact of laparoscopic versus open peritoneal shunt revision on the need for subsequent VPS revisions in pediatric patients. MATERIALS AND METHODS: A prospectively maintained, externally validated database of pediatric patients who underwent a first peritoneal VPS revision at a single center between 2008 and 2016 was reviewed. Outcomes, including subsequent revisions, shunt infections, operative time, and hospital stay between open and laparoscopic groups, were compared. RESULTS: A total of 148 patients underwent a first peritoneal VPS revision during the time period-40 laparoscopically and 108 open-with no significant difference in age or gender between the groups. Operative time, length of stay after shunt revision, and shunt infection rates did not vary between laparoscopic versus open revisions. There was no significant difference between need for subsequent overall (peritoneal or ventricular) shunt revisions in the laparoscopic (20%) versus the open group (34%), P = .07. However, there were significantly fewer frequent peritoneal revisions in the laparoscopic group (3% versus 15%, P = .04). CONCLUSIONS: This first cohort analysis of laparoscopic versus open VPS revision in pediatric patients suggests that laparoscopic peritoneal VPS revision may reduce the rate of subsequent peritoneal revisions without increasing shunt infections or operative time in pediatric patients.


Assuntos
Laparoscopia/estatística & dados numéricos , Reoperação/métodos , Reoperação/estatística & dados numéricos , Derivação Ventriculoperitoneal/efeitos adversos , Adolescente , Ventrículos Cerebrais/cirurgia , Criança , Pré-Escolar , Feminino , Humanos , Hidrocefalia/cirurgia , Tempo de Internação , Masculino , Duração da Cirurgia , Peritônio/cirurgia , Estudos Retrospectivos
14.
World Neurosurg ; 122: 544-548, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30472284

RESUMO

BACKGROUND: Giant pituitary adenomas are rare tumors that can have a devastating impact on a patient's life. They require a well-studied therapeutic approach that often combines different strategies. CASE DESCRIPTION: A 29-year-old woman was diagnosed with the largest GH-secreting pituitary adenoma reported in the literature, to the best of the author's knowledge. The tumor was removed with a combined approach: endoscopic endonasal transsphenoidal and transcortical transventricular. All available acromegaly drugs were used. After 2 surgeries, a large part of the tumor was removed. Both postoperative courses were uneventful. Because the disease was still active, medical therapy was initiated. The combination of pasireotide, pegvisomant, and cabergoline permitted satisfactory control of hormonal levels. CONCLUSIONS: Giant adenomas, >4 cm, are rare pituitary tumors. Therefore in order to achieve the best clinical results, they require complex management that involves a multidisciplinary team of ear, nose, and throat surgeons; endocrinologists; radiation therapists; ophthalmologists; and neurosurgeons.


Assuntos
Adenoma/cirurgia , Adenoma Hipofisário Secretor de Hormônio do Crescimento/cirurgia , Procedimentos Neurocirúrgicos , Adulto , Ventrículos Cerebrais/cirurgia , Feminino , Adenoma Hipofisário Secretor de Hormônio do Crescimento/diagnóstico , Humanos , Cirurgia Endoscópica por Orifício Natural/métodos , Resultado do Tratamento
15.
Arch Dis Child Fetal Neonatal Ed ; 104(1): F70-F75, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29440132

RESUMO

OBJECTIVE: To compare a low versus a higher threshold for intervention in preterm infants with posthaemorrhagic ventricular dilatation. DESIGN: Multicentre randomised controlled trial (ISRCTN43171322). SETTING: 14 neonatal intensive care units in six countries. PATIENTS: 126 preterm infants ≤34 weeks gestation with ventricular dilatation after grade III-IV haemorrhage were randomised to low threshold (LT) (ventricular index (VI) >p97 and anterior horn width (AHW) >6 mm) or higher threshold (HT) (VI>p97+4 mm and AHW >10 mm). INTERVENTION: Cerebrospinal fluid tapping by lumbar punctures (LPs) (max 3), followed by taps from a ventricular reservoir, to reduce VI, and eventually a ventriculoperitoneal (VP) shunt if stabilisation of the VI below the p97+4 mm did not occur. COMPOSITE MAIN OUTCOME MEASURE: VP shunt or death. RESULTS: 19 of 64 (30%) LT infants and 23 of 62 (37%) HT infants were shunted or died (P=0.45). A VP shunt was inserted in 12/64 (19%) in the LT and 14/62 (23%) infants in the HT group. 7/12 (58%) LT infants and 1/14 (7%) HT infants required shunt revision (P<0.01). 62 of 64 (97%) LT infants and 36 of 62 (58%) HT infants had LPs (P<0.001). Reservoirs were inserted in 40 of 64 (62%) LT infants and 27 of 62 (43%) HT infants (P<0.05). CONCLUSIONS: There was no significant difference in the primary composite outcome of VP shunt placement or death in infants with posthaemorrhagic ventricular dilatation who were treated at a lower versus a higher threshold for intervention. Infants treated at the lower threshold received more invasive procedures. Assessment of neurodevelopmental outcomes will provide further important information in assessing the risks and benefits of the two treatment approaches.


Assuntos
Hemorragia Cerebral/cirurgia , Ventrículos Cerebrais/cirurgia , Doenças do Prematuro/cirurgia , Derivação Portossistêmica Cirúrgica/métodos , Derivação Portossistêmica Cirúrgica/estatística & dados numéricos , Circulação Cerebrovascular , Dilatação Patológica , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Unidades de Terapia Intensiva Neonatal , Masculino , Índice de Gravidade de Doença , Punção Espinal
16.
Neurosurgery ; 84(3): 624-635, 2019 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-29618071

RESUMO

BACKGROUND: Image guidance is a promising technology that could lead to lower rates of premature shunt failure by decreasing the rate of inaccurate proximal catheter placement. OBJECTIVE: To perform a detailed radiographic analysis of ventricular size using 3 well-described methods and compare proximal revision rates. METHODS: Our shunt surgery research database was queried to identify procedures (new placement or revision) where frameless stereotactic electromagnetic neuronavigation was used (January 2010-June 2016). A randomly selected cohort of surgeries done without image guidance during the same time period served as the comparison group. A radiographic analysis utilizing the following indices was used to classify ventricular size: bifrontal, bicaudate, and frontal-occipital horn ratio. The primary outcome was shunt failure due specifically to proximal catheter malfunction at 90 and 180 days. RESULTS: A total of 108 stereotactic and 95 free-hand cases were identified. Overall, there was no difference in ventricular size between the 2 groups. Neuronavigation yielded improved accuracy rates (73% grade 1; P < .001). Although there was no statistically significant difference in proximal revision rates when all patients were analyzed, there was a clinically beneficial reduction in the 90- and 180-day failure rates across all radiographic indices in children with small-to-moderate ventricular sizes when using image guidance. CONCLUSION: Electromagnetic neuronavigation results in more accurate placement of catheters, but did not result in an overall reduction in proximal shunt failure at 90 and 180 days after the index surgery. However, subgroup analysis suggests a clinically important benefit in those patients with harder to cannulate ventricles.


Assuntos
Hidrocefalia/diagnóstico por imagem , Hidrocefalia/cirurgia , Neuronavegação/métodos , Reoperação/tendências , Derivação Ventriculoperitoneal/métodos , Adolescente , Adulto , Cateterismo/métodos , Ventrículos Cerebrais/diagnóstico por imagem , Ventrículos Cerebrais/cirurgia , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Humanos , Imageamento Tridimensional/métodos , Lactente , Recém-Nascido , Masculino , Procedimentos Cirúrgicos Reconstrutivos/métodos , Adulto Jovem
17.
Neurosciences (Riyadh) ; 23(4): 326-333, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30351291

RESUMO

Colloid cysts are cystic lesions that are usually located in the anterior portion of the third ventricle near the foramen of Monro. Rarely, hemorrhagic cysts can lead to acute obstructive hydrocephalus or sudden death. We herein report 2 cases and a review literature. We examine a 47-year old male who presented with progressive headache and a 55-year old male who presented with progressive memory disturbance and unsteady gait. Both cases demonstrated typical imaging features of hemorrhagic colloid cyst, and were histopathologically confirmed. Total excision was achieved in both cases with good outcomes. Hemorrhagic colloid cysts are rare; however, bleeding tendencies should be carefully considered in patients with these cysts. The degree of rapidity with which clinical deterioration occurs may play a major role in the preferred treatment approach and subsequent outcomes.


Assuntos
Ventrículos Cerebrais/patologia , Cistos Coloides/patologia , Hemorragia/patologia , Ventrículos Cerebrais/diagnóstico por imagem , Ventrículos Cerebrais/cirurgia , Cistos Coloides/complicações , Cistos Coloides/diagnóstico por imagem , Cistos Coloides/cirurgia , Hemorragia/diagnóstico por imagem , Hemorragia/etiologia , Hemorragia/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade
18.
Curr Med Sci ; 38(5): 880-887, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30341524

RESUMO

The efficacy and applied value of endoscopic hematoma evacuation vs. external ventricular drainage (EVD) in the treatment of severe ventricular hemorrhage (IVH) were explored and compared. From Jan. 2015 to Dec. 2016, the clinical data of 42 cases of IVH were retrospectively analyzed, including 18 patients undergoing endoscopic hematoma evacuation (group A), and 24 patients receiving EVD (group B). The hematoma clearance rate was calculated by 3D Slicer software, and complications and outcomes were compared between the two groups. There were no significant differences in age, sex and Graeb score between groups A and B (P>0.05). The hematoma clearance rate was 70.81%±27.64% in group A and 48.72%±36.58% in group B with a statistically significant difference (P<0.05). The operative time in groups A and B was 72.45±25.26 min and 28.54±15.27 min, respectively (P<0.05). The Glasgow Coma Scale (GCS) score increased from 9.28±2.72 at baseline to 11.83±2.91 at 1 week postoperatively in group A, and from 8.25±2.62 at baseline to 10.79±4.12 at 1 week postoperatively in group B (P<0.05). The length of hospital stay was 12.67±5.97 days in group A and 17.33±8.91 days in group B with a statistically significant difference (P<0.05). The GOS scores at 6 months after surgery were 3.83±1.12 in group A, and 2.75±1.23 in group B (P<0.05). These results suggested that endoscopic hematoma evacuation has an advantage of a higher hematoma clearance rate, fewer complications and better outcomes in the treatment of severe IVH, indicating it is a safe, effective and promising approach for severe IVH.


Assuntos
Hemorragia Cerebral Intraventricular/cirurgia , Ventrículos Cerebrais/cirurgia , Drenagem/métodos , Endoscopia/métodos , Idoso , Hemorragia Cerebral Intraventricular/fisiopatologia , Ventrículos Cerebrais/fisiopatologia , Drenagem/efeitos adversos , Endoscopia/efeitos adversos , Feminino , Fibrinolíticos/administração & dosagem , Escala de Coma de Glasgow , Hematoma/fisiopatologia , Hematoma/cirurgia , Humanos , Injeções Intraventriculares , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Índice de Gravidade de Doença , Resultado do Tratamento
19.
World Neurosurg ; 118: 55-58, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30017764

RESUMO

BACKGROUND: Bilateral occlusion of the foramen of Monro with aqueductal stenosis is a rare entity. Only 1 previous case has been reported in the literature. CASE DESCRIPTION: We present a 25-year-old female who presented with chronic headache of 7 years duration. Neurologic examination revealed only papilledema. Imaging showed symmetrical dilation of both lateral ventricles with mild dilation of the third ventricle and a normal fourth ventricle, suggesting occlusion of both foramina of Monro with membranous web formation in the upper part of the aqueduct. There was tonsillar herniation without syrinx. She underwent neuroendoscopic foraminoplasty, septostomy, and third ventriculostomy. The patient experienced total relief of headache and showed reduced volume of both lateral ventricles at follow-up. CONCLUSIONS: Bilateral occlusion of foramen of Monro with aqueductal stenosis and tonsillar herniation is rare cause of obstructive hydrocephalus, and can be managed effectively with neuroendoscopic procedure.


Assuntos
Malformação de Arnold-Chiari/cirurgia , Ventrículos Cerebrais/anormalidades , Ventrículos Cerebrais/cirurgia , Gerenciamento Clínico , Hidrocefalia/cirurgia , Neuroendoscopia/métodos , Adulto , Malformação de Arnold-Chiari/complicações , Malformação de Arnold-Chiari/diagnóstico por imagem , Ventrículos Cerebrais/diagnóstico por imagem , Feminino , Humanos , Hidrocefalia/complicações , Hidrocefalia/diagnóstico por imagem
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