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1.
Neurocirugía (Soc. Luso-Esp. Neurocir.) ; 34(1): 40-43, ene.-feb. 2023. ilus
Artigo em Espanhol | IBECS | ID: ibc-214412

RESUMO

La derivación ventrículo biliar se describe como un procedimiento alternativo eficaz en el tratamiento de la hidrocefalia. Presentamos el caso de un paciente de 19 años de edad diagnosticado de quiste aracnoideo supraselar e hidrocefalia, portador de doble sistema valvular de derivación ventrículo peritoneal y cisto peritoneal desde la infancia. Tras varios recambios por fallo peritoneal, fue sometido a derivación ventriculoauricular, con complicaciones asociadas y posterior recolocación a peritoneo. Tras nueva disfunción valvular por complicaciones peritoneales, se planteó la derivación ventriculobiliar como tratamiento alternativo para este paciente, que resultó segura y eficaz en la resolución de la clínica del paciente, siendo dado de alta, manteniendo estabilidad clínica durante más de 2 años de seguimiento. (AU)


Ventriculo-gallbladder shunt is described as an effective alternative procedure in the treatment of hydrocephalus. We present the case of a 19-year-old patient diagnosed with suprasellar arachnoid cyst since his childhood and hydrocephalus, with a double shunt; ventriculoperitoneal and peritoneal cyst shunt. After several replacements due to peritoneal failure, he underwent ventriculoatrial shunt, with associated complications and subsequent repositioning to the peritoneum. After new valve dysfunction due to peritoneal complications, ventriculo-gallbladder shunt was proposed as an alternative treatment for this patient, which was safe and effective in resolving the patient's symptoms, and the patient was discharged, maintaining clinical stability in the follow-up more than 2 years later. (AU)


Assuntos
Humanos , Masculino , Adulto Jovem , Cistos Aracnóideos/complicações , Cistos Aracnóideos/diagnóstico por imagem , Hidrocefalia/etiologia , Derivações do Líquido Cefalorraquidiano/métodos , Derivação Ventriculoperitoneal , Cistos Aracnóideos/cirurgia , Resultado do Tratamento , Seguimentos , Falha de Tratamento
2.
BMJ Case Rep ; 16(1)2023 Jan 03.
Artigo em Inglês | MEDLINE | ID: mdl-36596628

RESUMO

Listeria monocytogenes can cause severe illnesses such as gastroenteritis, sepsis and neurolisteriosis, especially in infants, the elderly and immunocompromised patients. We report a case of a previously healthy school-aged girl presenting with severe neurological deficits found to have Listeria meningoencephalitis. Her potential exposure to L. monocytogenes was consumption of contaminated cheese. She had some clinical improvement after initiation of tailored Listeria anti-microbial coverage with ampicillin and gentamicin; however, she developed hydrocephalus requiring external ventricular drain placement and tonsillar herniation requiring emergent posterior fossa decompression. The patient made significant improvements after neurosurgical intervention, and along with continued antibiotics and subsequent rehabilitation services, she improved to near full recovery within a year. The case highlights that neurolisteriosis can affect even immunocompetent children, and aggressive neurosurgical interventions should be considered in patients who develop severe complications such as hydrocephalus and tonsillar herniation to improve outcomes.


Assuntos
Hidrocefalia , Listeria monocytogenes , Meningite por Listeria , Lactente , Idoso , Feminino , Humanos , Criança , Meningite por Listeria/diagnóstico , Meningite por Listeria/tratamento farmacológico , Encefalocele/diagnóstico por imagem , Encefalocele/cirurgia , Encefalocele/complicações , Antibacterianos/uso terapêutico , Ampicilina/uso terapêutico , Hidrocefalia/cirurgia , Hidrocefalia/complicações
3.
No Shinkei Geka ; 51(1): 126-132, 2023 Jan.
Artigo em Japonês | MEDLINE | ID: mdl-36682757

RESUMO

Hemispherectomy/hemispherotomy is an important surgical procedure for patients with drug-resistant epilepsy who have a unilateral large epileptogenic lesion associated with neurological deficits, such as hemiparesis. Hemispherotomy consists of corpus callosotomy and dissection of projection fibers into the internal capsule. Hemispherotomy has two major approaches: periinsular lateral hemispherotomy(PIH)and vertical parasagittal hemispherotomy(VH). The white matter is incised along the periinsular sulcus to disrupt the internal capsule before corpus callosotomy is performed within the lateral ventricle in PIH. Corpus callosotomy is performed first with an interhemispheric approach, the lateral ventricle is entered, and the internal capsule is disconnected just lateral to the thalamus in the VH. Both approaches have similar efficacy for seizure control; however, a recent study suggested the possible superiority of VH. The chance of complete seizure freedom for one or two postoperative years has been reported to be 70% or greater. The risk of postoperative hydrocephalus is as high as 20%, particularly in young children. In this article, we present and discuss the surgical anatomy of hemispherotomy techniques.


Assuntos
Epilepsia Resistente a Medicamentos , Hemisferectomia , Hidrocefalia , Criança , Humanos , Pré-Escolar , Hemisferectomia/métodos , Resultado do Tratamento , Epilepsia Resistente a Medicamentos/cirurgia , Convulsões
5.
Genes (Basel) ; 14(1)2023 Jan 02.
Artigo em Inglês | MEDLINE | ID: mdl-36672867

RESUMO

PPP2R1A-related neurodevelopmental disorder (NDD) is expressed with autosomal dominant inheritance and is typically caused by a pathogenic de novo PPP2R1A mutation. It is characterized by the predominant features of hypotonia, developmental delay, moderate-to-severe intellectual disability, agenesis of corpus callosum (ACC), ventriculomegaly, and dysmorphic features; however, none of these anomalies have been diagnosed prenatally. We report on the prenatal diagnosis of PPP2R1A-related NDD in two fetuses by whole exome sequencing. Fetus 1 had partial ACC and severe lateral ventriculomegaly; the pathogenic heterozygous c.544C > T (p. Arg182Trp) de novo missense variant in PPP2R1A was detected. Fetus 2 had severe enlargement of the lateral and third ventricles and macrocephaly; they showed a heterozygous likely pathogenic mutation in PPP2R1A gene (c.547C > T, p. Arg183Trp). Both variants were de novo. This was the first study to use trio WES to prenatally analyze fetuses with PPP2R1A variants. Prenatal diagnosis will not only expand the fetal phenotype of this rare genetic condition but also allow for an appropriate counseling of prospective parents regarding pregnancy outcomes.


Assuntos
Hidrocefalia , Malformações do Sistema Nervoso , Transtornos do Neurodesenvolvimento , Gravidez , Feminino , Humanos , Estudos Prospectivos , Diagnóstico Pré-Natal , Transtornos do Neurodesenvolvimento/diagnóstico , Transtornos do Neurodesenvolvimento/genética , Fatores de Transcrição , Proteína Fosfatase 2/genética
6.
BMC Neurol ; 23(1): 38, 2023 Jan 24.
Artigo em Inglês | MEDLINE | ID: mdl-36694119

RESUMO

BACKGROUND: Parkinsonism after ventriculoperitoneal shunt in patients with hydrocephalus is a rare and profound complication that is often misdiagnosed, causing treatment to be delayed. To date, the characteristics of this disease have not been well described and summarized. Here, we report a rare case of parkinsonism after ventriculoperitoneal shunt; symptoms were aggravated by antipsychotic drugs but showed a good response to Madopar. Such cases have rarely been reported previously. CASE PRESENTATION: A 44-year-old man presented with parkinsonism, bilateral pyramidal tract signs, and oculomotor impairment four years after a successful ventriculoperitoneal shunt for idiopathic aqueduct stenosis resulting in obstructive hydrocephalus. Brain magnetic resonance imaging and computed tomography showed fluctuations in the lateral ventricle and the third ventricle without any intervention. The patient's condition was aggravated by antipsychotic drugs but showed a good response to Madopar. CONCLUSION: This observation suggests that parkinsonism in this patient was caused by reversible dysfunction of the presynaptic nigrostriatal dopaminergic pathway due to fluctuations in the lateral ventricle, representing the first hit to the dopaminergic signalling pathway, and antipsychotic drugs had an antagonistic effect on dopamine D2 receptors, representing the second hit. In addition, we summarize the pathophysiological mechanisms, clinical manifestations, treatments, and prognoses of this complication in 38 patients who met the inclusion criteria in 24 previous studies to increase neurologists' understanding of the disease.


Assuntos
Antipsicóticos , Hidrocefalia , Transtornos Parkinsonianos , Masculino , Humanos , Adulto , Derivação Ventriculoperitoneal/efeitos adversos , Transtornos Parkinsonianos/etiologia , Transtornos Parkinsonianos/complicações , Hidrocefalia/cirurgia , Hidrocefalia/etiologia , Dopamina
7.
Eur J Med Genet ; 66(2): 104692, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36592689

RESUMO

Poretti-Boltshauser syndrome (PTBHS) is an autosomal recessive disorder characterized by cerebellar dysplasia with cysts and an abnormal shape of the fourth ventricle on neuroimaging, due to pathogenic variants in the LAMA1 gene. The clinical spectrum mainly consists of neurological and ophthalmological manifestations, including non-progressive cerebellar ataxia, oculomotor apraxia, language impairment, intellectual disability, high myopia, abnormal eye movements and retinal dystrophy. We report a patient presenting with ventriculomegaly on antenatal neuroimaging and a neonatal diagnosis of Type III esophageal atresia. She subsequently developed severe myopia and strabismus with retinal dystrophy, mild developmental delay, and cerebellar dysplasia. Genetic investigations confirmed PTBHS. This report confirms previous reports of antenatal ventriculomegaly in PTBHS patients and documents a so far unreported occurrence of esophageal atresia in PTBHS. We additionally gathered phenotype and genotype descriptions of published cases in an effort to better define the spectrum of PTBHS.


Assuntos
Anormalidades Múltiplas , Apraxias , Ataxia Cerebelar , Atresia Esofágica , Hidrocefalia , Deficiência Intelectual , Miopia , Distrofias Retinianas , Gravidez , Humanos , Feminino , Ataxia Cerebelar/genética , Deficiência Intelectual/genética , Atresia Esofágica/diagnóstico por imagem , Atresia Esofágica/genética , Anormalidades Múltiplas/genética , Fenótipo , Distrofias Retinianas/genética , Hidrocefalia/diagnóstico por imagem , Hidrocefalia/genética , Apraxias/genética , Miopia/genética
8.
J Comput Assist Tomogr ; 47(1): 136-143, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36598462

RESUMO

BACKGROUND AND PURPOSE: Tectal gliomas (TGs) are rare tumors that involve critical locations in the brainstem, including the superior and inferior colliculi and the Sylvian aqueduct. The rarity of these tumors and the lack of large clinical studies have hindered adequate understanding of this disease. We sought to determine the association between imaging characteristics of TG and progression-free survival (PFS). MATERIALS AND METHODS: In this retrospective cohort study, impact of imaging characteristics (contrast enhancement, calcifications, cystic changes, presence of hydrocephalus) on survival was analyzed for 39 patients with TG. We used the Kaplan-Meier survival analysis method for determining the association between imaging characteristics and PFS. Progression-free survival was measured from time of diagnosis to radiographic or pathological disease progression during observation period. Progression was defined as more than 25% increase of the lesion in size, per response assessment in neuro-oncology, together with clinical deterioration and/or a need for intervention. Progression-free survival differences by various imaging characteristics were assessed using the log-rank test and univariable Cox proportional hazard regression. Because most of the studies in the current literature tend to overrepresent pediatric patients, we aimed to determine the association between TG tumors' imaging characteristics and PFS in both adult and pediatric patients. All statistical analyses were performed using STATA version 16.1 (Stata Corp, College Station, Tex). RESULTS: Of the 39 patients, radiographic tumor progression was observed in 15 cases (38.5%). Median PFS for 39 patients during observation was 21.8 years. Tectal gliomas that showed contrast enhancement initially or developed contrast enhancement during surveillance on magnetic resonance imaging had significantly lower PFS than those without (hazard ratio, 3.55; 95% confidence interval, 1.09-11.58; log-rank P value, 0.02). CONCLUSIONS: Analysis of this patient population showed that contrast-enhancing TGs should not be categorically defined as benign lesions. This subgroup of patients should be followed closely for signs of progression.


Assuntos
Neoplasias Encefálicas , Glioma , Hidrocefalia , Adulto , Humanos , Criança , Estudos Retrospectivos , Neoplasias Encefálicas/diagnóstico por imagem , Progressão da Doença , Glioma/diagnóstico por imagem , Imageamento por Ressonância Magnética
9.
PLoS One ; 18(1): e0280020, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36603010

RESUMO

Hydrocephalus is a neurological disease caused by an unusually high level of cerebrospinal fluid (CSF), which can be relieved by external ventricular drainage (EVD) insertion. However, the infection can lead to complications during the use of EVD. In this study, EVD was impregnated with three synergistic antibiotics, including rifampicin, clindamycin, and trimethoprim, to improve the antibacterial property. The impregnated drainage was studied for its characteristics in vitro and in vivo. Drug loading determination revealed that rifampicin had the highest concentration in the tube, followed by clindamycin and trimethoprim, respectively. In vitro cytotoxicity and hemolytic studies showed no toxic effects from antibiotics-impregnated EVD on fibroblast and red blood cells. For antibacterial testing, the impregnated EVD exhibited antibacterial activity against Staphylococcus aureus MRSA and Staphylococcus epidermidis up to 14 and 90 days, respectively. Moreover, biocompatibility and drug release into the bloodstream and surrounding tissues were investigated by implantation in rabbits for 30 days. Histology and morphology results showed that fibroblast cells began to adhere to the drainage surface and inflammatory cell numbers were noticeably small after the long-term implantation. In addition, there was no drug leakage to the bloodstream and surrounding tissues. Hence, this impregnated EVD can potentially be used for antibacterial application.


Assuntos
Infecções Relacionadas a Cateter , Doença pelo Vírus Ebola , Hidrocefalia , Animais , Coelhos , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Clindamicina/farmacologia , Rifampina/farmacologia , Infecções Relacionadas a Cateter/etiologia , Doença pelo Vírus Ebola/complicações , Derivações do Líquido Cefalorraquidiano/efeitos adversos , Trimetoprima , Drenagem/efeitos adversos , Hidrocefalia/cirurgia , Estudos Retrospectivos
10.
JAMA Netw Open ; 6(1): e2250366, 2023 Jan 03.
Artigo em Inglês | MEDLINE | ID: mdl-36626173

RESUMO

Importance: Proton pump inhibitors (PPIs) are increasingly used during pregnancy; however, several observational studies have raised concerns about an increased risk of specific types of congenital malformations. Objective: To examine the association between PPI exposure during early pregnancy and the risk of congenital malformations. Design, Setting, and Participants: This population-based cohort study used data from the National Health Insurance Service-National Health Information Database of South Korea (2010-2020); sibling-controlled analyses were conducted to account for familial factors. A total of 2 696 216 pregnancies in women aged 19 to 44 years between June 1, 2011, and December 31, 2019, and their live-born infants were identified. Pregnant women who were exposed to known teratogens or who delivered infants with chromosomal abnormalities or genetic syndromes were excluded. Data on participant race and ethnicity were not collected because the National Health Information Database does not report this information. Exposures: Proton pump inhibitor use during the first trimester. Main Outcomes and Measures: Primary outcomes were major congenital malformations, congenital heart defects, cleft palate, hydrocephalus, and hypospadias. The subtypes of major congenital malformations and congenital heart defects were evaluated as exploratory outcomes. Propensity score fine stratification was used to control for potential confounders, and a weighted generalized linear model was used to estimate relative risks with 95% CIs. Results: Of 2 696 216 pregnancies (mean [SD] maternal age, 32.1 [4.2] years), 40 540 (1.5%; mean [SD] age, 32.4 [4.6] years) were exposed to PPIs during the first trimester. The absolute risk of major congenital malformations was 396.7 per 10 000 infants in PPI-exposed pregnancies and 323.4 per 10 000 infants in unexposed pregnancies. The propensity score-adjusted relative risks were 1.07 (95% CI, 1.02-1.13) for major congenital malformations, 1.09 (95% CI, 1.01-1.17) for congenital heart defects, 1.02 (95% CI, 0.72-1.43) for cleft palate, 0.94 (95% CI, 0.54-1.63) for hydrocephalus, and 0.77 (95% CI, 0.51-1.17) for hypospadias. In the sibling-controlled analyses, no associations were observed between PPI use and primary outcomes, including major congenital malformations (odds ratio, 1.05; 95% CI, 0.91-1.22) and congenital heart defects (odds ratio, 1.07; 95% CI, 0.88-1.30). A range of sensitivity analyses revealed results that were similar to the main findings. Conclusions and Relevance: In this cohort study, the use of PPIs during early pregnancy was not associated with a substantial increase in the risk of congenital malformations, although small increased risks were observed for major congenital malformations and congenital heart defects; findings from sibling-controlled analyses revealed that PPIs were unlikely to be major teratogens. These findings may help guide clinicians and patients in decision-making about PPI use in the first trimester.


Assuntos
Anormalidades Induzidas por Medicamentos , Fissura Palatina , Cardiopatias Congênitas , Hidrocefalia , Hipospadia , Gravidez , Feminino , Humanos , Masculino , Adulto , Inibidores da Bomba de Prótons/efeitos adversos , Estudos de Coortes , Hipospadia/complicações , Teratógenos , Anormalidades Induzidas por Medicamentos/etiologia , Cardiopatias Congênitas/induzido quimicamente , Cardiopatias Congênitas/epidemiologia , Cardiopatias Congênitas/complicações , Hidrocefalia/complicações
11.
Neurosurgery ; 92(2): 300-307, 2023 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-36637266

RESUMO

BACKGROUND: Cerebral hemispherectomy can effectively treat unihemispheric epilepsy. However, posthemispherectomy hydrocephalus (PHH), a serious life-long complication, remains prevalent, requiring careful considerations in technique selection and postoperative management. In 2016, we began incorporating open choroid plexus cauterization (CPC) into our institution's hemispherectomy procedure in an attempt to prevent PHH. OBJECTIVE: To determine whether routine CPC prevented PHH without exacerbating hemispherectomy efficacy or safety. METHODS: A retrospective review of consecutive patients who underwent hemispherectomy for intractable epilepsy between 2011 and 2021 was performed. Multivariate logistic regression was used to identify factors independently associated with PHH requiring cerebrospinal fluid (CSF) shunting. RESULTS: Sixty-eight patients were included in this study, of whom 26 (38.2%) underwent CPC. Fewer patients required CSF shunting in the CPC group (7.7% vs 28.7%, P = .033) and no patients who underwent de novo hemispherectomy with CPC developed PHH. Both cohorts experienced seizure freedom (65.4% vs 59.5%, P = .634) and postoperative complications, including infection (3.8% vs 2.4%, P = .728), hemorrhage (0.0% vs 2.4%, P = .428), and revision hemispherectomy (19.2% vs 14.3%, P = .591) at similar rates. Patients without CPC had greater odds of developing PHH requiring CSF shunting (odds ratio = 8.36, P = .026). The number needed to treat with CPC to prevent an additional case of PHH was 4.8, suggesting high effectiveness. CONCLUSION: Preventing PHH is critical. Our early experience demonstrated that routinely incorporating CPC into hemispherectomy effectively prevents PHH without causing additional complications, especially in first-time hemispherectomies. A multicenter randomized controlled trial with long-term follow-up is required to corroborate the findings of our single-institutional case series and determine whether greater adoption of this technique is justified.


Assuntos
Hemisferectomia , Hidrocefalia , Humanos , Lactente , Plexo Corióideo/cirurgia , Hemisferectomia/efeitos adversos , Ventriculostomia/métodos , Hidrocefalia/etiologia , Hidrocefalia/prevenção & controle , Hidrocefalia/cirurgia , Cauterização/métodos , Resultado do Tratamento
12.
Neurosurgery ; 92(2): 382-390, 2023 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-36637272

RESUMO

BACKGROUND: Managing patients with hydrocephalus and cerebrospinal fluid (CSF) disorders requires repeated head imaging. In adults, it is typically computed tomography (CT) or less commonly magnetic resonance imaging (MRI). However, CT poses cumulative radiation risks and MRI is costly. Ultrasound is a radiation-free, relatively inexpensive, and optionally point-of-care alternative, but is prohibited by very limited windows through an intact skull. OBJECTIVE: To describe our initial experience with transcutaneous transcranial ultrasound through sonolucent burr hole covers in postoperative hydrocephalus and CSF disorder patients. METHODS: Using cohort study design, infection and revision rates were compared between patients who underwent sonolucent burr hole cover placement during new ventriculoperitoneal shunt placement and endoscopic third ventriculostomy over the 1-year study time period and controls from the period 1 year before. Postoperatively, trans-burr hole ultrasound was performed in the clinic, at bedside inpatient, and in the radiology suite to assess ventricular anatomy. RESULTS: Thirty-seven patients with sonolucent burr hole cover were compared with 57 historical control patients. There was no statistically significant difference in infection rates between the sonolucent burr hole cover group (1/37, 2.7%) and the control group (0/57, P = .394). Revision rates were 13.5% vs 15.8% (P = 1.000), but no revisions were related to the burr hole or cranial hardware. CONCLUSION: Trans-burr hole ultrasound is feasible for gross evaluation of ventricular caliber postoperatively in patients with sonolucent burr hole covers. There was no increase in infection rate or revision rate. This imaging technique may serve as an alternative to CT and MRI in the management of select patients with hydrocephalus and CSF disorders.


Assuntos
Hidrocefalia , Trepanação , Humanos , Adulto , Estudos de Coortes , Trepanação/métodos , Hidrocefalia/diagnóstico por imagem , Hidrocefalia/cirurgia , Ventriculostomia/métodos , Crânio/cirurgia
13.
Fluids Barriers CNS ; 20(1): 4, 2023 Jan 13.
Artigo em Inglês | MEDLINE | ID: mdl-36639792

RESUMO

The Hydrocephalus Association (HA) workshop, Driving Common Pathways: Extending Insights from Posthemorrhagic Hydrocephalus, was held on November 4 and 5, 2019 at Washington University in St. Louis. The workshop brought together a diverse group of basic, translational, and clinical scientists conducting research on multiple hydrocephalus etiologies with select outside researchers. The main goals of the workshop were to explore areas of potential overlap between hydrocephalus etiologies and identify drug targets that could positively impact various forms of hydrocephalus. This report details the major themes of the workshop and the research presented on three cell types that are targets for new hydrocephalus interventions: choroid plexus epithelial cells, ventricular ependymal cells, and immune cells (macrophages and microglia).


Assuntos
Hemorragia Cerebral , Hidrocefalia , Humanos , Hemorragia Cerebral/metabolismo , Plexo Corióideo/metabolismo
14.
Neurosurg Rev ; 46(1): 33, 2023 Jan 06.
Artigo em Inglês | MEDLINE | ID: mdl-36607461

RESUMO

Giant lateral ventricular meningiomas (LVMs), with the largest diameter of at least 5 cm, form a distinct subset. The incidence of giant LVMs is considered to be relatively low. Here, we evaluated clinical characteristics, and clinical outcomes after microsurgical resection, especially functional outcomes and morbidity of giant LVMs. We retrospectively reviewed 49 patients with LVMs, including 18 giant LVMs from 2012 to 2020. And we analyzed clinical, histopathological, surgical, and outcome data at our institution. Giant LVMs were most commonly present in the fourth decade of patients with the male-to-female ratio of 1:2. The most common subtypes were transitional and fibrous. Most lesions were resected via the temporal or parieto-occipital approach in our series. The median volume of blood loss was higher in the giant group (900 vs. 600 ml, p = 0.02). Meanwhile, the median length of hospital stay was prolonged for giant LVMs (20.5 vs. 16.0 days, p < 0.01). The proportion of discharged functional deterioration was higher in giant LVMs (38.9% vs. 6.5%, p = 0.02). However, there was no statistical significance between functional deterioration and tumor size at long-term follow-up (p = 0.28). Giant LVMs patients suffered from neurological and regional complications more commonly, particularly from a postoperative hematoma (4/18 vs. 1/31), and hydrocephalus (2/18 vs. 0/31). Patients with giant LVMs had a high incidence of immediate functional deterioration after microsurgery, and there was no difference in functional deterioration between the giant and non-giant LVMS during long-term follow-up. Microsurgery entails a higher complication rate in giant LVMs. We need to pay special attention to preventing postoperative hematoma and hydrocephalus.


Assuntos
Hidrocefalia , Neoplasias Meníngeas , Meningioma , Neoplasias Supratentoriais , Humanos , Masculino , Feminino , Meningioma/cirurgia , Meningioma/patologia , Estudos Retrospectivos , Microcirurgia , Hidrocefalia/cirurgia , Neoplasias Supratentoriais/cirurgia , Neoplasias Meníngeas/cirurgia , Hematoma/cirurgia , Resultado do Tratamento
15.
J Craniofac Surg ; 34(1): 262-266, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36608105

RESUMO

BACKGROUND: Complex vertex and posterior encephaloceles containing brain tissue have uncertain prognosis and high operative risk. Patients may not be offered operative intervention depending on local and regional specialist expertise. The authors present their experience treating 5 such pediatric patients. METHODS: This is a retrospective review of the surgical assessment, planning, and technique of cranial repairs, as well as surgical outcomes and developmental follow-up regarding adaptive functioning for patients presenting for second opinion for encephalocele of the cranial vertex after having been deemed too high risk at another institution. RESULTS: Five consecutive patients presented between January 2014 and June 2016. One patient was not offered repair. Of 4 patients who underwent reconstruction, average age at time of repair was 2.7 months (range, 0.9-6.7). One presented with ruptured encephalocele, whereas the remaining 3 underwent drainage of the encephalocele (average volume of 1200 mL) at time of surgical resection. Operative time averaged 3.7 hours (range, 2.2-5.3). There were no deaths. One patient had a single seizure postoperatively. Two patients required placement of permanent shunt for hydrocephalus. Two patients completed developmental evaluations, both of whom exhibited delays in adaptive functioning relative to same-aged peers. CONCLUSIONS: Patients with large, complex encephalocele warrant evaluation by an experienced high-volume tertiary care pediatric craniofacial center. The decision to proceed with surgical management should include an interdisciplinary team of surgeons, anesthesiologists, neurologists, and social work. Further study of developmental outcomes in both operated and unoperated patients is necessary to better understand risks and benefits of reconstruction.


Assuntos
Encefalocele , Hidrocefalia , Humanos , Criança , Recém-Nascido , Lactente , Encefalocele/diagnóstico por imagem , Encefalocele/cirurgia , Prognóstico , Convulsões , Cabeça , Estudos Retrospectivos
16.
Int J Mol Sci ; 24(2)2023 Jan 13.
Artigo em Inglês | MEDLINE | ID: mdl-36675153

RESUMO

Folate deficiencies, folate imbalance and associated abnormal methylation are associated with birth defects, developmental delays, neurological conditions and diseases. In the hydrocephalic Texas (H-Tx) rat, 10-formyl tetrahydrofolate dehydrogenase (FDH) is reduced or absent from the CSF and the nuclei of cells in the brain and liver and this is correlated with decreased DNA methylation. In the present study, we tested whether impaired folate metabolism or methylation exists in sexually mature, unaffected H-Tx rats, which may explain the propagation of hydrocephalus in their offspring. We compared normal Sprague Dawley (SD, n = 6) rats with untreated H-Tx (uH-Tx, n = 6 and folate-treated H-Tx (TrH-Tx, n = 4). Structural abnormalities were observed in the testis of uH-Tx rats, with decreased methylation, increased demethylation, and cell death, particularly of sperm. FDH and FRα protein expression was increased in uH-Tx males but not in folate-treated males but tissue folate levels were unchanged. 5-Methylcytosine was significantly reduced in untreated and partially restored in treated individuals, while 5-hydroxymethylcytosine was not significantly changed. Similarly, a decrease in DNA-methyltransferase-1 expression in uH-Tx rats was partially reversed with treatment. The data expose a significant germline methylation error in unaffected adult male H-Tx rats from which hydrocephalic offspring are obtained. Reduced methylation in the testis and sperm was partially recovered by treatment with folate supplements leading us to conclude that this neurological disorder may not be completely eradicated by maternal supplementation alone.


Assuntos
Ácido Fólico , Hidrocefalia , Animais , Masculino , Ratos , Metilação de DNA , Ácido Fólico/metabolismo , Ácido Fólico/farmacologia , Ácido Fólico/uso terapêutico , Ratos Sprague-Dawley , Sêmen/metabolismo , Hidrocefalia/congênito , Hidrocefalia/tratamento farmacológico , Hidrocefalia/genética , Hidrocefalia/metabolismo , Modelos Animais de Doenças , Receptor 1 de Folato/genética , Receptor 1 de Folato/metabolismo
17.
Nat Commun ; 14(1): 453, 2023 Jan 27.
Artigo em Inglês | MEDLINE | ID: mdl-36707519

RESUMO

Cerebrospinal fluid (CSF) is essential for the development and function of the central nervous system (CNS). However, the brain and its interstitium have largely been thought of as a single entity through which CSF circulates, and it is not known whether specific cell populations within the CNS preferentially interact with the CSF. Here, we develop a technique for CSF tracking, gold nanoparticle-enhanced X-ray microtomography, to achieve micrometer-scale resolution visualization of CSF circulation patterns during development. Using this method and subsequent histological analysis in rodents, we identify previously uncharacterized CSF pathways from the subarachnoid space (particularly the basal cisterns) that mediate CSF-parenchymal interactions involving 24 functional-anatomic cell groupings in the brain and spinal cord. CSF distribution to these areas is largely restricted to early development and is altered in posthemorrhagic hydrocephalus. Our study also presents particle size-dependent CSF circulation patterns through the CNS including interaction between neurons and small CSF tracers, but not large CSF tracers. These findings have implications for understanding the biological basis of normal brain development and the pathogenesis of a broad range of disease states, including hydrocephalus.


Assuntos
Hidrocefalia , Nanopartículas Metálicas , Animais , Ouro/metabolismo , Roedores , Microtomografia por Raio-X , Encéfalo/metabolismo , Líquido Cefalorraquidiano/metabolismo
18.
Neurosurg Rev ; 46(1): 45, 2023 Jan 28.
Artigo em Inglês | MEDLINE | ID: mdl-36708446

RESUMO

Trapped or isolated fourth ventricle (TFV) is a rare but critical neurosurgical condition, mostly occurring in pediatric patients, caused by a blockage of the in- and outlets of the fourth ventricle. The purpose of this study is to review all available data on the treatment options of TFV and to compare their safety, efficacy, and durability. MEDLINE, Embase, and Google Scholar were searched from inception to September 13, 2022, for prospective or retrospective cohorts, case-control studies, case series or case reports, reporting detailing outcomes of TFV patients, treated with an endoscopic-, microsurgical-, shunt placement,- or hybrid approaches to TFV. All authors were contacted to provide individual patient data. Eighty-seven articles (314 patients) were included in the individual patient data meta-analysis (IPD) and 9 (151 patients) in the cohort meta-analysis. The IPD revealed that primary endoscopic (aOR 0.21; [95% CI 0.08-0.57]) and microsurgical interventions (aOR 0.21; [95% CI 0.05-0.82]) were associated with a significantly lower revision rate, compared to shunt placement, when adjusted for confounders. Endoscopy was also associated with a significantly higher rate of clinical improvement (aOR 4.56; [95% CI 1.2-18]). The meta-analysis revealed no significant difference in revision rate between the endoscopic (0.33 [95% CI 0.0-0.52]) and shunt group (0.44 [95% CI 0.0-1.0]). Endoscopy should be considered as the first-line treatment of TFV due to its superior efficacy, durability, and similar safety, compared to shunt placement and its minimally invasive nature. Microsurgery should be considered as a second treatment option, due to its similar clinical outcomes and revision rate as endoscopy, but it is more invasive in nature.


Assuntos
Quarto Ventrículo , Hidrocefalia , Criança , Humanos , Quarto Ventrículo/cirurgia , Estudos Retrospectivos , Hidrocefalia/cirurgia , Estudos Prospectivos , Stents/efeitos adversos
20.
J Clin Neurosci ; 108: 30-36, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36580858

RESUMO

Decompressive craniectomy (DC) is used to treat severe traumatic brain injury [TBI]. The present study compared dural open and closed surgical procedures for DC and their relationship with Glasgow Coma Scale (GCS) and Glasgow Outcome Scale (E) (GOS-E) scores and survival in prospective randomized controlled TBI patients. Patients aged 10-65 (36.97 ± 13.23) with DC were hospitalized in the neurotrauma unit of King George's Medical University, Lucknow, India. The patients were randomized into test; with dural closure (n = 60) and control without dural closure (OD) (n = 60) groups. After decompressive craniectomy, patients were monitored daily until hospital discharge or death and for three months. GSC/E leakage, infection, and functional status were also assessed. Age (p = 0.795), sex (p = 0.104), mode of injury (p = 0.195), GCS score (p = 0.40, p = 0.469), Rotterdam score (p = 0.731), and preoperative midline shift (MLS) (p = 0.378) did not vary between the OD and CD groups. Neither technique affected the mortality, motor score, or pupil response (p > 0.05). After one and three months, GOS extension was associated with open and closed dural procedures (p = 0.089). Intracranial pressure, brain bulge, GCS score, and MLS were not associated with theoperative method(p > 0.05). The open dural group had a significantly shorter procedure time than the closed dural group (P = 0.026). Both groups showed no significant difference (p > 0.05) between CSF leak and post-traumatic hydrocephalus. Dural opensurgery for a compressed craniectomy is shorter and not associated with significant surgical consequences compared to close dural close surgery.


Assuntos
Lesões Encefálicas Traumáticas , Craniectomia Descompressiva , Hidrocefalia , Humanos , Craniectomia Descompressiva/métodos , Estudos Prospectivos , Lesões Encefálicas Traumáticas/complicações , Hidrocefalia/cirurgia , Pressão Intracraniana , Resultado do Tratamento , Estudos Retrospectivos
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