RESUMO
The authors treated a 14-year-old girl with posthemorrhagic hydrocephalus and an infected ventriculopleural shunt. She was taken for endoscopic third ventriculostomy with the hope of removing the hardware entirely, but she developed an arrhythmia and hypertension, followed rapidly by complete cardiac arrest. She was resuscitated successfully, made a complete recovery, and subsequently underwent a conventional shunt replacement. This is a newly reported life-threatening complication of neuroendoscopy that must be anticipated by any surgeon undertaking such a procedure.
Assuntos
Derivações do Líquido Cefalorraquidiano , Endoscópios , Parada Cardíaca/etiologia , Hidrocefalia/cirurgia , Complicações Intraoperatórias/etiologia , Ventriculostomia/instrumentação , Adolescente , Feminino , Parada Cardíaca/terapia , Humanos , Complicações Intraoperatórias/terapia , Reoperação , RessuscitaçãoRESUMO
Massive intracranial hemorrhage, no history of trauma and radiographic findings that were initially interpreted as linear parietal fractures raised the possibility of nonaccidental trauma in 2 infants. Both had severe coagulopathy, 1 due to hemorrhagic disease of the newborn (vitamin K deficiency) and the other due to disseminated herpes simplex virus infection. Both infants died. At autopsy, the parietal bone abnormalities were not fractures, but proved to be an anomalous suture in 1 and a connective tissue fissure in the other.
Assuntos
Maus-Tratos Infantis/diagnóstico , Tecido Conjuntivo/anormalidades , Hemorragias Intracranianas/etiologia , Osso Parietal/anormalidades , Osso Parietal/lesões , Fraturas Cranianas/diagnóstico por imagem , Autopsia , Diagnóstico Diferencial , Doenças em Gêmeos , Coagulação Intravascular Disseminada/etiologia , Evolução Fatal , Feminino , Herpes Simples/complicações , Humanos , Lactente , Recém-Nascido , Masculino , Osso Parietal/diagnóstico por imagem , Radiografia , Deficiência de Vitamina K/complicaçõesRESUMO
We report successful use of bleomycin in a low-grade astrocytoma tumor cyst of the tectal plate. A 6-year-old male underwent subtotal resection of a low-grade astrocytoma of the tectal plate followed by chemotherapy and proton beam radiation at age 2 and a half. Despite resolution of the solid portion of the tumor, serial MRI showed enlargement of a bilobar tumor cyst 3 years after the original diagnosis. The patient developed progressive ataxia, short-term memory loss and dysconjugate gaze. Following stereotactic placement of an Ommaya reservoir into the cyst, Isovue contrast and CT scan were used to confirm the integrity of the cyst. Five consecutive daily doses of 3.0 mg of bleomycin were instilled into the cyst after removal of cyst fluid. The therapy was well tolerated in the outpatient setting, and the clinical findings resolved. Subsequent CT and MRI at 4 months and 2 years after bleomycin confirmed no recurrence of the tumor or cyst.