Paediatric hydrocephalus

2019 ◽  
pp. 1023-1036
Author(s):  
Matt Bailey ◽  
Chris Parks ◽  
Conor L. Malucci
Keyword(s):  
Cerebrospinal Fluid ◽  
Surgical Procedures ◽  
Surgical Techniques ◽  
Disease Process ◽  
Surgical Care ◽  
Csf Shunts ◽  
Classification Management ◽  
Technological Improvements ◽  
Csf Production

Paediatric hydrocephalus is the commonest disorder to be managed by paediatric neurosurgeons. Rather than representing a single disease process, hydrocephalus can result from a variety of different pathological processes or insults that culminate in an imbalance of cerebrospinal fluid (CSF) production and absorption. If left untreated, the majority of cases are fatal, but with appropriate surgical management most patients survive, with some leading normal lives into adulthood. The mainstay of treatment is with CSF shunts, but with technological improvements in imaging and surgical techniques an increasing number are being successfully treated with neuroendoscopic procedures. The disorder can be complex to manage, with many patients requiring multiple surgical procedures and lifelong follow-up. This chapter gives an overview of paediatric hydrocephalus, its causes and classification, management with shunts and endoscopy, description of surgical techniques, and the outcomes of surgical care.

scholarly journals FREQUENCY OF INFECTION AFTER CEREBROSPINAL FLUID SHUNTING PROCEDURES

2020 ◽  
Author(s):  
Kashif Ramooz ◽  
Eesha Yaqoob ◽  
Nadeem Akhtar ◽  
Fraz Mehmood ◽  
Saad Javed
Keyword(s):  
Cerebrospinal Fluid ◽  
Age Distribution ◽  
Age Groups ◽  
Csf Shunts ◽  
Ethical Approval ◽  
The Central Nervous System ◽  
Rate Study ◽  
Cerebrospinal Fluid Shunting ◽  
Prolonged Hospital

ABSTRACTHydrocephalus is routinely treated by surgical procedures. Cerebrospinal fluid shunt placement is a critical therapeutic intervention for hydrocephalus.CSF shunting has multiple complications among which infection is very common. The major cause of morbidity and mortality in patients with CSF shunts is theinfection of the central nervous system (CNS).It can lead to prolonged hospital stay, increase the number of operative procedures 03 times more than then none infected cases and has twice the fatality rate. Study of such type of complication will help the patients to improve their health and also improve our sterilization techniques and reduce burden of hospital and patients expenditures. The objective of the study was to determine the frequency of infection after cerebrospinal fluid shunting procedures.Case series study was used as study design.Study was conducted from 10-2010 to 10-06-2011.One hundred and forty four patients with both genders of all age groups undergoing cerebrospinal fluid shunting, meeting inclusion and exclusion criteria, were selected for the present study after informed consent of patient or guardian and approval by the hospital ethical committee. Follow up was ensured by taking the telephonic contact and address of patient.Total no of patients were 144 among which, 89 were males and 55 were females. Age distribution was from 01 month to 75 years with the mean age of 15.280 and standard deviation was ± 20.450. Post-operative infection was present in 20(13.9%) patients.Author’s approvalAll the authors have seen the manuscript and approved it.Declaration of interestNoneConflict/Competing of InterestNone.Disclosure of FundingNone.Ethical ApprovalAttached

Study on spontaneous cerebrospinal fluid rhinorrhoea: its aetiology and management

2005 ◽  
Vol 119 (1) ◽  
pp. 12-15 ◽  
Author(s):  
C J Dunn ◽  
A Alaani ◽  
A P Johnson
Keyword(s):  
Cerebrospinal Fluid ◽  
Surgical Intervention ◽  
Surgical Techniques ◽  
Queen Elizabeth Hospital ◽  
Study Group ◽  
Common Features ◽  
Csf Rhinorrhoea ◽  
The Common ◽  
Csf Leaks

The aim of this study was to identify the common features in a study group of patients with spontaneous cerebrospinal fluid (CSF) rhinorrhoea, to develop a hypothesis to explain the cause of this condition and to investigate the outcome of surgical techniques adopted to repair the leak. In this retrospective study the authors have reviewed all the cases of spontaneous CSF leaks attending and receiving treatment from the otolaryngology department of Queen Elizabeth Hospital, Birmingham, from 1992 to 2002.Of 34 patients with CSF leaks, 15 were spontaneous in nature and formed the study group. Of these 15 patients, 14 were female; with ages ranging from 37 to 70 years and a median age of 50 years. All the female patients were overweight with a body mass index (BMI) >24.9 and, of these, nine were considered obese with a BMI >30. It was attempted to identify common factors in the study group and it was evident that female sex, obesity and age played a key role in this condition.The follow-up period ranged from two to 98 months. Thirteen patients were asymptomatic but two patients remained symptomatic, one of these despite repeated surgical intervention.

Mouse cardiac surgery: comprehensive techniques for the generation of mouse models of human diseases and their application for genomic studies

2004 ◽  
Vol 16 (3) ◽  
pp. 349-360 ◽  
Author(s):  
Oleg Tarnavski ◽  
Julie R. McMullen ◽  
Martina Schinke ◽  
Qing Nie ◽  
Sekwon Kong ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Cardiac Hypertrophy ◽  
Mouse Models ◽  
Surgical Procedures ◽  
Molecular Mechanisms ◽  
Ischemia Reperfusion ◽  
Surgical Techniques ◽  
Disease Process ◽  
Human Diseases ◽  
Genomic Studies

Mouse models mimicking human diseases are important tools in trying to understand the underlying mechanisms of many disease states. Several surgical models have been described that mimic human myocardial infarction (MI) and pressure-overload-induced cardiac hypertrophy. However, there are very few detailed descriptions for performing these surgical techniques in mice. Consequently, the number of laboratories that are proficient in performing cardiac surgical procedures in mice has been limited. Microarray technologies measure the expression of thousands of genes simultaneously, allowing for the identification of genes and pathways that may potentially be involved in the disease process. The statistical analysis of microarray experiments is highly influenced by the amount of variability in the experiment. To keep the number of required independent biological replicates and the associated costs of the study to a minimum, it is critical to minimize experimental variability by optimizing the surgical procedures. The aim of this publication was to provide a detailed description of techniques required to perform mouse cardiac surgery, such that these models can be utilized for genomic studies. A description of three major surgical procedures has been provided: 1) aortic constriction, 2) pulmonary artery banding, 3) MI (including ischemia-reperfusion). Emphasis has been placed on technical procedures with the inclusion of thorough descriptions of all equipment and devices employed in surgery, as well as the application of such techniques for expression profiling studies. The cardiac surgical techniques described have been, and will continue to be, important for elucidating the molecular mechanisms of cardiac hypertrophy and failure with high-throughput technology.

scholarly journals Optimization of Surgical Care and Anesthesia in the Treatment of Multilevel Degenerative Diseases of the Lumbar Spine in Patients with Overweight and Obesity

2018 ◽  
Vol 73 (6) ◽  
pp. 401-410 ◽  
Author(s):  
Vadim A. Byvaltsev ◽  
Andrey A. Kalinin ◽  
Victoria Yu. Goloborodko
Keyword(s):  
Lumbar Spine ◽  
Minimally Invasive ◽  
Surgical Procedures ◽  
Surgical Techniques ◽  
Surgical Care ◽  
Pain Syndrome ◽  
Overweight And Obesity ◽  
Degenerative Diseases ◽  
Minimally Invasive Surgical ◽  
Paravertebral Muscles

Background: The provision of surgical care in the treatment of degenerative diseases of the lumbar spine in patients with obesity and obesity is associated with significant risks of anesthesia and the development of perioperative complications. Aims: to analyze the results of the introduction of a combination of surgical procedures and anesthesia in the treatment of multilevel degenerative diseases of the lumbar spine in patients with excessive body weight and obesity.Materials and methods: The results of surgical treatment of 86 patients were studied, 2 groups were identified. In the study group (SG, n=37), minimally invasive surgical techniques and original surgical approach, paravertebral musculature infiltration with bupivacaine with epinephrine, and multimodal anesthesia with dexmedetomidine were used. The comparison group (CG, n=49) consisted of patients who used the technique of traditional open transpedicular fixation in combination with the posterior interbody fusion without the above combination of surgical procedures and anesthesia. Observation and clinical evaluation was performed in the early (during hospitalization) and in the distant (on average 36 months) postoperative periods.Results: In SG there were no changes in hemodynamics and better results were obtained on the speed of recovery of psychomotor functions. The use of local anesthetics significantly reduced the local pain syndrome (p0.05) and the need for analgesics (p=0.002). Comparative analysis in the main group revealed significantly better results in indices of the duration of the operation [SG 145 (105; 155) min, CG 185 (100; 205) min; p=0.02], the volume of blood loss [SG 110 (90; 140) ml, CG 510 (390; 640) ml; p0.001], the activation time [SG 1 (1; 2) days, CG 3 (3; 4) days; p=0.01], the length of hospitalization [SG 10 (9; 11) days, CG 13 (12; 15) days; p=0,03], remote clinical parameters of the pain syndrome level from the visual analogue scale in the lower extremities [SG 3 (1; 4) mm, CG 9 (6; 14) mm; p=0.006] and the lumbar spine [SG 6 (4; 9) mm, CG 16 (11; 21) mm; p=0.001], functional state according to ODI [SG 8 (6; 10) points, CG 16 (12; 24) points; p=0.008], subjective satisfaction with the operation performed on the Macnab scale (p=0.01). The number of postoperative complications in SG was 8%, in CG ― 18% (p=0.006).Conclusions: Analysis of the results of the introduction of a combination of surgical and anesthetic support methods in the treatment of multilevel degenerative diseases of the lumbar spine in patients with overweight and obesity, including minimally invasive surgical techniques, infiltration of paravertebral muscles with bupivacaine and epinephrine, multimodal anesthesia with dexmedetomidine showed its high perioperative safety, low number of complications, as well as better and clinical outcomes in the early and late postoperative periods.

Gram-Negative Cerebrospinal Fluid Shunt-Associated Infections

PEDIATRICS ◽  
1977 ◽  
Vol 59 (4) ◽  
pp. 614-618
Author(s):  
Clifford J. Sells ◽  
David B. Shurtleff ◽  
John D. Loeser
Keyword(s):  
Cerebrospinal Fluid ◽  
Early Recognition ◽  
Cerebrospinal Fluid Shunt ◽  
Significant Morbidity ◽  
Cure Rate ◽  
Csf Shunts ◽  
Gram Negative ◽  
Appropriate Therapy ◽  
Shunt Removal

Twenty hydrocephalic children with cerebrospinal fluid (CSF) shunts over an 11-year period were seen with Gram-negative central nervous system (CNS) infections. Seventeen infections were with single organisms and three were mixed. Sixteen of 20 (80%) of the infections occurred within five months of shunt surgery. Complete shunt removal or replacement in a new site plus systemic and intraventricular antibiotics resulted in a 100% (9/9) cure rate. Systemic and intraventricular antibiotics alone or in combination with incomplete shunt removal generally were unsuccessful. Significant morbidity and mortality were associated with these infections. Of the 18 patiens with follow-up data, seven (39%) died with the infection four (22%) sustained definite CNS damaeg, three (17%) were retarded after infection but their preinfection status was unknown, and only four (22%) patients escaped without definite sequelae. Early recognition and appropriate therapy, hopefully, will improve the current bleak prognosis.

scholarly journals Study on Spontaneous Cerebrospinal Fluid (CSF) Rhinorrhoea: A Birmingham Experience

2013 ◽  
Vol 24 (1) ◽  
pp. 40-43
Author(s):  
Mohammad Saleh Uddin Sayed ◽  
Chris J Dunn ◽  
A Alaani ◽  
Alan Johnson
Keyword(s):  
Cerebrospinal Fluid ◽  
Surgical Techniques ◽  
Queen Elizabeth Hospital ◽  
Study Group ◽  
Csf Rhinorrhoea ◽  
The Common ◽  
Medicine Today ◽  
Age Range ◽  
Csf Leaks

Spontaneous Cerebrospinal fluid (CSF) rhinorrhoea is not very common. The aim of this study is to identify the common features in the study group of patients with spontaneous CSF rhinorrhoea, to develop a hypothesis to explain the cause of this condition and to investigate the outcome of surgical techniques adopted to repair the leak. In this retrospective study we have reviewed all the cases of spontaneous CSF leaks attending and receiving treatment from the Department of ENT at Queen Elizabeth Hospital, Birmingham, from 1992 to 2002. Among the total number of 34 patients with CSF leaks, 15 were spontaneous in nature and formed our study group, of these 15 patients 14 were female; with age range from 37 to 70 years and a median age of 50 years. All the female patients were obese with a body mass index higher than normal range. We tried to identify common factors in the study group and it was evident that female sex, obesity and age play a key role in this condition. Follow up period ranged from 2 to 98 months and thirteen patients were asymptomatic but two patients remained symptomatic, one of these despite repeated surgical intervention. DOI: http://dx.doi.org/10.3329/medtoday.v24i1.14114 Medicine TODAY Vol.24(1) 2012 pp.40-43

Cerebrospinal Fluid Flow Dynamics in Children with External Ventricular Drains

Neurosurgery ◽  
1991 ◽  
Vol 28 (2) ◽  
pp. 242-250 ◽  
Author(s):  
James M. Drake ◽  
Christian Sainte-Rose ◽  
Marcia DaSilva ◽  
Hirsch Jean-François
Keyword(s):  
Cerebrospinal Fluid ◽  
Flow Rate ◽  
Csf Shunt ◽  
Csf Shunts ◽  
Gram Negative ◽  
Cerebrospinal Fluid Flow ◽  
Computer Monitoring ◽  
Weight Method ◽  
The Mean ◽  
Csf Production

Abstract Fifty-five children had 64 external ventricular drains (EVDs) placed predominantly (95%) for cerebrospinal fluid (CSF) shunt infections. In 9 children, a computer monitoring system measured the CSF output each second continuously for up to 24 hours. The monitoring was repeated daily for up to 9 days. The state of arousal of the patients was recorded simultaneously. In all children, daily EVD outputs were related to age, sex, weight, method of establishing the EVD, height of the drip chamber, time since insertion, and type of infecting organism. Computer monitoring revealed wide fluctuations in flow rate, with peak rates frequently >20 ml/h and periods of flow arrest. These changes were usually associated with increased arousal, but also occurred with sleep. The mean EVD flow rate for all children was 6.3 ml/h. EVD output increased with age and weight. EVD output decreased with Gram-negative or multiple-organism infections and with elevation of the drip chamber. Resolution of the infection, sex of the patient, and method of establishing the EVD had no effect on output. These results predict that CSF production increases with brain growth in humans; that CSF production is depressed by Gram-negative and multiple-organism infections; that implanted CSF shunts with standard valves flow at equivalent rates to an EVD in the supine position; and that the CSF drainage requirements in this group are approximately equal to their EVD outputs.

scholarly journals Surgical seeding of chordomas

2001 ◽  
Vol 10 (3) ◽  
pp. 1-6 ◽  
Author(s):  
Kenan I. Arnautoviæ ◽  
Ossama Al-Mefty
Keyword(s):  
Cerebrospinal Fluid ◽  
Surgical Treatment ◽  
Local Recurrence ◽  
Early Diagnosis ◽  
Primary Tumor ◽  
Surgical Techniques ◽  
Cervical Region ◽  
High Propensity ◽  
Postoperative Irradiation

Object Chordomas have a high propensity for local recurrence and progression, as well as for systemic and cerebrospinal fluid metastasis. The authors identified and analyzed a series of patients with chordomas, focusing on an underrecognized entity—surgical seeding. Methods In a retrospective analysis of 82 patients with chordomas treated over a 10-year period (1990–2000) the authors found six patients (7.3%) in whom surgical seeding had occurred. In five (83%) of these patients the primary tumor was located at the clivus. In one (17%) the tumor was present in the cervical region. There were two male (33%) and four female patients (67%) with a mean age of 34 years. The seeding sites, which were separate from the primary tumor, were located along the operative route or in the abdomen where fat was removed. The seeding was diagnosed 5 to 15 months after surgery (mean 12 months). One seeding site was present in five patients and 17 seeding sites were present in one patient. The involved tissues included mucosa, bone, dura, muscle, and fat. After resection, all seedings were documented histologically. Conclusions Seeding of chordomas occurs along the operative route and at distant locations where fat is harvested. Early diagnosis and aggressive surgical treatment are recommended. Based on the results of this study, it is suggested that surgical techniques, postoperative irradiation, the neuroradiological follow-up protocol, and even research on chordomas should be reevaluated.

Surgical seeding of chordomas

2001 ◽  
Vol 95 (5) ◽  
pp. 798-803 ◽  
Author(s):  
Kenan I. Arnautović ◽  
Ossama Al-Mefty
Keyword(s):  
Cerebrospinal Fluid ◽  
Cervical Spine ◽  
Local Recurrence ◽  
Primary Tumor ◽  
Postoperative Radiotherapy ◽  
Surgical Techniques ◽  
Content Type ◽  
High Propensity ◽  
Fine Print

Object. Chordomas have a high propensity for local recurrence and progression, as well as for systemic and cerebrospinal fluid metastasis. The authors identified and analyzed a series of patients with chordomas, focusing on an underrecognized pathological entity—surgical seeding of tumor cells. Methods. In a retrospective analysis of 82 patients with chordomas treated over a 10-year period (1990–2000), the authors found six patients (7.3%) in whom surgical seeding had occurred. In five (83%) of these patients the primary tumor was located at the clivus. In one (17%), the tumor was present at the cervical spine. There were two male (33%) and four female patients (67%) whose mean age was 34 years. The seeding sites, which were separate from the primary tumor, were located along the operative route or in the abdomen where fat was removed. The seeding was diagnosed 5 to 15 months (mean 12 months) after surgery. One seeding site was present in five patients, and 17 seeding sites were present in one patient. The involved tissues included mucosa, bone, dura, muscle, and fat. After resection, all seedings were confirmed histologically. Conclusions. Seeding of chordomas occurs along the operative route and at distant locations where tissue is harvested. Early diagnosis and aggressive surgery are recommended. Based on the results of this study, the authors suggest that surgical techniques, postoperative radiotherapy, neuroradiological follow-up protocol, and even research on chordomas should be reevaluated.

Extended Myectomy for Hypertrophic Obstructive Cardiomyopathy

2012 ◽  
Vol 15 (5) ◽  
pp. 251
Author(s):  
Changqing Gao ◽  
Chonglei Ren ◽  
Cangsong Xiao ◽  
Yang Wu ◽  
Gang Wang ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Left Ventricle ◽  
Mitral Regurgitation ◽  
Surgical Procedures ◽  
Hypertrophic Obstructive Cardiomyopathy ◽  
Systolic Anterior Motion ◽  
Anterior Leaflet ◽  
Septal Myectomy ◽  
The Mean

<p><b>Background:</b> The purpose of this study was to summarize our experience of extended ventricular septal myectomy in patients with hypertrophic obstructive cardiomyopathy (HOCM).</p><p><b>Methods:</b> Thirty-eight patients (26 men, 12 women) with HOCM underwent extended ventricular septal myectomy. The mean age was 36.3 years (range, 18-64 years). Diagnosis was made by echocardiography. The mean (mean � SE) systolic gradient between the left ventricle (LV) and the aorta was 89.3 � 31.1 mm Hg (range, 50-184 mm Hg) according to echocardiographic assessments before the operations. Moderate or severe systolic anterior motion (SAM) of the anterior leaflet of the mitral valve was found in 38 cases, and mitral regurgitation was present in 29 cases. Extended ventricular septal myectomy was performed in all 38 cases. The results of the surgical procedures were evaluated intraoperatively with transesophageal echocardiography (TEE) and with transthoracic echocardiography (TTE) at 1 to 2 weeks after the operation. All patients were followed up with TTE after their operation.</p><p><b>Results:</b> All patients were discharged without complications. The TEE evaluations showed that the mean systolic gradient between the LV and the aorta decreased from 94.8 � 35.6 mm Hg preoperatively to 13.6 � 10.8 mm Hg postoperatively (<i>P</i> = .0000) and that the mean thickness of the ventricular septum decreased from 28.3 � 7.9 mm to 11.8 � 3.2 mm (<i>P</i> = .0000). Mitral regurgitation and SAM were significantly reduced or eliminated. During the follow-up, all patients promptly became completely asymptomatic or complained of mild effort dyspnea only, and syncope was abolished. TTE examinations showed that the postoperative pressure gradient either remained the same or diminished.</p><p><b>Conclusions:</b> Extended ventricular septal myectomy is mostly an effective method for patients with HOCM, and good surgical exposure and thorough excision of the hypertrophic septum are of paramount importance for a successful surgery.</p>

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