scholarly journals First-in-human endovascular treatment of hydrocephalus with a miniature biomimetic transdural shunt

2021 ◽  
pp. neurintsurg-2021-018136
Author(s):  
Pedro Lylyk ◽  
Ivan Lylyk ◽  
Carlos Bleise ◽  
Esteban Scrivano ◽  
Pedro Nicolas Lylyk ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Venous Access ◽  
Csf Shunt ◽  
Communicating Hydrocephalus ◽  
Invasive Treatment ◽  
Non Invasive ◽  
Ventriculoperitoneal Shunting ◽  
The Central Nervous System ◽  
Transvenous Approach

Surgical ventriculoperitoneal shunting remains standard treatment for communicating hydrocephalus, despite persistently elevated infection and revision rates. A novel minimally invasive endovascular cerebrospinal fluid (CSF) shunt was developed to mimic the function of the arachnoid granulation which passively filters CSF from the central nervous system back into the intracranial venous sinus network. The endovascular shunt is deployed via a femoral transvenous approach across the dura mater into the cerebellopontine angle cistern. An octogenarian with intractable hydrocephalus following subarachnoid hemorrhage underwent successful endovascular shunting, resulting in swift intracranial pressure reduction from 38 to <20 cmH2O (<90 min) and resolution of ventriculomegaly. This first successful development of a percutaneous transluminal venous access to the central nervous system offers a new pathway for non-invasive treatment of hydrocephalus and the potential for intervention against neurological disorders.

scholarly journals Postoperative agitation syndrome in young children with perinatal damage to the central nervous system

2021 ◽  
Vol 16 (5) ◽  
pp. 355-360
Author(s):  
V.I. Snisar ◽  
O.S. Pavlysh
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Young Children ◽  
Postoperative Period ◽  
Anesthetic Management ◽  
Clinical Manifestations ◽  
Postoperative Recovery ◽  
Inhalation Anesthesia ◽  
Ventriculoperitoneal Shunting ◽  
The Central Nervous System

One of the complications of the postoperative period in children is postanesthetic agitation, a significant emotional and uncontrollable worry, clouding of consciousness, feeling of anxiety and fear, inappropriate behavior, irritability, inconso­lable crying, aggressive and negative attitude towards parents and medical staff. Postoperative agitation is very important for clinicians and hospitals, it has a risk of harming a patient, staying longer in the ward after anesthesia, and increasing the period of postoperative recovery. The frequency of postoperative agitation depends on age group. Most often agitation occurs in young children. There is evidence that agitation can also be due to the immature nervous system and a consequence of pathological conditions of the central nervous system (asthenoneurotic syndrome, encephalopathy, hyperactivity syndrome, perinatal posthypoxic and organic brain lesions, history of prematurity, epilepsy, psychophysical and speech delay, etc.). That is why the goal of our research was to study the patterns of clinical manifestations of postoperative agitation syndrome in children with prenatal da­mage to the central nervous system. The work was performed based on the analysis of the postoperative period in 109 young children: 59 patients with acquired hydrocephalus, who underwent ventriculoperitoneal shunting, and 50 children without neurological disorders in whom reconstructive surge­ries were carried out. Depending on the type anesthetic management, each group was divided into two subgroups: children, who received inhalation anesthesia with sevoflurane, and those, who received total intravenous anesthesia using propofol. In the postoperative period, the behavior of children was assessed on a Pediatric Ane­sthesia Emergence Delirium scale 30 minutes after anesthesia was completed. Criterion for the development of agitation was the presence of excitement in a child with a score of ≥ 10 points. Study showed that young children with perinatal damage to the central nervous system and children whose anesthetic provision is carried out using sevoflurane are the most vulnerable to the development of agitation syndrome. Agitation in such children is more pronounced and longer. These cases require prediction, detection and active surveillance.

Odor Perception

2012 ◽  
pp. 44-59 ◽  
Author(s):  
Mitsuo Tonoike
Keyword(s):  
Signal Transduction ◽  
Central Nervous System ◽  
Nervous System ◽  
Information Processing ◽  
Non Invasive ◽  
Olfactory Acuity ◽  
Central Regions ◽  
Olfactory Systems ◽  
The Central Nervous System ◽  
The Brain

Though olfaction is one of the necessary senses and indispensable for the maintenance of the life of the animal, the mechanism of olfaction had not yet been understood well compared with other sensory systems such as vision and audition. However, recently, the most basic principle of “signal transduction on the reception and transmission for the odor” has been clarified. Therefore, the important next problem is how the information of odors about is processed in the Central Nervous System (CNS) and how odor is perceived in the human brain. In this chapter, the basic olfactory systems in animal and human are described and examples such as “olfactory acuity, threshold, adaptation, and olfactory disorders” are discussed. The mechanism of olfactory information processing is described under the results obtained by using a few new non-invasive measuring methods. In addition, from a few recent studies, it is shown that olfactory neurophysiological information is passing through some deep central regions of the brain before finally being processed in the orbito-frontal areas.

scholarly journals Cerebral vasculitis: clinical features and diagnostic principles

2001 ◽  
Vol XXXIII (3-4) ◽  
pp. 71-77
Author(s):  
I. G. Salikhov ◽  
E. I. Bogdanov ◽  
A. T. Zabbarova
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Early Diagnosis ◽  
Clinical Manifestations ◽  
Cerebral Vasculitis ◽  
Malignant Diseases ◽  
Non Invasive ◽  
The Central Nervous System ◽  
Diagnostic Capabilities ◽  
Primary Vasculitis

Cerebral vasculitis (CV) is a severe, potentially disabling disease that usually develops in the presence of rheumatic, infectious, medicinal, or malignant diseases. In rare cases, isolated (primary) vasculitis of the central nervous system (CNS) is observed [17, 33]. The complex pathogenesis, polymorphism of clinical manifestations, and the absence in most cases of reliable non-invasive diagnostic criteria for CV complicate early diagnosis and treatment. In this regard, it seems relevant to analyze the features of clinical manifestations and diagnostic capabilities in cerebrovascular pathology caused by vasculitis.

Surgical treatment for fungal infections in the central nervous system

1985 ◽  
Vol 63 (3) ◽  
pp. 371-381 ◽  
Author(s):  
Ronald F. Young ◽  
George Gade ◽  
Verity Grinnell
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Mortality Rate ◽  
Fungal Infection ◽  
Surgical Therapy ◽  
Fungal Infections ◽  
Neurological Deficits ◽  
Morbidity Rate ◽  
Communicating Hydrocephalus ◽  
The Central Nervous System

✓ The hospital records of 78 patients who underwent surgical therapy for fungal infections of the central nervous system (CNS) between 1964 and 1984 are summarized. Nine different fungal types were identified, but Coccidioides immitis and Cryptococcus neoformans accounted for most (67.1%) of the infections. A variety of clinical syndromes were seen, including chronic basal meningitis (45 patients), intracranial mass lesions (12 patients), and communicating hydrocephalus (six patients). Thirteen patients had rhinocerebral forms of fungal infection, and two presented with spinal involvement. Delays in diagnosis were frequent and ranged from 2 months to 11 years. In 31 patients the CNS lesion was the first indication of a fungal infection, and lesion biopsy or cerebrospinal fluid (CSF) examination confirmed the diagnosis. A total of 144 surgical procedures were carried out, including lesion biopsy or excision in 13 patients, primary CSF shunting in 22, and placement of an Ommaya reservoir for administration of intraventricular or intracisternal antifungal agents in 48. All patients received parenteral and, in some cases, intrathecal or oral antifungal chemotherapy in addition to surgical therapy. Overall mortality was 43.6% (34 deaths). With prompt diagnosis and treatment, the mortality rate was 39% whereas, when appropriate treatment was delayed, the mortality rate was 64%. An additional 14 surviving patients (17.9%) exhibited permanent morbidity due to neurological deficits, seizure disorders, or renal toxicity following treatment with amphotericin B. The combined mortality and morbidity rate was 62.8%. Clinical symptoms were resolved completely in 29 patients, although in 10 evidence of disease persisted and chemotherapy was continued. Fungal infections of the CNS are being recognized with increased frequency. It is suggested that a high index of suspicion, aggressive attempts to obtain a diagnosis, and early and vigorous therapy may reduce the unfortunate outcome seen in a relatively high proportion of patients with CNS fungal infections.

scholarly journals A Novel Prodrug Approach for Central Nervous System-Selective Estrogen Therapy

Molecules ◽  
2019 ◽  
Vol 24 (22) ◽  
pp. 4197 ◽  
Author(s):  
Katalin Prokai-Tatrai ◽  
Laszlo Prokai
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Estrogen Therapy ◽  
High Concentration ◽  
Beneficial Effects ◽  
Non Invasive ◽  
Site Of Action ◽  
The Central Nervous System ◽  
And Gender ◽  
Preclinical Animal Models

Beneficial effects of estrogens in the central nervous system (CNS) results from the synergistic combination of their well-orchestrated genomic and non-genomic actions, making them potential broad-spectrum neurotherapeutic agents. However, owing to unwanted peripheral hormonal burdens by any currently known non-invasive drug administrations, the development of estrogens as safe pharmacotherapeutic modalities cannot be realized until they are confined specifically and selectively to the site of action. We have developed small-molecule bioprecursor prodrugs carrying the para-quinol scaffold on the steroidal A-ring that are preferentially metabolized in the CNS to the corresponding estrogens. Here, we give an overview of our discovery of these prodrugs. Selected examples are shown to illustrate that, independently of the route of administrations and duration of treatments, these agents produce high concentration of estrogens only in the CNS without peripheral hormonal liability. 10β,17β-Dihydroxyestra-1,4-dien-3-one (DHED) has been the best-studied representative of this novel type of prodrugs for brain and retina health. Specific applications in preclinical animal models of centrally-regulated and estrogen-responsive human diseases, including neurodegeneration, menopausal symptoms, cognitive decline and depression, are discussed to demonstrate the translational potential of our prodrug approach for CNS-selective and gender-independent estrogen therapy with inherent therapeutic safety.

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