Craniotomy for Fenestration of Multiloculated Hydrocephalus in Pediatric Patients

2005 ◽  
Vol 57 (suppl_1) ◽  
pp. 100-106 ◽  
Author(s):  
David I. Sandberg ◽  
J. Gordon McComb ◽  
Mark D. Krieger
Keyword(s):  
Pediatric Patients ◽  
Neurological Status ◽  
Neurological Deficits ◽  
Ventricular Catheter ◽  
Shunt System ◽  
Neurological Outcomes ◽  
Multiloculated Hydrocephalus ◽  
Before And After ◽  
Posterior Parietal ◽  
Ventricular Catheters

Abstract OBJECTIVE: To assess the treatment of progressive multiloculated hydrocephalus by craniotomy for microsurgical fenestration of cerebrospinal fluid (CSF) compartments to minimize the number of ventricular catheters. METHODS: We studied 33 pediatric patients who underwent craniotomies for fenestration of progressive multiloculated hydrocephalus between 1989 and 2003. In 20 of 33 patients, hydrocephalus was attributed to intraventricular hemorrhage associated with prematurity. Twenty-three of 33 patients had previous central nervous system infections. Craniotomy was typically performed via a posterior parietal approach. Communication between bilateral supratentorial loculated compartments and posterior fossa compartments was achieved. Surgical and neurological outcomes were assessed. RESULTS: Fenestration of loculated CSF spaces was performed successfully in all patients. No new neurological deficits were noted after surgery, and no patients required intraoperative blood transfusions. CSF infections within 3 months after surgery occurred in 4 of 33 patients. Over a median follow-up period of 3.7 years (range, 1.5 mo to 8.7 yr), 19 of 33 patients required additional fenestration procedures. The number of repeat fenestration procedures ranged from one to six, and a total of 47 additional fenestrations were performed in these 19 patients. The majority of patients (n = 25) ultimately required shunt systems with only one ventricular catheter. The neurological status of these patients was extremely poor both before and after surgery. Twenty-nine of 33 patients were severely delayed, and four were mildly delayed. CONCLUSION: Fenestration of multiloculated CSF compartments can enable most patients to function with a single ventricular catheter shunt system. Neurological status remains poor in this patient population.

Spinal meningiomas: Clinical and therapeutic tonsiderations

Open Medicine ◽  
2008 ◽  
Vol 3 (3) ◽  
pp. 322-326
Author(s):  
Johannes Schröder ◽  
Bernhard Fischer ◽  
Stefan Palkovic ◽  
Hansdetlef Wassmann
Keyword(s):  
Spinal Canal ◽  
Thoracolumbar Spine ◽  
Cauda Equina ◽  
Complete Removal ◽  
Neurological Status ◽  
Neurological Deficits ◽  
Before And After ◽  
Patient Will ◽  
Spinal Meningiomas ◽  
The Mean

AbstractMeningiomas of the spinal canal are rare, in contrast to their cranial counterparts. This study reports on the dominant features of spinal meningiomas before and after treatment. We treated 30 patients (23 female) with meningiomas of the spinal canal from 1992 to 2003. The mean age was 68 (range: 43–91). Upon admission, 26 patients presented with a marked neurological deficit (11 paraparesis, 9 motor weakness, 4 myelopathic ataxia, 1 quadriplegia, and 1 cauda equina syndrome). Two patients had sensory deficits, and two had pain only. The distribution of the tumors was as follows: 8 cases were cranio-cervical, 1 case was cervical, 6 cases were at the cervico-thoracic junction, 9 cases were of the thoracic spine, 5 cases were of the thoracolumbar spine, and 1 case was of the lumbar spine. Five cases also had intracranial manifestations. The mean interval between the onset of the first symptoms and treatment was 12 months. All cases were treated via (hemi)-laminectomy for complete removal of the tumor and occasionally via duraplasty. After a mean follow-up of 3 years, symptoms had improved by 3 points (on a 5-point scale) in 3 cases, by 2 points in 7 cases, and by 1 point in 12 cases; 7 cases were unchanged, and 1 case had worsened by 1 point. We observed 3 local recurrences. One case developed manifestations at a different site. Spinal meningiomas are often diagnosed late, after they have already caused major neurological deficits. Nevertheless, owing to their benign character, the outcome is favorable when treated appropriately. The outcome depends above all on the initial neurological status. The worse the deficit is, the less probable it is that the patient will recover neurologically.

Navigated endoscopic surgery for multiloculated hydrocephalus in children

2010 ◽  
Vol 5 (5) ◽  
pp. 434-442 ◽  
Author(s):  
Matthias Schulz ◽  
Georg Bohner ◽  
Hannah Knaus ◽  
Hannes Haberl ◽  
Ulrich-Wilhelm Thomale
Keyword(s):  
Mr Imaging ◽  
Endoscopic Surgery ◽  
Endoscopic Approach ◽  
Ventricular Catheter ◽  
Endoscopic Procedures ◽  
Additional Surgery ◽  
Multiloculated Hydrocephalus ◽  
Ventricular Catheters ◽  
Csf Diversion

Object Multiloculated hydrocephalus remains a challenging condition to treat in the pediatric hydrocephalic population. In a retrospective study, the authors reviewed their experience with navigated endoscopy to treat multiloculated hydrocephalus in children. Methods Between April 2004 and September 2008, navigated endoscopic procedures were performed in 16 children with multiloculated hydrocephalus (median age 8 months, mean age 16.1 ± 23.3 months). In all patients preoperative MR imaging was used for planning entry sites and trajectories of the endoscopic approach for cyst perforation and catheter positioning. Intraoperatively, a rigid endoscope was tracked by the navigation system. For all children the total number of operative procedures, navigated endoscopic procedures, implanted ventricular catheters, and drained compartments were recorded. In addition, postoperative complications and radiological follow-up data were analyzed. Results In 16 children, a total of 91 procedures were performed to treat multiloculated hydrocephalus, including 29 navigated endoscopic surgeries. Finally, 21 navigated procedures involved 1 ventricular catheter and 8 involved 2 catheters for CSF diversion via the shunt. The average number of drained compartments in a shunt was 3.6 ± 1.7 (range 2–9 compartments). In 9 patients (56%) a navigated endoscopic procedure constituted the last procedure within the follow-up period. One additional surgery was necessary in 3 patients (19%) after navigated endoscopy, and in 4 patients (25%) 2 further procedures were necessary after navigated endoscopy. Serial follow-up MR imaging demonstrated evidence of sufficient CSF diversion in all patients. Conclusions Navigated endoscopic surgery is a safe and effective treatment option for multiloculated hydrocephalus. The combination of the endoscopic approach and neuronavigation further refines preoperative planning and intraoperative orientation. The aim of treatment is to drain as many compartments as possible and as soon as possible, thereby establishing sufficient CSF drainage with few ventricular catheters in single shunt systems. Close clinical and radiological follow-up is mandatory because multiple revisions are likely.

scholarly journals Management of spinal dural arterio venous fistula with peri-medullar drainage

2019 ◽  
pp. 486-491
Author(s):  
Assoumane Ibrahim ◽  
Loucif Houari ◽  
Sanoussi Samuila ◽  
Sidi Said Abderahmane ◽  
Abdelhalim Morsli
Keyword(s):  
Venous Malformation ◽  
Clinical Status ◽  
Venous Drainage ◽  
Neurological Status ◽  
Neurological Deficits ◽  
Functional Rehabilitation ◽  
Disability Score ◽  
Surgical Department ◽  
Before And After ◽  
Venous Fistula

Introduction: Spinal Dural Arterio Venous Fistula (SDAVF) is an arteriovenous communication on the spinal dura with peri-medullar venous drainage. It is a curable cause of myelopathy and the most common form of spinal arterio venous malformation (AVM). The average age of revelation is the fifth decade; it is a diagnostic and therapeutic emergency. Materials and methods: This is a retrospective study conducted in the neuro surgical department of CHU Bab El Oued in Algiers during a five years time from November 2013 to September 2018. We assessed the clinical status of patients according to the Aminoff-Logue disability score before and after surgery. All patients did a total spine MRI followed by a Medullar angiography which facilitated the pin-pointing of the exact location of the dural fistula. The mean follow-up is 30 months. Results: There were five males and two females, all of them older than 45 years of age. At the admission, patients presented with signs of neurological deficits. After the diagnosis of SDAVF the surgical intervention consisted of a disconnection of the arteriovenous communication by coagulation and section of the fistula at the foot of the vein after a laminectomy. Functional rehabilitation was prescribed for all patients and they were regularly followed-up. Conclusion: Treatment of AVF is surgical or endovascular. Results depend largely on preoperative neurological status.

A 12-year single-center retrospective analysis of antisiphon devices to prevent proximal ventricular shunt obstruction for hydrocephalus

2019 ◽  
Vol 24 (6) ◽  
pp. 642-651
Author(s):  
Joyce Koueik ◽  
Mark R. Kraemer ◽  
David Hsu ◽  
Elias Rizk ◽  
Ryan Zea ◽  
...  
Keyword(s):  
Shunt Revision ◽  
Ventricular Catheter ◽  
Shunt Failure ◽  
Shunt System ◽  
Shunt Valve ◽  
Catheter Obstruction ◽  
Before And After ◽  
Observational Cohort ◽  
Shunt Obstruction

OBJECTIVERecent evidence points to gravity-dependent chronic shunt overdrainage as a significant, if not leading, cause of proximal shunt failure. Yet, shunt overdrainage or siphoning persists despite innovations in valve technology. The authors examined the effectiveness of adding resistance to flow in shunt systems via antisiphon devices (ASDs) in preventing proximal shunt obstruction.METHODSA retrospective observational cohort study was completed on patients who had an ASD (or additional valve) added to their shunt system between 2004 and 2016. Detailed clinical, radiographic, and surgical findings were examined. Shunt failure rates were compared before and after ASD addition.RESULTSSeventy-eight patients with shunted hydrocephalus were treated with placement of an ASD several centimeters distal to the primary valve. The records of 12 of these patients were analyzed separately due to a complex shunt revision history (i.e., > 10 lifetime shunt revisions). The authors found that adding an ASD decreased the 1-year ventricular catheter obstruction rates in the “simple” and “complex” groups by 67.3% and 75.8%, respectively, and the 5-year rates by 43.3% and 65.6%, respectively. The main long-term ASD complication was ASD removal for presumed valve pressure intolerance in 5 patients.CONCLUSIONSUsing an ASD may result in significant reductions in ventricular catheter shunt obstruction rates. If confirmed with prospective studies, this observation would lend further evidence that chronic shunt overdrainage is a central cause of shunt malfunction, and provide pilot data to establish clinical and laboratory studies that assess optimal ASD type, number, and position, and eventually develop shunt valve systems that are altogether resistant to siphoning.

scholarly journals Neurological outcomes of untreated brainstem cavernous malformations in a prospective observational cohort and literature review

2021 ◽  
pp. svn-2020-000608
Author(s):  
Da Li ◽  
Jing-Jie Zheng ◽  
Jian-Cong Weng ◽  
Pan-Pan Liu ◽  
Ze-Yu Wu ◽  
...  
Keyword(s):  
Neurological Status ◽  
Neurological Deficits ◽  
Developmental Venous Anomaly ◽  
Cavernous Malformations ◽  
Neurological Outcomes ◽  
Scale Scores ◽  
Risk Patients ◽  
History Of ◽  
Lost To Follow Up

BackgroundHaemorrhages of brainstem cavernous malformations (CMs) can lead to neurological deficits, the natural history of which is uncertain. The study aimed to evaluate the neurological outcomes of untreated brainstem CMs and to identify the adverse factors associated with worsened outcomes.MethodsFrom 2009 to 2015, 698 patients (321 women) with brainstem CMs were entered into the prospective cohort after excluding patients lost to follow-up (n=43). All patients were registered, clinical data were collected and scheduled follow-up was performed.ResultsAfter a median follow-up of 60.9 months, prospective haemorrhages occurred in 167 patients (23.9%). The mean modified Rankin Scale scores at enrolment and at censoring time were 1.6 and 1.2. Neurological status was improved, unchanged and worsened in 334 (47.9%), 293 (42.0%) and 71 (10.2%) patients, respectively; 233 (33.4%) recovered to normal levels. Lesions crossing the axial midpoint (relative risk (RR) 2.325, p=0.003) and developmental venous anomaly (DVA) (RR 1.776, p=0.036) were independently significantly related to worsened outcomes. The percentage of worsened outcomes was 5.3% (18 of 337) in low-risk patients (neither DVA nor crossing the axial point) and increased to 26.0% (13 of 50) in high-risk patients (with both DVA and crossing the axial point). The percentage of worsened outcomes significantly increased as the number of prospective haemorrhages increased (from 1.5% (8 of 531, if 0 prospective ictus) to 37.5% (48 of 128, if 1 ictus) and 38.5% (15 of 39, if >1 ictus)).ConclusionsThe neurological outcomes of untreated brainstem CMs were improved/unchanged in majority of patients (89.8%) with a fatality rate of 1.7% in our cohort, which seemed to be favourable. Radiological features significantly predicted worsened outcomes. Our results provide evidence for clinical consultation and individualised treatment. The referral bias of our cohort was underlined.

Nimodipine and Chronic Vasospasm in Monkeys: Part 1 Clinical and Radiological Findings

Neurosurgery ◽  
1985 ◽  
Vol 16 (2) ◽  
pp. 129-136 ◽  
Author(s):  
Michael Nosko ◽  
Bryce Weir ◽  
Christel Krueger ◽  
David Cook ◽  
Susan Norris ◽  
...  
Keyword(s):  
Cerebral Vasospasm ◽  
Neurological Status ◽  
Neurological Deficits ◽  
High Dose ◽  
Primate Model ◽  
Cerebral Vessel ◽  
Significant Difference ◽  
Before And After ◽  
The Right ◽  
Chronic Cerebral Vasospasm

Abstract The efficacy of the calcium channel blocker nimodipine in the prevention of chronic cerebral vasospasm (VSP) and delayed ischemia after subarachnoid hemorrhage (SAH) in monkeys was examined in a blind, randomized, placebocontrolled trial. The primate model developed in this laboratory reliably induces chronic cerebral vasospasm and can induce pathologically proven delayed ischemic neurological deficits (DINDs). With standard microsurgical procedures, an average 6.4-ml autologous hematoma was placed directly against the major anterior cerebral vessels in the right basal subarachnoid spaces of 24 monkeys. The monkeys were randomized to one of four groups and were treated orally q8h for 7 days with nimodipine (3, 6, or 12mg/kg) or placebo. An additional 2 monkeys underwent the surgical procedure without clot placement. Drug administration began between 14 and 20 hours after clot placement. Indices monitored before and after SAH included neurological status, angiographic cerebral vessel caliber, and cerebral blood flow. Significant VSP (25 to 100% reduction in vessel caliber) was present on Day 7 on the clot side in 83% of the animals (P ≤ 0.001). There was no significant difference (P > 0.05) in the incidence of VSP among the four groups. Similarly, there was no significant difference (P > 0.05) in the mean vessel caliber reduction after SAH among the four treatment groups. There was no VSP present on Day 7 in the sham-operated animals. One animal receiving high dose nimodipine (12 mg/kg p.o. q8h) developed a DIND on Day 5 after SAH. A second animal in the 12-mg/kg group developed a transient neurological deficit between Days 4 and 7.

scholarly journals Whether Evacuation surgery should be the first step for Postoperative Delayed Lumbar Epidural Hematomas?A Retrospective Comparative Study

2019 ◽  
Author(s):  
Liangliang Cao ◽  
Yumei Liu ◽  
Rundong Guo ◽  
Jianguang Xu ◽  
Wei Mei ◽  
...  
Keyword(s):  
Neurological Status ◽  
Invasive Treatment ◽  
Neurological Outcomes ◽  
Significant Difference ◽  
Surgical Evacuation ◽  
Before And After ◽  
Group A ◽  
Group B ◽  
Neurological State

Abstract Background To analyze the efficacy and necessity of multiple lumbar punctures for postoperative delayed lumbar epidural hematoma(PDLEH).Methods Patients who underwent lumbar spinal surgeries between 2012 and 2016 at our institution, were reviewed through their medical records. For patients with PDLEH, the therapies, duration to onset(DO), duration from onset to intervention (DOI), symptoms (ASIA grade), neurological outcomes, VAS before and after treatment were examined. Only patients that received evacuation surgery(Group A) or mutiple lumbar punctures(MLP)(Group B) were included. We compared ASIA grade and VAS before and after treatment, DOI between the two therapies, and analyzed the correlation among the parameters.Results 15 cases(Group A) were performed with emergent surgical evacuation of the hematoma, and 16 cases(Group B) were treated with lumbar MLP at surgical site. The DOIs were 10.87±6.14h in group A and 2.05±5.33 in group B(P=0,P<0.05.). Preoperative neurological status in Group A were slighter than that in Group B.(P=0,P<0.05.). There was significant difference on VAS after treatment (P=0,P<0.05). Correlation analysis revealed that DOI were significantly positively correlated with neurological state before interventions (r=0.672, p=0,). In Group A, neurological outcomes at 2 years follow-up were correlated significantly with DOI (r=0.594, p=002) and neurological state before reoperation (r=0.665,p=0.007,). And in Group B, the correlation coefficient of neurological state and neurological outcomes at 2 years follow-up was r=o.584 (p=0.02),while there was no correlation between neurological outcomes and DOI(r=0.158,p=0.558).Conclusions In addition to serving as a timely, minimally invasive treatment, MLP could also serve as a preliminary measure during preoperative preparation before surgical evacuation.

Shunt failure due to intracranial migration of BioGlide ventricular catheters

2011 ◽  
Vol 7 (4) ◽  
pp. 408-412 ◽  
Author(s):  
Hsin-Hung Chen ◽  
Jay Riva-Cambrin ◽  
Douglas L. Brockmeyer ◽  
Marion L. Walker ◽  
John R. W. Kestle
Keyword(s):  
Call Center ◽  
Neurological Deficits ◽  
Ventricular Catheter ◽  
Shunt Failure ◽  
Asymptomatic Children ◽  
The Us ◽  
New Type ◽  
Ventricular Catheters ◽  
Mean Time ◽  
Index Cases

Object In late 2008, the authors recognized a new type of ventriculoperitoneal shunt failure specific to the Bio-Glide Snap Shunt ventricular catheters. This prompted a retrospective review of the patient cohort and resulted in a recall by the FDA in the US. Methods After the index cases were identified, the FDA was notified by the hospital, leading to a recall of the product. Hospital operative logs were used to identify patients in whom the affected products were used. A letter describing the risk was sent to all patients offering a free screening CT scan to look for disconnection. A call center was established to respond to patient questions, and an informational video was made available on the hospital website. The authors reviewed the records of the index cases and other cases subsequently identified. Results Seven index cases and an additional 16 cases of disconnection were identified in the 466 patients in whom a BioGlide Snap Shunt ventricular catheter had been implanted. Mean time to disconnection was 2.7 years (range 4 days–5.8 years). Computed tomography slices in the plane of the catheter helped visualize disconnections. Retrieval was difficult, and in 5 patients the disconnected catheter was not removable. Three catheters were completely within the ventricle. At presentation, 4 children suffered from severe neurological deficits, including one who died as a result of the shunt malfunction. Conclusions BioGlide snap-design ventricular catheters are prone to disconnection. Continued vigilance and specific imaging are important. Catheter removal after disconnection may be difficult. Elective removal prior to disconnection in asymptomatic children has not been performed.

Artifact removal from neurophysiological signals: impact on intracranial and arterial pressure monitoring in traumatic brain injury

2020 ◽  
Vol 132 (6) ◽  
pp. 1952-1960 ◽  
Author(s):  
Seung-Bo Lee ◽  
Hakseung Kim ◽  
Young-Tak Kim ◽  
Frederick A. Zeiler ◽  
Peter Smielewski ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Neurological Status ◽  
Cerebrovascular Reactivity ◽  
Cerebral Hypoperfusion ◽  
Clinical Parameters ◽  
Artifact Removal ◽  
Clinical Events ◽  
Arterial Blood ◽  
Before And After

OBJECTIVEMonitoring intracranial and arterial blood pressure (ICP and ABP, respectively) provides crucial information regarding the neurological status of patients with traumatic brain injury (TBI). However, these signals are often heavily affected by artifacts, which may significantly reduce the reliability of the clinical determinations derived from the signals. The goal of this work was to eliminate signal artifacts from continuous ICP and ABP monitoring via deep learning techniques and to assess the changes in the prognostic capacities of clinical parameters after artifact elimination.METHODSThe first 24 hours of monitoring ICP and ABP in a total of 309 patients with TBI was retrospectively analyzed. An artifact elimination model for ICP and ABP was constructed via a stacked convolutional autoencoder (SCAE) and convolutional neural network (CNN) with 10-fold cross-validation tests. The prevalence and prognostic capacity of ICP- and ABP-related clinical events were compared before and after artifact elimination.RESULTSThe proposed SCAE-CNN model exhibited reliable accuracy in eliminating ABP and ICP artifacts (net prediction rates of 97% and 94%, respectively). The prevalence of ICP- and ABP-related clinical events (i.e., systemic hypotension, intracranial hypertension, cerebral hypoperfusion, and poor cerebrovascular reactivity) all decreased significantly after artifact removal.CONCLUSIONSThe SCAE-CNN model can be reliably used to eliminate artifacts, which significantly improves the reliability and efficacy of ICP- and ABP-derived clinical parameters for prognostic determinations after TBI.

Long-term stability of fusiform dilatation of the internal carotid artery following surgery adjacent to the circle of Willis: report of 2 cases

2020 ◽  
pp. 1-4
Author(s):  
Madeline B. Karsten ◽  
R. Michael Scott
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Arachnoid Cyst ◽  
Pediatric Patients ◽  
Internal Carotid ◽  
Imaging Finding ◽  
Neurological Status ◽  
Suprasellar Region

Fusiform dilatation of the internal carotid artery (FDCA) is a known postoperative imaging finding after craniopharyngioma resection. FDCA has also been reported following surgery for other lesions in the suprasellar region in pediatric patients and is thought to be due to trauma to the internal carotid artery (ICA) wall during tumor dissection. Here, the authors report 2 cases of pediatric patients with FDCA. Case 1 is a patient in whom FDCA was visualized on follow-up scans after total resection of a craniopharyngioma; this patient’s subsequent scans and neurological status remained stable throughout a 20-year follow-up period. In case 2, FDCA appeared after resection and fenestration of a giant arachnoid cyst in a 3-year-old child, with 6 years of stable subsequent follow-up, an imaging finding that to the authors’ knowledge has not previously been reported following surgery for arachnoid cyst fenestration. These cases demonstrate that surgery involving dissection adjacent to the carotid artery wall in pediatric patients may lead to the development of FDCA. On very long-term follow-up, this imaging finding rarely changes and virtually all patients remain asymptomatic. Neurointerventional treatment of FDCA in the absence of symptoms or significant late enlargement of the arterial ectasia does not appear to be indicated.

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