Intracranial Pressure during Wakefulness and Sleep in 55 Adult Patients with Chronic Hydrocephalus

Neurosurgery ◽  
2006 ◽  
Vol 59 (2) ◽  
pp. 326-332 ◽  
Author(s):  
Hannes Stephensen ◽  
Magnus Tisell ◽  
Carsten Wikkelsö
Keyword(s):  
Surgical Treatment ◽  
Intracranial Pressure ◽  
Clinical Symptoms ◽  
Adult Patients ◽  
Communicating Hydrocephalus ◽  
Sitting Position ◽  
Chronic Hydrocephalus ◽  
Continuous Scale ◽  
Noncommunicating Hydrocephalus ◽  
The Mean

Abstract OBJECTIVE: To record the levels of intracranial pressure (ICP) during wakefulness and sleep in hydrocephalic adults and to correlate the ICP levels with symptoms and degree of improvement after surgical treatment. METHODS: ICP and patient behavior were registered overnight (17–26 h) in 29 patients with noncommunicating and 26 with communicating hydrocephalus. Mean ICP was calculated during wakefulness (sitting or lying supine) and during sleep. Clinical symptoms and changes after surgery were scored on a continuous scale. RESULTS: Mean ICP during sleep was 13.4 mmHg (11.1–15.7 mmHg) in noncommunicating hydrocephalus versus 10.1 mmHg (8.8–11.4 mmHg) in communicating hydrocephalus (P < 0.001). Patients with idiopathic communicating hydrocephalus had higher ICP, 11.4 mmHg (9.9–12.9 mmHg), than patients with secondary communicating hydrocephalus, 8.6 mmHg (6.5–10.6 mmHg). ICP was higher during sleep than when the patients were awake lying supine, 10.9 mmHg (8.7–13.1 mmHg) in noncommunicating versus 6.8 mmHg (5.3–8.3 mmHg) in communicating hydrocephalus (P < 0.0001). The mean ICP in the sitting position was 2.4 mmHg (0.5–4.3 mmHg) in noncommunicating versus 0.5 mmHg (-0.7–1.8 mmHg) in communicating hydrocephalus. All but one patient with communicating hydrocephalus had a normal ICP (≤ 15 mmHg) versus 20 of the 29 patients with noncommunicating hydrocephalus. ICP levels showed no correlation with either symptoms or improvement after surgery. CONCLUSION: ICP is higher during sleep than during periods of awake lying supine (P < 0.001) and is not correlated with either symptoms or the rate of improvement after surgery. ICP is normal in most adults with hydrocephalus.

SURGICAL TREATMENT OF RATHKE CLEFT CYSTS IN CHILDREN

Neurosurgery ◽  
2009 ◽  
Vol 64 (6) ◽  
pp. 1132-1138 ◽  
Author(s):  
Gabriel Zada ◽  
Benjamin Ditty ◽  
Sean A. McNatt ◽  
J. Gordon McComb ◽  
Mark D. Krieger
Keyword(s):  
Surgical Treatment ◽  
Los Angeles ◽  
Transsphenoidal Surgery ◽  
Pediatric Patients ◽  
Clinical Symptoms ◽  
Incidental Finding ◽  
Effective Means ◽  
Sellar Lesions ◽  
Endocrine Insufficiency ◽  
The Mean

Abstract OBJECTIVE Rathke cleft cysts (RCCs) are cystic epithelial lesions in the sellar and suprasellar regions that are often discovered incidentally. They require surgical fenestration and drainage in a small proportion of patients who develop symptoms or demonstrate progressive enlargement. Our aim was to review our experience with pediatric patients treated surgically for RCCs. METHODS A retrospective review was conducted of all patients treated surgically for RCCs at Childrens Hospital Los Angeles between 1999 and 2007 after approval by the institutional review board. Clinical notes, operative reports, radiological studies, and pathology reports were reviewed. The median follow-up period was 34 months. RESULTS Ten patients undergoing surgical treatment of an RCC were identified, making up 20% of the 51 patients with RCCs followed clinically over the same time period. The mean age was 13 years (age range, 2–17 years). There were 6 females and 4 males. Patients requiring surgery presented with the following clinical symptoms: headache (8 patients, 80%), endocrine insufficiency (6 patients, 60%), meningitis followed by visual loss (1 patient, 10%), and incidental finding (1 patient, 10%). The mean cyst diameter was 13.6 mm (range, 8–18 mm). Four patients had strictly sellar lesions, 4 patients had suprasellar extension of an RCC, and 2 patients had primarily suprasellar RCCs. Nine of 10 patients underwent transsphenoidal surgery, and 1 patient underwent a pterional craniotomy. Complete cyst drainage on radiography was noted in 9 of 10 patients (90%), all of whom underwent transsphenoidal surgery. One patient experienced a symptomatic recurrence 6 years after complete surgical drainage. Headaches improved in 7 of 8 patients after surgery. Two patients had complete resolution of a hormonal axis deficit, whereas 3 patients developed new anterior pituitary axis deficits. Two patients developed persistent diabetes insipidus after surgery. CONCLUSION RCCs are an infrequent cause of symptoms in pediatric patients. The transsphenoidal approach offers an effective means of achieving complete cyst drainage for lesions requiring surgery. Fenestration and aspiration of the cyst are usually sufficient to achieve total resolution of symptoms and signs caused by RCCs. Clinical symptoms such as headaches improved in the majority of patients, whereas hormonal disturbances typically persisted. Patient selection remains of paramount importance when considering surgery for pediatric patients with RCCs.

INDEX OF CEREBROSPINAL COMPENSATORY RESERVE IN HYDROCEPHALUS

Neurosurgery ◽  
2009 ◽  
Vol 64 (3) ◽  
pp. 494-502 ◽  
Author(s):  
Dong-Joo Kim ◽  
Zofia Czosnyka ◽  
Nicole Keong ◽  
Danila K. Radolovich ◽  
Peter Smielewski ◽  
...  
Keyword(s):  
Intracranial Pressure ◽  
Pulse Amplitude ◽  
Normal Pressure ◽  
Csf Shunt ◽  
Intracranial Volume ◽  
Pressure Waveform ◽  
Compensatory Reserve ◽  
Resistance To Csf Outflow ◽  
Noncommunicating Hydrocephalus ◽  
The Mean

Abstract OBJECTIVE An index of cerebrospinal compensatory reserve (RAP) has been introduced as a potential descriptor of neurological deterioration after head trauma. It is numerically computed as a linear correlation coefficient between the mean intracranial pressure and the pulse amplitude of the pressure waveform. We explore how RAP varies with different forms of physiological or nonphysiological intracranial volume loads in adult hydrocephalus, with and without a functioning cerebrospinal fluid (CSF) shunt. METHODS A database of intracranial pressure recordings during CSF infusion studies and overnight monitoring in hydrocephalic patients was reviewed for clinical comparison of homogeneous subgroups of patients with hypothetical differences of pressure-volume compensatory reserve. The database includes 980 patients of mixed etiology: idiopathic normal pressure hydrocephalus (NPH), 47%; postsubarachnoid hemorrhage NPH, 12%; noncommunicating hydrocephalus, 22%; others, 19%. All CSF compensatory parameters were calculated by using intracranial pressure waveforms. RESULTS In NPH, RAP correlated strongly with the resistance to CSF outflow (rs = 0.35; P = 0.045), but weakly correlated with ventriculomegaly (rs = 0.13; P = 0.41). In idiopathic nonshunted NPH patients, RAP did not correlate significantly with elasticity calculated from the CSF infusion test (rs = 0.11; P = 0.21). During infusion studies, RAP increased in comparison to values recorded at baseline (from a median of 0.45–0.86, P = 0.14 * 10−8), indicating a narrowing of the volume-pressure compensatory reserve. During B-waves associated with the REM (rapid eye movement) phase of sleep, RAP increased from a median of 0.53 to 0.89; P = 1.2 * 10−5. After shunting, RAP decreased (median before shunting, 0.59; median after shunting, 0.34; P = 0.0001). RAP also showed the ability to reflect the functional state of the shunt (patent shunt median, 0.36; blocked shunt median, 0.84; P = 0.0002). CONCLUSION RAP appears to characterize pressure-volume compensatory reserve in patients with hydrocephalus.

scholarly journals Big and deep seated lipomatous tumours in children : results of surgical treatment

2021 ◽  
Vol 87 (2) ◽  
pp. 243-246
Author(s):  
Emin Özkul ◽  
Serhat Elçi ◽  
Muhsin Elçi ◽  
Celil Alemdar
Keyword(s):  
Surgical Treatment ◽  
Local Recurrence ◽  
Pediatric Patients ◽  
Adult Patients ◽  
Maximal Dimension ◽  
Median Size ◽  
Lower Complication ◽  
The Mean ◽  
Lipomatous Tumors

The objective of the study is aimed to evaluate results of our pediatric patients with big and deep-seated lipomatous tumors Results of 32 children who underwent resection for 5 cm or larger and deep-seated lipomas were evaluated. The mean age of the patients was 9.1 years (range, 0-16 ; 11 female/21 male), and median follow-up period was 3.21 years (range, 1-10 years). The median size of the excised tumour was 11 cm (range, 6-28 cm) in maximal dimension. Big lipomas in children can be treated with marginal resection procedures without biopsy with lower complication and local recurrence ratio compared to adult patients with similar tumours in similar size and location.

scholarly journals Intracranial pressure monitoring in pediatric and adult patients with hydrocephalus and tentative shunt failure: a single-center experience over 10 years in 146 patients

2015 ◽  
Vol 122 (5) ◽  
pp. 1076-1086 ◽  
Author(s):  
Terje Sæhle ◽  
Per Kristian Eide
Keyword(s):  
Intracranial Pressure ◽  
Adult Patients ◽  
Shunt Revision ◽  
Shunt Failure ◽  
Icp Monitoring ◽  
Shunt Valve ◽  
Single Center Experience ◽  
Study Population ◽  
The Mean ◽  
A Minor

OBJECT In patients with hydrocephalus and shunts, lasting symptoms such as headache and dizziness may be indicative of shunt failure, which may necessitate shunt revision. In cases of doubt, the authors monitor intracranial pressure (ICP) to determine the presence of over- or underdrainage of CSF to tailor management. In this study, the authors reviewed their experience of ICP monitoring in shunt failure. The aims of the study were to identify the complications and impact of ICP monitoring, as well as to determine the mean ICP and characteristics of the cardiac-induced ICP waves in pediatric versus adult over- and underdrainage. METHODS The study population included all pediatric and adult patients with hydrocephalus and shunts undergoing diagnostic ICP monitoring for tentative shunt failure during the 10-year period from 2002 to 2011. The patients were allocated into 3 groups depending on how they were managed following ICP monitoring: no drainage failure, overdrainage, or underdrainage. While patients with no drainage failure were managed conservatively without further actions, over- or underdrainage cases were managed with shunt revision or shunt valve adjustment. The ICP and ICP wave scores were determined from the continuous ICP waveforms. RESULTS The study population included 71 pediatric and 75 adult patients. There were no major complications related to ICP monitoring, but 1 patient was treated for a postoperative superficial wound infection and another experienced a minor bleed at the tip of the ICP sensor. Following ICP monitoring, shunt revision was performed in 74 (51%) of 146 patients, while valve adjustment was conducted in 17 (12%) and conservative measures without any actions in 55 (38%). Overdrainage was characterized by a higher percentage of episodes with negative mean ICP less than −5 to −10 mm Hg. The ICP wave scores, in particular the mean ICP wave amplitude (MWA), best differentiated underdrainage. Neither mean ICP nor MWA levels showed any significant association with age. CONCLUSIONS In this cohort of pediatric and adult patients with hydrocephalus and tentative shunt failure, the risk of ICP monitoring was very low, and helped the authors avoid shunt revision in 49% of the patients. Mean ICP best differentiated overdrainage, which was characterized by a higher percentage of episodes with negative mean ICP less than −5 to −10 mm Hg. Underdrainage was best characterized by elevated MWA values, indicative of impaired intracranial compliance.

Assessment of the Results of Surgical Treatment of Zenker’S Diverticulum in Own Material

2015 ◽  
Vol 87 (3) ◽  
Author(s):  
Adam Bobkiewicz ◽  
Tomasz Banasiewicz ◽  
Łukasz Krokowicz ◽  
Andrzej Dryjas ◽  
Mateusz Wykrętowicz ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Hospital Stay ◽  
Clinical Symptoms ◽  
Perioperative Complications ◽  
Operating Time ◽  
Oral Intake ◽  
Length Of Hospital Stay ◽  
Endoscopic Techniques ◽  
Zenker Diverticulum ◽  
The Mean

AbstractZenker diverticulum (ZD) is the most common type of diverticula of the esophagus. Most often refers to men with a peak incidence in the seventh and eighth decade of life. In the majority diverticula remains asymptomatic and in patients with symptomatic course of the disease symptoms are often nonspecific.Aim of the study was to present the authors’ own experience in surgical treatment of Zenker diverticulum.Material and methods. In this paper we present an analysis of 31 patients with confirmed ZD treated surgically at the Clinic in 2004-2014. Patients were analyzed in terms of age, gender, clinical symptoms, diverticulum size, type of surgery, the time to return to the oral intake, hospital stay and perioperative complications.Results. 22 men and 9 women were enrolled it this study. The mean age of the patients was 64.8 (SD, 10.7; in the range of 28 to 82 years). 29 patients (93.5%) underwent resection of the diverticulum, while diverticulopexy was performed in two patients. In 25 (80.6%) cases stapler device was used, while in 4 (12.9%) resection was performed manually. The average size of resected diverticulum was 4.9 cm (SD, 1.5). Following the surgery in four patients (12.9%) complications were present. The average operating time was 118.7 minutes (SD, 42.2, in the range of 50 to 240 minutes). The mean length of hospital stay was 9.3 (SD, 3.3).Conclusions. Surgical treatment of ZD is associated with high effectiveness and low recurrence rate. Despite the advantages of endoscopic techniques, surgical treatment is characterized by one- stage procedure. The use of mechanical suture (stapler) significantly improves the operation, although on the basis of our own analysis there was no superiority revealed over hand sewn. Unquestionable adventage of classical technique is the opportunity to histopathological evaluation of resected diverticulum what is impossible to achieve in endoscopic techniques.

scholarly journals Big and deep seated lipomatous tumours in children : results of surgical treatment

2021 ◽  
Vol 87 (1) ◽  
pp. 197-200
Author(s):  
Emin Özkul ◽  
Serhat Elçi ◽  
Muhsin Elçi ◽  
Celil Alemdar
Keyword(s):  
Surgical Treatment ◽  
Local Recurrence ◽  
Pediatric Patients ◽  
Adult Patients ◽  
Maximal Dimension ◽  
Median Size ◽  
Lower Complication ◽  
The Mean ◽  
Lipomatous Tumors

The objective of the study is aimed to evaluate results of our pediatric patients with big and deep-seated lipomatous tumors Results of 32 children who underwent resection for 5 cm or larger and deep-seated lipomas were evaluated. The mean age of the patients was 9.1 years (range, 0-16 ; 11 female/21 male), and median follow-up period was 3.21 years (range, 1-10 years). The median size of the excised tumour was 11 cm (range, 6-28 cm) in maximal dimension. Big lipomas in children can be treated with marginal resection procedures without biopsy with lower complication and local recurrence ratio compared to adult patients with similar tumours in similar size and location.

scholarly journals NEUROGENIC SPINAL DEFORMITIES IN ADULTS: MODERN PROBLEMS AND APPROACHES TO TREATMENT

2018 ◽  
Vol 15 (3) ◽  
pp. 39-51
Author(s):  
O. G. Prudnikova ◽  
A. O. Gushcha ◽  
I. N. Shatina
Keyword(s):  
Surgical Treatment ◽  
Multidisciplinary Approach ◽  
Clinical Symptoms ◽  
Clinical Manifestations ◽  
Adult Patients ◽  
High Rate ◽  
Spinal Deformities ◽  
Non Invasive ◽  
Definition Of ◽  
Invasive Techniques

Objective.To present the features of clinical manifestations, diagnostic aspects and approaches to the treatment of neurogenic deformi- ties of the spine in adults based on the literature data.Material and Methods.The literature review was performed using PubMed, Medline, Web of Science, Scopus, CrossRef, AOSpine, Clini- cal Key, eLibrary databases and references of key articles published in the period from 06.02.2017 till 04.11.2017.Results.General trends in the treatment of adult patients with neurogenic deformities of the spine have been determined. Assessment of the risk from performing an intervention, taking into account possible complications and potential outcome, determines the approach to surgery in these patients. It is necessary to develop protocols of management with the definition of the main clinical symptoms, the ratio- nale for the use of non-invasive, minimally invasive or other options for care. Surgical treatment of patients with spinal deformities asso- ciated with neurodegenerative diseases (Parkinson’s disease) is accompanied by a high rate of complications and repeated interventions. Tactical algorithms for these patients should include the consistency of non-surgical and mini-invasive techniques and considering clinical manifestations of myopathy, mielo-, radiculopathy, which, in comparison with diagnostic tests, can determine the indications and volume of decompressive interventions, and the extent and levels of spinal fixation.Conclusion.The complexity of pathogenetic mechanisms and ambiguous results of non-surgical and surgical treatment determine the need for multidisciplinary approach and the development of protocols for the management of adult patients with neurogenic deformities of the spine. 

Scrub typhus (Orientia tsutsugamushi), A rapidly spreading epidemic in Chennai - A standalone lab experience

2016 ◽  
Vol 5 (09) ◽  
pp. 4896
Author(s):  
Sripriya C.S.* ◽  
Shanthi B. ◽  
Arockia Doss S. ◽  
Antonie Raj I. ◽  
Mohana Priya
Keyword(s):  
Scrub Typhus ◽  
Clinical Symptoms ◽  
Clinical Manifestations ◽  
Febrile Illness ◽  
Orientia Tsutsugamushi ◽  
The Past ◽  
Igm Elisa ◽  
The Mean ◽  
Specific Symptoms ◽  
Symptoms And Signs

Scrub typhus (Orientia tsutsugamushi), is a strict intracellular bacterium which is reported to be a recent threat to parts of southern India. There is re-emergence of scrub typhus during the past few years in Chennai. Scrub typhus is an acute febrile illness which generally causes non-specific symptoms and signs. The clinical manifestations of this disease range from sub-clinical disease to organ failure to fatal disease. This study documents our laboratory experience in diagnosis of scrub typhus in patients with fever and suspected clinical symptoms of scrub typhus infection for a period of two years from April 2014 to April 2016 using immunochromatography and IgM ELISA methods. The study was conducted on 648 patients out of whom 188 patients were found to be positive for scrub typhus. Results also showed that pediatric (0 -12 years) and young adults (20 – 39 years) were more exposed to scrub typhus infection and female patients were more infected compared to male. The study also showed that the rate of infection was higher between September to February which also suggested that the infection rate is proportional to the climatic condition. Statistical analysis showed that the mean age of the patients in this study was 37.6, standard deviation was 18.97, CV % was 50.45. 

scholarly journals Intracranial Pressure during External Ventricular Drainage Weaning Is an Outcome Predictor of Traumatic Brain Injury

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Jia-cheng Gu ◽  
Hong Wu ◽  
Xing-zhao Chen ◽  
Jun-feng Feng ◽  
Guo-yi Gao ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Intracranial Pressure ◽  
External Ventricular Drainage ◽  
Unfavorable Outcome ◽  
Ventricular Drainage ◽  
Outcome Group ◽  
Significant Difference ◽  
The Mean ◽  
The Relationship

External ventricular drainage (EVD) is widely used in patients with a traumatic brain injury (TBI). However, the EVD weaning trial protocol varies and insufficient studies focus on the intracranial pressure (ICP) during the weaning trial. We aimed to establish the relationship between ICP during an EVD weaning trial and the outcomes of TBI. We enrolled 37 patients with a TBI with an EVD from July 2018 to September 2019. Among them, 26 were allocated to the favorable outcome group and 11 to the unfavorable outcome group (death, post-traumatic hydrocephalus, persistent vegetative state, and severe disability). Groups were well matched for sex, pupil reactivity, admission Glasgow Coma Scale score, Marshall computed tomography score, modified Fisher score, intraventricular hemorrhage, EVD days, cerebrospinal fluid output before the weaning trial, and the complications. Before and during the weaning trial, we recorded the ICP at 1-hour intervals to calculate the mean ICP, delta ICP, and ICP burden, which was defined as the area under the ICP curve. There were significant between-group differences in the age, surgery types, and intensive care unit days (p=0.045, p=0.028, and p=0.004, respectively). During the weaning trial, 28 (75.7%) patients had an increased ICP. Although there was no significant difference in the mean ICP before and during the weaning trial, the delta ICP was higher in the unfavorable outcome group (p=0.001). Moreover, patients who experienced death and hydrocephalus had a higher ICP burden, which was above 20 mmHg (p=0.016). Receiver operating characteristic analyses demonstrated the predictive ability of these variables (area under the curve AUC=0.818 [p=0.002] for delta ICP and AUC=0.758 [p=0.038] for ICP burden>20 mmHg). ICP elevation is common during EVD weaning trials in patients with TBI. ICP-related parameters, including delta ICP and ICP burden, are significant outcome predictors. There is a need for larger prospective studies to further explore the relationship between ICP during EVD weaning trials and TBI outcomes.

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