scholarly journals CSF Upward Motion Is Crucial for ETV Success

2022 ◽  
Author(s):  
Hans Ludwig ◽  
Steffi Dreha-Kulaczewski ◽  
Christoph Bock
Keyword(s):  
Educational Status ◽  
Aqueductal Stenosis ◽  
Outcome Evaluation ◽  
Success Rates ◽  
Csf Flow ◽  
Shunt Insertion ◽  
Postoperative Mri ◽  
3Rd Ventricle ◽  
Flow Void ◽  
A Prospective Study

Purpose: ETV is indicated for treating obstructions of major CSF pathways. The outcome evaluation often yields success rates of only +- 70% for shunt independency. Hence, compromised CSF absorption seems to occur more often than expected. We searched for parameters suitable to assess the involved CSF dynamics. Material and Methods: This was a prospective study in 58 paediatric patients (7.7 yrs. mean age) between 2000 and 2020 with aqueductal stenosis (11/58), obstruction of the aqueduct due to tumor growth (22/58),and connatal hydrocephalus (9/58). The average follow-up interval was 4.7 years. Head circumferences, Evans- and fronto-occipital horn ratios before and 3 months after ETV were obtained as Delta-indices. Furthermore ETV success score (ETVSS), the patency of the aqueduct pre- and postoperatively as well as of the stoma were assessed by flow void signs on MRI. Evaluation on MRI also included the shape of the floor of the 3rd ventricle and whether or not the septum pellucidum showed signs of perforation. Four patients were analysed pre- and postoperatively via real-time MRI. At least the educational status regarding protected or unprotected education was analyzed. Results:The prevalence of a bowing of the floor of the 3rd ventricle was 72%, and the ETVSS was 71.0%. In 26 children a septal perforations or an open aqueduct prior to ETV (19) could be identified. Mean ER and FOHR were reduced by 0.03 and 0.05 , respectively. Maintained open (flow void on postop MRI) or perforation could successfully be carried out during endoscopic surgery in 44 patients (79%). The disproportionate increase of head circumference abated in 79.4% of patients. New shunt insertion occurred in 16 patients (27.5%). Intraoperatively upward CSF flow was detected in all cases. Statistical analyses(ANOVA) showed significant results for unprotected education, postoperative ER and FOHR but not for open stoma. Conclusion: The identification of flow through the stoma on postoperative MRI seems to be a necessary but not sufficient condition for ETV success. In our study, ventricular volumes were used as parameters to determine success rates as well as unprotected education. Furthermore, enabling upward CSF flow driven by inspiration seems crucial for successful ETV.

Clinical manifestations of aqueductal stenosis in adults

1975 ◽  
Vol 43 (5) ◽  
pp. 546-552 ◽  
Author(s):  
John R. Little ◽  
O. Wayne Houser ◽  
Collin S. MacCarty
Keyword(s):  
Clinical Manifestations ◽  
Aqueductal Stenosis ◽  
Anterior Wall ◽  
Clinical Findings ◽  
Increased Intracranial Pressure ◽  
Shunt Insertion ◽  
Duration Of Symptoms ◽  
Content Type ◽  
X Ray ◽  
Angiographic Findings

✓ The authors review 17 cases of aqueductal stenosis in adults and describe five modes of clinical presentation. The average duration of symptoms was 6 years. Dementia was infrequent. Skull x-ray films frequently demonstrated some degree of cranial enlargement and signs of chronic increased intracranial pressure. Characteristic alterations of the sella included elongation of the anterior wall and flattening, erosion, and anterior displacement of the dorsum. Aqueductal configurations as defined by ventriculography and pneumoencephalography in all cases, and the angiographic findings in seven cases are described. Most of the patients improved substantially after shunt insertion. The clinical findings suggested that aqueductal narrowing and associated hydrocephalus had been present in most of these patients since early life.

Analysis of aqueductal cerebrospinal fluid flow after endoscopic aqueductoplasty by using cine phase-contrast magnetic resonance imaging

2000 ◽  
Vol 93 (2) ◽  
pp. 237-244 ◽  
Author(s):  
Henry W. S. Schroeder ◽  
Christiane Schweim ◽  
Klaus H. Schweim ◽  
Michael R. Gaab
Keyword(s):  
Cerebrospinal Fluid ◽  
Magnetic Resonance ◽  
Mr Imaging ◽  
Healthy Volunteers ◽  
Phase Contrast ◽  
Aqueductal Stenosis ◽  
Csf Flow ◽  
Content Type ◽  
Endoscopic Aqueductoplasty ◽  
Fine Print

Object. The purpose of this prospective study was to evaluate aqueductal cerebrospinal fluid (CSF) flow after endoscopic aqueductoplasty. In all patients, preoperative magnetic resonance (MR) imaging revealed hydrocephalus caused by aqueductal stenosis and lack of aqueductal CSF flow.Methods. In 14 healthy volunteers and in eight patients with aqueductal stenosis who had undergone endoscopic aqueductoplasty, aqueductal CSF flow was investigated using cine cardiac-gated phase-contrast MR imaging. For qualitative evaluation of CSF flow, the authors used an in-plane phase-contrast sequence in the midsagittal plane. The MR images were displayed in a closed-loop cine format. Quantitative through-plane measurements were performed in the axial plane perpendicular to the aqueduct. Evaluation revealed no significant difference in aqueductal CSF flow between healthy volunteers and patients with regard to temporal parameters, CSF peak and mean velocities, mean flow, and stroke volume. All restored aqueducts have remained patent 7 to 31 months after surgery.Conclusions. Aqueductal CSF flow after endoscopic aqueductoplasty is similar to aqueductal CSF flow in healthy volunteers. The data indicate that endoscopic aqueductoplasty seems to restore physiological aqueductal CSF flow.

scholarly journals Neuroendoscopic surgery in children: an analysis of 200 consecutive procedures

2013 ◽  
Vol 71 (3) ◽  
pp. 165-170 ◽  
Author(s):  
Luciano Lopes Furlanetti ◽  
Marcelo Volpon Santos ◽  
Ricardo Santos de Oliveira
Keyword(s):  
Cerebrospinal Fluid ◽  
Success Rate ◽  
Aqueductal Stenosis ◽  
Success Rates ◽  
Surgical Experience ◽  
Csf Circulation ◽  
Neuroendoscopic Surgery ◽  
Successful Outcomes ◽  
One Year

ObjectiveNeuroendoscopic surgery in children has particular features and is associated with different success rates (SR). The aim of this study was to identify putative factors that could influence the outcome in pediatric patients.MethodsClinical data of 177 patients under 18 years of age submitted to 200 consecutive neuroendoscopic procedures from January 2000 to January 2010 were reviewed.ResultsThe overall success rate was 77%. Out of the patients with successful outcomes, 46% were under six months, 68% were between six months and one year of age, and 85% older than one year. Neuroendoscopic techniques provide very good results for a wide number of indications in children. Tumor-related cerebrospinal fluid (CSF) circulation problems and aqueductal stenosis seem to be particularly well suited to neuroendoscopic treatment regardless of the patient's age.ConclusionPatients' age and etiology of hydrocephalus were associated with a different outcome. In all cases, surgical experience is extremely important to reduce complications.

scholarly journals Does the presence of a trainee compromise success of biliary cannulation at ERCP?

2017 ◽  
Vol 05 (07) ◽  
pp. E559-E562 ◽  
Author(s):  
John Frost ◽  
Arun Kurup ◽  
Sharan Shetty ◽  
Neil Fisher
Keyword(s):  
Primary Outcome Measure ◽  
Success Rates ◽  
Serious Adverse Events ◽  
Biliary Cannulation ◽  
Exact Test ◽  
Cannulation Technique ◽  
Cannulation Success ◽  
A Prospective Study ◽  
Mean Time ◽  
Training Protocol

Abstract Background and study aims Findings in the literature are conflicting on whether trainee involvement in endoscopic retrograde cholangiopancreatography (ERCP) procedures is detrimental to cannulation success rates. We addressed this in a prospective study, where cannulation success with or without trainee presence was the primary outcome measure. Patients and methods We prospectively recorded data on 2 senior endoscopists and their trainees over an 18-month period for ERCPs in patients with a virgin ampulla. Presence or absence of a trainee at ERCP procedures was pragmatic, reflecting their other service or training commitments or annual leave. For trainee presence, the training protocol allowed them 6 minutes of supervised time in which to achieve biliary cannulation after reaching the ampulla. Study outcome measures included cannulation success, time to cannulation, technique, whether this was achieved independently by the trainee, and complications. Results There were 219 procedures recorded and analyzed (134 with a trainee, 85 without). Three trainees were involved. Selective biliary cannulation was achieved in 201 (92 %) of cases. When a trainee was present, cannulation was successful in 122/134 procedures (91 %), compared to 79/85 (93 %) with a senior endoscopist alone (P = 0.8, Fisher’s exact test). Mean time to biliary cannulation with a trainee present was 7 minutes, compared with 5 minutes with no trainee. Mean time for successful independent cannulation by the trainee was 4 minutes, and 9 minutes for a consultant following a trainee’s attempt. There were no serious adverse events. Conclusion Our study shows that with this training protocol, involvement of a trainee on a routine secondary care ERCP list does not impair biliary cannulation success, and does not prolong a subsequent attempt by the senior endoscopist if initially unsuccessful. These findings support the involvement of trainees in routine ERCP lists with this training protocol.

Ventricular shunt tap as a predictor of proximal shunt malfunction in children: a prospective study

2008 ◽  
Vol 1 (6) ◽  
pp. 439-443 ◽  
Author(s):  
Brandon G. Rocque ◽  
Samir Lapsiwala ◽  
Bermans J. Iskandar
Keyword(s):  
Prospective Study ◽  
Clinical Judgment ◽  
Shunt Malfunction ◽  
Csf Shunt ◽  
Consecutive Series ◽  
Csf Flow ◽  
Opening Pressure ◽  
Distal Obstruction ◽  
A Prospective Study ◽  
Good Flow

Object The clinical diagnosis of cerebrospinal fluid (CSF) shunt malfunction can be challenging. In this prospective study, the authors evaluated a common method of interrogating shunts: the shunt tap; specifically, its ability to predict proximal malfunction. Methods The authors performed standardized shunt taps in a consecutive series of cases involving children with suspected or proven shunt malfunction, assessing flow and, when possible, opening pressure. Data were collected prospectively, and results analyzed in light of surgical findings. Results A shunt tap was performed prior to 68 operative explorations in 51 patients. Of the 68 taps, 28 yielded poor or no CSF flow on aspiration. After 26 of these 28 procedures, proximal catheter obstruction was identified. After 28 taps with good CSF return and normal or low opening pressure, 18 shunts were found to have a proximal obstruction, 8 had no obstruction, and 2 had a distal obstruction. Another 12 taps with good CSF flow had high opening pressure; subsequent surgery showed distal obstruction in 11 of the shunts, and proximal obstruction in 1. The positive predictive value of poor flow was 93%, while good flow on shunt tap predicted adequate proximal catheter function in only 55% of cases. Conclusions Poor flow of CSF on shunt tap is highly predictive of obstruction of the proximal catheter. Because not all patients with good flow on shunt tap underwent surgical shunt exploration, the specificity of this test cannot be determined. Nonetheless, a shunt tap that reveals good flow with a normal opening pressure can be misleading, and management of such cases should be based on clinical judgment.

Cine-MR Imaging of Aqueductal CSF Flow in Normal Pressure Hydrocephalus Syndrome before and after CSF Shunt

1993 ◽  
Vol 34 (6) ◽  
pp. 586-592 ◽  
Author(s):  
M. Mascalchi ◽  
G. Arnetoli ◽  
D. Inzitari ◽  
G. Dal Pozzo ◽  
F. Lolli ◽  
...  
Keyword(s):  
Normal Pressure Hydrocephalus ◽  
Normal Pressure ◽  
Csf Shunt ◽  
Communicating Hydrocephalus ◽  
Csf Flow ◽  
Cine Mr ◽  
Csf Shunting ◽  
Before And After ◽  
Flow Void ◽  
Central Flow

Reproducibility of the aqueductal CSF signal intensity on a gradient echo cine-MR sequence exploiting through plane inflow enhancement was tested in 11 patients with normal or dilated ventricles. Seven patients with normal pressure hydrocephalus (NPH) syndrome were investigated with the sequence before and after CSF shunting. Two patients exhibiting central flow void within a hyperintense aqueductal CSF improved after surgery and the flow void disappeared after shunting. One patient with increased maximum and minimum aqueductal CSF signal as compared to 18 healthy controls also improved and the aqueductal CSF signal was considerably decreased after shunting. Three patients with aqueductal CSF values similar to those in the controls did not improve, notwithstanding their maximum aqueductal CSF signals decreasing slightly after shunting. No appreciable aqueductal CSF flow related enhancement consistent with non-communicating hydrocephalus was found in the last NPH patient who improved after surgery. Cine-MR with inflow technique yields a reproducible evaluation of flow-related aqueductal CSF signal changes which might help in identifying shunt responsive NPH patients. These are likely to be those with hyperdynamic aqueductal CSF or aqueductal obstruction.

Phase-Contrast Cine Mr Imaging of Normal Aqueductal CSF Flow

1994 ◽  
Vol 35 (2) ◽  
pp. 123-130 ◽  
Author(s):  
F. Barkhof ◽  
M. Kouwenhoven ◽  
P. Scheltens ◽  
M. Sprenger ◽  
P. Algra ◽  
...  
Keyword(s):  
Mr Imaging ◽  
Phase Contrast ◽  
Volume Averaging ◽  
Cortical Atrophy ◽  
Csf Flow ◽  
Caudal Direction ◽  
Cine Mr ◽  
Flow Void ◽  
Phantom Studies ◽  
Cine Phase Contrast

Cine phase-contrast MR imaging was used to study pulsatile CSF flow in the aqueduct in 11 young controls (mean age 30 years) and 9 old controls (mean age 69 years). A high-resolution gradient echo technique and an oblique imaging plane, perpendicular to the aqueduct, was used to avoid volume averaging. Phantom studies confirmed that the technique was accurate. Aqueductal velocity and flux in old controls was higher than in young controls, but the differences were not significant. For all controls together, the averaged peak velocity was 4.2 ± 1.5 cm/s in rostral and −7.8 ± 4.9 cm/s in caudal direction; for the flux it was 0.16 ± 0.10 cm3/s in rostral and −0.29 ± 0.19 cm3/s in caudal direction. Phase-contrast measurements were significantly related to flow-void on modulus MR images, but not with ventricular size or cortical atrophy. The present technique avoids underestimation of aqueductal flow, and therefore reveals higher aqueductal velocity and flux values than previous studies. Factors other than age or atrophy seem to determine aqueductal CSF flow.

scholarly journals Weight Drives Caspofungin Pharmacokinetic Variability in Overweight and Obese People: Fractal Power Signatures beyond Two-Thirds or Three-Fourths

2013 ◽  
Vol 57 (5) ◽  
pp. 2259-2264 ◽  
Author(s):  
Ronald G. Hall ◽  
Mark A. Swancutt ◽  
Claudia Meek ◽  
Richard Leff ◽  
Tawanda Gumbo
Keyword(s):  
Power Law ◽  
Clinical Success ◽  
Dose Optimization ◽  
Peripheral Compartment ◽  
Success Rates ◽  
Pharmacokinetic Variability ◽  
Obese People ◽  
Drug Concentrations ◽  
Registration Number ◽  
A Prospective Study

ABSTRACTEchinocandins, such as caspofungin, are commonly used to treat candidemia and aspergilllosis. Success rates for candidemia treatment are approximately 70%. Dose optimization may further help improve these success rates, given that the microbial effect of these agents is concentration dependent. There are conflicting data as regards the effect of weight and/or obesity on caspofungin drug concentrations. We designed a prospective study to evaluate the population pharmacokinetics of caspofungin in adults with a weight difference range of 100 kg. Caspofungin pharmacokinetics were best described using a two-compartment pharmacokinetic model. There were 18 subjects studied, of whom half were women. The central volume was typically 4.2 liters but increased by a factor of (weight/53.6)3/4. The peripheral compartment volume was typically 2.53 liters but increased by a factor of (weight/53.6)3/2, an unusual power law signature. Similarly, the 3/4 power law best described the relationship between weight and systemic clearance for persons weighing >66.3 kg, whereas intercompartmental clearance was best described by the 3/2 power signature. There are two implications of our findings. First, lower caspofungin area-under-the-concentration-time curves are achieved in obese persons than thinner ones. This suggests that dose optimization in heavier patients may improve clinical success rates. Second, the 3/2 exponent is unusual in fractal geometry-based scaling and warrants further study. Moreover, this suggests that use of a “floating” instead of a fixed exponent may be more useful in studies where weight is under investigation as a potential cause of pharmacokinetic variability within adult patients. (This study protocol was registered atwww.clinicaltrials.govunder registration number NCT01062165.)

Visualization of CSF Flow with Time-resolved 3D MR Velocity Mapping in Aqueductal Stenosis Before and After Endoscopic Third Ventriculostomy

2016 ◽  
Vol 28 (1) ◽  
pp. 69-74 ◽  
Author(s):  
Sebastian Brandner ◽  
Michael Buchfelder ◽  
Ilker Y. Eyuepoglu ◽  
Hannes Luecking ◽  
Arnd Doerfler ◽  
...  
Keyword(s):  
Endoscopic Third Ventriculostomy ◽  
Aqueductal Stenosis ◽  
Third Ventriculostomy ◽  
Csf Flow ◽  
Velocity Mapping ◽  
Time Resolved ◽  
Before And After

scholarly journals A Prospective Study of Profile of Agricultural Orthopaedic Injuries in North India in a Tertiary Care Centre

2021 ◽  
Vol 9 (3) ◽  
pp. 172-180
Author(s):  
Dr. Roop Singh ◽  
◽  
Dr. Kunal Arora ◽  
Dr. Hemant More ◽  
Dr. Kiranpreet Kaur ◽  
...  
Keyword(s):  
Prospective Study ◽  
Tertiary Care ◽  
Educational Status ◽  
North India ◽  
Body Parts ◽  
Male Victims ◽  
Tertiary Care Centre ◽  
Skill Levels ◽  
Agricultural Injuries ◽  
A Prospective Study

Background: Over time agriculture has transformed into an industry, both in scale andmechanization. Growing demand for agricultural yield and increasing mechanization has led togrowth in the numbers of agricultural accidents and injuries causing significant morbidity andeconomical loss. Aim: To study the causes, patterns, outcomes of injuries due to agriculturalaccidents, their effect on the productivity of the victims, and to suggest possible remedial measures,a prospective study was undertaken. Methods: A total of 106 patients reporting agricultural injuries(AI) over 14 months in 2019-20 were enrolled and data was recorded on a pre-structured proforma.Results: With the preponderance of male victims, educational status, skill levels, lighting & climaticconditions, intoxication and fatigue were found to be major determinants in the causation of injurieswith upper limbs being the predominantly involved part (75.47%) and most of the cases ended uprequiring some form of surgery (88.68%). Agricultural machinery (56.60%) was the main cause ofAI and Chaff Cutter Machine caused the maximum AI (37.73%). Amputations were the mostcommon injuries sustained (47.16%). Agricultural injuries affected the range of motion of body parts(32.07%) and work (58.49%) & household activities (49.05%); thus impairing work efficiency andeconomy. Conclusion: The present study highlights the need for a robust surveillance and dataanalysis leading to better design of farming machinery and equipment, more relevant education andtraining systems, stronger legislations as well as a comprehensive rehabilitative program aimed atreducing the socio-economic burden caused by agricultural injuries.

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