Management of hydrocephalus secondary to posterior fossa tumors

1977 ◽  
Vol 46 (1) ◽  
pp. 52-55 ◽  
Author(s):  
Leland Albright ◽  
Donald H. Reigel
Keyword(s):  
Posterior Fossa ◽  
External Ventricular Drainage ◽  
Csf Shunt ◽  
Safe Procedure ◽  
Tumor Removal ◽  
Posterior Fossa Tumors ◽  
Csf Shunts ◽  
Content Type ◽  
Suboccipital Craniectomy ◽  
Methods Of Treatment

✓ The records of children with hydrocephalus secondary to posterior fossa tumors were reviewed and the methods of treatment compared with their subsequent clinical course. Of 86 patients evaluated, 47 had no treatment for hydrocephalus prior to tumor removal, 12 had external ventricular drainage, and 27 had cerebrospinal fluid (CSF) shunts before suboccipital craniectomy. Children with CSF shunts before tumor removal had significantly better postoperative conditions than the children without shunts (p < 0.01). Operative mortality of children without treatment of hydrocephalus before tumor surgery was 12.8%; it was 3.7% in the children with preexisting shunts. Treatment of hydrocephalus with a CSF shunt prior to suboccipital craniectomy was a safe procedure that significantly lowered the morbidity and mortality of subsequent tumor removal.

Results of surgical treatment of neurocysticercosis in 69 cases

1986 ◽  
Vol 65 (3) ◽  
pp. 309-315 ◽  
Author(s):  
Benedicto Oscar Colli ◽  
Nelson Martelli ◽  
João Alberto Assirati ◽  
Hélio Rubens Machado ◽  
Sylvio de Vergueiro Forjaz
Keyword(s):  
Posterior Fossa ◽  
Complement Fixation Test ◽  
Shunt Infection ◽  
Shunt Revision ◽  
Csf Shunt ◽  
Increased Intracranial Pressure ◽  
Csf Shunts ◽  
Content Type ◽  
Cerebral Parenchyma

✓ The clinical course of 69 patients with neurocysticercosis who underwent surgery to control increased intracranial pressure (ICP) or cyst removal is analyzed. Increased ICP was caused by hydrocephalus in 63 patients, by cerebral edema in four, and by giant cysts in two. Skull x-ray films showed calcifications in 14% and signs of elevated ICP in 46%. Examination of cerebrospinal fluid (CSF) revealed pleocytosis with eosinophils in 52% of cases and a positive complement fixation test for cysticercosis in 66%. Ventriculography allowed localization of the CSF obstruction and ventricular cysts, and generally differentiated between an obstruction due to cysts and an inflammatory process. Computerized tomography showed cysts in the cerebral parenchyma and ventricular dilatation. Ventricular cysts were best seen when intraventricular metrizamide was used. Intracranial shunting and posterior fossa exploration were less effective in the treatment of hydrocephalus than was ventriculoatrial (VA) or ventriculoperitoneal (VP) shunting, although VA or VP shunting was associated with a high percentage of complications. Quality of survival was good in 87% of the cases in the first 3 postoperative months and in 93% of patients who survived 2 years after surgery. Fortyseven patients (68%) were readmitted one or more times for CSF shunt revision; 14 of them for shunt infection (meningitis). The early operative mortality rate was 1.8% for patients with VA or VP shunt placement and 5.3% for those with posterior fossa exploration. The authors conclude that placement of CSF shunts is indicated in the treatment of hydrocephalus, and cyst removal is indicated only when the cyst exhibits tumor-like behavior. Surgical exploration is also indicated when the diagnosis is uncertain.

Surgical procedures for posterior fossa tumors in children: does craniotomy lead to fewer complications than craniectomy?

2002 ◽  
Vol 97 (4) ◽  
pp. 821-826 ◽  
Author(s):  
Kanna K. Gnanalingham ◽  
Jesus Lafuente ◽  
Dominic Thompson ◽  
William Harkness ◽  
Richard Hayward
Keyword(s):  
Hospital Stay ◽  
Posterior Fossa ◽  
Wound Infections ◽  
Posterior Fossa Tumors ◽  
Content Type ◽  
Suboccipital Craniectomy ◽  
Significant Difference ◽  
Csf Leakage ◽  
Fine Print ◽  
Csf Leaks

Object. Traditionally, access to the posterior fossa involved a suboccipital craniectomy. More recently, posterior fossa craniotomies have been described, although the long-term benefits of this procedure are not clear. The authors compared the postoperative complications of craniectomies and craniotomies in children with posterior fossa tumors. Methods. From a total of 110 children undergoing surgery for posterior fossa tumors, 56 underwent craniectomy and 54 had a craniotomy. The mean duration of the hospital stay was longer in the craniectomy group (17.5 compared with 14 days). At operation, similar numbers of patients in both groups had total macroscopic clearance of the tumor, complete dural closure, and duraplasty. Postoperatively, more patients in the craniectomy group were noted to have cerebrospinal fluid (CSF) leakage (27 compared with 4%; p < 0.01) and pseudomeningoceles (23 compared with 9%; p < 0.05). There was no significant difference between the two groups in the numbers of patients with CSF infections, wound infections, or hydrocephalus requiring permanent CSF drainage. Patients with CSF leaks had a longer duration of hospital stay (20.7 compared with 14.9 days; p < 0.01), and were more likely to have CSF infections (35 compared with 12%; p < 0.01) and wound infections (24 compared with 1%; p < 0.01) than patients without CSF leaks. Postoperatively, wound exploration and reclosures for CSF leakage were more likely in the craniectomy group (11 compared with 0%; p < 0.01). Multivariate analysis revealed that the only predictor of CSF leakage postoperatively was the type of surgery (that is, craniotomy compared with craniectomy; odds ratio 10.8; p = 0.03). Conclusions. Craniectomy was associated with postoperative CSF leaks, pseudomeningocele, increased wound reclosures, and thus prolonged hospital stays. In turn, CSF leakage was associated with infections of the CSF and wound. The authors propose mechanisms that may explain why CSF leakage is less likely if the bone flap is replaced.

External Ventricular Drainage in the Management of Posterior Fossa Tumors in Children and Adolescents

Neurosurgery ◽  
1982 ◽  
Vol 10 (1) ◽  
pp. 13-15 ◽  
Author(s):  
I. Papo ◽  
G. Caruselli ◽  
A. Luongo
Keyword(s):  
Children And Adolescents ◽  
Posterior Fossa ◽  
External Ventricular Drainage ◽  
Ventricular Drainage ◽  
Total Removal ◽  
Posterior Fossa Tumors ◽  
Postoperative Course ◽  
Csf Shunting ◽  
Before And After ◽  
Overall Mortality

Abstract External ventricular drainage (EVD) was used before and after posterior fossa operations in 62 children and adolescents. In all cases, the removal of the tumor (midline in 47 and lateral in 15) was attempted: total removal was achieved in 41. The overall mortality was 6.5% (4 patients). Only 25% of the survivors needed permanent cerebrospinal fluid (CSF) shunting. EVD seems, therefore, to be effective in controlling preoperative intracranial hypertension and in securing a smooth postoperative course. Preoperative CSF shunting seems to be necessary or advisable only in particular circum- stances.

Long-term outcome after operation for trigeminal neuralgia in patients with posterior fossa tumors

1996 ◽  
Vol 84 (5) ◽  
pp. 818-825 ◽  
Author(s):  
Fred G. Barker ◽  
Peter J. Jannetta ◽  
Ramesh P. Babu ◽  
Spiros Pomonis ◽  
David J. Bissonette ◽  
...  
Keyword(s):  
Trigeminal Neuralgia ◽  
Posterior Fossa ◽  
Trigeminal Nerve ◽  
Posterior Fossa Tumors ◽  
Duration Of Symptoms ◽  
Long Term Outcome ◽  
Entry Zone ◽  
Content Type ◽  
Root Entry Zone ◽  
Fine Print

✓ During a 20-year period, 26 patients with typical symptoms of trigeminal neuralgia were found to have posterior fossa tumors at operation. These cases included 14 meningiomas, eight acoustic neurinomas, two epidermoid tumors, one angiolipoma, and one ependymoma. The median patient age was 60 years and 69% of the patients were women. Sixty-five percent of the symptoms were left sided. The median preoperative duration of symptoms was 5 years. The distribution of pain among the three divisions of the trigeminal nerve was similar to that found in patients with trigeminal neuralgia who did not have tumors; however, more divisions tended to be involved in the tumor patients. The mean postoperative follow-up period was 9 years. At operation, the root entry zone of the trigeminal nerve was examined for vascular cross-compression in 21 patients. Vessels compressing the nerve at the root entry zone were observed in all patients examined. Postoperative pain relief was frequent and long lasting. Using Kaplan—Meier methods the authors estimated excellent relief in 81% of the patients 10 years postoperatively, with partial relief in an additional 4%.

The pathophysiology of oral pharyngeal apraxia and mutism following posterior fossa tumor resection in children

1995 ◽  
Vol 83 (3) ◽  
pp. 467-475 ◽  
Author(s):  
Andrew T. Dailey ◽  
Guy M. McKhann ◽  
Mitchel S. Berger
Keyword(s):  
Posterior Fossa ◽  
Pediatric Patients ◽  
Tumor Resection ◽  
Posterior Fossa Tumor ◽  
Posterior Fossa Tumors ◽  
Lower Cranial Nerve ◽  
Content Type ◽  
Cranial Nerve Function ◽  
Pharyngeal Musculature ◽  
Fine Print

✓ Mutism following posterior fossa tumor resection in pediatric patients has been previously recognized, although its pathophysiology remains unclear. A review of the available literature reveals 33 individuals with this condition, with only a few adults documented in the population. All of these patients had large midline posterior fossa tumors. To better understand the incidence and anatomical substrate of this syndrome, the authors reviewed a 7-year series of 110 children who underwent a posterior fossa tumor resection. During that time, nine (8.2%) of the 110 children exhibited mutism postoperatively. They ranged from 2.5 to 20 years of age (mean 8.1 years) and became mute within 12 to 48 hours of surgery. The period of mutism lasted from 1.5 to 12 weeks after onset: all children had difficulty coordinating their oral pharyngeal musculature as manifested by postoperative drooling and inability to swallow. Further analysis of these cases revealed that all children had splitting of the entire inferior vermis at surgery, as confirmed on postoperative magnetic resonance studies. Lower cranial nerve function was intact in all nine patients. Current concepts of cerebellar physiology emphasize the importance of the cerebellum in learning and language. The syndrome described resembles a loss of learned activities, or an apraxia, of the oral and pharyngeal musculature. To avoid the apraxia, therefore, the inferior vermis must be preserved. For large midline tumors that extend to the aqueduct, a combined approach through the fourth ventricle and a midvermis split may be used to avoid injuring the inferior vermis.

Vancomycin and rifampin therapy for Staphylococcus epidermidis meningitis associated with CSF shunts

1981 ◽  
Vol 55 (4) ◽  
pp. 633-636 ◽  
Author(s):  
Myles E. Gombert ◽  
Sheldon H. Landesman ◽  
Michael L. Corrado ◽  
Sherman C. Stein ◽  
Ellen T. Melvin ◽  
...  
Keyword(s):  
Staphylococcus Epidermidis ◽  
Susceptibility Testing ◽  
Csf Shunt ◽  
Csf Shunts ◽  
Methicillin Resistant ◽  
Content Type ◽  
Favorable Clinical Response ◽  
Time Kill ◽  
Fine Print

✓ Three patients with Staphylococcus epidermidis meningitis associated with cerebrospinal fluid (CSF) shunt devices were treated with a combination of intravenous vancomycin and oral rifampin. Two of the isolates were methicillin-resistant. All patients had a favorable clinical response. Time-kill curves showed that the addition of rifampin to vancomycin resulted in enhanced bactericidal activity against all isolates when compared to either antibiotic alone. This finding suggests that the combination of oral rifampin and intravenous vancomycin may be useful in the treatment of methicillin-resistant and recalcitrant methicillin-sensitive S. epidermidis meningitis associated with CSF shunts. In vitro susceptibility testing should be performed.

Telemetric ICP monitoring after surgery for posterior fossa and third ventricular tumors

1984 ◽  
Vol 60 (3) ◽  
pp. 649-651 ◽  
Author(s):  
Paul H. Chapman ◽  
Eric Cosman ◽  
Michael Arnold
Keyword(s):  
Posterior Fossa ◽  
External Ventricular Drainage ◽  
Ventricular Catheter ◽  
Ventricular Drainage ◽  
Icp Monitoring ◽  
Pressure Monitoring ◽  
Content Type ◽  
Clinical Observations ◽  
Ventricular Tumors ◽  
Fine Print

✓ After surgery for posterior fossa or third ventricular tumors, hydrocephalus may persist or evolve. Proper management of this complication requires timely detection. Temporary external ventricular drainage has been suggested by some authors as an adjunct to clinical observations and radiographic studies for unshunted patients. As an alternative, the authors have used a telemetric method of pressure monitoring in association with a ventricular catheter and subcutaneous reservoir. This has been found useful in eight patients without the disadvantages inherent in other methods of management.

Brain scans of the posterior fossa

1972 ◽  
Vol 36 (2) ◽  
pp. 148-152 ◽  
Author(s):  
Robert A. Moody ◽  
John O. Olsen ◽  
Alexander Gottschalk ◽  
Paul B. Hoffer
Keyword(s):  
Parotid Gland ◽  
Posterior Fossa ◽  
Detection Rate ◽  
Posterior Fossa Tumors ◽  
Content Type ◽  
Brain Scans ◽  
Acoustic Neuromas ◽  
Fine Print

✓ The results of posterior fossa brain scanning in 37 patients with proven posterior fossa tumors were reviewed. Pertechnetate-99m was used as the scanning agent, and attention was paid to careful positioning of the patient. Perchlorate was used to block the parotid gland. The overall detection rate was 78%, particularly good results being obtained with meningiomas, ependymomas, juvenile astrocytomas, metastases, and acoustic neuromas, in that order.

scholarly journals Upward transtentorial herniation: A new role for endoscopic third ventriculostomy

2021 ◽  
Vol 12 ◽  
pp. 334
Author(s):  
Júlia Moscardini-Martelli ◽  
Juan Antonio Ponce-Gomez ◽  
Victor Alcocer-Barradas ◽  
Samuel Romano-Feinholz ◽  
Pilar Padilla-Quiroz ◽  
...  
Keyword(s):  
Endoscopic Third Ventriculostomy ◽  
Obstructive Hydrocephalus ◽  
External Ventricular Drainage ◽  
Hemorrhagic Transformation ◽  
Third Ventriculostomy ◽  
Safe Procedure ◽  
Cerebellar Stroke ◽  
Transtentorial Herniation ◽  
Suboccipital Craniectomy ◽  
Upward Herniation

Background: The placement of external ventricular drainage (EVD) to treat hydrocephalus secondary to a cerebellar stroke is controversial because it has been associated to upward transtentorial herniation (UTH). This case illustrates the effectiveness of endoscopic third ventriculostomy (ETV) after the ascending herniation has occurred. Case Description: A 50-year-old man had a cerebellar stroke with hemorrhagic transformation, tonsillar herniation, and non-communicating obstructive hydrocephalus. Considering that the patient was anticoagulated and thrombocytopenic, an EVD was placed initially, followed by clinical deterioration and UTH. We performed a suboccipital craniectomy immediately after clinical worsening, but the patient did not show clinical or radiological improvement. On the 5th day, we did an ETV, which reverses the upward herniation and hydrocephalus. The patient improved progressively with good neurological recovery. Conclusion: ETV is an effective and safe procedure for obstructive hydrocephalus. The successful resolution of the patient’s upward herniation after the ETV offers a potential option to treat UTH and advocates further research in this area.

Adult rhombencephalosynapsis

2000 ◽  
Vol 93 (2) ◽  
pp. 323-325 ◽  
Author(s):  
Lisa L. Guyot ◽  
Chris D. Kazmierczak ◽  
Daniel B. Michael
Keyword(s):  
Posterior Fossa ◽  
Symptomatic Relief ◽  
Cerebral Aqueduct ◽  
Intractable Pain ◽  
Local Pressure ◽  
Mr Image ◽  
Content Type ◽  
Cerebrospinal Fluid Flow ◽  
Suboccipital Craniectomy ◽  
Cine Mr

✓ Rhombencephalosynapsis (RS) is a relatively rare developmental disorder of the cerebellum in which the cerebellar hemispheres are fused across the midline without being separated by a cleft or the vermis. The condition may be associated with hydrocephalus and other intracranial and extracranial abnormalities. The authors report on the case of a symptomatic adult who was successfully treated with suboccipital decompression and duraplasty. A 39-year-old woman presented with intractable pain radiating from the thoracolumbar column to the occiput. A general examination yielded normal findings and a neurological examination revealed only subtle ataxia of tandem gait. The patient underwent magnetic resonance (MR) imaging, the results of which revealed an absent cerebellar vermis with fusion of the cerebellum and mild hydrocephalus. A cine-MR image obtained to evaluate her cerebrospinal fluid flow (CSF) revealed attenuated flow in the posterior fossa and cerebral aqueduct. Preoperative intracranial pressure (ICP) monitoring demonstrated no elevation of ICP (mean 4.3 mm Hg). The patient consented to undergo suboccipital craniectomy and duraplasty. Despite an increase in postoperative ICP (mean 10.77 mm Hg; difference from preoperative level according to a t-test, p = 0.002), the patient experienced symptomatic relief, which has persisted for 3 years. One year postoperatively, a cine-MR image was obtained, which revealed improvement in the patient's CSF dynamics. The authors conclude that, although RS may cause altered flow in the adult, their patient has experienced symptomatic relief, suggesting that her pain was related to local pressure in the posterior fossa.

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