scholarly journals Ruptured Suprasellar Dermoid Cyst Treated With Lumbar Drain to Prevent Postoperative Hydrocephalus: Case Report and Focused Review of Literature

2021 ◽  
Vol 8 ◽  
Author(s):  
Sarah E. Blitz ◽  
Joshua D. Bernstock ◽  
Adam A. Dmytriw ◽  
Daniel Francis Ditoro ◽  
Ari D. Kappel ◽  
...  
Keyword(s):  
Dermoid Cyst ◽  
Subarachnoid Space ◽  
Obstructive Hydrocephalus ◽  
External Ventricular Drain ◽  
Communicating Hydrocephalus ◽  
Lumbar Drain ◽  
Fat Particles ◽  
Subarachnoid Spaces ◽  
Postoperative Hydrocephalus ◽  
Chemical Meningitis

Background: Ruptured intracranial dermoid cysts are extremely rare. Standard treatment consists of endonasal decompression or craniotomy with evacuation and copious irrigation of subarachnoid spaces to remove any disseminated cystic contents. Disseminated fat particles in the subarachnoid space may be the cause of further sequalae, including the subsequent development of chemical meningitis and hydrocephalus. Here, we present a case of ruptured suprasellar dermoid cyst treated with craniotomy for emergent optic nerve decompression, followed by postoperative hydrocephalus successfully treated with lumbar drain.Case description: We describe a 30-year-old man with a history of migraines who presented with acute onset of headache, photophobia, nausea, vomiting, and vision loss in the left eye. Head CT and brain MRI demonstrated a ruptured suprasellar dermoid cyst with associated mass effect on the optic nerves and frontal lobes as well as fat attenuation material within the subarachnoid spaces. The patient underwent left frontotemporal craniotomy for cyst resection and developed non-obstructive hydrocephalus on postoperative day 1, refractory to external ventricular drainage. Placement of a lumbar drain cleared the subarachnoid space of debris derived from the ruptured dermoid cyst, and the hydrocephalus resolved. The patient did not require permanent CSF diversion.Conclusions: Intracranial dermoid cysts are uncommon, and rupture is a rare event. Standard surgical treatment with craniotomy for evacuation may leave disseminated dermoid contents and fat particles throughout the subarachnoid spaces. We highlight a case of ruptured suprasellar dermoid cyst with postoperative communicating hydrocephalus treated with lumbar drain when external ventricular drain (EVD) was ineffective. Review of the current literature reveals inconsistent findings on the effects of remaining fat particles. In cases with clinical evidence of increased intracranial pressure due to non-obstructive hydrocephalus attributable to chemical meningitis, temporary lumbar drainage is an option to be considered before committing the patient to permanent shunting.

Intraventricular fat from a ruptured sacral dermoid cyst: clinical, radiographic, and pathological correlation

1993 ◽  
Vol 78 (4) ◽  
pp. 666-668 ◽  
Author(s):  
Tim A. Scearce ◽  
Cheng-Mei Shaw ◽  
Andrew D. Bronstein ◽  
Phillip D. Swanson
Keyword(s):  
Dermoid Cyst ◽  
Subarachnoid Space ◽  
Unique Case ◽  
Content Type ◽  
Pathological Correlation ◽  
Subarachnoid Spaces ◽  
Fine Print

✓ The authors report a unique case of a dermoid cyst that ruptured into the lumbosacral subarachnoid space following trauma, resulting in dissemination of cyst contents into the ventricles and cerebrospinal subarachnoid spaces. An intraspinous source should be considered when intraventricular fat is identified without a clear intracranial source.

scholarly journals Endoscopic third ventriculostomy

2012 ◽  
Vol 03 (02) ◽  
pp. 163-173 ◽  
Author(s):  
Yad Ram Yadav ◽  
Vijay Parihar ◽  
Sonjjay Pande ◽  
Hemant Namdev ◽  
Moneet Agarwal
Keyword(s):  
Magnetic Resonance ◽  
Subarachnoid Space ◽  
Endoscopic Third Ventriculostomy ◽  
Obstructive Hydrocephalus ◽  
External Ventricular Drain ◽  
Third Ventriculostomy ◽  
Type I ◽  
Slit Ventricle Syndrome ◽  
Prepontine Cistern ◽  
Operative Care

ABSTRACTEndoscopic third ventriculostomy (ETV) is considered as a treatment of choice for obstructive hydrocephalus. It is indicated in hydrocephalus secondary to congenital aqueductal stenosis, posterior third ventricle tumor, cerebellar infarct, Dandy-Walker malformation, vein of Galen aneurism, syringomyelia with or without Chiari malformation type I, intraventricular hematoma, post infective, normal pressure hydrocephalus, myelomeningocele, multiloculated hydrocephalus, encephalocele, posterior fossa tumor and craniosynostosis. It is also indicated in block shunt or slit ventricle syndrome. Proper Pre-operative imaging for detailed assessment of the posterior communicating arteries distance from mid line, presence or absence of Liliequist membrane or other membranes, located in the prepontine cistern is useful. Measurement of lumbar elastance and resistance can predict patency of cranial subarachnoid space and complex hydrocephalus, which decides an ultimate outcome. Water jet dissection is an effective technique of ETV in thick floor. Ultrasonic contact probe can be useful in selected patients. Intraoperative ventriculo-stomography could help in confirming the adequacy of endoscopic procedure, thereby facilitating the need for shunt. Intraoperative observations of the patent aqueduct and prepontine cistern scarring are predictors of the risk of ETV failure. Such patients may be considered for shunt surgery. Magnetic resonance ventriculography and cine phase contrast magnetic resonance imaging are effective in assessing subarachnoid space and stoma patency after ETV. Proper case selection, post-operative care including monitoring of ICP and need for external ventricular drain, repeated lumbar puncture and CSF drainage, Ommaya reservoir in selected patients could help to increase success rate and reduce complications. Most of the complications develop in an early post–operative, but fatal complications can develop late which indicate an importance of long term follow up.

ENDOSCOPIC THIRD VENTRICULOSTOMY (ETV) IS A BETTER ALTERNATIVE FOR VP SHUNT FAILURE IN NON-COMMUNICATING HYDROCEPHALUS

2021 ◽  
pp. 65-67
Author(s):  
Ramesh Tanger ◽  
Dinesh Kumar Barolia ◽  
Arka Chatterjee ◽  
Punit Singh Parihar ◽  
Arun Gupta
Keyword(s):  
Success Rate ◽  
Endoscopic Third Ventriculostomy ◽  
Obstructive Hydrocephalus ◽  
Shunt Revision ◽  
Third Ventriculostomy ◽  
Communicating Hydrocephalus ◽  
Shunt Failure ◽  
Shunt Insertion ◽  
Vp Shunt

CONTEXT: VP Shunt is most commonly used procedure for hydrocephalus but shunt failure is also the common complication in many patients. Endoscopic third ventriculostomy (ETV) is an accepted procedure for the treatment of obstructive hydrocephalus. The aim of our study is to evaluate the success rate AIM AND OBJECTIVE - of ETV in patients of obstructive hydrocephalus formerly treated by ventriculo-peritoneal (VP shunt) shunt. The failure VP shunt was removed before ETV. MATERIALS AND METHOD: This study was conducted between June 2015 and December 2019 in single unit of our department. Twenty one (n=21) patients were enrolled for this study. All patients were admitted with failure of VP shunt. They were known case of non-communicating hydrocephalus previously operated for VP shunt. Six patients were excluded for ETV because CT/MRI show grossly distorted anatomy of ventricles. Endoscopic third ventriculostomy was attempted in 15 patients, but ventriculostomy was done successfully in 10 patients, rests were treated with revision of VP shunt. All patients in this study were radiologically diagnosed RESULTS: case of hydrocephalus due to aqueduct stenosis. They were experienced VP shunt insertion but there were failure of shunt due to any reason. ETV procedures were done successfully in 10 patients. Out of 10 patients one patient needed shunt insertion due ineffective ETV. Shunt revision was done in 11 patients. There was no serious complication during and after ETV procedures. The follow-up period of patients with successful ETV was 6–60 months. This follow-up was uneventful and peaceful for their parents. ETV can be considered as an alternative treatment for the patients w CONCLUSION: ith VP shunt failure with an acceptable success rate of 80%, although long-term follow-up is needed for these patients.

External Ventricular Drainage

2018 ◽  
pp. 165-172
Author(s):  
Nitin Agarwal ◽  
Andrew F. Ducruet
Keyword(s):  
Traumatic Brain Injury ◽  
Cerebrospinal Fluid ◽  
Neurological Disease ◽  
External Ventricular Drain ◽  
Management Strategies ◽  
External Ventricular Drainage ◽  
Postoperative Management ◽  
Ventricular Drainage ◽  
Cerebrospinal Fluid Diversion ◽  
Lumbar Drain

External ventricular drainage, or ventriculostomy, refers to surgical placement of a catheter into the ventricle to achieve temporary cerebrospinal fluid diversion and remains one of the most frequently performed neurosurgical interventions. External ventricular drainage is an essential therapeutic strategy for a myriad of neurological disease processes causing hydrocephalus or increased intracranial pressure including traumatic brain injury, subarachnoid hemorrhage, and intracranial hemorrhage with intraventricular extension. In select cases, lumbar drains may provide a suitable alterative to an external ventricular drain (EVD). Complications related to both EVD and lumbar drain placement include malfunction, infection, and hemorrhage. This chapter reviews the indications, surgical technique, postoperative management strategies, and potential complications associated with external ventricular drainage.

scholarly journals The 50 most cited publications in endoscopic third ventriculostomy: a bibliometric analysis

2019 ◽  
Vol 23 (2) ◽  
pp. 145-152 ◽  
Author(s):  
Nirmeen Zagzoog ◽  
Ahmed Attar ◽  
Kesh Reddy
Keyword(s):  
Bibliometric Analysis ◽  
Endoscopic Third Ventriculostomy ◽  
Present Report ◽  
Obstructive Hydrocephalus ◽  
Current Status ◽  
Third Ventriculostomy ◽  
Communicating Hydrocephalus ◽  
Publish Or Perish ◽  
Pediatric Age Group ◽  
Current Century

OBJECTIVEAlthough endoscopic third ventriculostomy (ETV) for the treatment of hydrocephalus was introduced in 1923, the method was relegated to the sidelines in favor of extracranial techniques. Since the 1990s to the beginning of the current century, however, ETV has undergone a remarkable resurgence to become the first-line treatment for obstructive hydrocephalus, and for some groups, the procedure has been applied for communicating hydrocephalus as well. In the present study, the authors identified the top 50 cited ETV works. These articles represent works of significance that document current practices and provide guidance for future inquiry.METHODSThe top 50 cited articles pertaining to ETV were identified using bibliometric data obtained with the Harzing’s Publish or Perish software search engine. These high-impact works were evaluated for publication properties including year, country of authorship, category, and journal.RESULTSThe top 50 works were cited an average of 141.02 times with a mean of 9.45 citations per year. Articles published in 2005 were the most numerous in the top 50 group. These top articles were most frequently published in the Journal of Neurosurgery: Pediatrics. Most of the articles were clinical studies reporting on patients in the pediatric age group. The country of most authorship was the US, although many other countries were among the top 50 works.CONCLUSIONSThe present report discusses the bibliometric analysis of the top 50 ETV articles. This list may be useful to those interested in the progress and current status of this procedure.

scholarly journals Spontaneous Intraventricular Hemorrhage: When Should Intraventricular tPA Be Considered?

2017 ◽  
Vol 38 (06) ◽  
pp. 745-759 ◽  
Author(s):  
Peter Abdelmalik ◽  
Wendy Ziai
Keyword(s):  
Intraventricular Hemorrhage ◽  
Obstructive Hydrocephalus ◽  
External Ventricular Drain ◽  
Standard Of Care ◽  
Phase Iii ◽  
Functional Improvement ◽  
Severity Factor ◽  
Surgical Interventions ◽  
Intraventricular Fibrinolysis ◽  
Recent Phase

AbstractSpontaneous intracerebral hemorrhage (ICH) is the most common cause of intraventricular hemorrhage (IVH) in adults. Complicating approximately 40% of ICH cases, IVH adds to the morbidity and mortality of this often fatal form of stroke. It is also a severity factor that complicates subarachnoid hemorrhage and traumatic brain injury, along with other less common causes of intracranial bleeding. Medical and surgical interventions to date have focused on limiting ICH and IVH expansion, controlling intracranial pressure, and relieving obstructive hydrocephalus. The placement of an external ventricular drain (EVD) can achieve the latter two goals but has not demonstrated improvement in clinical outcomes beyond mortality reduction. More recently, intraventricular fibrinolysis, utilizing the EVD, has gained interest as a safe and potentially effective method to maintain catheter patency and facilitate hematoma removal. A recent phase III clinical trial evaluating the efficacy of intraventricular alteplase versus intraventricular saline showed a mortality benefit, but failed to meet the primary endpoint of significant functional improvement. However, planned subgroup analysis focusing on patients with IVH volume > 20 mL, and those with IVH removal > 85% suggest that significant functional benefits may be attainable with this therapy. The practice of intraventricular fibrinolysis for spontaneous IVH is not the standard of care; however, based on 20 years of experience, it meets thresholds as a safe intervention, and in those patients with a high burden of intraventricular blood, aggressive clearance may lead to improved quality of life in survivors of this morbid syndrome.

A very young patient with Tubercular Meningitis and its complications

2020 ◽  
Vol 10 (2) ◽  
pp. 400-401
Author(s):  
Rowshan Jahan Akhter ◽  
BH Nazma Yasmeen
Keyword(s):  
Mycobacterium Tuberculosis ◽  
Cranial Nerve ◽  
Obstructive Hydrocephalus ◽  
Cns Infection ◽  
Communicating Hydrocephalus ◽  
Mycobacterium Tuberculosis Infection ◽  
Nerve Roots ◽  
Tubercular Meningitis ◽  
Medical College ◽  
The Brain

A case report on a successful management of an eight months old boy with Tubercular Meningitis with Multiple Tuberculoma in Brain with Obstructive Hydrocephalus with Left sided Lower motor neuron type Facial Palsy with Right Sided Hemiparesis. Tuberculous meningitis (TBM) is Mycobacterium tuberculosis infection of the Brain Meninges.1,2 In TBM inflammation occur mainly in the base of the brain and when the inflammation affect the brain stem subarachnoid area, cranial nerve roots then symptoms may occur like space-occupying lesions.3,4 TBM is more common in children than in adults, especially children aged 0-5 years.5 In children central nervous system tuberculosis usually presents as tubercular meningitis, post-tubercular meningitis hydrocephalus, and rarely a space-occupying lesions known as tuberculomas.6 TBM accounts for 2–5% of all active cases of Mycobacterium tuberculosis.7 Pulmonary infection coexists in 25–83% of TBM.8-10 Predominately primary CNS infection is found in children and leptomeningeal infection presents as meningitis, cranial nerve (CN) palsies (most commonly CN 2, 3, 4, and 7), and communicating hydrocephalus.11 Northern International Medical College Journal Vol.10 (2) Jan 2019: 400-401

POSTOPERATIVE HYDROCEPHALUS IN PATIENTS UNDERGOING DECOMPRESSIVE HEMICRANIECTOMY FOR ISCHEMIC OR HEMORRHAGIC STROKE

Neurosurgery ◽  
2007 ◽  
Vol 61 (3) ◽  
pp. 489-494 ◽  
Author(s):  
Allen Waziri ◽  
David Fusco ◽  
Stephan A. Mayer ◽  
Guy M. McKhann ◽  
E. Sander Connolly
Keyword(s):  
Intracranial Pressure ◽  
Hemorrhagic Stroke ◽  
Communicating Hydrocephalus ◽  
Imaging Data ◽  
Decompressive Hemicraniectomy ◽  
Pressure Dynamics ◽  
Csf Diversion ◽  
Postoperative Hydrocephalus ◽  
Early Cranioplasty ◽  
Persistent Hydrocephalus

Abstract OBJECTIVE We have frequently observed the development of postoperative communicating hydrocephalus in patients undergoing decompressive hemicraniectomy. This condition may persist in some patients after cranioplasty and require permanent cerebrospinal fluid (CSF) diversion. To confirm an independent correlation between hemicraniectomy and the development of communicating hydrocephalus, and to detail the frequency and potential clinical factors contributing to this complication, we evaluated our series of patients undergoing hemicraniectomy for life-threatening increases in intracranial pressure secondary to ischemic or hemorrhagic stroke. METHODS A retrospective analysis was performed with a cohort of consecutive patients who underwent emergent hemicraniectomy for medically refractory elevations in intracranial pressure. Patients with known independent risk factors for the development of communicating hydrocephalus were excluded. Clinical and imaging data were reviewed to determine the incidence and type of hydrocephalus after hemicraniectomy, the persistence of hydrocephalus after cranioplasty, and the need for permanent CSF diversion. RESULTS Eighty-eight percent of the eligible patients undergoing hemicraniectomy in our cohort developed postoperative communicating hydrocephalus. Half of these patients harbored persistent hydrocephalus after cranioplasty and required placement of a ventriculoperitoneal shunt. We noted a strong correlation between prolonged time to replacement of the bone flap and persistence of hydrocephalus. CONCLUSION Communicating hydrocephalus is an almost universal finding in patients after hemicraniectomy. Delayed time to cranioplasty is linked with the development of persistent hydrocephalus, necessitating permanent CSF diversion in some patients. We propose that early cranioplasty, when possible, may restore normal intracranial pressure dynamics and prevent the need for permanent CSF diversion in patients after hemicraniectomy.

Sign in / Sign up

Export Citation Format

Share Document