scholarly journals Tips and Tricks in Difficult ETV

2021 ◽  
Vol 3 (1(January-April)) ◽  
pp. e782021
Author(s):  
Sérgio Cavalheiro
Keyword(s):  
Intraventricular Hemorrhage ◽  
Fetal Surgery ◽  
Field Of View ◽  
Cerebral Aqueduct ◽  
Tips And Tricks ◽  
The Third ◽  
Complex Anatomy ◽  
Low Visibility ◽  
Iii Ventricle ◽  
Great Development

The neuroendoscopy is supported by three pivotal pillars: training, planning, and prudence. The training consists of attending practical courses with synthetic head models for immersion in the intricate ventricular anatomy and practice in handling the neuroendoscope. The planning begins with the choice of the entry point, usually performed at the Kocher's point, and measurement of this to the ventricle. Neuroendoscopy in intraventricular hemorrhage or ventriculitis is always challenging due to low visibility, thus, copious irrigation with a heated solution at 37°C, like plasma type, is mandatory, often reaching 6L of solution. Narrow spaces between the clivus and basilar artery can be very dangerous, therefore we prefer a "Sputnik" fórceps rather than blunt instruments to open the floor of the III ventricle and subsequently widen it with Fogarty n°3. Sometimes it is necessary to mechanically remove the larger clots that do not come off the ventricle walls only with irrigation; in these cases, we aspirate them through the neuroendoscope until we see the structures that allow us to perform ETV and guarantee its patency. Navigating inside the ventricle when the complex anatomy is distorted, such as cases of myelomeningoceles with large interthalamic masses, can be very difficult; for these cases, we use the optics inversion technique to access different locations with the same field of view. The innovation in neuroendoscope models allowed us to associate techniques, such as the concomitant use of an ultrasonic aspirator to remove intraventricular lesions. Another field of great development was fetal surgery for hydrocephalus; initially with cephalocenteses passing through the ventriculo-aminiotic shunt until the fetal ETV. For complex cases of the second look of ETV, we can still associate techniques such as aqueductoplasty and implantation of stents in the third ventricular floor and cerebral aqueduct to keep them patent. Last but not least, we have the pillar of prudence. Any neuroendoscopy, regardless of the surgeon's experience or the apparent simplicity of the case, must be done with the utmost caution, avoiding minimal bleeding, avoiding touching structures that are not vital to the procedure, and be objective.

Neuroendoscopic Aspiration of Blood Clots in the Cerebral Aqueduct and Third Ventricle During Posterior Fossa Surgery in the Prone Position

2018 ◽  
Vol 17 (2) ◽  
pp. 143-148 ◽  
Author(s):  
Alberto Feletti ◽  
Riccardo Stanzani ◽  
Matteo Alicandri-Ciufelli ◽  
Giuliano Giliberto ◽  
Matteo Martinoni ◽  
...  
Keyword(s):  
Prone Position ◽  
Posterior Fossa ◽  
Fourth Ventricle ◽  
Blood Clot ◽  
Third Ventricle ◽  
Cerebral Aqueduct ◽  
Posterior Fossa Surgery ◽  
The Third ◽  
Blood Clots ◽  
Surgical Field

AbstractBACKGROUNDDuring surgery in the posterior fossa in the prone position, blood can sometimes fill the surgical field, due both to the less efficient venous drainage compared to the sitting position and the horizontally positioned surgical field itself. In some cases, blood clots can wedge into the cerebral aqueduct and the third ventricle, and potentially cause acute hydrocephalus during the postoperative course.OBJECTIVETo illustrate a technique that can be used in these cases: the use of a flexible scope introduced through the opened roof of the fourth ventricle with a freehand technique allows the navigation of the fourth ventricle, the cerebral aqueduct, and the third ventricle in order to explore the cerebrospinal fluid pathways and eventually aspirate blood clots and surgical debris.METHODSWe report on one patient affected by an ependymoma of the fourth ventricle, for whom we used a flexible neuroendoscope to explore and clear blood clots from the cerebral aqueduct and the third ventricle after the resection of the tumor in the prone position. Blood is aspirated with a syringe using the working channel of the scope as a sucker.RESULTSA large blood clot that was lying on the roof of the third ventricle was aspirated, setting the ventricle completely free. Other clots were aspirated from the right foramen of Monro and from the optic recess.CONCLUSIONWe describe this novel technique, which represents a safe and efficient way to clear the surgical field at the end of posterior fossa surgery in the prone position. The unusual endoscopic visual perspective and instrument maneuvers are easily handled with proper neuroendoscopic training.

scholarly journals KEGIATAN TARI KREASI MANUK DADALI UNTUK MENINGKATKAN KECERDASAN KINESTETIK ANAK KELOMPOK B DI TK ARTANITA AL- KHAIRIYAH KOTA TASIKMALAYA

2020 ◽  
Vol 3 (2) ◽  
pp. 164-177
Author(s):  
Aan Darwati ◽  
Heri Yusuf Muslihin ◽  
Rosarina Giyartini
Keyword(s):  
Motor Development ◽  
The Elderly ◽  
Early Child Development ◽  
Gross Motor ◽  
Gross Motor Development ◽  
The Third ◽  
Is Research ◽  
Group B ◽  
Research Action ◽  
Great Development

ABSTRACTKinestetik Intelligence especially in gross motor development is one that need to be considered by all parties, especially the elderly because of its urgency in the growth of early child development. Problems found in Group B in TK Artanita Al-Khairiyah Tasikmalaya still low motoric crude child skills caused by learning that is still cause by learning that is still conventional. The purpose of this study to improve gross motor of early childhood dance creation manuk dadali. The method used that is research action class Kemmis dan Mc Taggart. The first indicator is flexibility which has significant raising. The final ability is 15,4% in the criteria of development as the expectation and 84,6 % in the criteria of great development. The second indicator is balance which increases with the final ability is 38% in the criteria of development  as the expectation and 61,5% in the criteria of great development. The third indicator is agility which increases with the final ability is 30,8% in the criteria of development as the expectation and 69,2% in the criteria of great development. The fourth indicator is coordination of eyes and foot movement which increases with the final ability is 7,7% in the criteria of beginning development, 38,5% in the criteria of development as the expectation, and 53,8% in the criteria of great development. Moreover, for the fifth indicator; coordination of hands and head movement increases with the final ability is 23,1% in the criteria of development as the expectation and 76,9% in the criteria of great development.ABSTRAKKecerdasan kinestetik khususnya dalam perkembangan motorik kasar merupakan salahsatu yang perlu diperhatikan oleh semua pihak khususnya orangtua karena urgensinya dalam tumbuh kembang anak usia dini. Masalah yang ditemukan pada kelompok B di TK Artanita Al-Khairiyah Kota Tasikmalaya masih rendahnya keterampilan motorik kasar anak yang salah satunya disebabkan pembelajaran masih konvensional. Tujuan dari penelitian ini yaitu untuk meningkatkan kecerdasan kinestetik khususnya pada motorik kasar yaitu dengan tari kreasi baru manuk dadali. Metode yang digunakan yaitu penelitian tindakan kelas model Kemmis dan Mc Taggart. Kecerdasan kinestetik anak pada aspek motorik kasar anak mengalami peningkatan pada setiap indikatornya. Indikator yang pertama yaitu kelenturan mengalami peningkatan yang signifikan dengan kemampuan akhir 15,4% pada kriteria berkembang sesuai harapan dan sebesar 84,6% pada kriteria berkembang sangat baik. Indikator yang kedua yaitu Keseimbangan mengalami peningkatan  dengan kemampuan akhir sebesar 38,5% pada kriteria berkembang sesuai harapan, dan 61,5% pada kriteri berkembang sangat baik. Indikator yang ketiga kelincahan mengalami peningkatan dengan kemampuan akhir sebesar 30,8% pada kriteria berkembang sesuai harapan, dan sebesar 69,2% pada kriteria berkembang sangat baik. Indikator yang ke empat yaitu koordinasi gerakan mata-kaki mengalami peningkatan dengan kemampuan akhir sebesar 7,7% pada kriteria mulai berkembang, 38,5% pada kriteria berkembang sesuai harapan, dan 53,8% pada kriteri berkembang sangat baik.  Begitupun dengan indikator yang ke lima koordinasi gerakan tangan-kepala mangalami peningkatan dengan kemampuan akhir anak sebesar 23,1% pada kriteria berkembang sesuai harapan, dan 76,9% pada kritetia berkembang sangat baik.

scholarly journals The Use of the Baker Interference Microscope for the Study of Optically Heterogeneous Specimens

1956 ◽  
Vol s3-97 (40) ◽  
pp. 569-591
Author(s):  
R. C. FAUST
Keyword(s):  
Incident Light ◽  
Field Of View ◽  
Variation Method ◽  
Specimen Thickness ◽  
Immersion Liquid ◽  
Interference Microscope ◽  
Relative Index ◽  
The Third ◽  
Wavelength Variation ◽  
The Mean

The refractive index of an optically heterogeneous specimen will generally vary in directions parallel and normal to the microscope axis, but a mean index can be defined such that the optical thickness of the specimen is equal to the product of the mean index and the specimen thickness. If such a specimen is examined under an interference microscope, the fringe displacement will be zero at those parts of the specimen for which the mean index is equal to the index of the immersion liquid. Thus, by gradually changing the index of the liquid relative to that of the specimen, one can determine the manner in which the mean index varies from region to region of the specimen. In the present work these changes in relative index have been effected by varying either the wavelength of the incident light or the temperature of the system. The Baker two-beam interference microscope has been successfully used for such investigations. Three types of interference pattern have been tried: (i) a single fringe is made to fill the field of view and the intensity differences between the specimen and the background are studied; (ii) monochromatic fringes are formed in a quartz wedge and their linear displacements are examined; and (iii) a quartz plate is used, channelled spectra being produced by the spectrographic analysis of the interference colours. The first two types can be used with either the temperature or the wavelength variation method, but the third was specifically designed for use with the wavelength variation method. Although these experiments have mostly been carried out on birefringent fibres, the techniques are applicable to any kind of object. The attainable accuracy increases with specimen thickness; under favourable circumstances the index at any point of a specimen 10 µ thick should not be in error by more than †3x10-4

Endoscopic Resection of Hemorrhaged Third Ventricle Cavernous Malformation: 2-Dimensional Operative Video

2018 ◽  
Vol 16 (2) ◽  
pp. E51-E51
Author(s):  
Giorgio Palandri ◽  
Thomas Sorenson ◽  
Mino Zucchelli ◽  
Nicola Acciarri ◽  
Paolo Mantovani ◽  
...  
Keyword(s):  
Gold Standard ◽  
Intraventricular Hemorrhage ◽  
Cavernous Malformation ◽  
Third Ventricle ◽  
Gross Total Resection ◽  
Vascular Lesions ◽  
Total Resection ◽  
Cavernous Malformations ◽  
The Third

Abstract Cavernous malformations of the third ventricle are uncommon vascular lesions. Evidence suggests that cavernous malformations in this location might have a more aggressive natural history due to their risk of intraventricular hemorrhage and hydrocephalus.1 The gold standard of treatment is considered to be microsurgical gross total resection of the lesion. However, with progressive improvement in endoscopic capabilities, several authors have recently advocated for the role of minimally-invasive neuroendoscopy for resecting intraventricular cavernous malformations.2-4 In this timely intraoperative video, we demonstrate the gross total resection of a third ventricle cavernous malformation that presented with hemorrhage via a right-sided trans-frontal neuroendoscopic approach.

scholarly journals Investigation of the relationship between umbilical cord pH and intraventricular hemorrhage of infants delivered preterm

2019 ◽  
Vol 65 (5) ◽  
pp. 647-656
Author(s):  
Ali Mazouri ◽  
Mahtab Massahi ◽  
Nasrin Khalesi ◽  
Ladan Younesi asl ◽  
Mandana Kashaki
Keyword(s):  
Umbilical Cord ◽  
Premature Infants ◽  
Intraventricular Hemorrhage ◽  
Neonatal Intensive Care ◽  
Blood Gases ◽  
Blood Gas ◽  
The Third ◽  
The Relationship ◽  
Type Of Delivery ◽  
Control Study

SUMMARY OBJECTIVE: We measured the level of pH gases in premature infants at birth, and examined the relationship between brain ultrasonography on the third and seventh day after birth. A case-control study conducted at the Neonatal Intensive Care Unit (NICU) of Shahid Akbar Abadi Hospital, Iran, during the years 2016-2017. METHODS: All premature infants who were admitted to NICU were enrolled in the current study. At birth, a blood gas sample was taken from the umbilical cord of the infants. On the third and seventh day after birth, an ultrasound of the brain of each neonate was performed by a radiologist. The umbilical cord was evaluated for blood gases in 72 neonates (mostly boys). RESULTS: Sixty-six newborns had normal sonography, and 16.7% (12 cases) had anomalies. A total of 75% of the 8 infants with intravenous bleeding were girls, which were significantly different from those in the non-hemodynamic group (62.5% male) (P 0.049). However, the type of delivery, mean weight, height, head circumference, the circumference of the chest, and Apgar score did not differ between the two groups. Mean pH, HCO3– and PCO2 in umbilical cord blood gas samples were not significantly different between the two groups with or without intraventricular hemorrhage (IVH). Although it was not related to gender and type of delivery in newborns CONCLUSION: Blood gases do not help in determining the occurrence of IVH in infants. Nevertheless, it is associated with immaturity and fetal age.

Presence within Virtual Environments as a Function of Visual Display Parameters

1996 ◽  
Vol 5 (3) ◽  
pp. 274-289 ◽  
Author(s):  
Claudia Hendrix ◽  
Woodrow Barfield
Keyword(s):  
Virtual Environments ◽  
Virtual Environment ◽  
Virtual World ◽  
Visual Image ◽  
Visual Display ◽  
Field Of View ◽  
Head Tracking ◽  
The Third ◽  
Sense Of Presence ◽  
Being There

This paper reports the results of three studies, each of which investigated the sense of presence within virtual environments as a function of visual display parameters. These factors included the presence or absence of head tracking, the presence or absence of stereoscopic cues, and the geometric field of view used to create the visual image projected on the visual display. In each study, subjects navigated a virtual environment and completed a questionnaire designed to ascertain the level of presence experienced by the participant within the virtual world. Specifically, two aspects of presence were evaluated: (1) the sense of “being there” and (2) the fidelity of the interaction between the virtual environment participant and the virtual world. Not surprisingly, the results of the first and second study indicated that the reported level of presence was significantly higher when head tracking and stereoscopic cues were provided. The results from the third study showed that the geometric field of view used to design the visual display highly influenced the reported level of presence, with more presence associated with a 50 and 90° geometric field of view when compared to a narrower 10° geometric field of view. The results also indicated a significant positive correlation between the reported level of presence and the fidelity of the interaction between the virtual environment participant and the virtual world. Finally, it was shown that the survey questions evaluating several aspects of presence produced reliable responses across questions and studies, indicating that the questionnaire is a useful tool when evaluating presence in virtual environments.

scholarly journals Attenuation of lipopolysaccharide anorexia by antagonism of caudal brain stem but not forebrain GLP-1-R

2004 ◽  
Vol 287 (5) ◽  
pp. R1190-R1193 ◽  
Author(s):  
Harvey J. Grill ◽  
Jill S. Carmody ◽  
L. Amanda Sadacca ◽  
Diana L. Williams ◽  
Joel M. Kaplan
Keyword(s):  
Food Intake ◽  
Brain Stem ◽  
Third Ventricle ◽  
Cerebral Aqueduct ◽  
Relative Importance ◽  
The Third ◽  
Native Peptide ◽  
Glucagon Like Peptide ◽  
Glucagon Like Peptide 1 ◽  
Rule Out

The central glucagon-like peptide-1 (GLP-1) system has been implicated in the control of feeding behavior. Here we explore GLP-1 mediation of the anorexic response to administration of systemic LPS and address the relative importance of caudal brain stem and forebrain GLP-1 receptor (GLP-1-R) for the mediation of the response. Fourth-intracerebroventricular delivery of the GLP-1-R antagonist exendin-(9–39) (10 μg) did not itself affect food intake in the 24 h after injection but significantly attenuated the otherwise robust (∼60%) reduction in food intake obtained after LPS (100 μg/kg) treatment. This result highlights a role for caudal brain stem GLP-1-R in the mediation of LPS anorexia but does not rule out the possibility that forebrain receptors also contribute to the response. Forebrain contribution was addressed by delivery of the GLP-1-R antagonist to the third ventricle with the caudal flow of cerebrospinal fluid blocked by occlusion of the cerebral aqueduct. Exendin-(9–39) delivery thus limited to forebrain did not attenuate the anorexic response to LPS. These data suggest that LPS anorexia is mediated, in part, by release of the native peptide acting on GLP-1-R within the caudal brain stem.

scholarly journals Comparative anatomical analysis of the transcallosal-transchoroidal and transcallosal-transforniceal-transchoroidal approaches to the third ventricle

2017 ◽  
Vol 127 (1) ◽  
pp. 209-218 ◽  
Author(s):  
João Luiz Vitorino Araujo ◽  
José C. E. Veiga ◽  
Hung Tzu Wen ◽  
Almir F. de Andrade ◽  
Manoel J. Teixeira ◽  
...  
Keyword(s):  
Corpus Callosum ◽  
Third Ventricle ◽  
Anterior Region ◽  
Cerebral Aqueduct ◽  
Tuber Cinereum ◽  
The Third ◽  
Longitudinal Plane ◽  
The Mean ◽  
The Right ◽  
Longitudinal Diameter

OBJECTIVEAccess to the third ventricle is a veritable challenge to neurosurgeons. In this context, anatomical and morphometric studies are useful for establishing the limitations and advantages of a particular surgical approach. The transchoroidal approach is versatile and provides adequate exposure of the middle and posterior regions of the third ventricle. However, the fornix column limits the exposure of the anterior region of the third ventricle. There is evidence that the unilateral section of the fornix column has little effect on cognitive function. This study compared the anatomical exposure afforded by the transforniceal-transchoroidal approach with that of the transchoroidal approach. In addition, a morphometric evaluation of structures that are relevant to and common in the 2 approaches was performed.METHODSThe anatomical exposure provided by the transcallosal-transchoroidal and transcallosal-transforniceal-transchoroidal approaches was compared in 8 fresh cadavers, using a neuronavigation system. The working area, microsurgical exposure area, and angular exposure on the longitudinal and transversal planes of 2 anatomical targets (tuber cinereum and cerebral aqueduct) were compared. Additionally, the thickness of the right frontal lobe parenchyma, thickness of the corpus callosum trunk, and longitudinal diameter of the interventricular foramen were measured. The values obtained were submitted to statistical analysis using the Wilcoxon test.RESULTSIn the quantitative evaluation, compared with the transchoroidal approach, the transforniceal-transchoroidal approach provided a greater mean working area (transforniceal-transchoroidal 150 ± 11 mm2; transchoroidal 121 ± 8 mm2; p < 0.05), larger mean microsurgical exposure area (transforniceal-transchoroidal 101 ± 9 mm2; transchoroidal 80 ± 5 mm2; p < 0.05), larger mean angular exposure area on the longitudinal plane for the tuber cinereum (transforniceal-transchoroidal 71° ± 7°; transchoroidal 64° ± 6°; p < 0.05), and larger mean angular exposure area on the longitudinal plane for the cerebral aqueduct (transforniceal-transchoroidal 62° ± 6°; transchoroidal 55° ± 5°; p < 0.05). No differences were observed in angular exposure along the transverse axis for either anatomical target (tuber cinereum and cerebral aqueduct; p > 0.05). The mean thickness of the right frontal lobe parenchyma was 35 ± 3 mm, the mean thickness of the corpus callosum trunk was 10 ± 1 mm, and the mean longitudinal diameter of the interventricular foramen was 4.6 ± 0.4 mm. In the qualitative assessment, it was noted that the transforniceal-transchoroidal approach led to greater exposure of the third ventricle anterior region structures. There was no difference between approaches in the exposure of the structures of the middle and posterior region.CONCLUSIONSThe transforniceal-transchoroidal approach provides greater surgical exposure of the third ventricle anterior region than that offered by the transchoroidal approach. In the population studied, morphometric analysis established mean values for anatomical structures common to both approaches.

scholarly journals Cryotherapy Has No Significant Effect on MMP-9 anTGF-β1 Expression in Fungal Corneal Ulcer

2021 ◽  
Vol 13 (3) ◽  
pp. 295-302
Author(s):  
Dwita Permatasari ◽  
Hendrian Dwikoloso Soebagjo ◽  
Ismi Zuhria ◽  
Nila Kurniasari ◽  
Hari Basuki Notobroto ◽  
...  
Keyword(s):  
Corneal Ulcer ◽  
Surgical Intervention ◽  
Healing Process ◽  
Field Of View ◽  
Fourth Group ◽  
Corneal Ulcers ◽  
The Third ◽  
Days Of Therapy ◽  
Significant Difference ◽  
Tgf Β1

BACKGROUND: Usually, surgical intervention is needed to eradicate the fungal microorganism that cause fungal corneal ulcers. However, since surgical intervention is invasive, the latest technology uses cryotherapy in treating it. Cryotherapy plays a vital role in the wound healing process. We aimed to evaluate is to study the decreased expression of matrix metalloproteinase 9 (MMP-9) and transforming growth factor β1 (TGF-β1) in fungal corneal ulcers after the administration of cryotherapy.METHODS: Aspergillus flavus fungus was injected to the intrastromal corneas of all Sprague Dawley rats. The rats were divided into four groups, the first group was not given any therapy, the second group was given topical natamycin therapy, the third group was given cryotherapy, and the fourth group was given a combination between cryotherapy and topical natamycin therapy. Therapy was given after five days of follow up on the formation of a corneal ulcer. After four days of therapy, the eyes were enucleated to determine MMP-9 and TGF-β1 expression.RESULTS: The result in the third group showed lower MMP-9 expression (20.0±10.0% cells per field of view) compared to the second group (40.0±20.0% cells per field of view) and the fourth group (30.0±25.0% cells per field of view), but had the same MMP-9 expression value as the first group. There was no significant difference in MMP-9 expression between the four groups (p=0.356). The third group reduced more TGF-β1 expression (10.0±12.50% cells per field of view) compared to the fourth group (30±27.5% cells per field of view) and the first group (30±32.5% cells per field of view). There was also no significant difference in TGF-β1 between the four groups (p=0.315).CONCLUSION: There is no significant difference in the expression of TGF-β1 and MMP-9 after the cryotherapy treatment.KEYWORDS: corneal ulcer, cryotherapy, MMP-9, TGF-β1

Diagnosis of digital flexor tendon sheath conditions in the horse

UK-Vet Equine ◽  
2021 ◽  
Vol 5 (1) ◽  
pp. 24-31
Author(s):  
Victoria J. Tannahill
Keyword(s):  
Flexor Tendon ◽  
Tendon Sheath ◽  
Imaging Findings ◽  
Tips And Tricks ◽  
Common Occurrence ◽  
Diagnostic Ability ◽  
Complex Anatomy ◽  
Diagnostic Potential ◽  
Flexor Tendon Sheath

Diagnosis of digital flexor tendon sheath conditions can be challenging, although they are a common occurrence in horses. Injuries can occur in either the fore- or hindlimbs and a thorough understanding of the complex anatomy of the digital flexor tendon sheath will help practitioners to gain confidence in their diagnostic ability of its pathologies. This article outlines the clinically relevant anatomy, approaches to and interpretation of diagnostic anaesthesia, as well as common stable-side imaging findings that may be expected for the main pathologies associated with the digital flexor tendon sheath. Tips and tricks to maximise diagnostic potential are also included throughout the article.

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