CSF Upward Motion Is Crucial for ETV Success

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.

Н. Hudden. Klinische und anatomische Beiträge zurKenntniss der multiplen alcohol. Neuritis. —Archiv für Psy-chiatrie, ХХVIII Bd., Heft 3

The work of Hudden presents a large monograph on alcoholic neuritis, five complete histories of the disease with detailed pathological studies and two brief histories of the disease without opening. The author comes to the following conclusions: The mental illness described by S.S.Korsakov in polyneuritis is also observed regardless of the polyneuritis. When combined with alcoholic neuritis, psychosis often occurs encephalitic lesion of the cerebral trunk, especially around the 3rd ventricle; the centers of the eye nerves can be whole. Atrophy of the corp.mammill is not uncommon in psychosis, combined with alcoholic neuritis.

Purely Neuro-endoscopic Transventricular Approach for Cystic Craniopharyngiomas

Background and Importance: Craniopharyngiomas are tumors made up of mixed components which can present intraventricular cystic portion. The aim of our work is to evaluate the outcome of the endoscopic marsupialization as a surgical approach. Methods and Materials/Patients: We report 11 cases presenting craniopharyngioma with intraventricular cystic portion inducing hydrocephalus managed at Neurosurgery Unit of Fann Hospital between June 2013 and June 2017. Endoscopic marsupialization was realized for all patients with a rigid neuroendoscope Karl Storz. Results: The mean age of cases was 30.18 years with a ranged 07-69. There was a male predominance with a sex ratio of 1.75. All patients were suffering from an intracranial pressure syndrome. Lowering visual acuity including two (02) blindness cases was found in patients under 15 years. Frontal lobe syndrome was found in all patients of more than 50 years. A cerebral CT scan was realized for 9 patients and an MRI for 4 patients. A cystic marsupialization with biopsy was realized by precoronal approach. Fluid looked like “waste oil” for 9 patients. Ventriculocisternostomy of the 3rd ventricle was realized in 2 cases. Progress was favorable with intracranial pressure signs disappearance in 8 cases. We noticed 3 failures with cyst persistence at control CT Scan. Three patients had a recurrence, requiring revised marsupialization complicated by death in 1 case. Conclusion: Endoscopic marsupialization represents a seductive technique which is an easy and reproducible treatment for intraventricular cystic craniopharyngioma.