Clinical Impact of the Patient Age Following Endoscopic Third Ventriculostomy: A Review

Background: Clinically erratic cerebrospinal fluid (CSF) outflow within brain ventricles was described as non-communicating and communicating hydrocephalous. Neurosurgical patients are commonly seen with increased intracranial pressure due to increased CSF accumulation. (1) Initially scientists followed ventriculoperitoneal shunt an inexpensive and available technique to treat hydrocephalous disorders. Due to least successful outcomes, Scientists used other alternative endoscopic techniques. These endoscopic techniques include aqueductal endoscopic stenting, aqueductoplasty and third ventriculostomy (2). Defining success rate of Endoscopic third ventriculostomy clinical and radiographic analysis are considered gold standard. Objectives: Our review aims to assess comparative role of patient age, patient selection, hydrocephalus etiology, surgical advancement and epigenetic treatment strategies following endoscopic third ventriculostomy focusing hydrocephalous. The main objectives of current study, to critically analyze available literature till to date and a step forward for the development of standard surgical protocols. Methodology: Clinical studies from Level I-IV published in English language focusing human subject only were only considered by retrieving NCBI/PubMed, Medline databases. Studies purely focusing third ventriculostomy in subject of patient age, hydrocephalus etiology and age associated complications were processed further. Objective based data inspection approach was followed. From each included study focusing third ventriculostomy detailed information demographic information was collected. Further data analysis was done by using SAS and multiple tools of Microsoft Excel Version 2010. Outcomes: From total 11 included studies specifically focusing hydrocephaly treatment via endoscopic third ventriculostomy, 757 patients with equal 1:1 male and female gender ratio and 125 cases of unknown gender were considered. Current study highlighting efficacy of Endoscopic third ventriculostomy at the rate of 77% effective treating obstructive hydrocephalus. On basis of etiological concerns about 36.32 % cases hydrocephalous cases were linked with encephalitis, underweight birth and nonspecific etiology. However, 24 % cases of hydrocephalus were led by group of tumors including, Ependymoma, Medulloblastoma, Meningioma, Cerebella pontine angle Tumors and Pineal gland carcinomas as well. 154 (20%) cases of obstructive hydrocephalus were associated with aqueduct stenosis, 16% cases reporting hemorrhage and only 23 cyst cases. Conclusion and future recommendations: Endoscopic third ventriculostomy (ETV) is a safe and effective (77%) treatment option for the treatment of obstructive hydrocephalus among all age groups. However, specifically highest efficacy was noted among patients of 15-30-year age group. Understanding disease etiology and patient selection criteria both are considered potential components following successful endoscopic third ventriculostomy. We highly recommend further research following a universal age criteria and reporting results in distinct age category to standardize ETV treating hydrocephaly efficiently. Key words: Endoscopic third ventriculostomy, ETV, hydrocephalous, aqueductal endoscopic stenting, aqueductoplasty.

Cognitive, emotional and motor disorders and their impact on the postoperative rehabilitation of neurosurgical patients

Pathological post-anesthetic changes can be determined by the type and duration of anesthesia, the somatic and neurological status of the patient in the preoperative period, age, etc.Objective: to assess the severity of cognitive (CI), emotional and motor impairments in patients who underwent spinal surgery.Patients and methods. The clinical study included 60 patients aged 30-74 years who underwent spinal surgery under general anesthesia. The neuropsychological, emotional, somatic, and neurological status were assessed at the baseline and one week, 3, and 6 months after the surgery. Thirty patients underwent a course of cognitive training (main group), and 30 patients were included in a comparison group.Results and discussion. In the postoperative period, pain indicators decreased in both groups. There was an improvement in cognitive functions, emotional state, and quality of life (QoL) in the main group 3 and 6 months after surgery. The inclusion of cognitive training in the rehabilitation program for patients undergoing neurosurgical spinal surgery improved cognitive and motor functions and the QoL of patients. Evaluation and treatment of neurosurgical patients are discussed, which are helpful to improve the results of rehabilitation and QoL in the postoperative period.Conclusion. Additional positive impact of cognitive-motor training for pain regression in patients after spinal surgery was observed.

Post-operative meningeal thickening seen on magnetic resonance imaging

Posterior fossa tumors are relatively common in children, and the meningeal dissemination of these tumors is well established in the literature. Although leptomeningeal dissemination is more common in high-grade tumors, even low-grade tumors can generate meningeal metastases. In this case report, we would like to discuss the importance of leptomeningeal dissemination assessment of posterior fossa tumors in children, in the preoperative period, through the entire neuroaxis magnetic resonance imaging (MRI). This is important since transient meningeal thickening is very common in the postoperative periods of neurosurgical patients, and can be found for up to 5 or 6 years after surgery, causing these patients to undergo prolonged follow-ups and repeated MRIs and lumbar punctures.

Mechanical ventilation is controlled by volume or pressure during neurosurgery. Is there an advantage?

Background. One of the main technologies of modern anesthesiology is mechanical ventilation (MV). At present, the protective technology of MV is widely recognized. The feasibi-lity of using this technology in the operating room, especially in patients with intact lungs, is not so obvious. Most of the scientific sources that cover this problem relate to patients with abdominal pathology, and less coverage remains in patients with neurosurgical pathology. However, patients who are operated on for neurosurgical pathology belong to the group of patients of high surgical risk, which forced us to conduct this study. The study was aimed to examine the feasibility of using protective MV during surgery in neurosurgical patients. Materials and methods. We examined 46 patients who were hospitalized in KNP 8 MKL in Lviv for spinal pathology and who underwent surgery for vertebroplasty with spondylodesis. Patients were divided into two groups: in the first group (34 patients), MV was performed by S-IPPV technology — synchronized intermittent positive pressure ventilation with volume control; and in the second group (12 patients), MV was performed by PCV technology — controlled ventilation pressure. Results. We retrospectively determined the incidence of post-operative pulmonary complications (POPC) in patients of the first and second groups. Of the 34 patients of the first group, the signs of POPC were detected in 17 patients (50 %), and of 12 patients of the second group, POPC were detected in 4 patients (33.3 %). It should be noted that MV in patients of both groups did not differ in such parameters as respiratory rate, end-alveolar pressure, and the fraction of oxygen in the respiratory mixture. Conclusions. A relatively small number of patients clearly do not allow the conclusions to be drawn, but it should be noted that MV (especially volume-controlled) contributes to postoperative pulmonary complications in patients with intact lungs in the preoperative period. And pressure-controlled MV tends to reduce the incidence of postoperative pulmonary complications in the postoperative period. Given that respiration rate, end-alveolar expiratory pressure and oxygen fraction in the respiratory mixture were comparable in patients of both groups, it can be assumed that the factor influencing the incidence of POPC is the mechanics of pulmonary ventilation.

A Beautiful Friendship—and a Lesson about Friends and Colleagues: A Classic Partnership Revisited

David Warner, M.D., and Michael Todd, M.D., first met in 1985. They began working together at the University of Iowa (Iowa City, Iowa) a year later with a shared interest in both laboratory and clinical neuroscience—and in the operative care of neurosurgical patients. That collaboration has now lasted for 35 yr, resulting in more than 70 joint publications. More importantly, they have had the privilege of working together with close to 1,000 colleagues from around the world, in a dozen medical specialties. Their careers are an example of what can be accomplished by friendship, mutual commitment, persistence, and a willingness to join with others.

Single-dose antibiotic prophylaxis compared with multiple-dose protocol in clean pediatric neurosurgical interventions: a nonrandomized, historically controlled equivalence trial

OBJECTIVE Guidelines recommend antimicrobial prophylaxis (AMP) preoperatively for "clean" spinal and cranial surgeries, while dose and timing remain controversial. The use of multiple-dose AMP for such surgeries is under debate in the pediatric context. In this clinical study, the authors aimed to compare single-dose with multiple-dose prophylactic antibiotic usage in cranial and spinal neurosurgical interventions of pediatric patients. METHODS All neurosurgical patients aged 28 days to 18 years who underwent surgery at a single tertiary center were assessed. Three cohorts (noninstrumented clean spinal, noninstrumented cranial, and instrumented cranial interventions), each of which comprised two 50-patient arms (i.e., single-dose AMP and multiple-dose AMP), were included after propensity score–matched retrospective sampling and power analysis. Records were examined for surgical site infections. Using a previously published meta-analysis as the prior and 80% acceptance of equivalence (margin of OR 0.88–1.13), logistic regression was carried out for the total cohort and each subcohort and adjusted for etiology by consideration of multiple-dose AMP as reference. RESULTS The overall sample included 300 age- and sex-matched patients who were evenly distributed in 3 bi-arm cohorts. There was no statistical intercohort difference based on etiology or type of operation (p < 0.05). Equivalence analysis revealed nondiscriminating results for the total cohort (adjusted OR 0.65, 95% CI 0.27–1.57) and each of the subcohorts (noninstrumented clean spinal, adjusted OR 0.65, 95% CI 0.12–3.44; noninstrumented cranial, adjusted OR 0.52, 95% CI 0.14–2.73; and instrumented cranial, adjusted OR 0.68, 95% CI 0.13–3.31). CONCLUSIONS No significant benefit for multiple-dose compared with single-dose AMPs in any of the pediatric neurosurgery settings could be detected. Since unnecessary antibiotic use should be avoided as much as possible, it seems that usage of single-dose AMP is indicated.

White matter disconnectivity fingerprints causally linked to dissociated forms of alexia

For over 150 years, the study of patients with acquired alexia has fueled research aimed at disentangling the neural system critical for reading. An unreached goal, however, relates to the determination of the fiber pathways that root the different visual and linguistic processes needed for accurate word reading. In a unique series of neurosurgical patients with a tumor close to the visual word form area, we combine direct electrostimulation and population-based streamline tractography to map the disconnectivity fingerprints characterizing dissociated forms of alexia. Comprehensive analyses of disconnectivity matrices establish similarities and dissimilarities in the disconnection patterns associated with pure, phonological and lexical-semantic alexia. While disconnections of the inferior longitudinal and posterior arcuate fasciculi are common to all alexia subtypes, disconnections of the long arcuate and vertical occipital fasciculi are specific to phonological and pure alexia, respectively. These findings provide a strong anatomical background for cognitive and neurocomputational models of reading.

Impact of the first wave of the SARS-CoV-2 pandemic on the outcome of neurosurgical patients: a nationwide study in Spain

ObjectiveTo assess the effect of the first wave of the SARS-CoV-2 pandemic on the outcome of neurosurgical patients in Spain.SettingsThe initial flood of COVID-19 patients overwhelmed an unprepared healthcare system. Different measures were taken to deal with this overburden. The effect of these measures on neurosurgical patients, as well as the effect of COVID-19 itself, has not been thoroughly studied.ParticipantsThis was a multicentre, nationwide, observational retrospective study of patients who underwent any neurosurgical operation from March to July 2020.InterventionsAn exploratory factorial analysis was performed to select the most relevant variables of the sample.Primary and secondary outcome measuresUnivariate and multivariate analyses were performed to identify independent predictors of mortality and postoperative SARS-CoV-2 infection.ResultsSixteen hospitals registered 1677 operated patients. The overall mortality was 6.4%, and 2.9% (44 patients) suffered a perioperative SARS-CoV-2 infection. Of those infections, 24 were diagnosed postoperatively. Age (OR 1.05), perioperative SARS-CoV-2 infection (OR 4.7), community COVID-19 incidence (cases/105 people/week) (OR 1.006), postoperative neurological worsening (OR 5.9), postoperative need for airway support (OR 5.38), ASA grade ≥3 (OR 2.5) and preoperative GCS 3–8 (OR 2.82) were independently associated with mortality. For SARS-CoV-2 postoperative infection, screening swab test <72 hours preoperatively (OR 0.76), community COVID-19 incidence (cases/105 people/week) (OR 1.011), preoperative cognitive impairment (OR 2.784), postoperative sepsis (OR 3.807) and an absence of postoperative complications (OR 0.188) were independently associated.ConclusionsPerioperative SARS-CoV-2 infection in neurosurgical patients was associated with an increase in mortality by almost fivefold. Community COVID-19 incidence (cases/105 people/week) was a statistically independent predictor of mortality.Trial registration numberCEIM 20/217.