Tips and Tricks in Difficult ETV

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.

Diffuse Leptomeningeal Oligodendrogliomatosis in a Cow

A 4.5-year-old cow showing neurological signs consistent with predictors of bovine spongiform encephalopathy (BSE) was investigated as a potential BSE-suspect case and proved to be negative. Macroscopic analysis revealed a tan neoplastic mass growing along the leptomeninges of the caudal brain and extending into the third (III) ventricle without significantly involving the neuroparenchyma. Pathological features (uniform round hyperchromatic neoplastic cells embedded in abundant myxoid matrix, microcysts, microvascular proliferation) and diffuse Olig2 expression were most consistent with diffuse high-grade leptomeningeal oligodendrogliomatosis. In line with former reports of extensive leptomeningeal involvement in bovine oligodendroglioma, this report suggests that bovine oligodendroglial tumors have a strong propensity to grow within the leptomeningeal space. In addition, it indicates that Olig2 is a useful marker to confirm glial lineage in formalin-fixed, paraffin-embedded bovine tissue.

Morphological and Functional Changes in the Brain in the Long-Term Period after On-Pump Cabg

Purpose: evaluation of brain substance’s morphological state and dynamics of cerebral tissue perfusion in patients undergoing on-pump CABG surgery compared preoperative and late postoperative period.Materials and methods. The study included 14 male patients who underwent on-pump CABG surgery. CT and PCT with intravenous bolus radiopaque drug in the cubital vein conducted to all patients in the preoperative period. Cranio-ventricular index, width III ventricle was measured. The presence and degree leukoaraiosis, the presence of cysts, areas of gliosis, CBF, CBV, TTP in symmetric cortical and subcortical regions was recorded. CT and PCT repeat after 5 years.Results.In preoperative period III ventricle width was 6.8 ± 1.4 mm; cranio-ventricular index = 4.9 ± 1.3. It were found cysts on the level of the basal ganglia in two cases (14%). Leukoaraiosis detected in four patients (28%). PCT in the preoperative period noted the absence of blood flow asymmetry, reducing blood flow to the frontal lobes, in the area of the junction of the parietal, temporal and occipital lobes. Significant expansion of the III ventricle 8.5 ± 2.5 mm, reducing cranio-ventricular index 3.6 ± 0.5, increasing the number of cysts and glial changes in 6 (43%) cases, leukoaraiosis in 8 (57%) cases, a significant increase in TTP in the index of the thalamus (11.5 ± 2.1 sec) was determined after the operation.Conclusions.Сhronic cerebral ischemia revealed progression of manifestations in the late postoperative period in patients undergoing on-pump CABG. The identified changes are not a direct result of on-pump CABG, because similar changes observed in patients with atherosclerotic lesions of the microvasculature and damage the blood-brain barrier and also in patients without cardiac surgery.

Morphological parallels of communications between the circumventricular system in adolescents

This article presents, based on the example of morphometric study of magnetic resonance tomograms of persons of various ages, the complex of vital characteristics of the cerebrospinal system of the brain in adolescents. The study tested gender characteristics and inter hemispheric asymmetry of the analyzed indexes. An asymmetry of anatomical structures of the right and left hemispheres with the tendency to increase in their sizes in the right hemisphere was found both for males and for females. Females had some age differences in the longitudinal dimension of the III ventricle (this index was lower in older females), the width and index of the IV ventricle was significantly lower in the 18 and 20 year old girls. Objective and methods. The research was conducted on the base of the radiation diagnosis department of Rivne Regional Clinical Hospital on the CT scan General Electric Healthcare Signa MRI 1.5 T and in the office of magnetic resonance imaging of Lutsk City Clinical Hospital on the CT scan Signa Profile Ce Medical System – 1,5 Tl in standard anatomic planes (sagittal, frontal andaxial). Measurements were carried out in persons without visual signs of organic lesions of the brain and skull. Analysis was made of 11 tomograms (males 17–21 years old – 6 persons, females 16–20 years old – 5 persons). In comparing pairs of parameters (of lateral ventricles) the factor of asymmetry was calculated, which is equal to the difference between the right and left lateral ventricles divided by the sum of right and left ventricles indexes (%). The results were processed by methods of descriptional statistics. In young males of this age group a significant increase in the following indicators was identified: the length of the anterior horn of the lateral ventricle on the right side, the length of the body of the lateral ventricle on both sides and the height of the III ventricle. Females had significantly increases in the following parameters: the width of the anterior horn of the lateral ventricle on the right side and the width of the posterior horn of the lateral ventricle on the left side. Consequently, in male adoles cents a parallelism in the formation of various structures of the ventricular system was traced. Since this is a single system, morphological and functional connections between its different components are stored. Mathematical analysis of the values of the structures of ventricular system in females characterize a hormonal influence on its development in adolescents. We can assume that organs which are the part of the circumventricular system (subcommisural organ, subfornical organ, median rise etc.), definitely have the character of anatomical connections between these components. Their functional unity in maintaining the homeostasis of the body is undeniable.