The treatment of patients with posthemorrhagic hydrocephalus

The article discusses the possible causes of polycystic posthemorrhagic ventriculomegaly in infants, as well as predictors of this pathological process. When choosing a treatment method the doctor shall take into account not only the etiology of the disease, but also age parameters, concomitant pathology. An important aspect in the approach to the treatment of polycystic posthemorrhagic multilevel hydrocephalus includes the determination of the biomechanical properties of the craniospinal system, especially the compliance of the brain and resorption of cerebrospinal fluid. Particular attention is paid to the timely correction of complications, including the analysis of inflammatory changes markers in the craniospinal system, which serve as predictors of the outcome of cerebrospinal fluid resorption. The authors also noted that the violation of the cerebrospinal fluid outflow from the cranial cavity in children may depend on a large number of «extracerebral» factors. They consider the stages of neurosurgical care to patients in this group on a clinical example. This example and literature data demonstrate that children with age develop changes not only in the craniospinal segment, which is responsible for the transformation of free fluid, but also in the extracranial cavities. Thus, we are able to recommend an integrated approach for the management of newborns with intracranial hemorrhage, complicated by posthemorrhagic hyporesorbent and occlusive hydrocephalus, with the justification of the optimal neurosurgical tactics for managing drainage-dependent patients, the course of the disease in which is accompanied by a multicomponent inflammatory syndrome.

SIMULTANEOUS PERFORMANCE OF ENDOSCOPIC VENTRICULOCISTERNOSTOMY OF THE THIRD VENTRICLE FLOOR, AQUEDUCTOPLASTY, FENESTRATION OF THE SUPRACEREBELLAR CYST IN OCCLUSIVE HYDROCEPHALUS IN A CHILD IN THE FIRST MONTH OF LIFE

The article presents a clinical case of the simultaneous execution of endoscopic ventriculocisternostomy of the third ventricle floor (ETV), aqueductoplasty, fenestration of the supracerebellar cyst in occlusive hydrocephalus using a semi-rigid needle neuroendoscope. The authors describe a child who, at the age of 1 month, was admitted to Neurosurgical Department No. 1 of the Federal Center for Neurosurgery of the Ministry of Health of the Russian Federation in Tyumen with a diagnosis of congenital internal occlusive hydrocephalus, subcompensated course. MRI scan of the brain: triventricular occlusive asymmetric hydrocephalus is visualized, adhesions in the upper parts of the aqueduct, supracerebellar arachnoid cyst were visualised. ETV, aqueductoplasty, fenestration of the supracerebellar cyst were performed. There were no postoperative neurological, endocrine and infectious complications. The observation period after surgery is 7 years from today. Conclusion: preoperative MRI analysis of the structures of the third ventricular floor, interventricular and prepontine cisterns is important for understanding endoscopic, microsurgical anatomy and surgical planning. The use of modern improved endoscopic instruments, low-traumatic performance of all stages of the operation allow to restore cerebrospinal fluid circulation and achieve high efficiency in the treatment of occlusive hydrocephalus in the long-term period. This, in turn, relieves patients of the shunt-dependent state, constant correction of the dysfunctions of the shunt system and long-term, and often ineffective, treatment performed by neurologists and pediatricians.

Assessing the Predictive Value of TRIPS in Newborns

The objective: to determine the predictive value of TRIPS at the stage of pre-transport preparation in relation to treatment outcomes of newborns.Subjects: The cohort study included data from 604 visits of the team of the intensive case and consultation center. The TRIPS score was assessed, and the outcomes of the hospital phase of treatment were studied. The AUC ROC curve of the TRIPS score was calculated in relation to the binary outcomes of hospital treatment. The correlation analysis of the quantitative data was performed by Spearman's criterion.Results. AUC was greater than 0.8 only for the risk of death (AUC 0.827 (0.764-0.891)), the formation of severe IVH (AUC 0.831 (0.786-0.877)) and the development of occlusive hydrocephalus (AUC 0.839 (0.764-0.915)). For other binary outcomes, the score shows AUC below 0.8. A weak but significant correlation was found between the TRIPS score and the duration of intensive care (r = 0.478,p < 0.0001).Conclusion: TRIPS demonstrated an acceptable level of accuracy (AUC>0.8) in predicting hospital mortality, severe IVH, and the formation of occlusive hydrocephalus. A weak but significant correlation was found with the quantitative outcomes.

Repeated endoscopic third ventriculostomy (ETV). Role of advanced instruments for performing this minimally invasive surgery

This series of studies presents the results of repeated endoscopic third ventriculostomy (ETV) in patients with occlusive hydrocephalus. 33 cases of repeated ETV were considered as a material for the study: 7 adult patients aged 18 years and older (19 % (3 men, 4 women)) and 26 children aged 0 to 17 years (81 % (15 boys, 11 girls)). The average period of clinical observation after the surgery was 42,3 ± 2,7 months. 21 patients (64 %) had the effect from the surgery, they became shunt-independent. 23 repeated endoscopic third ventriculostomy were performed using standard rigid endoscopes (Gaab, Lotta, Little Lotta Endoscopes), the other 10 surgeries were performed using miniature semi-rigid needle endoscope. There were no postoperative neurological, endocrine and infectious complications in the studied group.

RARE-03. CNS GERMINOMA WITH SYNCHRONOUS LESIONS IN THE SELLAR AND PINEAL REGIONS

Germinomas comprise approximately 2–5% of all CNS malignancies, and have a favourable prognosis. Bad outcomes are relatively rare. Synchronous lesions occurs in 5–10% of cases. We report a case of 28 years old male, presented with motor aphasia, visual impairment and dysphagia. In period of last 15 months patient underwent 3 surgical interventions due to occlusive hydrocephalus. MRI revealed volume formations of the pineal and sellar regions. Taking into account the severity of the patient’s condition, consilium decided to refrain from surgical intervention and adjuvant therapy. Patient was transferred to the palliative unit. He died after 3 months. According to the results of the autopsy, the histological changes in tumors of the pineal and infundibular regions, corresponds to the germinoma. Due to the lack of information about patient’s treatment, carried out until hospitalization in our center, we don’t undertake to judge whether there was diagnostic omission, or incorrect treatment in this clinical case. But in our opinion, in case of suspected CNS germinoma, it is necessary to conduct more “aggressive treatment” (Tumor biopsy, followed by radiotherapy and chemotherapy). Symptomatic treatment should be used in cases, where the treatment of main disease is impossible. We hope that this sad clinical case will help Neurosurgeons in making decisions in a difficult situation.

Treatment of a pregnant woman with glioblastoma complicated by acute occlusive hydrocephalus in the subcompensation stage (from practice)

The study objective is to present a rare clinical observation, describe a successful 2-stage neurosurgical treatment of a pregnant patient with glioblastoma complicated by acute occlusive hydrocephalus.Materials and methods. A pregnant woman, 36 years (pregnancy 28–29 weeks), was urgently hospitalized with a suspicion for preeclampsia at a multispecialty hospital with a maternity ward. One day prior to hospitalization the patient developed hypertensive syndrome manifesting through headache, nausea, vomiting, depressed consciousness to stupor, then seizures in the extremities with loss of consciousness.Examination had shown malignant paraventricular tumor of the left temporal and parietal lobes accompanied by perifocal edema, brain dislocation, and acute occlusive triventricular hydrocephalus.Results. Treatment included the following stages: 1) emergency endoscopic third ventriculocisternostomy under local anesthesia, 2) premature delivery per cesarean section, 3) microsurgical resection of the brain tumor. Histological examination diagnosed glioblastoma (grade IV). The patient was discharged with minimal neurological deficiency (elements of motor and sensory aphasia) for administration of chemoradiation therapy.Conclusion. Surgical treatment of a patient with glioblastoma and acute occlusive hydrocephalus in the 3rd trimester can be performed safely and effectively for the mother and fetus in 2 stages. Third ventriculocisternostomy under local anesthesia is recommended as a method of cerebrospinal fluid drainage.