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Kahle KT, Klinge PM, Koschnitzky JE, Kulkarni AV, MacAulay N, Robinson S, Schiff SJ, Strahle JM. Paediatric hydrocephalus. Nat Rev Dis Primers 2024; 10:35. [PMID: 38755194 DOI: 10.1038/s41572-024-00519-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/11/2024] [Indexed: 05/18/2024]
Abstract
Hydrocephalus is classically considered as a failure of cerebrospinal fluid (CSF) homeostasis that results in the active expansion of the cerebral ventricles. Infants with hydrocephalus can present with progressive increases in head circumference whereas older children often present with signs and symptoms of elevated intracranial pressure. Congenital hydrocephalus is present at or near birth and some cases have been linked to gene mutations that disrupt brain morphogenesis and alter the biomechanics of the CSF-brain interface. Acquired hydrocephalus can develop at any time after birth, is often caused by central nervous system infection or haemorrhage and has been associated with blockage of CSF pathways and inflammation-dependent dysregulation of CSF secretion and clearance. Treatments for hydrocephalus mainly include surgical CSF shunting or endoscopic third ventriculostomy with or without choroid plexus cauterization. In utero treatment of fetal hydrocephalus is possible via surgical closure of associated neural tube defects. Long-term outcomes for children with hydrocephalus vary widely and depend on intrinsic (genetic) and extrinsic factors. Advances in genomics, brain imaging and other technologies are beginning to refine the definition of hydrocephalus, increase precision of prognostication and identify nonsurgical treatment strategies.
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Affiliation(s)
- Kristopher T Kahle
- Department of Neurosurgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
- Broad Institute of Harvard and MIT, Cambridge, MA, USA.
- Department of Neurosurgery and Division of Genetics and Genomics, Boston Children's Hospital, Boston, MA, USA.
| | - Petra M Klinge
- Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Jenna E Koschnitzky
- Department of Neurosurgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Abhaya V Kulkarni
- Division of Paediatric Neurosurgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Nanna MacAulay
- Department of Neuroscience, University of Copenhagen, Copenhagen, Denmark
| | - Shenandoah Robinson
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Paediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Steven J Schiff
- Department of Neurosurgery, Yale University, New Haven, CT, USA
- Department of Epidemiology of Microbial Diseases, Yale University, New Haven, CT, USA
| | - Jennifer M Strahle
- Department of Neurosurgery, Washington University School of Medicine, Saint Louis, MO, USA
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Roethe AL, Beer L, Schulz M, Schaumann A, Thomale UW. Tailored Concept for Accurate Neuroendoscopy: A Comparative Retrospective Single-Center Study on Image-Guided Neuroendoscopic Procedures. World Neurosurg 2024; 185:60-70. [PMID: 38325702 DOI: 10.1016/j.wneu.2024.01.171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 01/30/2024] [Indexed: 02/09/2024]
Abstract
OBJECTIVE Precise planning and execution is key for neuroendoscopic interventions, which can be based on different available aiding technologies. The aim of this retrospective study is to report a case-based use of guided neuroendoscopy and to develop a stratification algorithm for the available technologies. METHODS We reviewed consecutive neuroendoscopic cases performed at our center from 2016 to 2018. We distinguished between patients receiving a new burr hole (group A) and those with a preexisting burr hole (group B). Case-specific technical requirements for procedure planning and execution, complication rate, surgical outcome, and possible subsequent surgery were evaluated. From this experience, a stratification system was developed to tailor the available guiding technologies. RESULTS A total of 309 neuroendoscopic interventions in 243 patients were included in the present study. The cases included hydrocephalic (81.6%) and nonhydrocephalic (18.4%) conditions. The interventions were supported by coordinate-based (group A, n = 49; group B, n = 67), guide-based (group A, n = 42; group B, n = 0), ultrasound-guided (group A, n = 50; group B, n = 7), or navigated augmented reality-guided (group A, n = 85; group B, n = 9) techniques. The overall complication rate was 4.5%. Stratified by the surgical indication, fontanel status, entry point localization, presence of a preexisting burr hole, ventricular size, and number of targets, an approach toward image-guided neuroendoscopy is suggested. CONCLUSIONS Planning and technical guidance is essential in neuroendoscopic procedures. The stratified decision-making algorithm for different available technologies aims to achieve lower cost and time consumption, which was found to be safe and efficient. Further investigations are warranted to deliver solid data on procedure efficiency.
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Affiliation(s)
- Anna L Roethe
- Department of Neurosurgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Lilian Beer
- Pediatric Neurosurgery, Department of Neurosurgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Matthias Schulz
- Pediatric Neurosurgery, Department of Neurosurgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Andreas Schaumann
- Pediatric Neurosurgery, Department of Neurosurgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Ulrich-Wilhelm Thomale
- Pediatric Neurosurgery, Department of Neurosurgery, Charité-Universitätsmedizin Berlin, Berlin, Germany.
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Huang LT, Zhou Q, Tong X. Treatment of Pineal Region Lesions in Children. J Craniofac Surg 2024; 35:e60-e66. [PMID: 37948620 DOI: 10.1097/scs.0000000000009846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 10/01/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Pineal region lesions are more common in children than adults; however, therapeutic strategies for pineal region lesions in children are controversial. METHODS A retrospective study involving 54 pediatric with pineal region lesions was conducted. The therapeutic strategies for lesions and hydrocephalus were classified and analyzed. RESULTS Radiotherapy of pineal region lesions was shown to result in better postoperative recovery and fewer complications in the short-term compared with lesion resection. Total resection was related to smaller lesion size, endoscopic procedures, and a better prognosis. Cerebrospinal fluid (CSF) diversion before the resection reduced hydrocephalus recurrences, whereas further lesion resection had a negative short-term influence on CSF diversion. Among the 4 therapeutic strategies to manage hydrocephalus, a third ventriculostomy (ETV) was reasonable and further resection did not have a negative impact on the ETV. The relief of hydrocephalus was also related to better postoperative recovery, a higher total resection rate, fewer complications, and a better prognosis. Logistical regression analysis indicated that lesion size and intracranial complications were predictors of outcome. CONCLUSIONS For lesion treatment, total resection and radiotherapy are essential components in children. Total resection and CSF diversion before resection were beneficial, whereas further lesion resection had a negative impact on CSF diversion. For hydrocephalus treatment, ETV was shown to be the best therapeutic strategy for management of pediatric hydrocephalus. Total resection and better preoperative health status were associated with greater hydrocephalus relief. For the overall prognosis, a lack of hydrocephalus relief was associated with poor outcomes. Lesion size and intracranial complications may be the best predictors of outcome.
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Affiliation(s)
- Li-Tian Huang
- Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin
| | - Quan Zhou
- Department of Neurosurgery, The First Affiliated Hospital of Guangxi Medical University, No 6 Shuang Yong Road Nanning, Guangxi, Guangxi Province, China
| | - Xiaoguang Tong
- Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin
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Chen B, Dammann P, Jabbarli R, Sure U, Quick HH, Kraff O, Wrede KH. Safety and function of programmable ventriculo-peritoneal shunt valves: An in vitro 7 Tesla magnetic resonance imaging study. PLoS One 2023; 18:e0292666. [PMID: 37819939 PMCID: PMC10566673 DOI: 10.1371/journal.pone.0292666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 09/26/2023] [Indexed: 10/13/2023] Open
Abstract
OBJECTIVE The quantity of ultra-high field MRI neuroimaging studies has rapidly increased. This study tests function, safety, and image artifacts of two frequently implanted programmable ventriculo-peritoneal (VP) shunt valves in a 7T MRI system. METHODS All tests were performed using a whole-body 7T MRI system. Three proGAV 2.0 and 3 CODMAN CERTAS® Plus programmable VP-shunt valves were tested in three steps. 1) Deflection angle tests close to the bore opening at the location of a static magnetic field gradient of 3-5 T/m. 2) Valves were fixed on a spherical phantom in 3 positions (a. lateral, b. cranial, c. cranial with 22.5° tilt anteriorly) and assessed for keeping the programmed pressure setting and reprogrammability. 3) Valves were fixed on the phantom and positioned lateral in a radiofrequency head coil. MRI scans were performed for both models, including MPRAGE, GRE and SE sequences. RESULTS Deflection angles were moderate (13°, 14°, 13°) for the proGAV valves and close to critical (43°, 43°, 41°) for the CODMAN valves at the test location. Taking a scaling factor of 2-3 for the maximum spatial magnetic field gradient accessible to a patient within the magnet bore into account renders both valves MR unsafe regarding ferromagnetic attraction. The proGAV valves kept the pressure settings in all positions and were reprogrammable in positions a. and b. In position c., reprogrammability was lost. The CODMAN valves changed their pressure setting and reprogrammability was lost in all positions. MR image signal homogeneity was unaltered in the phantom center, artifacts limit the assessability of structures in close vicinity to the valves. CONCLUSION Both tested programmable VP-shunt valves are MR unsafe for 7T systems. Novel programming mechanisms using permanent magnets with sufficient magnetic coercivity or magnet-free mechanisms may allow the development of programmable VP-shunt valves that are conditional for 7T MR systems.
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Affiliation(s)
- Bixia Chen
- Erwin L. Hahn Institute for Magnetic Resonance Imaging, University Duisburg-Essen, Essen, North Rhine Westphalia, Germany
- Department of Neurosurgery, University Hospital Essen, University Duisburg-Essen, Essen, North Rhine Westphalia, Germany
| | - Philipp Dammann
- Erwin L. Hahn Institute for Magnetic Resonance Imaging, University Duisburg-Essen, Essen, North Rhine Westphalia, Germany
- Department of Neurosurgery, University Hospital Essen, University Duisburg-Essen, Essen, North Rhine Westphalia, Germany
| | - Ramazan Jabbarli
- Department of Neurosurgery, University Hospital Essen, University Duisburg-Essen, Essen, North Rhine Westphalia, Germany
| | - Ulrich Sure
- Department of Neurosurgery, University Hospital Essen, University Duisburg-Essen, Essen, North Rhine Westphalia, Germany
| | - Harald H. Quick
- Erwin L. Hahn Institute for Magnetic Resonance Imaging, University Duisburg-Essen, Essen, North Rhine Westphalia, Germany
- High-Field and Hybrid MR Imaging, University Hospital Essen, University Duisburg-Essen, Essen, North Rhine Westphalia, Germany
| | - Oliver Kraff
- Erwin L. Hahn Institute for Magnetic Resonance Imaging, University Duisburg-Essen, Essen, North Rhine Westphalia, Germany
| | - Karsten H. Wrede
- Erwin L. Hahn Institute for Magnetic Resonance Imaging, University Duisburg-Essen, Essen, North Rhine Westphalia, Germany
- Department of Neurosurgery, University Hospital Essen, University Duisburg-Essen, Essen, North Rhine Westphalia, Germany
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Zhang N, Zhang D, Sun J, Sun H, Ge M. Contribution of tumor characteristics and surgery-related factors to symptomatic hydrocephalus after posterior fossa tumor resection: a single-institution experience. J Neurosurg Pediatr 2023; 31:99-108. [PMID: 36446021 DOI: 10.3171/2022.10.peds22281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 10/04/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Pediatric patients are at risk of persistent hydrocephalus after posterior fossa tumor resection. The relationship between surgery-related factors and postoperative symptomatic hydrocephalus has not been elucidated. The objective of this study was to analyze features influencing postoperative hydrocephalus in Chinese children. METHODS The authors retrospectively evaluated 197 patients younger than 15 years of age who underwent posterior fossa tumor resection at their institution from January 2015 to June 2021. The outcome was whether children underwent CSF diversion within 6 months of resection. Preoperative characteristics, surgery-related factors, and postoperative features were included to identify independent prognosticators. A new logistic model containing independent prognosticators was developed and compared with the modified Canadian Preoperative Prediction Rule for Hydrocephalus (mCPPRH). RESULTS In this study, 30 patients (15.2%) underwent CSF diversion within 6 months after tumor resection. Tumor location and consistency, intracranial or spinal tumor metastasis determined by perioperative cerebral and spinal MRI, intraoperative blood loss, ventricular blood as determined on postoperative CT, and pathology were statistically significant variables in the univariate analysis. The only two independent predictors of postoperative symptomatic hydrocephalus were tumor metastasis (OR 3.463, 95% CI 1.137-10.549; p = 0.029) and postoperative ventricular blood (OR 4.212, 95% CI 1.595-11.122; p = 0.004). The final logistic model comprising tumor metastasis and postoperative ventricular blood was found to have better discrimination than the mCPPRH. CONCLUSIONS Tumor characteristics and surgery-related features were associated with postoperative symptomatic hydrocephalus. Tumor metastasis and postoperative ventricular blood were found to be important prognosticators of persistent hydrocephalus.
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Affiliation(s)
| | | | - Jihang Sun
- 2Radiology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | | | - Ming Ge
- Departments of1Neurosurgery and
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Yao D, Zhao J, Ren Y. Efficacy of Shuanghe Jiyu Decoction in 126 Patients with Bone Marrow Suppression. CONTRAST MEDIA & MOLECULAR IMAGING 2022; 2022:9333718. [PMID: 36128171 PMCID: PMC9470345 DOI: 10.1155/2022/9333718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 08/02/2022] [Accepted: 08/18/2022] [Indexed: 11/18/2022]
Abstract
Bone marrow suppression is a common complication of chemotherapy. In order to observe the effects of Shuanghe Jiyu decoction on peripheral white blood cells (WBC), hemoglobin (Hb), and platelet (PLT) in patients with bone marrow suppression, a total of 126 patients with bone marrow suppression were given at least three consecutive cycles of chemotherapy. The results show that among 126 patients with bone marrow suppression, 16 achieved marked efficacy and 100 achieved moderate efficacy. The overall effective rate is 92.06%. Moreover, the symptoms of bone marrow suppression are mitigated. No adverse events are reported during the treatment.
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Affiliation(s)
- Dapeng Yao
- College of Traditional Chinese Medicine, Liaoning University of Traditional Chinese Medicine, Shenyang 110847, China
| | - Jing Zhao
- Laboratory of Quality Assessment, Shenyang Institute of Food and Drug Control, Shenyang 110000, China
| | - Yanling Ren
- College of Traditional Chinese Medicine, Liaoning University of Traditional Chinese Medicine, Shenyang 110847, China
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