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Deora H, Thakur D, Shashidhar A, Konar S, PrabhuRaj AR, Sadashiva N, A A, Srinivas D. Huge hydrocephalus: a rare case series with insights into management and outcomes of this neglected cohort. Childs Nerv Syst 2024:10.1007/s00381-024-06495-5. [PMID: 38898287 DOI: 10.1007/s00381-024-06495-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Accepted: 06/07/2024] [Indexed: 06/21/2024]
Abstract
PURPOSE This study aims to discuss the management challenges of huge hydrocephalus (HH), a severe subset of hydrocephalus, presenting predominantly in underprivileged backgrounds. Insights into the condition's characteristics, factors affecting outcomes, and associated morbidity are discussed. METHODS A retrospective review of all operated cases of hydrocephalus with head circumference greater than body length (HC>L) was conducted (January 2019-January 2023). Data on epidemiological parameters, associated cranial abnormalities, cortical mantle thickness, peri-conceptional folic acid intake, surgical interventions, age-appropriate milestones, and complications were collected. Follow-up was conducted for at least 12 months or until expiration. RESULTS The cohort consisted of 7 males and 5 females with age ranging from 3 to 48 months. 33% of them had associated neurological abnormalities, and 18 surgical interventions were needed for these 12 cases, including ventriculoperitoneal shunt or endoscopic diversion. A 17% wound breakdown rate requiring re-suturing was present, and 33% of cases had postoperative CSF infection, with 33% mortality, with only one case having age-appropriate development seen. The average hospital stay was 11.9 days, six times our center's average. All cases with an Evans index with an average of 0.7 expired within 12 months. None of the 12 mothers took peri-conceptional folic acid, and no case agreed to reduction cranioplasty. CONCLUSION Huge hydrocephalus is a rare cohort with significant management challenges and poor prognosis even after treatment. Factors such as delayed intervention and low socioeconomic status contribute to adverse outcomes. Prevention through peri-conceptual folic acid intake and addressing socioeconomic disparities is crucial in reducing disease burden and improving prognosis.
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Affiliation(s)
- Harsh Deora
- Department of Neurosurgery, National Institute of Mental Health and Neuro Sciences, Bengaluru, India
| | - Digvijay Thakur
- Department of Neurosurgery, National Institute of Mental Health and Neuro Sciences, Bengaluru, India
| | - Abhinith Shashidhar
- Department of Neurosurgery, National Institute of Mental Health and Neuro Sciences, Bengaluru, India.
| | - Subhas Konar
- Department of Neurosurgery, National Institute of Mental Health and Neuro Sciences, Bengaluru, India
| | - A R PrabhuRaj
- Department of Neurosurgery, National Institute of Mental Health and Neuro Sciences, Bengaluru, India
| | - Nishant Sadashiva
- Department of Neurosurgery, National Institute of Mental Health and Neuro Sciences, Bengaluru, India
| | - Arivazhaghan A
- Department of Neurosurgery, National Institute of Mental Health and Neuro Sciences, Bengaluru, India
| | - Dwarakanath Srinivas
- Department of Neurosurgery, National Institute of Mental Health and Neuro Sciences, Bengaluru, India
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Raut R, Shams S, Scalia G, Umana GE, Ranganathan S, Rasheed M, Vats A, Chaurasia B. Comparison of ventriculoperitoneal shunt versus endoscopic third ventriculostomy in managing hydrocephalus due to tuberculous meningitis: a randomized controlled trial with a 30-day follow-up. Ann Med Surg (Lond) 2024; 86:881-885. [PMID: 38333284 PMCID: PMC10849454 DOI: 10.1097/ms9.0000000000001701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 12/29/2023] [Indexed: 02/10/2024] Open
Abstract
Background Hydrocephalus is a significant complication arising from tuberculous meningitis (TBM). While ventriculoperitoneal shunt (VPS) remains the primary surgical approach for TBM-related hydrocephalus, there is a rising trend in the use of endoscopic third ventriculostomy (ETV). Materials and methods This randomized controlled trial, conducted from February 2018 to July 2019, enroled 60 patients aged 20-50 with TBM-related hydrocephalus. Patients underwent either VPS or ETV. Both groups were followed up for a minimum of 30 days, evaluating clinical outcomes and modifications in the modified Vellore grading system. Glasgow Coma Scale (GCS) assessments were conducted at 7-days and 30-day post-surgery for both groups. Results The mean GCS scores were comparable between the two groups on the 7th and 30th postoperative days. The association between modified Vellore Grade and treatment modality did not show statistically significant differences (P=1.0 and P=0.3) on the seventh and thirtieth postoperative days respectively. Conclusions Both VPS and ETV demonstrate efficacy in managing hydrocephalus secondary to TBM in adult patients. Our 30-day outcomes did not reveal discernible differences between the two procedures. Therefore, considering technical expertise and experience with ETV, it may be considered as the primary choice for cerebrospinal fluid (CSF) diversion in TBM-associated hydrocephalus, owing to its avoidance of several lifelong complications linked with VPS.
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Affiliation(s)
- Rupesh Raut
- Department of Neurosurgery, Patan Hospital, Patan Academy of Health Sciences, Lalitpur
| | - Shahzad Shams
- Department of Neurosurgery, King Edward Medical University, Mayo Hospital, Lahore, Pakistan
| | - Gianluca Scalia
- Neurosurgery Unit, Department of Head and Neck Surgery, Garibaldi Hospital
| | | | | | - Muddassar Rasheed
- Department of Neurosurgery, King Edward Medical University, Mayo Hospital, Lahore, Pakistan
| | - Atul Vats
- James Cook University Hospital, Middlesbrough, UK
| | - Bipin Chaurasia
- Department of Neurosurgery, Neurosurgery Clinic, Birgunj, Nepal
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Montemurro N. Clinical and surgical outcome of endoscopic third ventriculostomy (ETV) and ventriculoperitoneal shunt (VPS) in patients with Long-Standing Overt Ventriculomegaly in Adults (LOVA): a systematic review. Neurol Res 2024; 46:81-88. [PMID: 37722694 DOI: 10.1080/01616412.2023.2257461] [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: 04/23/2023] [Accepted: 07/19/2023] [Indexed: 09/20/2023]
Abstract
OBJECTIVES The optimal surgical procedure for long-standing overt ventriculomegaly in adults (LOVA) remains controversial. METHODS A systematic search of three databases was performed for studies published between January 1999 and March 2022. This systematic review included 12 studies with a total of 318 patients with LOVA surgically treated. PRISMA guidelines were followed. RESULTS Gait disturbance (74.8%) and headache (59.7%) were the most common clinical presentation. Overall, the rate of postoperative clinical improvement at the last follow-up was 83.6% (95% CI 78.1-86.1). A lower rate of postoperative clinical improvement or halt of progression of presenting symptoms was observed after ETV (211/257 = 82.1% 95% CI 76.2-85.1%) compared with VPS (55/61 = 90.2% 95% CI 80.3-96.1%). Overall, surgical and postoperative complications were reported in 22/297 patients (7.5% 95% CI 4.4-20%) (11 studies). A higher rate of surgical complications was observed in patients treated with VPS (19.7% 95 CI 5.9-46.7%), compared with patients treated with ETV (4.3% 95% CI 2.1-10.9%). The overall rate of second surgery due to failure of first surgical approach (ETV or VPS) was 46/275 (16.7%). DISCUSSION This meta-analysis confirmed the efficacy of EVT and VPS in symptomatic patients with LOVA, reporting a roughly 84% of postoperative clinical improvement or halt of progression of symptoms. A higher rate of surgical complications was observed in patients treated with VPS compared with patients treated with ETV. In addition, roughly 18% of patients treated with ETV required a further VPS. These findings should be considered when advising LOVA patients regarding the management of hydrocephalus.
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Affiliation(s)
- Nicola Montemurro
- Department of Neurosurgery, Azienda Ospedaliero Universitaria Pisana (AOUP), Pisa, Italy
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Niedermeyer S, Terpolilli NA, Nerlinger P, Weller J, Schmutzer M, Quach S, Thon N. Minimally invasive third ventriculostomy with stereotactic internal shunt placement for the treatment of tumor-associated noncommunicating hydrocephalus. Acta Neurochir (Wien) 2023; 165:4071-4079. [PMID: 37676505 PMCID: PMC10739544 DOI: 10.1007/s00701-023-05768-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 08/11/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND Intracranial tumors can cause obstructive hydrocephalus (OH). Most often, symptomatic treatment is pursued through ventriculoperitoneal shunt (VS) or endoscopic third ventriculostomy (ETV). In this study, we propose stereotactic third ventriculostomy with internal shunt placement (sTVIP) as an alternative treatment option and assess its safety and efficacy. METHODS In this single-center, retrospective analysis, clinical symptoms, procedure-related complications, and revision-free survival of all patients with OH due to tumor formations treated by sTVIP between January 2010 and December 2021 were evaluated. RESULTS Clinical records of thirty-eight patients (11 female, 27 male) with a mean age of 40 years (range 5-88) were analyzed. OH was predominantly (in 92% of patients) caused by primary brain tumors (with exception of 3 cases with metastases). Following sTVIP, 74.2% of patients experienced symptomatic improvement. Preoperative headache was a significant predictor of postoperative symptomatic improvement (OR 26.25; 95% CI 4.1-521.1; p = 0.0036). Asymptomatic hemorrhage was detected along the stereotactic trajectory in 2 cases (5.3%). One patient required local revision due to CSF fistula (2.6%); another patient had to undergo secondary surgery to connect the catheter to a valve/abdominal catheter due to CSF malabsorption. However, in the remaining 37 patients, shunt independence was maintained during a median follow-up period of 12 months (IQR 3-32 months). No surgery-related mortality was observed. CONCLUSIONS sTVIP led to a significant symptom control and was associated with low operative morbidity, along with a high rate of ventriculoperitoneal shunt independency during the follow-up period. Therefore, sTVIP constitutes a highly effective and minimally invasive treatment option for tumor-associated obstructive hydrocephalus, even in cases with a narrow prepontine interval.
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Affiliation(s)
- Sebastian Niedermeyer
- Department of Neurosurgery, LMU Hospital, Ludwig-Maximilian-University Munich, Marchioninistrasse 15, 81377, Munich, Germany.
| | - Nicole A Terpolilli
- Department of Neurosurgery, LMU Hospital, Ludwig-Maximilian-University Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Pia Nerlinger
- Department of Neurosurgery, LMU Hospital, Ludwig-Maximilian-University Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Jonathan Weller
- Department of Neurosurgery, LMU Hospital, Ludwig-Maximilian-University Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Michael Schmutzer
- Department of Neurosurgery, LMU Hospital, Ludwig-Maximilian-University Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Stefanie Quach
- Department of Neurosurgery, LMU Hospital, Ludwig-Maximilian-University Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Niklas Thon
- Department of Neurosurgery, LMU Hospital, Ludwig-Maximilian-University Munich, Marchioninistrasse 15, 81377, Munich, Germany
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Rostgaard N, Olsen MH, Lolansen SD, Nørager NH, Plomgaard P, MacAulay N, Juhler M. Ventricular CSF proteomic profiles and predictors of surgical treatment outcome in chronic hydrocephalus. Acta Neurochir (Wien) 2023; 165:4059-4070. [PMID: 37857909 PMCID: PMC10739511 DOI: 10.1007/s00701-023-05832-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 09/22/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND By applying an unbiased proteomic approach, we aimed to search for cerebrospinal fluid (CSF) protein biomarkers distinguishing between obstructive and communicating hydrocephalus in order to improve appropriate surgical selection for endoscopic third ventriculostomy vs. shunt implants. Our second study purpose was to look for potential CSF biomarkers distinguishing between patients with adult chronic hydrocephalus benefitting from surgery (responders) vs. those who did not (non-responders). METHODS Ventricular CSF samples were collected from 62 patients with communicating hydrocephalus and 28 patients with obstructive hydrocephalus. CSF was collected in relation to the patients' surgical treatment. As a control group, CSF was collected from ten patients with unruptured aneurysm undergoing preventive surgery (vascular clipping). RESULTS Mass spectrometry-based proteomic analysis of the samples identified 1251 unique proteins. No proteins differed significantly between the communicating hydrocephalus group and the obstructive hydrocephalus group. Four proteins were found to be significantly less abundant in CSF from communicating hydrocephalus patients compared to control subjects. A PCA plot revealed similar proteomic CSF profiles of obstructive and communicating hydrocephalus and control samples. For obstructive hydrocephalus, ten proteins were found to predict responders from non-responders. CONCLUSION Here, we show that the proteomic profile of ventricular CSF from patients with hydrocephalus differs slightly from control subjects. Furthermore, we find ten predictors of response to surgical outcome (endoscopic third ventriculostomy or ventriculo-peritoneal shunt) in patients with obstructive hydrocephalus.
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Affiliation(s)
- Nina Rostgaard
- Department of Neurosurgery, The Neuroscience Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Markus Harboe Olsen
- Department of Neuroanaesthesiology, The Neuroscience Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Sara Diana Lolansen
- Department of Neurosurgery, The Neuroscience Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Neuroscience, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Nicolas Hernandez Nørager
- Department of Neurosurgery, The Neuroscience Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Peter Plomgaard
- Department of Clinical Biochemistry, Centre of Diagnostic Investigations, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Nanna MacAulay
- Department of Neuroscience, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Marianne Juhler
- Department of Neurosurgery, The Neuroscience Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
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Sanker V, Kundu M, El Kassem S, El Nouiri A, Emara M, Maaz ZA, Nazir A, Bekele BK, Uwishema O. Posttraumatic hydrocephalus: Recent advances and new therapeutic strategies. Health Sci Rep 2023; 6:e1713. [PMID: 38028696 PMCID: PMC10652704 DOI: 10.1002/hsr2.1713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 10/28/2023] [Accepted: 11/01/2023] [Indexed: 12/01/2023] Open
Abstract
Background Hydrocephalus or ventriculomegaly is a condition brought on by an overabundance of cerebrospinal fluid (CSF) in the ventricular system. The major contributor to posttraumatic hydrocephalus (PTH) is traumatic brain injuries (TBIs), especially in individuals with occupations set in industrial settings. A variety of criteria have been employed for the diagnosis of PTH, including the combination of neurological symptoms like nerve deficits and headache, as well as an initial improvement followed by a worsened relapse of altered consciousness and neurological deterioration, which is detected by computed tomography-brain imaging that reveals gradual ventriculomegaly. Aim In this article, we discuss and summarize briefly the current understandings and advancements in the management of PTH. Methods The available literature for this review was searched on various bibliographic databases using an individually verified, prespecified approach. The level of evidence of the included studies was considered as per the Centre for Evidence-Based Medicine recommendations. Results The commonly practiced current treatment modality involves shunting CSF but is often associated with complications and recurrence. The lack of a definitive management strategy for PTH warrants the utilization of novel and innovative modalities such as stem cell transplantations and antioxidative stress therapies. Conclusion One of the worst complications of a TBI is PTH, which has a high morbidity and mortality rate. Even though there hasn't been a successful method in stopping PTH from happening, hemorrhage-derived blood, and its metabolic by-products, like iron, hemoglobin, free radicals, thrombin, and red blood cells, may be potential targets for PTH hindrance and management. Also, using stem cell transplantations in animal models and antioxidative stress therapies in future studies can lower PTH occurrence and improve its outcome. Moreover, the integration of clinical trials and theoretical knowledge should be encouraged in future research projects to establish effective and updated management guidelines for PTH.
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Affiliation(s)
- Vivek Sanker
- Oli Health Magazine Organization, Research and EducationKigaliRwanda
- Society of Brain Mapping and TherapeuticsLos AngelesCaliforniaUSA
| | - Mrinmoy Kundu
- Oli Health Magazine Organization, Research and EducationKigaliRwanda
- Institute of Medical Sciences and SUM HospitalBhubaneswarIndia
| | - Sarah El Kassem
- Oli Health Magazine Organization, Research and EducationKigaliRwanda
- Faculty of MedicineBeirut Arab UniversityBeirutLebanon
| | - Ahmad El Nouiri
- Oli Health Magazine Organization, Research and EducationKigaliRwanda
- Faculty of MedicineBeirut Arab UniversityBeirutLebanon
| | - Mohamed Emara
- Oli Health Magazine Organization, Research and EducationKigaliRwanda
- College of MedicineUniversity of SharjahSharjahUnited Arab Emirates
| | - Zeina Al Maaz
- Oli Health Magazine Organization, Research and EducationKigaliRwanda
- Faculty of MedicineBeirut Arab UniversityBeirutLebanon
| | - Abubakar Nazir
- Oli Health Magazine Organization, Research and EducationKigaliRwanda
| | - Bezawit Kassahun Bekele
- Oli Health Magazine Organization, Research and EducationKigaliRwanda
- School of MedicineAddis Ababa UniversityAddis AbabaEthiopia
- Milken Institute of Public HealthGeorge Washington UniversityWashingtonDistrict of ColumbiaUSA
| | - Olivier Uwishema
- Oli Health Magazine Organization, Research and EducationKigaliRwanda
- Department of medicineClinton Global Initiative UniversityNew YorkNew YorkUSA
- Faculty of MedicineKaradeniz Technical UniversityTrabzonTurkey
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Mezzacappa FM, Weisbrod LJ, Schmidt CM, Surdell D. Neuroendoscopic Evacuation Improves Outcomes Compared with External Ventricular Drainage in Patients with Spontaneous Intraventricular Hemorrhage: A Systematic Review with Meta-Analyses. World Neurosurg 2023; 175:e247-e253. [PMID: 36958716 DOI: 10.1016/j.wneu.2023.03.061] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 03/13/2023] [Accepted: 03/14/2023] [Indexed: 03/25/2023]
Abstract
BACKGROUND Spontaneous intraventricular hemorrhage (IVH) is a cause of significant morbidity and mortality. Treatment for resulting obstructive hydrocephalus has traditionally been via an external ventricular drain (EVD). We aimed to compare patient outcomes after neuroendoscopic surgery (NES) evacuation of IVH versus EVD management. METHODS MEDLINE, Embase, and Cochrane Library databases were searched on October 8, 2022. Of the 252 records remaining after removal of duplicates, 12 met study inclusion criteria. After extraction of outcomes data, fixed-effect and random-effects models were used to establish odds ratios (ORs) with 95% confidence intervals (CIs) for intensive care unit length of stay, rate of permanent cerebrospinal fluid diversion, Glasgow Outcome Scale score, and mortality rate. RESULTS The results of the pooled analysis showed that intensive care unit length of stay was shorter (OR -2.61 [95% CI -5.02, -0.19]; I2 = 97.76%; P = 0.034), permanent cerebrospinal fluid diversion was less likely (OR -0.79, 95% CI [-1.17, -0.41], I2 = 46.96%, P < 0.001), higher Glasgow Outcome Scale score was more likely (OR 0.48, 95% CI [0.04, 0.93], I2 = 60.12%, P = 0.032), and all-cause mortality was less likely (OR -1.11, 95% CI [-1.79, -0.44], I2 = 0%, P = 0.001) in the NES evacuation group compared with the EVD group. CONCLUSIONS NES for evacuation of spontaneous IVH results in reduced intensive care unit length of stay, reduced permanent cerebrospinal fluid diversion rates, improved Glasgow Outcome Scale score, and reduced mortality when compared with EVD. More robust prospective, randomized studies are necessary to help inform the safety and utility of NES for IVH.
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Affiliation(s)
- Frank M Mezzacappa
- Department of Neurological Surgery, University of Nebraska Medical Center, Omaha, Nebraska, USA.
| | - Luke J Weisbrod
- Department of Neurological Surgery, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Cindy M Schmidt
- McGoogan Health Sciences Library, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Daniel Surdell
- Department of Neurological Surgery, University of Nebraska Medical Center, Omaha, Nebraska, USA
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González-López P, Gómez-Revuelta C, Puchol Rizo M, Verdú Martínez I, Fernández Villa de Rey Salgado J, Lafuente J, Fernández-Jover E, Fernández-Cornejo V, Nieto-Navarro J. Development and evaluation of a 3d printed training model for endoscopic third ventriculostomy in low-income countries. BRAIN & SPINE 2023; 3:101736. [PMID: 37383453 PMCID: PMC10293302 DOI: 10.1016/j.bas.2023.101736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 03/24/2023] [Accepted: 04/03/2023] [Indexed: 06/30/2023]
Abstract
Introduction Pediatric hydrocephalus is highly prevalent and therefore a major neurosurgical problem in Africa. In addition to ventriculoperitoneal shunts, which have high cost and potential complications, endoscopic third ventriculostomy is becoming an increasingly popular technique especially in this part of the world. However, performing this procedure requires trained neurosurgeons with an optimal learning curve. For this reason, we have developed a 3D printed training model of hydrocephalus so that neurosurgeons without previous experience with endoscopic techniques can acquire these skills, especially in low-income countries, where specific techniques training as this, are relatively absent. Research Question Our research question was about the possibility to develop and produce a low-cost endoscopic training model and to evaluate the usefulness and the skills acquired after training with it. Material and Methods A neuroendoscopy simulation model was developed. A sample of last year medical students and junior neurosurgery residents without prior experience in neuroendoscopy were involved in the study. The model was evaluated by measuring several parameters, as procedure time, number of fenestration attempts, diameter of the fenestration, and number of contacts with critical structures. Results An improvement of the average score on the ETV-Training-Scale was noticed between the first and last attempt (11.6, compared to 27.5 points; p<0.0001). A statistically significant improvement in all parameters, was observed. Discussion and Conclusion This 3D printed simulator facilitates acquiring surgical skills with the neuroendoscope to treat hydrocephalus by performing an endoscopic third ventriculostomy. Furthermore, it has been shown to be useful to understand the intraventricular anatomical relationships.
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Affiliation(s)
- Pablo González-López
- Department of Neurosurgery, Alicante General University Hospital, Alicante Institute of Health and Biomedical Research (ISABIAL), Avda. Pintor Baeza Sn, 03010, Alicante, Spain
| | - Cristina Gómez-Revuelta
- Department of Neurosurgery, Alicante General University Hospital, Alicante Institute of Health and Biomedical Research (ISABIAL), Avda. Pintor Baeza Sn, 03010, Alicante, Spain
| | - Martin Puchol Rizo
- Department of Neurosurgery, Alicante General University Hospital, Alicante Institute of Health and Biomedical Research (ISABIAL), Avda. Pintor Baeza Sn, 03010, Alicante, Spain
| | - Iván Verdú Martínez
- Department of Neurosurgery, Alicante General University Hospital, Alicante Institute of Health and Biomedical Research (ISABIAL), Avda. Pintor Baeza Sn, 03010, Alicante, Spain
| | - Jaime Fernández Villa de Rey Salgado
- Department of Neurosurgery, Alicante General University Hospital, Alicante Institute of Health and Biomedical Research (ISABIAL), Avda. Pintor Baeza Sn, 03010, Alicante, Spain
| | - Jesús Lafuente
- Department of Neurosurgery, Hospital Universitario del Mar, Pg. Marítim de la Barceloneta, 25, 29, 08003, Barcelona, Spain
| | - Eduardo Fernández-Jover
- Instituto de Bioingeniería, Univ. Miguel Hernández, Av. de la Universidad S/n, E-03202, Elche, Spain and CIBER-BBN, Spain
| | - Víctor Fernández-Cornejo
- Department of Neurosurgery, Alicante General University Hospital, Alicante Institute of Health and Biomedical Research (ISABIAL), Avda. Pintor Baeza Sn, 03010, Alicante, Spain
| | - Juan Nieto-Navarro
- Department of Neurosurgery, Alicante General University Hospital, Alicante Institute of Health and Biomedical Research (ISABIAL), Avda. Pintor Baeza Sn, 03010, Alicante, Spain
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9
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Huang K, Zhou L, Liu Y. Primary versus secondary endoscopic ventriculostomy for patients with obstructive hydrocephalus: A meta-analysis and systematic review. Asian J Surg 2023; 46:1837-1838. [PMID: 36334995 DOI: 10.1016/j.asjsur.2022.10.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 10/20/2022] [Indexed: 11/06/2022] Open
Affiliation(s)
- Keru Huang
- Department of Neurosurgery, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, China.
| | - Liangxue Zhou
- Department of Neurosurgery, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, China.
| | - Yu Liu
- Department of Neurosurgery, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, China.
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Ramasy Razafindratovo RM, Chevret S, Champeaux-Depond C. Failure of Internal Cerebrospinal Fluid Shunt: A Systematic Review and Meta-Analysis of the Overall Prevalence in Adults. World Neurosurg 2023; 169:20-30. [PMID: 36309337 DOI: 10.1016/j.wneu.2022.10.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 10/19/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Reported rates of failures of internal cerebrospinal fluid shunt (ICSFS) vary greatly from less than 5% to more than 50% and no meta-analysis to assess the overall prevalence has been performed. We estimated the failure rate after ICSFS insertion and searched for associated factors. METHODS Six databases were searched from January 1990 to February 2022. Only original articles reporting the rate of adult shunt failure were included. Random-effects meta-analysis with a generalized linear mixed model method and logit transformation was used to compute the overall failure prevalence. Subgroup analysis and meta-regression were implemented to search for associated factors. RESULTS Of 1763 identified articles, 46 were selected, comprising 70,859 ICSFS implantations and 13,603 shunt failures, suggesting an accumulated incidence of 19.2%. However, the calculated pooled prevalence value and its 95% confidence interval (CI) were 22.7% (95% CI, 19.8-5.8). The CI of the different estimates did not overlap, indicating a strong heterogeneity confirmed by a high I2 of 97.5% (95% CI, 97.1-97.8; P < 0.001; τ2 = 0.3). Ninety-five percent prediction interval of shunt failure prevalence ranged from 8.75% to 47.36%. A meta-regression of prevalence of publication found a barely significant decreasing failure rate of about 2% per year (-2.11; 95% CI, -4.02 to -0.2; P = 0.031). CONCLUSIONS Despite being a simple neurosurgical procedure, ICSFS insertion has one of the highest risk of complications, with failure prevalence involving more than 1 patient of 5. Nonetheless, all efforts to lower this high level of shunt failure seem to be effective.
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Affiliation(s)
- Rado Malalatiana Ramasy Razafindratovo
- Service de biostatistique et information médicale, Hôpital Saint-Louis, Paris, France; INSERM U1153, Statistic and Epidemiologic Research Center Sorbonne Paris Cité (CRESS), ECSTRRA Team, Université de Paris, Paris, France
| | - Sylvie Chevret
- Service de biostatistique et information médicale, Hôpital Saint-Louis, Paris, France; INSERM U1153, Statistic and Epidemiologic Research Center Sorbonne Paris Cité (CRESS), ECSTRRA Team, Université de Paris, Paris, France
| | - Charles Champeaux-Depond
- Service de biostatistique et information médicale, Hôpital Saint-Louis, Paris, France; INSERM U1153, Statistic and Epidemiologic Research Center Sorbonne Paris Cité (CRESS), ECSTRRA Team, Université de Paris, Paris, France; Department of Neurosurgery, Larbiboisière Hospital, Paris, France.
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Greuter L, Schenker T, Guzman R, Soleman J. Endoscopic third ventriculostomy compared to ventriculoperitoneal shunt as treatment for idiopathic normal pressure hydrocephalus: a systematic review and meta-analysis. Br J Neurosurg 2022:1-7. [PMID: 36537195 DOI: 10.1080/02688697.2022.2149697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 11/14/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND The accepted treatment for idiopathic normal pressure hydrocephalus (iNPH) is the insertion of a ventriculoperitoneal shunt (VPS). Recently, some studies examined endoscopic third ventriculostomy (ETV) for the treatment of iNPH with controversial results. The aim of this systematic review and meta-analysis was to compare ETV to VPS regarding complications and outcome for the treatment of iNPH. METHODS We searched Medline, Embase and Scopus. Due to the scarcity of data, we did not include only randomized controlled trials, but also retro- and prospective studies. The primary outcome was failure of cerebrospinal fluid diversion method. Secondary endpoints were clinical postoperative improvement rate, morbidity and mortality. RESULTS Out of 311 screened studies, three were included in the quantitative analysis including one RCT and two retrospective cohort studies. No statistically significant difference concerning failure rate of CSF diversion method (ETV 27.5% vs. VPS 33.2%, RR 1.19, 95% CI [0.69-2.04], p = 0.52) or postoperative improvement was found (68% for ETV vs. 72.8% for VPS, RR 0.81, 95% CI [0.57-1.16], p = 0.26). ETV showed a significantly lower complication rate compared to VPS (7.5% vs. 51.1%, RR 0.25, 95% CI [0.08-0.76], p = 0.02). CONCLUSION ETV and VPS did not differ significantly regarding their failure rate for iNPH, while ETV showed a significantly lower complication rate than VPS. However, the data available is scarce with only one RCT investigating this important matter. Further well-designed trials are necessary to investigate the clinical outcome of ETV in iNPH. TRIAL REGISTRATION NUMBER PROSPERO (ID: CRD42020199173).
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Affiliation(s)
- Ladina Greuter
- Department of Neurosurgery, University Hospital Basel, Basel, Switzerland
| | - Timo Schenker
- Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Raphael Guzman
- Department of Neurosurgery, University Hospital Basel, Basel, Switzerland
- Division of Pediatric Neurosurgery, University Children Hospital Basel, Basel, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Jehuda Soleman
- Department of Neurosurgery, University Hospital Basel, Basel, Switzerland
- Division of Pediatric Neurosurgery, University Children Hospital Basel, Basel, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
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12
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Analysis of the risk factors of post-operative seizure in pediatric patients with hydrocephalus undergoing endoscopic third ventriculostomy. Childs Nerv Syst 2022; 38:2141-2148. [PMID: 36190523 DOI: 10.1007/s00381-022-05634-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 08/02/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE The cause and mechanism of epilepsy after endoscopic third ventriculostomy (ETV) have still remained elusive. This single-center study aimed to explore and analyze the risk factors of post-operative seizure in pediatric patients with hydrocephalus undergoing ETV. METHODS Data of pediatric patients with hydrocephalus who were treated with ETV from October 1, 2015, to November 31, 2021, were retrospectively analyzed. Basic demographic characteristics, etiology of hydrocephalus, surgical details, and laboratory measurements were collected. An early postoperative seizure was defined as the occurrence of at least one clinical seizure within 24 h of ETV. RESULTS A total of 50 participants were included in the study, of whom 5 (10.00%) cases were in postoperative epilepsy group and 45 (90.00%) cases were in non-epilepsy group. Epilepsy patients were younger than those without epilepsy, while no statistically significant difference was found (P = 0.0836). In the age subgroup, children with epilepsy were younger than 2 years old. All patients with epilepsy received Ringer's solution intraoperatively. The mean postoperative serum calcium and potassium concentrations were significantly lower in patients with epilepsy than in those without epilepsy (Pcalcium = 0.0429; Ppotassium = 0.0250). Moreover, a faster decrease of serum potassium and calcium levels was found in children with epilepsy compared with those without epilepsy after ETV. CONCLUSION The decrease of serum calcium and potassium levels, younger age, and using Ringer's solution as irrigation fluid were risk factors for epilepsy after ETV.
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Soriano LG, Melo JRT. Costs of pediatric hydrocephalus treatment for the Brazilian public health system in the Northeast of Brazil. Childs Nerv Syst 2022; 38:2149-2154. [PMID: 35948831 DOI: 10.1007/s00381-022-05630-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 07/19/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE To estimate the costs of the surgical treatment of pediatric hydrocephalus, specifically ventriculoperitoneal shunt (VPS) and endoscopic third ventriculostomy (ETV), for the Brazilian public health system (SUS). METHODS Retrospective cohort study of health records of patients < 14 years of age with a diagnosis of hydrocephalus who underwent VPS or ETV between September 2009 and June 2016, regularly followed up for 24 months. RESULTS Seventy-six medical records were included. The groups of children who underwent VPS and ETV consisted of 60 and 16 patients, respectively. Complications during 2 years of follow-up were identified in 56% of the children undergoing VPS and in 18% of those undergoing ETV (p = 0.0103). The initial cost of VPS was lower than that of ETV up to approximately 1 year of post-surgical follow-up. After that, VPS generated higher expenses for the SUS due to higher rates of late post-surgical complications and repeated readmissions. CONCLUSION Higher public expenditures were observed in the group of children undergoing VPS due to higher rates of infectious and mechanical complications requiring repeated hospitalizations and prosthesis replacements. Public policies must be tailored to offer the best treatment to children with hydrocephalus and to make judicious use of public resources without compromising the quality of treatment.
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Karasudani K, Ito Y, Muroi A, Sato M, Marushima A, Hayakawa M, Matsumaru Y, Ishikawa E. Endoscopic third ventriculostomy for noncommunicating hydrocephalus by vertebrobasilar dolichoectasia: A case report. Surg Neurol Int 2022; 13:166. [PMID: 35509551 PMCID: PMC9062920 DOI: 10.25259/sni_1041_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 04/08/2022] [Indexed: 11/25/2022] Open
Abstract
Background: Vertebrobasilar dolichoectasia (VBD) is a vasculopathy characterized by the elongation, widening, and tortuosity of a cerebral artery. Rarely, hydrocephalus results when the extended basilar artery impairs communication of the cerebral ventricle and cerebrospinal fluid dynamics. We experienced such a case when a patient underwent endoscopic third ventriculostomy (ETV) for noncommunicating hydrocephalus with VBD. Case Description: A 54-year-old man presented with cognitive dysfunction and was diagnosed with VBD by magnetic resonance imaging (MRI). Seven years later, he exhibited subacute impaired consciousness due to acute noncommunicating hydrocephalus, undergoing external ventricular drainage (EVD) that improved consciousness. After EVD removal, the noncommunicating hydrocephalus did not recur; however, 7 months later, subacute consciousness impairment due to noncommunicating hydrocephalus was again observed. MRI showed a significant dilation of both lateral ventricles and ballooning of the third ventricle while the right posterior cerebral artery shifted slightly posteriorly. The patient underwent ETV and clinical symptoms improved. One year after the treatment, MRI observed a patent ETV fenestration and no deleterious changes in clinical symptoms were observed. Conclusion: ETV can be an effective treatment for the noncommunicating hydrocephalus with VBD when performed with preoperative assessment of vascular anatomy and attention to vascular injury.
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Affiliation(s)
- Kazuho Karasudani
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Yoshiro Ito
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Ai Muroi
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Masayuki Sato
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Aiki Marushima
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Mikito Hayakawa
- Division of Stroke Prevention and Treatment, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Yuji Matsumaru
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Eiichi Ishikawa
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
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Gillespie CS, Richardson GE, Mustafa MA, Evans D, George AM, Islim AI, Mallucci C, Jenkinson MD, McMahon CJ. How should we treat long-standing overt ventriculomegaly in adults (LOVA)? A retrospective cohort study. Neurosurg Rev 2022; 45:3193-3200. [PMID: 35688957 PMCID: PMC9492616 DOI: 10.1007/s10143-022-01812-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 04/16/2022] [Accepted: 05/10/2022] [Indexed: 02/03/2023]
Abstract
Long-standing overt ventriculomegaly in adults (LOVA) is a heterogenous group of conditions with differing presentations. Few studies have evaluated success rates of available surgical treatments, or ascertained the natural history. There is a need to assess the efficacy of both endoscopic third ventriculostomy (ETV) and ventriculoperitoneal shunt (VPS) as first-line treatments. We conducted a retrospective, single-centre study of adults with LOVA at a tertiary neurosurgery centre in England, UK, aiming to identify presentation, management strategy, and outcome following treatment. A total of 127 patients were included (mean age 48.1 years, 61/127 male). Most patients were symptomatic (73.2%, n = 93/127, median symptom duration 10 months). The most common symptoms were gait ataxia, headache, and cognitive decline (52.8%, 50.4%, and 33.9%, respectively). Fourteen patients had papilloedema. Ninety-one patients (71.7%) underwent surgery (84 ETV, 7 VPS). Over a median follow-up of 33.0 months (interquartile range [IQR] 19.0-65.7), 82.4% had a clinical improvement after surgery, and 81.3% had radiological improvement. Clinical improvement rates were similar between ETV and VP shunt groups (82.1% vs 85.7%, p = 0.812). Surgical complication rates were significantly lower in the ETV group than the VP shunt group (4.8% vs 42.9%, p < 0.001). Of the patients treated surgically, 20 (22.0%) underwent further surgery, with 14 patients improving. This study demonstrates the efficacy of ETV as a first-line treatment for LOVA.
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Affiliation(s)
- Conor S. Gillespie
- Institute of Systems, Molecular and Integrative Biology, School of Medicine, University of Liverpool, Cedar House, Ashton Street, Liverpool, L69 3GE UK ,Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - George E. Richardson
- Institute of Systems, Molecular and Integrative Biology, School of Medicine, University of Liverpool, Cedar House, Ashton Street, Liverpool, L69 3GE UK ,Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Mohammad A. Mustafa
- Institute of Systems, Molecular and Integrative Biology, School of Medicine, University of Liverpool, Cedar House, Ashton Street, Liverpool, L69 3GE UK ,Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Daisy Evans
- School of Medicine, Keele University, Staffordshire, UK
| | - Alan M. George
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK ,School of Medicine, University of Birmingham, Birmingham, UK
| | - Abdurrahman I. Islim
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Conor Mallucci
- Department of Neurosurgery, Alder Hey Children’s NHS Foundation Trust, Liverpool, UK
| | - Michael D. Jenkinson
- Institute of Systems, Molecular and Integrative Biology, School of Medicine, University of Liverpool, Cedar House, Ashton Street, Liverpool, L69 3GE UK ,Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Catherine J. McMahon
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
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16
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Palandri G, Carretta A, La Corte E, Mazzatenta D, Conti A. Longstanding overt ventriculomegaly in adults (LOVA) with patent aqueduct: surgical outcome and etiopathogenesis of a possibly distinct form of chronic hydrocephalus. Acta Neurochir (Wien) 2021; 163:3343-3352. [PMID: 34491433 PMCID: PMC8599222 DOI: 10.1007/s00701-021-04983-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 08/23/2021] [Indexed: 12/03/2022]
Abstract
Purpose Longstanding overt ventriculomegaly in adults (LOVA) represents a form of chronic adulthood hydrocephalus with symptomatic manifestation in late adulthood. Based on the patency of the aqueduct, two different subcohorts of LOVA can be distinguished. Surgical treatments of this condition are also debated. Therefore, we analyzed preoperative characteristics and clinical outcome after different surgical treatments in a subgroup of LOVA patients with a patent aqueduct. Methods Eighteen LOVA patients with a patent aqueduct consecutively treated at our institution between July 2013 and December 2019 were analyzed for this study. Median age was 70 years. Preoperative radiological and clinical features, surgical procedures (ventriculo-peritoneal shunt or endoscopic third ventriculostomy), and outcomes were collected. Successful outcome was qualitatively defined as an improvement or a halt of progression of the presenting symptoms at follow-up, and quantitatively by changes in mRS and iNPHGS scales. Results Twelve patients underwent an ETV as a primary treatment, while 6 underwent VPS. A total of 22.2% of them were lost to follow-up. Median follow-up time was 38 months. Six patients (66.7%) in the ETV cohort achieved a successful outcome after treatment, with a complication rate of 11.1%. Two patients underwent rescue VPS after ETV failure with a good outcome. Four patients (100%) underwent primary VPS and achieved a satisfactory outcome after treatment, with a reported complications rate of 25%. Conclusion LOVA with patent aqueduct represents, in our opinion, a distinct clinical form of chronic hydrocephalus. For this subgroup, as well as for other forms of LOVA, ETV remains an acceptable first-line treatment option considering the good results, and the low complication rate, obtained in those patients and the hypothesis that hydrocephalus is due to an “intracisternal” obstruction.
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Affiliation(s)
- Giorgio Palandri
- Department of Neurosurgery, IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Via Altura 3, 40139, Bologna, Italy
| | - Alessandro Carretta
- Department of Neurosurgery, IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Via Altura 3, 40139, Bologna, Italy.
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy.
| | - Emanuele La Corte
- Department of Neurosurgery, IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Via Altura 3, 40139, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - Diego Mazzatenta
- Department of Neurosurgery, IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Via Altura 3, 40139, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
- Programma Neurochirurgia Ipofisi - Pituitary Unit, IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Bologna, Italy
| | - Alfredo Conti
- Department of Neurosurgery, IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Via Altura 3, 40139, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
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Wolfsegger T, Assar H. Assessment of neurological symptoms in adult hydrocephalus occlusus. A pilot study. J Clin Neurosci 2021; 90:89-93. [PMID: 34275587 DOI: 10.1016/j.jocn.2021.05.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 04/28/2021] [Accepted: 05/25/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Comprehensively describe and compare (pre⁄postoperatively) the clinical symptomatology in adult non-communicated hydrocephalus. Associated hydrocephalus signs were analyzed with the idiopathic Normal Pressure Hydrocephalus Scale (iNPH Scale). A standardized clinical scale for non-communicated hydrocephalus is currently not in use. METHODS Ten patients with hydrocephalus occlusus (HO) were analyzed. Hydrocephalus signs were examined with the iNPH Scale in gait, neuropsychology, continence, and balance before and three months after treatment with shunt operation or third endoscopic ventriculostomy. RESULTS Patients significantly improved in iNPH total score (25.8%) and gait score (35.4%) three months after neurosurgical intervention. Domain scores in neuropsychology, continence, and balance reached statistical trends (p ≤ 0.066). Most clinical symptoms and signs at baseline improved after surgery (dizziness, lapse of concentration, gait instability, and headache). CONCLUSION Patients with non-communicated HO also showed classical hydrocephalus symptoms as communicated in iNPH patients. The iNPH Scale allows a structured neurological assessment over the disease's progress and surgical intervention. Further studies with a larger patient samples are necessary to support our results.
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Affiliation(s)
- Thomas Wolfsegger
- Kepler University Hospital, Neuromed Campus, Department of Neurology 1, Linz, Austria.
| | - Hamid Assar
- Kepler University Hospital, Neuromed Campus, Department of Neurology 1, Linz, Austria.
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18
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Dhandapani S, Dhandapani M, Yagnick N, Mohanty M, Ahuja C. Clinical Outcome, Cognitive Function, and Quality of Life after Endoscopic Third Ventriculostomy versus Ventriculo-Peritoneal Shunt in Non-Tumor Hydrocephalus. Neurol India 2021; 69:S556-S560. [DOI: 10.4103/0028-3886.332271] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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19
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Hasbun R. Healthcare-associated ventriculitis: current and emerging diagnostic and treatment strategies. Expert Rev Anti Infect Ther 2020; 19:993-999. [PMID: 33334204 DOI: 10.1080/14787210.2021.1866544] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Introduction: Healthcare-associated ventriculitis and meningitis occur after neurosurgical procedures, is associated with an adverse outcome in the majority of patients and represent a diagnostic challenge to clinicians. As the cerebrospinal fluid (CSF) culture is the cornerstone of diagnosis, obtaining CSF studies prior to starting antibiotic therapy is key.Areas covered: This review will evaluate the incidence, risk factors, clinical presentation, diagnosis, empirical intravenous antibiotic therapy, adjunctive intrathecal therapy, microbiology, prognosis, and prevention of HCAVM. We highlight the challenges and limitations of the currently available diagnostic methods and definitions and explore novel technologies. Our review included the search for published literature until June 2020.Expert opinion: Despite available preventive measures, HCAVM continues to occur and to be independently associated with significant neurological morbidity and mortality in the majority of patients. The cornerstone of the diagnosis of HCAVM is a positive CSF culture but the microbiological yield is reduced to ~50% with prior antimicrobial therapy. Although the CSF profile is not affected by antibiotic therapy it has a fair diagnostic accuracy. Future research efforts should concentrate in identifying novel diagnostic tools such as polymerase chain reaction (PCR) or metagenomic sequencing.
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Affiliation(s)
- Rodrigo Hasbun
- Professor of Medicine, McGovern Medical School UT Health, Houston, TX, USA
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Pande A, Lamba N, Mammi M, Gebrehiwet P, Trenary A, Doucette J, Papatheodorou S, Bunevicius A, Smith TR, Mekary RA. Endoscopic third ventriculostomy versus ventriculoperitoneal shunt in pediatric and adult population: a systematic review and meta-analysis. Neurosurg Rev 2020; 44:1227-1241. [PMID: 32476100 DOI: 10.1007/s10143-020-01320-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 04/29/2020] [Accepted: 05/18/2020] [Indexed: 11/28/2022]
Abstract
Treatment options for hydrocephalus include endoscopic third ventriculostomy (ETV) and ventriculoperitoneal shunt (VPS). Some ambiguity remains regarding indications, safety, and efficacy for these procedures in different clinical scenarios. The objective of the present study was to pool the available evidence to compare outcomes among patients with hydrocephalus undergoing ETV versus VPS. A systematic search of the literature was conducted via PubMed, EMBASE, and Cochrane Library through 11/29/2018 to identify studies evaluating failure and complication rates, following ETV or VPS. Pooled effect estimates were calculated using random effects. Heterogeneity was assessed by the Cochrane Q test and the I2 value. Heterogeneity sources were explored through subgroup analyses and meta-regression. Twenty-three studies (five randomized control trials (RCTs) and 18 observational studies) were meta-analyzed. Comparing ETV to VPS, failure rate was not statistically significantly different with a pooled relative risk (RR) of 1.48, 95%CI (0.85, 2.59) for RCTs and 1.17 (0.89, 1.53) for cohort studies; P-interaction: 0.44. Complication rates were not statistically significantly different between ETV and VPS in RCTs (RR: 1.34, 95%CI: 0.50, 3.59) but were statistically significant for prospective cohort studies (RR: 0.47, 95%CI: 0.30, 0.78); P-interaction: 0.07. Length of hospital stay was no different, when comparing ETV and VPS. These results remained unchanged when stratifying by intervention type and when regressing on age when possible. No significant differences in failure rate were observed between ETV and VPS. ETV was found to have lower complication rates than VPS in prospective cohort studies but not in RCTs. Further research is needed to identify the specific patient populations who may be better suited for one intervention versus another.
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Affiliation(s)
- Apurva Pande
- School of Pharmacy, MCPHS University, Boston, MA, 02115, USA
| | - Nayan Lamba
- Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Marco Mammi
- Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Neurosurgery Unit, Department of Neurosciences, University of Turin, Turin, Italy
| | | | - Alyssa Trenary
- School of Pharmacy, MCPHS University, Boston, MA, 02115, USA
| | - Joanne Doucette
- School of Pharmacy, MCPHS University, Boston, MA, 02115, USA
| | | | - Adomas Bunevicius
- Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Timothy R Smith
- Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Rania A Mekary
- School of Pharmacy, MCPHS University, Boston, MA, 02115, USA. .,Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
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Lu L, Chen H, Weng S, Xu Y. Endoscopic Third Ventriculostomy versus Ventriculoperitoneal Shunt in Patients with Obstructive Hydrocephalus: Meta-Analysis of Randomized Controlled Trials. World Neurosurg 2019; 129:334-340. [PMID: 31136836 DOI: 10.1016/j.wneu.2019.04.255] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 04/29/2019] [Accepted: 04/30/2019] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Endoscopic third ventriculostomy (ETV) and ventriculoperitoneal shunt (VPS) are 2 surgical methods used for the treatment of obstructive hydrocephalus. However, the efficacy and safety of these 2 procedures are unknown. Therefore we conducted a meta-analysis to compare the safety and efficiency of ETV and VPS in patients with obstructive hydrocephalus. METHODS In January 2019, a comprehensive search strategy of 3 electronic databases was initiated. A systematic search from database inception to December 30, 2018, on clinical outcome, safety, and efficiency of ETV and VPS in the treatment of obstructive hydrocephalus was conducted. The following electronic databases were searched: PubMed, Embase, and Cochrane Library for related randomized controlled trials (RCTs). Main outcomes included postoperative hematoma, postoperative infection, postoperative cerebrospinal fluid leakage, blockage rate, and mortality. RESULTS Of the 546 studies identified, 4 RCTs involving 250 patients met our inclusion criteria. The pooled results show that ETV was associated with lower incidence of postoperative infection (risk ratio [RR] 0.09, 95% confidence interval [CI]: 0.02-0.32, P = 0.0002); postoperative hematoma (RR 0.26, 95% CI: 0.08-0.88, P = 0.03); and blockage rate (RR 0.28, 95% CI: 0.13-0.60, P = 0.001) compared with VPS. Compared with VPS, ETV had no significant effect on incidence rate of postoperative cerebrospinal fluid leakage (RR 2.00, 95% CI: 0.30-13.16, P = 0.47) and mortality rates (RR 0.19, 95% CI: 0.03-1.09, P = 0.06), but there have been no deaths in patients treated with ETV. CONCLUSIONS On the basis of the meta-analysis of RCTs evaluating ETV and VPS, the incidence of complications and mortality was higher with the VPS procedure, and therefore greater benefits can be achieved using ETV.
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Affiliation(s)
- Liang Lu
- Department of Neurosurgery, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, PR China
| | - Hongwu Chen
- Department of Neurosurgery, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, PR China
| | - Shaotao Weng
- Department of Neurosurgery, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, PR China
| | - Yimin Xu
- Department of Neurosurgery, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, PR China.
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22
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Dhandapani S, Sahoo SK. Developmental Retrocerebellar Cysts: A New Classification for Neuroendoscopic Management and Systematic Review. World Neurosurg 2019; 132:e654-e664. [PMID: 31442641 DOI: 10.1016/j.wneu.2019.08.052] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 08/07/2019] [Accepted: 08/09/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Posterior fossa cystic malformations are diversely classified with considerable overlap without therapeutic relevance. These cysts posterior to the cerebellum, presenting in children younger than 5 years, are labeled developmental retrocerebellar cysts (DRCCs) under a new classification in relation to neuroendoscopy. METHODS DRCC was categorized as type 0 for asymptomatic enlarged cistern magna and was not treated. Among symptomatic cases, cysts with a compressed fourth ventricle were labeled type 1, whereas cysts in continuity with the fourth ventricle were termed type 2. They were further categorized as subtype B if hydrocephalus was greater relative to the cyst, or otherwise as subtype A. The literature was reviewed according to PRISMA guidelines. RESULTS There were 13 children aged 3-48 months. Type 1A DRCC was noted in 5 patients, with onset before 6 months, 4 of whom (80%) had intracranial hypertension. All underwent suboccipital endoscopic deroofing and cisternostomy (SEDC), a new technique. Type 1B DRCC was seen in 2 patients, with onset at 8-9 months, who underwent endoscopic third ventriculostomy (ETV) + endoscopic ventriculocystostomy (EVC). Type 2A DRCC was observed in 4 patients, with onset at 5-47 months, who underwent SEDC. Type 2B DRCC was noted in 2 patients, with onset 6-8 months, who underwent ETV. With a mean follow-up of 32 months, all showed clinicoradiologic improvement. The application of our classification to other studies showed ETV/EVC to be successful in only 67% of type 1A DRCC and 72% of type 2A DRCC, compared with 100% efficacy of SEDC in our series. CONCLUSIONS This is probably the first ever endoscopic classification of pediatric posterior fossa cyts, elucidating pathophysiology, presentation, and treatment. Patients with type 1 DRCC present early because of extraneous compression. Among patients with type 2 DRCC, posterior fossa compliance determines the degree of hydrocephalus. The newly described SEDC seems more appropriate for types 1A and 2A DRCC. ETV is adequate in type 2B DRCC and effective with EVC in type 1B.
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Affiliation(s)
- Sivashanmugam Dhandapani
- Department of Neurosurgery, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
| | - Sushant K Sahoo
- Department of Neurosurgery, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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