1
|
Li Z, Zhang H, Hu G, Zhang G. Post-traumatic hydrocephalus: An overview of classification, diagnosis, treatment, and post-treatment imaging evaluation. Brain Res Bull 2023; 205:110824. [PMID: 37995869 DOI: 10.1016/j.brainresbull.2023.110824] [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: 06/18/2023] [Revised: 11/02/2023] [Accepted: 11/20/2023] [Indexed: 11/25/2023]
Abstract
The syndrome of post-traumatic hydrocephalus (PTH) has been recognized since Dandy's report in 1914. The pathogenesis of PTH has not been fully clarified. At present, it is believed that the obstacles of cerebrospinal fluid (CSF) secretion, absorption and circulation pathways are the reasons for the development of PTH. However, recent studies have also suggested that the osmotic pressure load of CSF and the pathological changes of CSF dynamics are caused by the development of hydrocephalus. Therefore, a better understanding of the definition, classification, diagnostic criteria, treatment, and evaluation of post-treatment effects of PTH is critical for the effective prevention and treatment of PTH. In this paper, we reviewed the classification and diagnosis of PTH and focused on the treatment and the imaging evaluation of post-treatment effects of PTH. This review might provide a judgment criterion for diagnosis of PTH and a basis for the effective prevention and treatment of PTH in the future.
Collapse
Affiliation(s)
- Zhao Li
- Department of Neurosurgery, Shengzhou Hospital of Traditional Chinese Medicine, Shengzhou City, Zhejiang Province 312400, China
| | - Han Zhang
- Department of Neurosurgery, Shengzhou People's Hospital, Shengzhou City, Zhejiang Province 312400, China
| | - Guojie Hu
- Department of Neurosurgery, Shengzhou Hospital of Traditional Chinese Medicine, Shengzhou City, Zhejiang Province 312400, China
| | - Guohai Zhang
- Department of Neurosurgery, Shengzhou Hospital of Traditional Chinese Medicine, Shengzhou City, Zhejiang Province 312400, China.
| |
Collapse
|
2
|
Baig Mirza A, Boardman T, Okasha M, El-Hariri HM, Al Banna Q, Syrris C, Baig Mirza K, Vastani A, Visagan R, Shapey J, Maratos E, Barazi S, Thomas N. Fat in the Fossa and the Sphenoid Sinus: A Simple and Effective Solution to CSF Leaks in Transsphenoidal Surgery. Cohort Study and Systematic Review. J Neurol Surg B Skull Base 2023; 84:143-156. [PMID: 36895808 PMCID: PMC9991530 DOI: 10.1055/a-1757-3069] [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: 09/29/2021] [Accepted: 01/30/2022] [Indexed: 10/19/2022] Open
Abstract
Objectives Cerebrospinal fluid (CSF) leak following endoscopic transsphenoidal surgery (TSS) remains a challenge and is associated with high morbidity. We perform a primary repair with f at in the pituitary f ossa and further fat in the s phenoid sinus (FFS). We compare the efficacy of this FFS technique with other repair methods and perform a systematic review. Design, Patients, and Methods This is a retrospective analysis of patients undergoing standard TSS from 2009 to 2020, comparing the incidence of significant postoperative CSF rhinorrhea (requiring intervention) using the FFS technique compared with other intraoperative repair strategies. Systematic review of current repair methods described in the literature was performed following the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. Results In all, there were 439 patients, with 276 patients undergoing multilayer repair, 68 patients FFS repair, and 95 patients no repair. No significant differences were observed in baseline demographics between the groups. Postoperative CSF leak requiring intervention was significantly lower in the FFS repair group (4.4%) compared with the multilayer (20.3%) and no repair groups (12.6%, p < 0.01). This translated to fewer reoperations (2.9% FFS vs. 13.4% multilayer vs. 8.4% no repair, p < 0.05), fewer lumbar drains (2.9% FFS vs. 15.6% multilayer vs. 5.3% no repair, p < 0.01), and shorter hospital stay (median days: 4 [3-7] FFS vs. 6 (5-10) multilayer vs. 5 (3-7) no repair, p < 0.01). Risk factors for postoperative leak included female gender, perioperative lumbar drain, and intraoperative leak. Conclusion Autologous fat on fat graft for standard endoscopic transsphenoidal approach effectively reduces the risk of significant postoperative CSF leak with reduced reoperation and shorter hospital stay.
Collapse
Affiliation(s)
- Asfand Baig Mirza
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Timothy Boardman
- GKT School of Medical Education, King's College London, London, United Kingdom
| | - Mohamed Okasha
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | | | - Qusai Al Banna
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Christoforos Syrris
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | | | - Amisha Vastani
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Ravindran Visagan
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Jonathan Shapey
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, United Kingdom.,Department of Surgical and Interventional Engineering, School of Biomedical Engineering and Imaging Science, King's College London, United Kingdom
| | - Eleni Maratos
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Sinan Barazi
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Nick Thomas
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, United Kingdom
| |
Collapse
|
3
|
Xie D, Chen H, Guo X, Liu Y. Comparative study of lumboperitoneal shunt and ventriculoperitoneal shunt in the treatment of idiopathic normal pressure hydrocephalus. Am J Transl Res 2021; 13:11917-11924. [PMID: 34786122 PMCID: PMC8581892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 05/26/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE This study aimed to compare lumboperitoneal shunt (LPS) and ventriculoperitoneal shunt (VPS) in the treatment of idiopathic normal pressure hydrocephalus (iNPH). METHODS From September 2016 to November 2019, 76 iNPH patients who underwent shunt operation were recruited and assigned to a lumboperitoneal shunt group (LPS group, n=40) and a ventriculoperitoneal shunt (VPS group, n=36) according to different treatment methods. The right first time (RFT) and improvement in triad of the two groups were observed. Keifer's hydrocephalus score (KHS) was used to evaluate the improvement of clinical symptoms, Mini-Mental State Examination (MMSE) and National Institutes of Health Stroke Scale (NIHSS) were used to evaluate the improvement of cognitive function, and the Functional Independence Measure (FIM) to evaluate the postoperative living status of patients. The two groups of patients were followed up for 6 months to observe the postoperative curative effect and incidence of complications. RESULTS The RFT of LPS group was markedly higher than that of VPS group. There was no remarkable difference in the improvement of triad, KHS score, MMSE score, NIHSS score, and FIM score between the two groups after treatment, as well as overall response rate (ORR) after six months. The total incidence of complications in LPS group was considerably lower than that in VPS group. CONCLUSION LPS and VPS have similar curative effect in the treatment of iNPH, but LPS can avoid intraparenchymal hemorrhage (IPH) caused by ventricular puncture, and it increases the RFT.
Collapse
Affiliation(s)
- Dongcheng Xie
- Department of Neurosurgery for Cerebrospinal Fluid Diseases, Aviation General Hospital of China Medical University Chaoyang District, Beijing 100012, China
| | - Hongwei Chen
- Department of Neurosurgery for Cerebrospinal Fluid Diseases, Aviation General Hospital of China Medical University Chaoyang District, Beijing 100012, China
| | - Xiaochuan Guo
- Department of Neurosurgery for Cerebrospinal Fluid Diseases, Aviation General Hospital of China Medical University Chaoyang District, Beijing 100012, China
| | - Yiran Liu
- Department of Neurosurgery for Cerebrospinal Fluid Diseases, Aviation General Hospital of China Medical University Chaoyang District, Beijing 100012, China
| |
Collapse
|
4
|
Non-communicating hydrocephalus with a primary empty sella presenting with growth hormone deficiency and delayed puberty successfully treated by endoscopic third ventriculocisternostomy. Acta Neurochir (Wien) 2021; 163:511-514. [PMID: 32638133 DOI: 10.1007/s00701-020-04481-9] [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: 05/19/2020] [Accepted: 06/30/2020] [Indexed: 10/23/2022]
Abstract
The authors present the unusual case of a 15-year-old boy with a primary empty sella caused by non-communicating hydrocephalus due to fourth ventricle outflow obstruction whose secondary symptoms of growth hormone deficiency and delayed puberty were successfully treated by endoscopic third ventriculocisternostomy (ETV). Hypopituitarism occurs only rarely in cases of hydrocephalus; rarer still are cases where hypopituitarism is the sole symptom of hydrocephalus. A primary empty sella may indicate elevated intracranial pressure; if the cause is non-communicating hydrocephalus, ETV is indicated as the preferred treatment modality.
Collapse
|
5
|
Ouma J. Primary empty sella syndrome associated with visual deterioration salvaged by chiasmapexy: Report of a case and discussion of the literature. Surg Neurol Int 2020; 11:48. [PMID: 32257574 PMCID: PMC7110400 DOI: 10.25259/sni_309_2019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 03/06/2020] [Indexed: 12/20/2022] Open
Abstract
Background: Empty sella syndrome (ESS) is a condition in which there is loss of volume of the pituitary gland, which is the normal constituent of the sella turcica. There may be visual and endocrine deficits associated with this condition, and radiologically, there may be downward prolapse of the optic chiasm. It occurs in a primary ESS, poorly understood form, as well as a secondary ESS form that follows medical or surgical treatment of a pituitary macroadenoma, or else spontaneous hemorrhage into such a tumor. Case Description: A 56-year-old man presenting with deficits of both visual acuity and visual fields in the setting of radiological ESS without associated optic chiasm prolapse is discussed. He underwent endoscopic endonasal chiasmapexy with gradual improvement of his visual function over the following 6 months. Conclusion: ESS is a potentially potent cause of visual deterioration that lends itself to reversal through a relatively simple neurosurgical technique. This case illustrates that actual prolapse of the chiasm is neither a prerequisite for visual deterioration nor its reversal the mechanism of visual improvement after chiasmapexy, raising the question of the mechanisms at play in cases such as this. It confirms the role of chiasmapexy in the management of selected cases of ESS.
Collapse
Affiliation(s)
- John Ouma
- Department of Neurosurgery, Medical School, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| |
Collapse
|