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Hall BJ, Duddy JC, Apostolopoulou K, Pettorini B. A tailored approach to the management of post-haemorrhagic hydrocephalus. Childs Nerv Syst 2024; 40:665-671. [PMID: 37952209 PMCID: PMC10891183 DOI: 10.1007/s00381-023-06214-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 11/03/2023] [Indexed: 11/14/2023]
Abstract
PURPOSE Neuro-endoscopic lavage (NEL) is an increasingly popular intervention for intraventricular haemorrhage (IVH) and post-haemorrhagic hydrocephalus (PHH), with considerable variation in technique dependent on clinician and clinical circumstances. Whilst efforts to standardise the technique are ongoing, this work describes a tertiary centre experience utilising NEL, highlighting potential caveats to standardisation. METHODS A retrospective review of electronic case notes for patients undergoing temporising surgical intervention for IVH between 2012 and 2021 at our centre was performed. Data collected included (i) gestational age, (ii) aetiology of hydrocephalus, (iii) age at time of intervention, (iv) intervention performed, (v) need for permanent CSF diversion, (vi) 'surgical burden', i.e. number of procedures following primary intervention, and (vii) wound failure and infection rate. Data was handled in Microsoft Excel and statistical analysis SPSS v27.0 RESULTS: 49 neonates (n = 25 males) were included. Overall mean gestational age was 27 weeks and at intervention 35 + 3 weeks. IVH was the predominant cause of hydrocephalus (93.8%) and primary surgical interventions included insertion of a ventriculosubgaleal shunt (VSGS) in n = 41 (83.6%) patients, NEL in n = 6 (12.2%) patients and insertion of an EVD in n = 2 (4.1%). N = 9 (18.4%) patients underwent NEL at some point during the time interval reviewed; n = 4 (8.2%) received NEL monotherapy and n = 5 (10.2%) also received a VSGS. Rate of conversion to definitive CSF diversion between NEL (n = 8, 88.9%) and VSGS cohorts (n = 37, 92.5%) was not significantly different (p = 0.57), nor between NEL alone (n = 3, 75%) and NEL + VSGS (n = 5, 100%) (p = 0.44). None of the patients that underwent NEL monotherapy had any wound issues or CNS infection as a result of the initial intervention, compared to n = 3 (60%) of those that underwent NEL and implantation of VSGS (p = 0.1). CONCLUSION Both NEL and VSGS are effective in temporising hydrocephalus in neonates, occasionally offering a definitive solution in and of themselves. The benefit of dual therapy however remains to be seen, with the addition of VSGS potentially increasing the risk of wound failure in an already vulnerable cohort.
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Affiliation(s)
- Benjamin J Hall
- Department of Neurosurgery, Alder Hey Children's Hospital NHS Foundation Trust, Liverpool, UK.
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK.
- Institute of Infection, Veterinary and Ecological Sciences (IVES), The University of Liverpool, Liverpool, UK.
| | - John C Duddy
- Department of Neurosurgery, Alder Hey Children's Hospital NHS Foundation Trust, Liverpool, UK
| | - Katerina Apostolopoulou
- Department of Neurosurgery, Alder Hey Children's Hospital NHS Foundation Trust, Liverpool, UK
| | - Benedetta Pettorini
- Department of Neurosurgery, Alder Hey Children's Hospital NHS Foundation Trust, Liverpool, UK
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Spennato P, Cinalli MA, Di Costanzo M, Vitulli F, Ruggiero C, Di Martino G, Cinalli G. Endoscopic ultrasonic aspirator-assisted removal of a third ventricular colloid cyst. Childs Nerv Syst 2023; 39:3391-3395. [PMID: 37193852 DOI: 10.1007/s00381-023-05994-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 05/11/2023] [Indexed: 05/18/2023]
Abstract
BACKGROUND Colloid cysts are benign tumors usually located on the roof of the third ventricle. Cyst removal is the treatment of choice. It can be accomplished microsurgically through a transcortical- or transcallosal approach, or endoscopically. There is a lack of consensus regarding the best strategy for cyst removal. One of the challenges of the traditional endoscopic technique is dealing with the cyst content density. Hyperdensity on computed tomography scan and low signal on T2-weighted magnetic resonance imaging (MRI) cyst are correlated with high viscosity cystic content. CASE REPORTS We present a case of a colloid cyst of the third ventricle in a 15-year-old boy removed through a pure endoscopic transventricular approach. The cyst presented a low signal on T2 MRI; nevertheless, it was easily removed with the help of an endoscopic ultrasonic aspirator. DISCUSSION AND CONCLUSION The colloid cyst of the third ventricle can be safely treated by a purely endoscopic approach. The rationale of the use of the ultrasonic aspirator relies on the facilitation of aspiration of the content even when the consistency is extremely firm.
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Affiliation(s)
- Pietro Spennato
- Department of Neurosciences, Unit of Neurosurgery, Santobono-Pausilipon Children's Hospital, Via Mario Fiore 6, 80121, Naples, Italy.
| | - Maria Allegra Cinalli
- Department of Medicine and Surgery, University of Milan Bicocca, Milan, Italy
- Neurosurgery Department, Ospedale San Gerardo, Monza, Italy
| | - Marianna Di Costanzo
- Department of Neurosciences, Unit of Neurosurgery, Santobono-Pausilipon Children's Hospital, Via Mario Fiore 6, 80121, Naples, Italy
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Università Degli Studi di Napoli "Federico II", Naples, Italy
| | - Francesca Vitulli
- Department of Neurosciences, Unit of Neurosurgery, Santobono-Pausilipon Children's Hospital, Via Mario Fiore 6, 80121, Naples, Italy
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Università Degli Studi di Napoli "Federico II", Naples, Italy
| | - Claudio Ruggiero
- Department of Neurosciences, Unit of Neurosurgery, Santobono-Pausilipon Children's Hospital, Via Mario Fiore 6, 80121, Naples, Italy
| | - Giuliana Di Martino
- Department of Neurosciences, Unit of Neurosurgery, Santobono-Pausilipon Children's Hospital, Via Mario Fiore 6, 80121, Naples, Italy
| | - Giuseppe Cinalli
- Department of Neurosciences, Unit of Neurosurgery, Santobono-Pausilipon Children's Hospital, Via Mario Fiore 6, 80121, Naples, Italy
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Dahamou M, Khoulali M, Oulali N, Moufid F. Bobble head doll syndrome (BHDS): Case report. Radiol Case Rep 2023; 18:2498-2502. [PMID: 37214320 PMCID: PMC10196909 DOI: 10.1016/j.radcr.2023.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 04/03/2023] [Accepted: 04/05/2023] [Indexed: 05/24/2023] Open
Abstract
The bobble head doll syndrome is a rare neurological disorder characterized by repetitive and involuntary movement of the head that typically appear in childhood. It is usually associated with the dilatation of the third ventricle and one or more cystic lesions that can be treated surgically. We present the case of a 7-year-old girl with a history of autism, who has experiencing repetitive up and down head movements for 2 years, which were initially thought to be stereotypies. However, 2 months prior to admission, the movements worsened and were accompanied by symptoms of intracranial hypertension. The neurological examination revealed a coordination disorder, specifically a tremor, along with impairment of thermo-algic sensitivity. Ophthalmological examination was unremarkable, but the MRI indicated a colloid cyst of the third ventricle. A minimally invasive neuro-endoscopy procedure was chosen as the treatment of choice for our patient. The bobble head doll syndrome is a complex neurological disorder, and imaging is crucial in the diagnosis and treatment of any movement disorder to enable an early diagnosis and treatment.
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Affiliation(s)
- Mohamed Dahamou
- Department of Neurosurgery, Mohammed VI University Hospital, Oujda 60000, Morocco
- Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, Morocco
| | - Mohamed Khoulali
- Department of Neurosurgery, Mohammed VI University Hospital, Oujda 60000, Morocco
- Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, Morocco
| | - Noureddine Oulali
- Department of Neurosurgery, Mohammed VI University Hospital, Oujda 60000, Morocco
- Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, Morocco
| | - Fayçal Moufid
- Department of Neurosurgery, Mohammed VI University Hospital, Oujda 60000, Morocco
- Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, Morocco
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Lavé A, Gondar R, Demetriades AK, Meling TR. Ergonomics and musculoskeletal disorders in neurosurgery: a systematic review. Acta Neurochir (Wien) 2020; 162:2213-2220. [PMID: 32705353 PMCID: PMC7415019 DOI: 10.1007/s00701-020-04494-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 07/14/2020] [Indexed: 12/23/2022]
Abstract
Background Work-related musculoskeletal disorders (WMSDs) are a growing and probably undervalued concern for neurosurgeons and spine surgeons, as they can impact their quality of life and career length. This systematic review aims to ascertain this association and to search for preventive measures. Methods We conducted a PRISMA-P-based review on ergonomics and WMSDs in neurosurgery over the last 15 years. Twelve original articles were included, of which 6 focused on spine surgery ergonomics, 5 cranio-facial surgery (mainly endoscopic), and one on both domains. Results We found a huge methodological and content diversity among studies with 5 surveys, 3 cross-sectional studies, 2 retrospective cohorts, and 2 technical notes. Spine surgeons have sustained neck flexion and neglect their posture during surgery. In a survey, low back pain was found in 62% of surgeons, 31% of them with a diagnosed lumbar disc herniation, and 23% of surgery rate. Pain in the neck (59%), shoulder (49%), finger (31%), and wrist (25%) are more frequent than in the general population. Carpal tunnel syndrome showed a linear relationship with increasing cumulative hours of spine surgery practice. Among cranial procedures, endoscopy was also significantly related to shoulder pain while pineal region surgery received some attempts to optimize ergonomics. Conclusions Ergonomics in neurosurgery remains underreported and lack attention from surgeons and authorities. Improvements shall target postural ergonomics, equipment design, weekly schedule adaptation, and exercise.
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Affiliation(s)
- Alexandre Lavé
- Department of Clinical Neurosciences, Division of Neurosurgery, Geneva University Hospitals, Geneva, Switzerland
| | - Renato Gondar
- Department of Clinical Neurosciences, Division of Neurosurgery, Geneva University Hospitals, Geneva, Switzerland
| | | | - Torstein R Meling
- Department of Clinical Neurosciences, Division of Neurosurgery, Geneva University Hospitals, Geneva, Switzerland.
- Faculty of Medicine, University of Geneva, Geneva, Switzerland.
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Singh R, Baby B, Damodaran N, Srivastav V, Suri A, Banerjee S, Kumar S, Kalra P, Prasad S, Paul K, Anand S, Kumar S, Dhiman V, Ben-Israel D, Kapoor KS. Design and Validation of an Open-Source, Partial Task Trainer for Endonasal Neuro-Endoscopic Skills Development: Indian Experience. World Neurosurg 2015; 86:259-69. [PMID: 26410199 DOI: 10.1016/j.wneu.2015.09.045] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 09/06/2015] [Accepted: 09/08/2015] [Indexed: 11/15/2022]
Abstract
BACKGROUND Box trainers are ideal simulators, given they are inexpensive, accessible, and use appropriate fidelity. OBJECTIVE The development and validation of an open-source, partial task simulator that teaches the fundamental skills necessary for endonasal skull-base neuro-endoscopic surgery. METHODS We defined the Neuro-Endo-Trainer (NET) SkullBase-Task-GraspPickPlace with an activity area by analyzing the computed tomography scans of 15 adult patients with sellar suprasellar parasellar tumors. Four groups of participants (Group E, n = 4: expert neuroendoscopists; Group N, n =19: novice neurosurgeons; Group R, n = 11: neurosurgery residents with multiple iterations; and Group T, n = 27: neurosurgery residents with single iteration) performed grasp, pick, and place tasks using NET and were graded on task completion time and skills assessment scale score. RESULTS Group E had lower task completion times and greater skills assessment scale scores than both Group N and R (P ≤ 0.03, 0.001). The performance of Groups N and R was found to be equivalent; in self-assessing neuro-endoscopic skill, the participants in these groups were found to have equally low pretraining scores (4/10) with significant improvement shown after NET simulation (6, 7 respectively). Angled scopes resulted in decreased scores with tilted plates compared with straight plates (30° P ≤ 0.04, 45° P ≤ 0.001). With tilted plates, decreased scores were observed when we compared the 0° with 45° endoscope (right, P ≤ 0.008; left, P ≤ 0.002). CONCLUSIONS The NET, a face and construct valid open-source partial task neuroendoscopic trainer, was designed. Presimulation novice neurosurgeons and neurosurgical residents were described as having insufficient skills and preparation to practice neuro-endoscopy. Plate tilt and endoscope angle were shown to be important factors in participant performance. The NET was found to be a useful partial-task trainer for skill building in neuro-endoscopy.
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Affiliation(s)
- Ramandeep Singh
- Centre for Biomedical Engineering, Indian Institute of Technology Delhi, New Delhi, India
| | - Britty Baby
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Natesan Damodaran
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Vinkle Srivastav
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Ashish Suri
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India.
| | - Subhashis Banerjee
- Department of Computer Science and Engineering, Indian Institute of Technology Delhi, Hauz Khas, New Delhi, India
| | - Subodh Kumar
- Department of Computer Science and Engineering, Indian Institute of Technology Delhi, Hauz Khas, New Delhi, India
| | - Prem Kalra
- Department of Computer Science and Engineering, Indian Institute of Technology Delhi, Hauz Khas, New Delhi, India
| | - Sanjiva Prasad
- Department of Computer Science and Engineering, Indian Institute of Technology Delhi, Hauz Khas, New Delhi, India
| | - Kolin Paul
- Department of Computer Science and Engineering, Indian Institute of Technology Delhi, Hauz Khas, New Delhi, India
| | - Sneh Anand
- Centre for Biomedical Engineering, Indian Institute of Technology Delhi, New Delhi, India
| | - Sanjeev Kumar
- Central Scientific Instruments Organization (CSIR-CSIO) Sector 30-C, Chandigarh, India
| | - Varun Dhiman
- Central Scientific Instruments Organization (CSIR-CSIO) Sector 30-C, Chandigarh, India
| | - David Ben-Israel
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Kulwant Singh Kapoor
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
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Johnson R, Szymanski L, Mills S. Hierarchical structure from motion optical flow algorithms to harvest three-dimensional features from two-dimensional neuro-endoscopic images. J Clin Neurosci 2014; 22:378-82. [PMID: 25304436 DOI: 10.1016/j.jocn.2014.08.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Accepted: 08/01/2014] [Indexed: 11/26/2022]
Abstract
Technical advances have led to an increase in the use of the endoscope in neurosurgery in recent years, particularly for intraventricular procedures and pituitary and anterior skull base surgery. Recently stereoscopic three-dimensional (3D) endoscopes have become available and may over time replace traditional two-dimensional (2D) imagery. An alternative strategy would be to use computer software algorithms to give monocular 2D endoscopes 3D capabilities. In this study our objective was to recover depth information from 2D endoscopic images using optical flow techniques. Digital images were recorded using a 2D endoscope and a hierarchical structure from motion algorithm was applied to the motion of the endoscope in order to calculate depth information for the generation of 3D anatomical structure. We demonstrate that 3D data can be recovered from 2D endoscopic images taken during endoventricular surgery where there is a mix of rapid camera motion and periods where the camera is nearly stationary. These algorithms may have the potential to give 3D visualization capabilities to 2D endoscopic hardware.
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Affiliation(s)
- Reuben Johnson
- Department of Neurosurgery, University of Otago, Great King Street, Dunedin, Otago 9016, New Zealand.
| | - Lech Szymanski
- Department of Computer Science, University of Otago, PO Box 56, Dunedin, New Zealand
| | - Steven Mills
- Department of Computer Science, University of Otago, PO Box 56, Dunedin, New Zealand
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