1
|
de Jong GA, Meulstee JW, van Lindert EJ, Borstlap WA, Maal TJJ, Delye HHK. Longitudinal 3D Follow-up and secondary treatment aspects after endoscopic and open scaphocephaly surgery. Plast Reconstr Surg 2023:00006534-990000000-01876. [PMID: 37189218 DOI: 10.1097/prs.0000000000010701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
SUMMARY
Collapse
Affiliation(s)
- Guido A de Jong
- Department of Neurosurgery, Radboudumc, Nijmegen, The Netherlands Radboudumc, Huispost 633, Stafsecretariaat Neurochirurgie, Postbus 9101, 6500 HB Nijmegen, The Netherlands
- Radboudumc 3D Lab, Radboudumc, Nijmegen, The Netherlands Radboudumc, Huispost 562, Stafsecretariaat Mond- Kaak- en Aangezichtschirurgie/3D-Lab, Postbus 9101, 6500 HB Nijmegen, The Netherlands
- Department of Oral and Maxillofacial Surgery, Radboudumc, The Netherlands Radboudumc, Huispost 562, Stafsecretariaat Mond- Kaak- en Aangezichtschirurgie, Postbus 9101, 6500 HB Nijmegen, The Netherlands
| | - Jene W Meulstee
- Radboudumc 3D Lab, Radboudumc, Nijmegen, The Netherlands Radboudumc, Huispost 562, Stafsecretariaat Mond- Kaak- en Aangezichtschirurgie/3D-Lab, Postbus 9101, 6500 HB Nijmegen, The Netherlands
- Department of Oral and Maxillofacial Surgery, Radboudumc, The Netherlands Radboudumc, Huispost 562, Stafsecretariaat Mond- Kaak- en Aangezichtschirurgie, Postbus 9101, 6500 HB Nijmegen, The Netherlands
| | - Erik J van Lindert
- Department of Neurosurgery, Radboudumc, Nijmegen, The Netherlands Radboudumc, Huispost 633, Stafsecretariaat Neurochirurgie, Postbus 9101, 6500 HB Nijmegen, The Netherlands
| | - Wilfred A Borstlap
- Department of Oral and Maxillofacial Surgery, Radboudumc, The Netherlands Radboudumc, Huispost 562, Stafsecretariaat Mond- Kaak- en Aangezichtschirurgie, Postbus 9101, 6500 HB Nijmegen, The Netherlands
| | - Thomas J J Maal
- Radboudumc 3D Lab, Radboudumc, Nijmegen, The Netherlands Radboudumc, Huispost 562, Stafsecretariaat Mond- Kaak- en Aangezichtschirurgie/3D-Lab, Postbus 9101, 6500 HB Nijmegen, The Netherlands
- Department of Oral and Maxillofacial Surgery, Radboudumc, The Netherlands Radboudumc, Huispost 562, Stafsecretariaat Mond- Kaak- en Aangezichtschirurgie, Postbus 9101, 6500 HB Nijmegen, The Netherlands
| | - Hans H K Delye
- Department of Neurosurgery, Radboudumc, Nijmegen, The Netherlands Radboudumc, Huispost 633, Stafsecretariaat Neurochirurgie, Postbus 9101, 6500 HB Nijmegen, The Netherlands
| |
Collapse
|
2
|
Arts S, van Lieshout JH, van Bilsen M, Karadag C, Beez T, van den Abbeele L, Aquarius R, Vinke S, Bartels RHMA, van Lindert EJ, Hänggi D, Boogaarts HD. Non-adjustable gravitational valves or adjustable valves in the treatment of hydrocephalus after aneurysmal subarachnoid hemorrhage patients? Acta Neurochir (Wien) 2022; 164:2867-2873. [PMID: 36149501 PMCID: PMC9613573 DOI: 10.1007/s00701-022-05361-0] [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: 04/21/2022] [Accepted: 09/03/2022] [Indexed: 01/31/2023]
Abstract
PURPOSE Hydrocephalus requiring permanent CSF shunting after aneurysmal subarachnoid hemorrhage (aSAH) is frequent. It is unknown which type of valve is optimal. This study evaluates if the revision rate of gravitational differential pressure valves (G-DPVs, GAV® system (B Braun)) (G-DPV) is comparable to adjustable pressure valves (Codman Medos Hakim) (APV) in the treatment of post-aSAH hydrocephalus. METHODS The use of a gravitational differential pressure valve is placed in direct comparison with an adjustable pressure valve system. A retrospective chart review is performed to compare the revision rates for the two valve systems. RESULTS Within the registry from Radboud University Medical Center, 641 patients with a SAH could be identified from 1 January 2013 until 1 January 2019, whereas at the Heinrich Heine University, 617 patients were identified, totaling 1258 patients who suffered from aSAH. At Radboud University Medical Center, a gravitational differential pressure valve is used, whereas at the Heinrich Heine University, an adjustable pressure valve system is used. One hundred sixty-six (13%) patients required permanent ventricular peritoneal or atrial shunting. Shunt dysfunction occurred in 36 patients: 13 patients of the 53 (25%) of the gravitational shunt cohort, and in 23 of the 113 (20%) patients with an adjustable shunt (p = 0.54). Revision was performed at a mean time of 3.2 months after implantation with the gravitational system and 8.2 months with the adjustable shunt system. Combined rates of over- and underdrainage leading to revision were 7.5% (4/53) for the gravitational and 3.5% (4/113) for the adjustable valve system (p = 0 .27). CONCLUSION The current study does not show a benefit of a gravitational pressure valve (GAV® system) over an adjustable pressure valve (CODMAN ® HAKIM®) in the treatment of post-aSAH hydrocephalus. The overall need for revision is high and warrants further improvements in care.
Collapse
Affiliation(s)
- Sebastian Arts
- grid.10417.330000 0004 0444 9382Department of Radiology, Radboud University Medical Center, Nijmegen, The Netherlands ,grid.10417.330000 0004 0444 9382Department of Neurosurgery, Radboud University Medical Center, Geert Grooteplein-Zuid 10, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Jasper Hans van Lieshout
- grid.411327.20000 0001 2176 9917Department of Neurosurgery, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Martine van Bilsen
- grid.10417.330000 0004 0444 9382Department of Neurosurgery, Radboud University Medical Center, Geert Grooteplein-Zuid 10, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Cihat Karadag
- grid.411327.20000 0001 2176 9917Department of Neurosurgery, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Thomas Beez
- grid.411327.20000 0001 2176 9917Department of Neurosurgery, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Leonie van den Abbeele
- grid.10417.330000 0004 0444 9382Department of Neurosurgery, Radboud University Medical Center, Geert Grooteplein-Zuid 10, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Rene Aquarius
- grid.10417.330000 0004 0444 9382Department of Neurosurgery, Radboud University Medical Center, Geert Grooteplein-Zuid 10, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Saman Vinke
- grid.10417.330000 0004 0444 9382Department of Neurosurgery, Radboud University Medical Center, Geert Grooteplein-Zuid 10, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Ronald H. M. A. Bartels
- grid.10417.330000 0004 0444 9382Department of Neurosurgery, Radboud University Medical Center, Geert Grooteplein-Zuid 10, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Erik J. van Lindert
- grid.10417.330000 0004 0444 9382Department of Neurosurgery, Radboud University Medical Center, Geert Grooteplein-Zuid 10, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Daniel Hänggi
- grid.411327.20000 0001 2176 9917Department of Neurosurgery, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Hieronymus D. Boogaarts
- grid.10417.330000 0004 0444 9382Department of Neurosurgery, Radboud University Medical Center, Geert Grooteplein-Zuid 10, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| |
Collapse
|
3
|
Arts S, van Bilsen M, van Lindert EJ, Bartels RHMA, Aquarius R, Boogaarts HD. Implementation of an Automated Cerebrospinal Fluid Drainage System for Early Mobilization in Neurosurgical Patients. Brain Sci 2021; 11:brainsci11060683. [PMID: 34067446 PMCID: PMC8224576 DOI: 10.3390/brainsci11060683] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 04/25/2021] [Revised: 05/15/2021] [Accepted: 05/18/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Automated cerebrospinal fluid (CSF) drainage systems allow for the mobilization of patients with an external CSF drain. The aim of this study is to describe the implementation of an automated CSF drainage system in neurosurgical patients with external CSF drains. METHODS A feasibility study was performed using an automated CSF drainage system (LiquoGuard®7, Möller Medical GmbH, Fulda, Germany) in adult neurosurgical patients treated with external lumbar or external ventricular drains between December 2017 and June 2020. Limited mobilization was allowed-patients were allowed to adjust their inclined beds, sit in chairs and walk under the supervision of a nurse or physical therapist. The primary outcome was the number of prematurely terminated drainage sessions. RESULTS Twenty-three patients were included. Drainage was terminated prematurely in eight (35%) patients. In three (13%) of these patients, drainage was terminated due to signs of hydrocephalus. Pressure-controlled drainage in patients with external lumbar drains (ELD) showed inaccurate pressure curves, which was solved by using volume-controlled drainage in ELD patients. CONCLUSION The implementation of an automated CSF drainage system (LiquoGuard®7) for CSF drainage allows for early mobilization in a subset of patients with external CSF drains. External lumbar drains require volume-based drainage rather than differential pressure-dependent drainage.
Collapse
|
4
|
Arts S, van Lindert EJ, Aquarius R, Bartels RHMA, Boogaarts HD. Complications of external cerebrospinal fluid drainage in aneurysmal subarachnoid haemorrhage. Acta Neurochir (Wien) 2021; 163:1143-1151. [PMID: 33387044 PMCID: PMC7965850 DOI: 10.1007/s00701-020-04681-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 09/30/2020] [Accepted: 12/14/2020] [Indexed: 12/22/2022]
Abstract
Background The need for external cerebrospinal fluid (CSF) drains in aneurysmal subarachnoid haemorrhage (aSAH) patients is common and might lead to additional complications. Objective A relation between the presence of an external CSF drain and complication risk is investigated. Methods A prospective complication registry was analysed retrospectively. We included all adult aSAH patients admitted to our academic hospital between January 2016 and January 2018, treated with an external CSF drain. Demographic data, type of external drain used, the severity of the aSAH and complications, up to 30 days after drain placement, were registered. Complications were divided into (1) complications with a direct relation to the external CSF drain and (2) complications that could not be directly related to the use of an external CSF drain referred to as medical complications Results One hundred and forty drains were implanted in 100 aSAH patients. In total, 112 complications occurred in 59 patients. Thirty-six complications were drain related and 76 were medical complications. The most common complication was infection (n = 34). Drain dislodgement occurred 16 times, followed by meningitis (n = 11) and occlusion (n = 9). A Poisson model showed that the mean number of complications raised by 2.9% for each additional day of drainage (95% CI: 0.6–5.3% p = 0.01). Conclusion Complications are common in patients with aneurysmal subarachnoid haemorrhage of which 32% are drain-related. A correlation is present between drainage period and the number of complications. Therefore, reducing drainage period could be a target for further improvement of care.
Collapse
Affiliation(s)
- Sebastian Arts
- Department of Neurosurgery, Radboud University Medical Center, Geert Grooteplein-Zuid 10, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Erik J van Lindert
- Department of Neurosurgery, Radboud University Medical Center, Geert Grooteplein-Zuid 10, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Rene Aquarius
- Department of Neurosurgery, Radboud University Medical Center, Geert Grooteplein-Zuid 10, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Ronald H M A Bartels
- Department of Neurosurgery, Radboud University Medical Center, Geert Grooteplein-Zuid 10, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Hieronymus D Boogaarts
- Department of Neurosurgery, Radboud University Medical Center, Geert Grooteplein-Zuid 10, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
| |
Collapse
|
5
|
de Bree K, Atsma F, van Lindert EJ, Westert GP, Bartels RMHA. Need for post-operative outpatient appointments after discharge following cervical spinal surgery - a narrative review. BMC Musculoskelet Disord 2020; 21:614. [PMID: 32933488 PMCID: PMC7491072 DOI: 10.1186/s12891-020-03624-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 08/31/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In the Netherlands most patients are currently seen in an outpatient clinic after an anterior cervical discectomy, which is an effective neurosurgical procedure with relatively low rate of severe complications. In this back sight, the need for patients returning to the post-operative outpatient clinic could be questioned. The aim of the study is to evaluate whether a post-operative outpatient appointment after anterior cervical discectomy could be replaced by an alternative or be omitted without adversely impacting, or increasing, the value of healthcare and patient satisfaction for this procedure. METHODS A narrative review was performed to evaluate the quality of care and patient satisfaction for patients with and without a post-operative outpatient appointment after spinal surgery. A literature search of the previous ten years was performed in Pubmed, CENTRAL and EMBASE. RESULTS A total of 403 articles were identified. Four studies remained after title and abstract selection by 3 independent reviewers. No papers were selected for further analysis, due to the absence of interventional studies that compared the utility of a post-operative outpatient clinic appointment with an intervention after spinal surgery. CONCLUSIONS Currently, there is a lack of evidence for the need of a post-operative follow-up after anterior cervical discectomy. Nor is there any literature in favor of omitting these appointments. No determinants which patients benefits from these outpatient appointments could be identified. Potential harmful and beneficial effects of omitting these post-operative follow-ups should be investigated to identify possible determinant for patients who might benefit from a post-operative appointment.
Collapse
Affiliation(s)
- Karel de Bree
- Department of Neurosurgery, Institute for Health Sciences, Radboud University Medical Centre, Postbus 9101, Geert Grooteplein Zuid 10, Nijmegen, 6500 HB, The Netherlands.
| | - Femke Atsma
- Scientific Center for Quality of Healthcare, Institute for Health Sciences, Radboud University Medical Centre, Postbus 9101, Geert Grooteplein 21, Nijmegen, 6500 HB, The Netherlands
| | - Erik J van Lindert
- Department of Neurosurgery, Institute for Health Sciences, Radboud University Medical Centre, Postbus 9101, Geert Grooteplein Zuid 10, Nijmegen, 6500 HB, The Netherlands
| | - Gert P Westert
- Scientific Center for Quality of Healthcare, Institute for Health Sciences, Radboud University Medical Centre, Postbus 9101, Geert Grooteplein 21, Nijmegen, 6500 HB, The Netherlands
| | - Ronald M H A Bartels
- Department of Neurosurgery, Institute for Health Sciences, Radboud University Medical Centre, Postbus 9101, Geert Grooteplein Zuid 10, Nijmegen, 6500 HB, The Netherlands
| |
Collapse
|
6
|
Coulter IC, Kulkarni AV, Sgouros S, Constantini S, Constantini S, Sgouros S, Kulkarni AV, Leitner Y, Kestle JR, Cochrane DD, Choux M, Gjerris F, Sherer A, Akalan N, Bilginer B, Navarro R, Vujotic L, Haberl H, Thomale UW, Zúccaro G, Jaimovitch R, Frim D, Loftis L, Swift DM, Robertson B, Gargan L, Bognár L, Novák L, Cseke G, Cama A, Ravegnani GM, Preuß M, Schroeder HW, Fritsch M, Baldauf J, Mandera M, Luszawski J, Skorupka P, Mallucci C, Williams D, Zakrzewski K, Nowoslawska E, Srivastava C, Mahapatra AK, Kumar R, Sahu RN, Melikian AG, Korshunov A, Galstyan A, Suri A, Gupta D, Grotenhuis JA, van Lindert EJ, da Costa Val JA, Di Rocco C, Tamburrini G, Zymberg ST, Cavalheiro S, Jie M, Feng J, Friedman O, Rajmohamed N, Roszkowski M, Barszcz S, Jallo G, Pincus DW, Richter B, Mehdorn HM, Schultka S, de Ribaupierre S, Thompson D, Gatscher S, Wagner W, Koch D, Cipri S, Zaccone C, McDonald P. Cranial and ventricular size following shunting or endoscopic third ventriculostomy (ETV) in infants with aqueductal stenosis: further insights from the International Infant Hydrocephalus Study (IIHS). Childs Nerv Syst 2020; 36:1407-1414. [PMID: 31965292 DOI: 10.1007/s00381-020-04503-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 01/02/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE The craniometrics of head circumference (HC) and ventricular size are part of the clinical assessment of infants with hydrocephalus and are often utilized in conjunction with other clinical and radiological parameters to determine the success of treatment. We aimed to assess the effect of endoscopic third ventriculostomy (ETV) and shunting on craniometric measurements during the follow-up of a cohort of infants with symptomatic triventricular hydrocephalus secondary to aqueductal stenosis. METHODS We performed a post hoc analysis of data from the International Infant Hydrocephalus Study (IIHS)-a prospective, multicenter study of infants (< 24 months old) with hydrocephalus from aqueductal stenosis who were treated with either an ETV or shunt. During various stages of a 5-year follow-up period, the following craniometrics were measured: HC, HC centile, HC z-score, and frontal-occipital horn ratio (FOR). Data were compared in an analysis of covariance, adjusting for baseline variables including age at surgery and sex. RESULTS Of 158 enrolled patients, 115 underwent an ETV, while 43 received a shunt. Both procedures led to improvements in the mean HC centile position and z-score, a trend which continued until the 5-year assessment point. A similar trend was noted for FOR which was measured at 12 months and 3 years following initial treatment. Although the values were consistently higher for ETV compared with shunt, the differences in HC value, centile, and z-score were not significant. ETV was associated with a significantly higher FOR compared with shunting at 12 months (0.52 vs 0.44; p = 0.002) and 3 years (0.46 vs 0.38; p = 0.03) of follow-up. CONCLUSION ETV and shunting led to improvements in HC centile, z-score, and FOR measurements during long-term follow-up of infants with hydrocephalus secondary to aqueductal stenosis. Head size did not significantly differ between the treatment groups during follow-up, however ventricle size was greater in those undergoing ETV when measured at 1 and 3 years following treatment.
Collapse
Affiliation(s)
- Ian C Coulter
- The Hospital for Sick Children, University of Toronto, 555 University Avenue, Suite 1503, Toronto, Ontario, M5G 1X8, Canada
| | - Abhaya V Kulkarni
- The Hospital for Sick Children, University of Toronto, 555 University Avenue, Suite 1503, Toronto, Ontario, M5G 1X8, Canada.
| | - Spyros Sgouros
- Department of Pediatric Neurosurgery, Mitera Children's Hospital, Athens, Greece.,University of Athens Medical School, Athens, Greece
| | - Shlomi Constantini
- Department of Pediatric Neurosurgery, Dana Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
7
|
van Lindert EJ, Liem KD, Geerlings M, Delye H. Bedside placement of ventricular access devices under local anaesthesia in neonates with posthaemorrhagic hydrocephalus: preliminary experience. Childs Nerv Syst 2019; 35:2307-2312. [PMID: 31506779 DOI: 10.1007/s00381-019-04361-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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: 12/05/2018] [Accepted: 08/30/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE Posthaemorrhagic ventricular dilatation in preterm infants is primarily treated using temporising measures, of which the placement of a ventricular access device (VAD) is one option. Permanent shunt dependency rates are high, though vary widely. In order to improve the treatment burden and lower shunt dependency rates, we implemented several changes over the years. One of these changes involves the setting of the surgery from general anaesthesia in the OR to local anaesthesia in bed at the neonatal intensive care unit (NICU), which may seem counterintuitive to many. In this article, we describe our surgical technique and present the results of this regimen and compare it to our previous techniques. METHODS Retrospective study of a consecutive series of 37 neonates with posthaemorrhagic ventricular dilatation (PHVD) treated using a VAD, with a cohort I (n = 13) treated from 2004 to 2008 under general anaesthesia in the OR, cohort II (n = 11) treated from 2009 to 2013 under general anaesthesia in the NICU and cohort III (n = 13) treated from December 2013 to December 2017 under local anaesthesia on the NICU. RESULTS The overall infection rate was 14%; the VAD revision rate was 22% and did not differ significantly between the cohorts. Procedures under local anaesthesia never required conversion to general anaesthesia and were well tolerated. After an average of 33 tapping days, 38% of the neonates received a permanent ventriculoperitoneal (VP) shunt. The permanent VP shunt rate was 9% with VAD placement under local anaesthesia and 52% when performed under general anaesthesia (p = 0.02). CONCLUSION Bedside placement of VADs for PHVD under local anaesthesia in neonates is a low-risk, well-tolerated procedure that results in at least equal results to surgery performed under general anaesthesia and/or performed in an OR.
Collapse
Affiliation(s)
- Erik J van Lindert
- Department of Neurosurgery, Radboud University Medical Center, Geert Groteplein-Zuid 10, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
| | - K Djien Liem
- Department of Paediatrics-Neonatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Martin Geerlings
- Department of Neurosurgery, Radboud University Medical Center, Geert Groteplein-Zuid 10, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Hans Delye
- Department of Neurosurgery, Radboud University Medical Center, Geert Groteplein-Zuid 10, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| |
Collapse
|
8
|
Abstract
BACKGROUND The main complication of cerebrospinal fluid (CSF) shunt surgery is shunt infection. Prevention of these shunt infections consists of the perioperative use of antibiotics that can be administered in five different ways: orally; intravenously; intrathecally; topically; and via the implantation of antibiotic-impregnated shunt catheters. OBJECTIVES To determine the effect of different routes of antibiotic prophylaxis (i.e. oral, intravenous, intrathecal, topical and via antibiotic-impregnated shunt catheters) on CSF-shunt infections in persons treated for hydrocephalus using internalised CSF shunts. SEARCH METHODS We conducted a systematic electronic search without restrictions on language, date or publication type. We performed the search on the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library, MEDLINE and Embase, with the help of the Information Specialist of the Cochrane Multiple Sclerosis and Rare Diseases of the CNS Group. The search was performed in January 2018. SELECTION CRITERIA All randomised and quasi-randomised controlled trials that studied the effect of antibiotic prophylaxis, in any dose or administration route, for the prevention of CSF-shunt infection in patients that were treated with an internal cerebrospinal fluid shunt. Patients with external shunts were not eligible. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data from included studies. We resolved disagreements by discussion or by referral to an independent researcher within our department when necessary. Analyses were also performed by at least two authors. MAIN RESULTS We included a total of 11 small randomised controlled trials, containing 1109 participants, in this systematic review. Three of these studies included solely children, and the remaining eight included participants of all ages. Most studies were limited to the evaluation of ventriculoperitoneal shunts. However, five studies included participants with ventriculoatrial shunts, of which one study contained four participants with a subduroperitoneal shunt. We judged four out of 11 (36%) trials at unclear risk of bias, while the remaining seven trials (64%) scored high risk of bias in one or more of the components assessed.We analysed all included studies in order to estimate the effect of antibiotic prophylaxis on the proportion of shunt infections regardless of administration route. Although the quality of evidence in these studies was low, there may be a positive effect of antibiotic prophylaxis on the number of participants who had shunt infections (RR 0.55, 95% CI 0.36 to 0.84), meaning a 55% reduction in the number of participants who had shunt infection compared with standard care or placebo.Within the different administration routes, only within intravenous administration of antibiotic prophylaxis there may be evidence of an effect on the risk of shunt infections (RR 0.55, 95% CI 0.33 to 0.90). However, this was the only route that contained more than two studies (8 studies; 797 participants). Evidence was uncertain for both, intrathecal administration of antibiotics (RR 0.73, 95% CI 0.28 to 1.93, 2 studies; 797 participants; low quality evidence) and antibiotic impregnated catheters (RR 0.36, 95% CI 0.10 to 1.24, 1 study; 110 participants; very low quality evidence) AUTHORS' CONCLUSIONS: Antibiotic prophylaxis may have a positive effect on lowering the number of participants who had shunt infections. However, the quality of included studies was low and the effect is not consistent within the different routes of administration that have been analysed. It is therefore uncertain whether prevention of shunt infection varies by different antibiotic agents, different administration routes, timing and doses; or by characteristics of patients, e.g. children and adults. The results of the review should be seen as hypothesis-generating rather than definitive, and the results should be confirmed in adequately powered trials or large multicentre studies in order to obtain high-quality evidence in the field of ventricular shunt infection prevention.
Collapse
Affiliation(s)
- Sebastian HHMJ Arts
- Radboud University Medical CenterDepartment of NeurosurgeryGeert Grooteplein Zuid 10NijmegenNetherlands
| | | | - Erik J van Lindert
- Radboud University Medical CenterDepartment of NeurosurgeryGeert Grooteplein Zuid 10NijmegenNetherlands
| | | |
Collapse
|
9
|
Arts S, Delye H, van Lindert EJ, Blok L, Borstlap W, Driessen J. Evaluation of anesthesia in endoscopic strip craniectomy: A review of 121 patients. Paediatr Anaesth 2018; 28:647-653. [PMID: 29851178 DOI: 10.1111/pan.13414] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/30/2018] [Indexed: 12/24/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate pre-, intra-, and postoperative anesthetic parameters in endoscopic strip craniectomy in order to improve anesthesiological care. MATERIALS AND METHODS This is a retrospective patient cohort study of our first 121 patients treated by endoscopic strip craniectomy. Preoperative as well as intra- and postoperative anesthesiological and neurological parameters were analyzed. Furthermore, the need for intensive care unit admission, blood loss, and blood transfusion rate were measured. RESULTS The mean age of patients was 3.9 months (standard deviation = 1) at a mean weight of 6.3 kg (standard deviation = 1.3). Comorbidity was registered in 13 (11%) patients of which 5 had syndrome-related comorbidities. Mean duration of anesthesia was 131 minutes (standard deviation = 32) . One hundred and sixteen patients were induced by mask induction with sevoflurane and 5 patients were induced intravenously. In 10 patients, mild intraoperative hypothermia (between 35 and 36 degrees Celsius) occurred. The mean estimated blood loss was 35.4 mL (standard deviation = 28.9) and blood transfusion rate was 21.5%. Brief and small intraoperative oxygen saturation drops were common during this study. No indication for venous air embolism was found based on endtidal CO2 . Postoperative temperature above 38 degrees Celsius occurred 16 times and benign deviations in postoperative cardiopulmonary parameters occurred in 17 patients. Postoperative pain management was mainly established by paracetamol and low-dose morphine when necessary. No postoperative neurological symptoms were reported and no deaths occurred. CONCLUSION These patients had a relatively short intraoperative course with stable vital parameters during surgery. We report a low incidence of significant venous air embolism, a blood transfusion rate of 21% and only minor perioperative disturbances in vital parameters.
Collapse
Affiliation(s)
- Sebastian Arts
- Department of Neurosurgery, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Anaesthesiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Hans Delye
- Department of Neurosurgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Erik J van Lindert
- Department of Neurosurgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Laura Blok
- Department of Anaesthesiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Wilfred Borstlap
- Department of Oral and Maxillofacial Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jacques Driessen
- Department of Anaesthesiology, Radboud University Medical Center, Nijmegen, The Netherlands
| |
Collapse
|
10
|
Shimanskaya VE, Wagenmakers MA, Bartels RH, Boogaarts HD, Grotenhuis JA, Hermus AR, van de Ven AC, van Lindert EJ. Toward Shorter Hospitalization After Endoscopic Transsphenoidal Pituitary Surgery: Day-by-Day Analysis of Early Postoperative Complications and Interventions. World Neurosurg 2018; 111:e871-e879. [DOI: 10.1016/j.wneu.2017.12.174] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Revised: 12/27/2017] [Accepted: 12/30/2017] [Indexed: 11/30/2022]
|
11
|
Arts S, Delye H, van Lindert EJ. Intraoperative and postoperative complications in the surgical treatment of craniosynostosis: minimally invasive versus open surgical procedures. J Neurosurg Pediatr 2018; 21:112-118. [PMID: 29171801 DOI: 10.3171/2017.7.peds17155] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To compare minimally invasive endoscopic and open surgical procedures, to improve informed consent of parents, and to establish a baseline for further targeted improvement of surgical care, this study evaluated the complication rate and blood transfusion rate of craniosynostosis surgery in our department. METHODS A prospective complication registration database that contains a consecutive cohort of all pediatric neurosurgical procedures in the authors' neurosurgical department was used. All pediatric patients who underwent neurosurgical treatment for craniosynostosis between February 2004 and December 2014 were included. In total, 187 procedures were performed, of which 121 were endoscopically assisted minimally invasive procedures (65%). Ninety-three patients were diagnosed with scaphocephaly, 50 with trigonocephaly, 26 with plagiocephaly, 3 with brachycephaly, 9 with a craniosynostosis syndrome, and 6 patients were suffering from nonsyndromic multisutural craniosynostosis. RESULTS A total of 18 complications occurred in 187 procedures (9.6%, 95% CI 6.2-15), of which 5.3% (n = 10, 95% CI 2.9-10) occurred intraoperatively and 4.2% (n = 8, 95% CI 2.2-8.2) occurred postoperatively. In the open surgical procedure group, 9 complications occurred: 6 intraoperatively and 3 postoperatively. In the endoscopically assisted procedure group, 9 complications occurred: 4 intraoperatively and 5 postoperatively. Blood transfusion was needed in 100% (n = 66) of the open surgical procedures but in only 21% (n = 26, 95% CI 15-30) of the endoscopic procedures. One patient suffered a transfusion reaction, and 6 patients suffered infections, only one of which was a surgical site infection. A dural tear was the most common intraoperative complication that occurred (n = 8), but it never led to postoperative sequelae. Intraoperative bleeding from a sagittal sinus occurred in one patient with only minimal blood loss. There were no deaths, permanent morbidity, or neurological sequelae. CONCLUSIONS Complications during craniosynostosis surgery were relatively few and minor and were without permanent sequelae in open and in minimally invasive procedures. The blood transfusion rate was significantly reduced in endoscopic procedures compared with open procedures.
Collapse
|
12
|
van Lindert EJ, van Bilsen M, van der Flier M, Kolwijck E, Delye H, Oever JT. Topical vancomycin reduces the cerebrospinal fluid shunt infection rate: A retrospective cohort study. PLoS One 2018; 13:e0190249. [PMID: 29315341 PMCID: PMC5760031 DOI: 10.1371/journal.pone.0190249] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 12/11/2017] [Indexed: 11/18/2022] Open
Abstract
Object Despite many efforts at reduction, cerebrospinal fluid (CSF) shunt infections are a major cause of morbidity in shunt surgery, occurring in 5–15% of cases. To attempt to reduce the shunt infection rate at our institution, we added topical vancomycin (intrashunt and perishunt) to our existing shunt infection prevention protocol in 2012. Methods We performed a retrospective cohort study comparing all shunted patients in January 2010 to December 2011 without vancomycin (control group, 263 procedures) to all patients who underwent shunt surgery between April 2012 and December 2015 with vancomycin (intervention group, 499 procedures). Results The overall shunt infection rate significantly decreased from 6.8% (control group) to 3.0% (intervention group) (p = 0.023, absolute risk reduction 3.8%, relative risk reduction 56%). Multivariate logistic regression analysis confirmed that the addition of topical vancomycin showed that cases treated under a protocol of topical vancomycin were associated with a decreased shunt infection rate (odds ratio [OR] 0.49 95% CI 0.25–0.998; p = 0.049). Age < 1 year was associated with an increased risk of infection (OR) 4.41, 95% CI 2,10–9,26; p = 0.001). Time from surgery to infection was significantly prolonged in the intervention group (p = 0.001). Conclusion Adding intraoperative vancomycin to a shunt infection prevention protocol significantly reduces CSF shunt infection rate.
Collapse
Affiliation(s)
- Erik J. van Lindert
- Department of Neurosurgery, Radboud University Medical Center, Nijmegen, The Netherlands
- * E-mail:
| | - Martine van Bilsen
- Department of Neurosurgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Michiel van der Flier
- Department of Pediatrics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Eva Kolwijck
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Hans Delye
- Department of Neurosurgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jaap ten Oever
- Department of Internal Medicine, and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
| |
Collapse
|
13
|
van Lindert EJ, Arts S, Blok LM, Hendriks MP, Tielens L, van Bilsen M, Delye H. Intraoperative complications in pediatric neurosurgery: review of 1807 cases. J Neurosurg Pediatr 2016; 18:363-71. [PMID: 27231823 DOI: 10.3171/2016.3.peds15679] [Citation(s) in RCA: 6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Minimal literature exists on the intraoperative complication rate of pediatric neurosurgical procedures with respect to both surgical and anesthesiological complications. The aim of this study, therefore, was to establish intraoperative complication rates to provide patients and parents with information on which to base their informed consent and to establish a baseline for further targeted improvement of pediatric neurosurgical care. METHODS A clinical complication registration database comprising a consecutive cohort of all pediatric neurosurgical procedures carried out in a general neurosurgical department from January 1, 2004, until July 1, 2012, was analyzed. During the study period, 1807 procedures were performed on patients below the age of 17 years. RESULTS Sixty-four intraoperative complications occurred in 62 patients (3.5% of procedures). Intraoperative mortality was 0.17% (n = 3). Seventy-eight percent of the complications (n = 50) were related to the neurosurgical procedures, whereas 22% (n = 14) were due to anesthesiology. The highest intraoperative complication rates were for cerebrovascular surgery (7.7%) and tumor surgery (7.4%). The most frequently occurring complications were cerebrovascular complications (33%). CONCLUSIONS Intraoperative complications are not exceptional during pediatric neurosurgical procedures. Awareness of these complications is the first step in preventing them.
Collapse
Affiliation(s)
| | - Sebastian Arts
- Anesthesiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Laura M Blok
- Anesthesiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Mark P Hendriks
- Anesthesiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Luc Tielens
- Anesthesiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | | | | |
Collapse
|
14
|
Abstract
CASE REPORT The authors report a case of an 11-year-old boy that presented with headache and vomiting that was present for several months. CT and MR imaging revealed a large prepontine mass and an obstructive hydrocephalus. A ventriculoperitoneal shunt was inserted, and in a second operation, a radiologically proven total resection was performed, using a left frontotemporal transsylvian approach. The tumour showed no involvement of the dura or clivus. Histological examination showed the characteristics of a chordoma. No further adjuvant treatment was given. The patient remained disease or tumour free after a 6-year follow-up. DISCUSSION Intradural chordomas are extremely rare tumours that originate from notochordal remnants. Only three other cases have been reported in the paediatric population. Ecchordosis physaliphora (EP) is an ectopic notochordal remnant that has a similar biological behaviour and is difficult to distinguish from intradural chordomas. They might exist in a continuum from benign notochordal tumour to malignant chordoma. A surgical resection without adjuvant radiation therapy is suggested to be the treatment of choice in the paediatric population. CONCLUSION The authors describe a rare case of an intradural prepontine chordoma in an 11-year-old boy that stayed disease free after a 6-year follow-up.
Collapse
Affiliation(s)
- R. Saman Vinke
- Department of Neurosurgery, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | | | - Benno Kusters
- Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Erik J. van Lindert
- Department of Neurosurgery, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| |
Collapse
|
15
|
Cox MC, Kusters JM, Gidding CE, Schieving JH, van Lindert EJ, Kaanders JH, Janssens GO. Acute toxicity profile of craniospinal irradiation with intensity-modulated radiation therapy in children with medulloblastoma: A prospective analysis. Radiat Oncol 2015; 10:241. [PMID: 26597178 PMCID: PMC4657242 DOI: 10.1186/s13014-015-0547-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 11/17/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To report on the acute toxicity in children with medulloblastoma undergoing intensity-modulated radiation therapy (IMRT) with daily intrafractionally modulated junctions. METHODS Newly diagnosed patients, aged 3-21, with standard-risk (SR) or high-risk (HR) medulloblastoma were eligible. A dose of 23.4 or 36.0 Gy in daily fractions of 1.8 Gy was prescribed to the craniospinal axis, followed by a boost to the primary tumor bed (54 or 55.8 Gy) and metastases (39.6-55.8 Gy), when indicated. Weekly, an intravenous bolus of vincristine was combined for patients with SR medulloblastoma and patients participating in the COG-ACNS-0332 study. Common toxicity criteria (CTC, version 2.0) focusing on skin, alopecia, voice changes, conjunctivitis, anorexia, dysphagia, gastro-intestinal symptoms, headache, fatigue and hematological changes were scored weekly during radiotherapy. RESULTS From 2010 to 2014, data from 15 consecutive patients (SR, n = 7; HR, n = 8) were collected. Within 72 h from onset of treatment, vomiting (66 %) and headache (46 %) occurred. During week 3 of treatment, a peak incidence in constipation (33 %) and abdominal pain/cramping (40 %) was observed, but only in the subgroup of patients (n = 9) receiving vincristine (constipation: 56 vs 0 %, P = .04; pain/cramping: 67 vs 0 %, P = .03). At week 6, 73 % of the patients developed faint erythema of the cranial skin with dry desquamation (40 %) or moist desquamation confined to the skin folds of the auricle (33 %). No reaction of the skin overlying the spinal target volume was observed. CONCLUSIONS Headache at onset and gastro-intestinal toxicity, especially in patients receiving weekly vincristine, were the major complaints of patients with medulloblastoma undergoing craniospinal irradiation with IMRT.
Collapse
Affiliation(s)
- Maurice C Cox
- Department of Radiation Oncology, Radboud University Medical Centre, Nijmegen, The Netherlands.
| | - Johannes M Kusters
- Department of Radiation Oncology, Radboud University Medical Centre, Nijmegen, The Netherlands.
| | - Corrie E Gidding
- Department of Pediatric Oncology, Radboud University Medical Centre, Nijmegen, The Netherlands.
| | - Jolanda H Schieving
- Department of Neurology, Radboud University Medical Centre, Nijmegen, The Netherlands.
| | - Erik J van Lindert
- Department of Neurosurgery, Radboud University Medical Centre, Nijmegen, The Netherlands.
| | - Johannes H Kaanders
- Department of Radiation Oncology, Radboud University Medical Centre, Nijmegen, The Netherlands.
| | - Geert O Janssens
- Department of Radiation Oncology, University Medical Center Utrecht and Princess Maxima Center for Pediatric Oncology, Utrecht, 3584, CX, The Netherlands.
| |
Collapse
|
16
|
de Rotte AAJ, Groenewegen A, Rutgers DR, Witkamp T, Zelissen PMJ, Meijer FJA, van Lindert EJ, Hermus A, Luijten PR, Hendrikse J. High resolution pituitary gland MRI at 7.0 tesla: a clinical evaluation in Cushing's disease. Eur Radiol 2015; 26:271-7. [PMID: 25991481 PMCID: PMC4666272 DOI: 10.1007/s00330-015-3809-x] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [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: 01/22/2015] [Revised: 03/29/2015] [Accepted: 04/16/2015] [Indexed: 11/26/2022]
Abstract
Objective To evaluate the detection of pituitary lesions at 7.0 T compared to 1.5 T MRI in 16 patients with clinically and biochemically proven Cushing’s disease. Methods In seven patients, no lesion was detected on the initial 1.5 T MRI, and in nine patients it was uncertain whether there was a lesion. Firstly, two readers assessed both 1.5 T and 7.0 T MRI examinations unpaired in a random order for the presence of lesions. Consensus reading with a third neuroradiologist was used to define final lesions in all MRIs. Secondly, surgical outcome was evaluated. A comparison was made between the lesions visualized with MRI and the lesions found during surgery in 9/16 patients. Results The interobserver agreement for lesion detection was good at 1.5 T MRI (κ = 0.69) and 7.0 T MRI (κ = 0.62). In five patients, both the 1.5 T and 7.0 T MRI enabled visualization of a lesion on the correct side of the pituitary gland. In three patients, 7.0 T MRI detected a lesion on the correct side of the pituitary gland, while no lesion was visible at 1.5 T MRI. Conclusion The interobserver agreement of image assessment for 7.0 T MRI in patients with Cushing’s disease was good, and lesions were detected more accurately with 7.0 T MRI. Key Points • Interobserver agreement for lesion detection on 1.5 T MRI was good; • Interobserver agreement for lesion detection on 7.0 T MRI was good; • 7.0 T enabled confirmation of unclear lesions at 1.5 T; • 7.0 T enabled visualization of lesions not visible at 1.5 T. Electronic supplementary material The online version of this article (doi:10.1007/s00330-015-3809-x) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Alexandra A J de Rotte
- Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, Postbox 85500, 3508 GA, Utrecht, The Netherlands.
| | - Amy Groenewegen
- Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, Postbox 85500, 3508 GA, Utrecht, The Netherlands
| | - Dik R Rutgers
- Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, Postbox 85500, 3508 GA, Utrecht, The Netherlands
| | - Theo Witkamp
- Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, Postbox 85500, 3508 GA, Utrecht, The Netherlands
| | - Pierre M J Zelissen
- Department of Internal Medicine (Section of Endocrinology), University Medical Center Utrecht, Utrecht, The Netherlands
| | - F J Anton Meijer
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Erik J van Lindert
- Department of Neurosurgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ad Hermus
- Department of Internal Medicine (Section of Endocrinology), Radboud University Medical Center, Nijmegen, The Netherlands
| | - Peter R Luijten
- Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, Postbox 85500, 3508 GA, Utrecht, The Netherlands
| | - Jeroen Hendrikse
- Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, Postbox 85500, 3508 GA, Utrecht, The Netherlands
| |
Collapse
|
17
|
Valckx WJARM, Duarte Conde MP, Claassen JAHR, van Lindert EJ, Olde Rikkert MGM. [Idiopathic normal pressure hydrocephalus and the older patient]. Tijdschr Gerontol Geriatr 2015; 46:168-73. [PMID: 25904439 DOI: 10.1007/s12439-015-0123-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Idiopathic Normal Pressure Hydrocephalus (iNPH) is characterized by the clinical triad of cognitive disorders, gait impairment and urinary incontinence. The treatment is the implantation of a ventriculoperitoneal shunt. At present there are still no high quality determinants to predict the long term outcome after shunt implantation, because studies are likely to be biased, use many different study methods and are difficult to interpret by potential concomitant neurodegenerative diseases, like Alzheimer and vascular dementia. Because this comorbidity also determines whether the expected positive outcome of a shunt outweighs the risk of complications, a critical multidisciplinary analysis of comorbidity, frailty and patient preferences is a precondition to realize added value.
Collapse
|
18
|
Vliet RV, Roelofs LAJ, Rassouli-Kirchmeier R, de Gier RPE, Claahsen-van der Grinten HL, Verhaak C, Hosman AJ, Beerendonk CCM, van Lindert EJ, Willemsen MAAP, Wijnen MHWA, Feitz WFJ, de Blaauw I. Clinical outcome of cloacal exstrophy, current status, and a change in surgical management. Eur J Pediatr Surg 2015; 25:87-93. [PMID: 25422902 DOI: 10.1055/s-0034-1387943] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Cloacal exstrophy is a complex and rare congenital malformation. Because of improvements in medicine, operative techniques, and perioperative management the survival rates are now approaching 100%. Currently, treatment is focused on improving quality of life. Since 1974, we encountered 20 patients with cloacal exstrophy in our hospital. The aim of this study is to evaluate our clinical experience and outcome during the last 39 years. PATIENTS AND METHODS A retrospective study of the medical records was performed. We evaluated anatomical status, phenotype and genotype at birth, subsequent surgical treatment and current gastrointestinal, urinary, spinal, genital, and gender status and outcome. RESULTS The records of all 20 patients who were treated in our center were included in this study. Of the 20 patients, 18 were primary patients, 2 referred. Six patients died within the first year of life. Median age of the surviving 14 patients was 25 years (range, 4-39 years) at time of evaluation. At the last follow-up, 11 patients had an endileostomy or endcolostomy. Three patients had a pull-through; two of them were continent for feces. Two patients were continent for urine; one with a sinus urogenitalis and one after urethra reconstruction. Eleven patients are incontinent; six of them had an incontinent urinary deviation (Bricker deviation). Of the other five incontinent patients, two had a urethral reconstruction, one vesicovaginal anastomosis, one perineotomy, and one epispadias bladder. Urinary continence was unknown in one patient. Of the surviving patients, nine have 46 XY karyotype and five 46 XX karyotype. Initially, six XY patients underwent external genital reconstruction with reassignment to female gender; however, one died postoperatively. One declared to feel like a man at age of 15 years. Remaining four XY patients underwent male external genital reconstruction. All XX patients underwent vagina or vulva reconstruction, except for one who still has aplasia vaginae. All patients were born with varying types of spinal dysraphism. DISCUSSION Despite medical efforts and development in treatment and support, satisfaction in outcome of cloacal exstrophy remains a challenge. Although reconstruction may be very difficult, male genital reconstruction in 46 XY patients has been given preference for more than a decade. A specialized multidisciplinary team should provide lifelong colorectal, urological, sexual, and psychosocial support to these patients, taking into account their age and phase of life.
Collapse
Affiliation(s)
- Rob van Vliet
- Division of Pediatric Surgery, Department of Surgery, Radboudumc Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Luc A J Roelofs
- Division of Pediatric Urology, Department of Urology, Radboudumc Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Roxana Rassouli-Kirchmeier
- Division of Pediatric Surgery, Department of Surgery, Radboudumc Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Robert P E de Gier
- Division of Pediatric Urology, Department of Urology, Radboudumc Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Hedi L Claahsen-van der Grinten
- Department of Pediatric Endocrinology, Radboudumc Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Chris Verhaak
- Department of Medical Psychology, Radboudumc Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Allard J Hosman
- Department of Orthopedics, Radboudumc Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Catharina C M Beerendonk
- Department of Obstetrics and Gynecology, Radboudumc Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Erik J van Lindert
- Department of Neurosurgery, Radboudumc Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Michel A A P Willemsen
- Division of Pediatric Neurology, Department of Neurology, Radboudumc Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marc H W A Wijnen
- Division of Pediatric Surgery, Department of Surgery, Radboudumc Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Wout F J Feitz
- Division of Pediatric Urology, Department of Urology, Radboudumc Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ivo de Blaauw
- Division of Pediatric Surgery, Department of Surgery, Radboudumc Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, The Netherlands
| |
Collapse
|
19
|
van Lindert EJ, Delye H, Leonardo J. Prospective review of a single center's general pediatric neurosurgical intraoperative and postoperative complication rates. J Neurosurg Pediatr 2014; 13:107-13. [PMID: 24236448 DOI: 10.3171/2013.9.peds13222] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT The authors conducted a study to compare the complication rate (CR) of pediatric neurosurgical procedures in a general neurosurgery department to the CRs that are reported in the literature and to establish a baseline of CR for further targeted improvement of quality neurosurgical care. METHODS The authors analyzed the prospectively collected data from a complication registration of 1000 consecutive pediatric neurosurgical procedures in 581 patients from the beginning of the registration in January 2004 through August 2008. A pediatric neurosurgeon was involved in 50.5% of the procedures. All adverse events (AEs) from induction of anesthesia until 30 days postoperatively were recorded. RESULTS Overall, 229 complications were counted in 202 procedures. The overall CR was 20.2%, with a 2.7% intraoperative CR and a 17.5% postoperative CR. Tumor surgery was associated with the highest CR (32.7%), followed by CSF disorders (21.8%). The mortality rate was 0.3%. An unplanned return to the operating room in relation to an AE happened in 10.5% of all procedures and in 52% of procedures associated with AEs, the majority of which were related to CSF disorders. CONCLUSIONS The CR in pediatric neurosurgical procedures was significant, and more than half of the patients with an AE required a repeat surgical procedure. Analysis of CRs should be a prerequisite for the prevention of complications and for the development of targeted interventions to reduce the CR (for example, infection rates).
Collapse
Affiliation(s)
- Erik J van Lindert
- Department of Neurosurgery, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands; and
| | | | | |
Collapse
|
20
|
Versteegh HP, Feitz WFJ, van Lindert EJ, Marcelis C, de Blaauw I. "This bicycle gives me a headache", a congenital anomaly. BMC Res Notes 2013; 6:412. [PMID: 24124700 PMCID: PMC3852820 DOI: 10.1186/1756-0500-6-412] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2012] [Accepted: 10/01/2013] [Indexed: 11/10/2022] Open
Abstract
Backround The combination of a presacral mass, a sacral bone deformity, and an anorectal malformation are also known as the Currarino triad or Currarino syndrome. The syndrome is associated with a very high rate of severe and intractable constipation and urinary incontinence. However, it can also result in less common complaints and symptoms. Although the syndrome is known since 1981 and the involved genes are clarified to a great extent, the diagnosis may be delayed or missed if unrecognized. Case presentation A 24-year old female presented with periodical headaches. She was born with an imperforate anus, absent rectum and colon, double bladder, and sacral defect. Soon after birth she underwent several surgical procedures for anorectal and bladder reconstructions. The patient now came to her pediatric urologist for urinary incontinence and mentioned severe headaches on the side, particularly when riding a bike. Finally, she solved her headache problem by stopping to ride her bicycle. On physical examination no abnormalities were found except the ileostomy that was present ever since soon after birth and her urinary incontinence. Blood tests showed no abnormalities. Additional MRI showed a large and previously not known anterior meningocele at the level of the sacrum. Surgical treatment consisted of closure of the dura by posterior approach. Conclusion In this case report we describe the late discovery with an atypical presentation of an anterior meningocele in a young adult with urinary incontinence, a sacral defect, an anorectal malformation and headaches during bicycle riding. After surgical treatment of our patient the meningocele regressed. Three months after successful surgery she had no complaints and was able to ride a bike again.
Collapse
Affiliation(s)
- Hendt P Versteegh
- Department of Surgery-Pediatric Surgery, Radboud University Medical Center, Nijmegen, the Netherlands.
| | | | | | | | | |
Collapse
|
21
|
van Lindert EJ, Siepel FJ, Delye H, Ettema AM, Bergé SJ, Maal TJJ, Borstlap WA. Validation of cephalic index measurements in scaphocephaly. Childs Nerv Syst 2013; 29:1007-14. [PMID: 23468203 DOI: 10.1007/s00381-013-2059-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Accepted: 02/20/2013] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The cephalic index (CI) of the head can be measured manually using a caliper, the original technique, but it is also possible to determine it using skull X-ray, 2DCT and 3DCT images, 3D photo and with help of plagiocephalometry (PCM). PATIENTS AND METHODS In this study, the manual caliper determination is statistically compared with other measuring methods for scaphocephaly patients (n = 39). RESULTS The CI mean differences for the most representative data are sequentially 3.74, 2.16, 1.09 and 0.97 for the 2DCT, PCM, 3D photo and 3DCT techniques. The CI 2DCT values show a significant difference (p < 0.01) in reference to CI manually, while the other techniques show a p > 0.05. CONCLUSION The conclusions are that significantly different results are achieved when using 2DCT relative to the manual caliper determination. No significant difference is observed between the 3D techniques and the manual method.
Collapse
Affiliation(s)
- Erik J van Lindert
- Department of Neurosurgery, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
| | | | | | | | | | | | | |
Collapse
|
22
|
Janssens GO, Jansen MH, Lauwers SJ, Nowak PJ, Oldenburger FR, Bouffet E, Saran F, Kamphuis-van Ulzen K, van Lindert EJ, Schieving JH, Boterberg T, Kaspers GJ, Span PN, Kaanders JH, Gidding CE, Hargrave D. Hypofractionation vs conventional radiation therapy for newly diagnosed diffuse intrinsic pontine glioma: a matched-cohort analysis. Int J Radiat Oncol Biol Phys 2012; 85:315-20. [PMID: 22682807 DOI: 10.1016/j.ijrobp.2012.04.006] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2012] [Revised: 03/16/2012] [Accepted: 04/05/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE Despite conventional radiation therapy, 54 Gy in single doses of 1.8 Gy (54/1.8 Gy) over 6 weeks, most children with diffuse intrinsic pontine glioma (DIPG) will die within 1 year after diagnosis. To reduce patient burden, we investigated the role of hypofractionation radiation therapy given over 3 to 4 weeks. A 1:1 matched-cohort analysis with conventional radiation therapy was performed to assess response and survival. METHODS AND MATERIALS Twenty-seven children, aged 3 to 14, were treated according to 1 of 2 hypofractionation regimens over 3 to 4 weeks (39/3 Gy, n=16 or 44.8/2.8 Gy, n=11). All patients had symptoms for ≤3 months, ≥2 signs of the neurologic triad (cranial nerve deficit, ataxia, long tract signs), and characteristic features of DIPG on magnetic resonance imaging. Twenty-seven patients fulfilling the same diagnostic criteria and receiving at least 50/1.8 to 2.0 Gy were eligible for the matched-cohort analysis. RESULTS With hypofractionation radiation therapy, the overall survival at 6, 9, and 12 months was 74%, 44%, and 22%, respectively. Progression-free survival at 3, 6, and 9 months was 77%, 43%, and 12%, respectively. Temporary discontinuation of steroids was observed in 21 of 27 (78%) patients. No significant difference in median overall survival (9.0 vs 9.4 months; P=.84) and time to progression (5.0 vs 7.6 months; P=.24) was observed between hypofractionation vs conventional radiation therapy, respectively. CONCLUSIONS For patients with newly diagnosed DIPG, a hypofractionation regimen, given over 3 to 4 weeks, offers equal overall survival with less treatment burden compared with a conventional regimen of 6 weeks.
Collapse
Affiliation(s)
- Geert O Janssens
- Department of Radiation Oncology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
23
|
Kusters JM, Louwe RJ, van Kollenburg PG, Kunze-Busch MC, Gidding CE, van Lindert EJ, Kaanders JH, Janssens GO. Optimal Normal Tissue Sparing in Craniospinal Axis Irradiation Using IMRT With Daily Intrafractionally Modulated Junction(s). Int J Radiat Oncol Biol Phys 2011; 81:1405-14. [DOI: 10.1016/j.ijrobp.2010.07.1987] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2010] [Revised: 07/16/2010] [Accepted: 07/20/2010] [Indexed: 10/18/2022]
|
24
|
van Lindert EJ, Ingels K, Mylanus E, Grotenhuis JA. Variations of endonasal anatomy: relevance for the endoscopic endonasal transsphenoidal approach. Acta Neurochir (Wien) 2010; 152:1015-20. [PMID: 20306338 PMCID: PMC2872017 DOI: 10.1007/s00701-010-0629-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2010] [Accepted: 03/03/2010] [Indexed: 11/24/2022]
Abstract
BACKGROUND The endoscopic endonasal transsphenoidal approach (EETA) to the pituitary is performed by ear, nose, and throat (ENT) surgeons in collaboration with neurosurgeons but also by neurosurgeons alone even though neurosurgeons have not been trained in rhinological surgery. PURPOSE To register the frequency of endonasal anatomical variations and to evaluate whether these variations hinder the progress of EETA and require extra rhinological surgical skills. METHODS A prospective cohort study of 185 consecutive patients receiving an EETA through a binostril approach was performed. All anatomical endonasal variations were noted and the relevance for the progress of surgery evaluated. RESULTS In 48% of patients, anatomical variations were recognized, the majority of which were spinae septi and septum deviations. In 5% of patients, the planned binostril approach had to be converted into a mononostril approach; whereas in 18% of patients with an anatomical variation, a correction had to be performed. There was no difference between the ENT surgeon and the neurosurgeon performing the approach. Complications related to the endonasal phase of the surgery occurred in 3.8%. Fluoroscopy or electromagnetic navigation has been used during 6.5% of the surgeries. CONCLUSION Although endonasal anatomical variations are frequent, they do not pose a relevant obstacle for EETA.
Collapse
Affiliation(s)
- Erik J van Lindert
- Department of Neurosurgery, Radboud University Nijmegen Medical Center, Postbus 9101, 6500 HB Nijmegen, The Netherlands.
| | | | | | | |
Collapse
|
25
|
de Roos PB, van Lindert EJ, van der Vliet TA, Sie LTL. MRI of pneumorachis in a newborn infant with open myelomeningocele. Pediatr Neurol 2009; 40:377-9. [PMID: 19380075 DOI: 10.1016/j.pediatrneurol.2008.11.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2008] [Revised: 11/18/2008] [Accepted: 11/25/2008] [Indexed: 10/20/2022]
Abstract
Pneumorachis, or air within the spinal canal, is a very rare radiographic finding, frequently of traumatic origin. A newborn infant with an open lumbosacral myelomeningocele presented with severe paraparesis and an unexpected dysfunction of the brainstem with somnolence, irregular respiration, and motor deficits of the upper extremities. Magnetic resonance imaging revealed hypoplasia of the brainstem and cerebellum and low-signal lesions on T(2)-weighted images at the cervicocranial junction, in the lateral ventricles, and in the spinal canal. Computed tomography confirmed the presence of intracranial and intraspinal air. The air disappeared 2 weeks later according to magnetic resonance imaging, but no clinical improvement occurred, even after 6 months. Pneumorachis and pneumocephalus can occur in newborn infants as an unexpected complication of an open myelomenigocele, with or without signs. The radiographic appearance of intraspinal air on magnetic resonance imaging was not described previously.
Collapse
Affiliation(s)
- Petra B de Roos
- Department of Neurology, Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands.
| | | | | | | |
Collapse
|
26
|
Plooij JM, Verhamme Y, Bergé SJ, van Lindert EJ, Borstlap-Engels VM, Borstlap WA. Unilateral craniosynostosis of the frontosphenoidal suture: A case report and a review of literature. J Craniomaxillofac Surg 2009; 37:162-6. [DOI: 10.1016/j.jcms.2008.10.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2008] [Revised: 08/27/2008] [Accepted: 10/06/2008] [Indexed: 10/21/2022] Open
|
27
|
van Lindert EJ, Bartels RHMA, Noordam K. Spinal stenosis with paraparesis in albright hereditary osteodystrophy. Case report and review of the literature. Pediatr Neurosurg 2008; 44:337-40. [PMID: 18552518 DOI: 10.1159/000138373] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2007] [Accepted: 02/05/2008] [Indexed: 11/19/2022]
Abstract
We describe thoracic spinal stenosis with progressive myelopathy in association with Albright hereditary osteodystrophy (AHO) in a 12-year-old child with delayed diagnosis and review the relevant literature in order to identify the pathophysiological mechanism. The child was successfully treated by decompressive upper thoracic laminoplasty with full neurological recovery. The pathological changes of the skin also dissolved. Ten more cases of myelopathy and paraparesis in association with AHO, of whom two were children, could be found in the literature. Basically, two different causes for the spinal canal stenosis could be identified: abnormal ossifications of ligaments and congenital narrow spinal canal due to short vertebral pedicles. Awareness of structural spinal column changes in AHO is essential in order to appreciate the neurological symptoms of a beginning myelopathy before irreversible damage to the myelum occurs.
Collapse
Affiliation(s)
- Erik J van Lindert
- Department of Neurosurgery, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands.
| | | | | |
Collapse
|
28
|
Abstract
OBJECTIVE To describe the different imaging modalities used for the diagnosis and classification of hydrocephalus, their role in defining the optimal treatment of hydrocephalus and to define the optimal preoperative diagnostics for endoscopic third ventriculocisternostomy (ETV). METHODS An overview on available imaging modalities for hydrocephalus will be given and their pros and cons discussed. In addition, different aspects of the treatment of hydrocephalus by shunts and by ETV will be highlighted. DISCUSSION The role of the technical aspects of performing an ETV, the role of the surgeon's philosophy, the role of the urgency of the procedure, and the role of informed consent on the requirements for the imaging of the hydrocephalus will be discussed. CONCLUSION The authors conclude that MRI is a conditio sine qua non for ETV in elective surgical cases.
Collapse
Affiliation(s)
- Erik J van Lindert
- Neurosurgical Department, Radboud University Nijmegen Medical Centre, Postbus 9101, 6500 HB, Nijmegen, The Netherlands.
| | | | | |
Collapse
|
29
|
van Lindert EJ, Grotenhuis JA. New Endoscope Shaft for Endoscopic Transsphenoidal Pituitary Surgery. Oper Neurosurg (Hagerstown) 2005; 57:203-6; discussion 203-6. [PMID: 15987590 DOI: 10.1227/01.neu.0000163681.28487.2f] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2004] [Accepted: 12/17/2004] [Indexed: 11/19/2022] Open
Abstract
Abstract
OBJECTIVE:
To describe a new endoscope shaft developed for suction-aspiration during endoscopic transsphenoidal pituitary surgery.
METHODS:
A custom-made shaft for a Wolf endoscope (Richard Wolf GmbH, Knittlingen, Germany) was developed with a height of 10 mm and a width of 5 mm, allowing an additional working channel for the endoscope for flexible suction tubes with a diameter of up to 10-French.
RESULTS:
The new shaft was used in 30 consecutive endoscopic transsphenoidal procedures for pituitary adenomas. It allowed true bimanual manipulation without having to fixate the endoscope. Tumor removal was facilitated, technical problems were not encountered, and operation time was reduced. There were no instrumentation-related complications.
CONCLUSION:
The new shaft improves the ergonomics of endoscopic transsphenoidal pituitary surgery in cases in which the endoscope is handheld.
Collapse
Affiliation(s)
- Erik J van Lindert
- Department of Neurosurgery, University Medical Center Nijmegen, Nijmegen, The Netherlands.
| | | |
Collapse
|
30
|
Abstract
BACKGROUND Symptomatic brain metastases from prostatic carcinoma are rare (0.05% to 0.5%). CASE REPORT A 70-year-old man presented with a homonymous hemianopsia due to brain metastatic prostatic carcinoma shortly before becoming symptomatic of prostatic disease. CT and MRI of the brain showed a tumour deep in the right hemisphere near the thalamus and involving the optic radiation. RESULTS Routine haematological and biochemical tests were normal. The prostate specific antigen level was low on two separate occasions. The prostatic and brain tumours showed identical appearances, namely of a poorly differentiated adenocarcinoma with neuroendocrine differentiation (small cell carcinoma). CONCLUSION A literature review suggests that small cell carcinoma of the prostate is more likely to spread to the brain compared to adenocarcinoma and that brain metastases indicate a poor prognosis. The prostate gland should be remembered as a possible cause of brain metastases and that a normal serum prostate specific antigen does not exclude this diagnosis.
Collapse
Affiliation(s)
- Corrie E Erasmus
- Department of Neurosurgery, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | | | | | | |
Collapse
|