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Otero-Rodriguez A, Arandia-Guzman DA, Pascual-Argente D, Ruiz-Martin L, de Oca JCRM, Garcia-Martin A, Torres-Carretero L, Uriel-Lavin R, Garrido-Ruiz PA, Rodriguez-Cedeño D, Cid-Mendes L. Slope until reaching the plateau: a new predictor of valve response obtained by lumbar infusion test for idiopathic normal pressure hydrocephalus. Acta Neurochir (Wien) 2023; 165:2533-2539. [PMID: 37347295 DOI: 10.1007/s00701-023-05670-y] [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] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 06/07/2023] [Indexed: 06/23/2023]
Abstract
BACKGROUND Diagnosis of idiopathic normal pressure hydrocephalus (iNPH) is based on clinical, radiological, and hydrodynamic data of cerebrospinal fluid (CSF) obtained by invasive methods such as lumbar infusion test, which is used to determine the resistance to CSF outflow (Rout). However, Rout has limitations, and its value as predictor of valve response is questioned. Other variables can be obtained by lumbar infusion test, such as the time to reach the plateau (TRP) and the slope until reaching the plateau (SRP). The objectives were to determine if SRP could be a predictor of response to ventriculoperitoneal shunt (VPS) and what variable (Rout versus SRP) would have greater predictive value. METHOD Patients with probable iNPH who underwent a lumbar infusion test and were indicated for a VPS were retrospectively studied. Two groups were established, responders and non-responders. Rout, TRP (period between the start of infusion until reaching the plateau measured in seconds) and SRP ((plateau pressure-opening pressure)/TRP) were obtained. For Rout and SRP, the receiver operating curves (ROC) with its areas under the curve (AUC) were calculated. RESULTS One hundred ten patients were included, being 86 responders (78.20%). Shunt responders had a significantly greater Rout (17.02 (14.45-20.23) versus 13.34 (12.10-16.28) mmHg/ml/min, p = 0.002) and SRP (0.049 (0.043-0.054) versus 0.031 (0.026-0.036) mmHg/sec, p < 0.001) and smaller TRP (641.28 (584.83-697.73) versus 777.65 (654.03-901.27) sec, p = 0.028) than non-responders. The AUC for SRP was greater than the AUC for Rout (0.763 (95 % CI 0.655-0.871, p < 0.001) versus 0.673 (95 % CI 0.595-0.801, p = 0.008), respectively), but the differences were not significant (p = 0.180). CONCLUSIONS SRP could be considered predictor of response to VPS, and its accuracy tends to be better than Rout. So, this variable may be a useful tool to select shunt candidates among patients with probable iNPH.
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Affiliation(s)
- Alvaro Otero-Rodriguez
- Department of Neurosurgery, Hospital Universitario de Salamanca, Paseo de la Transición Española, s/n, 37007, Salamanca, Spain.
| | - Daniel Angel Arandia-Guzman
- Department of Neurosurgery, Hospital Universitario de Salamanca, Paseo de la Transición Española, s/n, 37007, Salamanca, Spain
| | - Daniel Pascual-Argente
- Department of Neurosurgery, Hospital Universitario de Salamanca, Paseo de la Transición Española, s/n, 37007, Salamanca, Spain
| | - Laura Ruiz-Martin
- Department of Neurosurgery, Hospital Universitario de Salamanca, Paseo de la Transición Española, s/n, 37007, Salamanca, Spain
| | - Juan-Carlos Roa-Montes de Oca
- Department of Neurosurgery, Hospital Universitario de Salamanca, Paseo de la Transición Española, s/n, 37007, Salamanca, Spain
| | - Andoni Garcia-Martin
- Department of Neurosurgery, Hospital Universitario de Salamanca, Paseo de la Transición Española, s/n, 37007, Salamanca, Spain
| | - Luis Torres-Carretero
- Department of Neurosurgery, Hospital Universitario de Salamanca, Paseo de la Transición Española, s/n, 37007, Salamanca, Spain
| | - Rocio Uriel-Lavin
- Department of Neurosurgery, Hospital Universitario de Salamanca, Paseo de la Transición Española, s/n, 37007, Salamanca, Spain
| | - Patricia-Alejandra Garrido-Ruiz
- Department of Neurosurgery, Hospital Universitario de Salamanca, Paseo de la Transición Española, s/n, 37007, Salamanca, Spain
| | - Disney Rodriguez-Cedeño
- Department of Neurosurgery, Hospital Universitario de Salamanca, Paseo de la Transición Española, s/n, 37007, Salamanca, Spain
| | - Laura Cid-Mendes
- Department of Neurosurgery, Hospital Universitario de Salamanca, Paseo de la Transición Española, s/n, 37007, Salamanca, Spain
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Torres-Carretero L, Otero-Rodríguez Á, Alejos-Herrera MV, Vázquez-Casares G, García-Martín A, Garrido-Ruiz PA. [Utility of the intraoperative neurophysiological monitoring as a prognostic value of postoperative facial paresis in vestibular schwannomas]. Neurocirugia (Astur : Engl Ed) 2023; 34:238-246. [PMID: 36931931 DOI: 10.1016/j.neucie.2022.09.004] [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] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 09/07/2022] [Indexed: 03/17/2023]
Abstract
BACKGROUND AND OBJECTIVE Intraoperative neurophysiological monitoring allows us to predict the functional status of the facial nerve after vestibular schwannoma surgery. Due to the great variability of the neurophysiological protocols used for it, the goal of this study is to determine the prognostic ability of our neurophysiological protocol. MATERIAL AND METHODS We have performed a statistical analysis of the neurophysiological monitoring data collected from patients operated between March 2009 and July 2021 at the Neurosurgery Service of Salamanca according to their functional status, both in the immediate post-surgical period and one year after surgery. RESULTS A number of 51 patients between 46 and 63 years old (median: 54) were analyzed. We have found significant differences studying the threshold value of the stimulation intensity of the facial nerve and the variation of the Cortico-bulbar Evoked Motor Potentials (P=0.043 and P=0.011, respectively) between the patients with good and bad clinical situation after surgery. The most discriminating intensity threshold value was 0.35mA (Sensitivity: 85%; Specificity: 48%). No statistical relationship was found in the study group one year after surgery. CONCLUSIONS Our intraoperative monitoring protocol allows us to predict the clinical situation of patients in the immediate postoperative period and improve information for the patient and her relatives after surgery. We cannot, however, use these parameters to predict the functional situation one year after surgery and make clinical decisions in this regard.
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Affiliation(s)
| | | | | | | | - Andoni García-Martín
- Servicio de Neurocirugía, Hospital Universitario de Salamanca, Salamanca, España
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Torres-Carretero L, Otero-Rodríguez Á, Alejos-Herrera MV, Vázquez-Casares G, García-Martín A, Garrido-Ruiz PA. Utilidad de la monitorización neurofisiológica intraoperatoria como valor pronóstico de la parálisis facial posquirúrgica en schwannomas vestibulares. Neurocirugia (Astur) 2022. [DOI: 10.1016/j.neucir.2022.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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García-Martín A, Otero-Rodríguez A, Miranda-Zambrano D, Arandia-Guzmán DA, Torres-Carretero L, Sousa-Casasnovas P, Pascual-Argente D. Abdominal pseudocysts, an unusual complication of ventriculoperitoneal shunt systems: Literature systematic review. Neurocirugia (Astur) 2020; 32:69-77. [PMID: 32430242 DOI: 10.1016/j.neucir.2020.03.005] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 11/07/2019] [Accepted: 03/18/2020] [Indexed: 10/24/2022]
Abstract
Since the first report in 1954, abdominal pseudocysts have been recognized as a particularly uncommon complication of ventriculoperitoneal shunts of CSF, so their etiology, diagnosis, and therapeutic management remain very controversial. Our objective is to offer a critical and updated systematic review of those controversial points, using a thorough search and review of the most relevant literature available. The clinical presentation of pseudocysts is normally through non-specific abdominal symptoms. The most validated etiology consists on the existence of a concomitant infection of the CSF shunt system, and so, treatment needs of antibiotherapy and total or partial substitution of the system. However, the pseudocyst itself doesn't need an active treatment, except for some specific cases. This management, algorithmically presented in the present work, achieves a lower recurrence rate than other options, but this one is still important, and is also associated with other complications of those shunts related with several other factors which need to be taken in account.
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Affiliation(s)
- Andoni García-Martín
- Servicio de Neurocirugía, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain.
| | - Alvaro Otero-Rodríguez
- Servicio de Neurocirugía, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - David Miranda-Zambrano
- Servicio de Neurocirugía, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | | | - Luis Torres-Carretero
- Servicio de Neurocirugía, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - Pablo Sousa-Casasnovas
- Servicio de Neurocirugía, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - Daniel Pascual-Argente
- Servicio de Neurocirugía, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
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