RESUMO
Introduction Weaning from external ventricular drainage (EVD) of cerebrospinal fluid (CSF) in hydrocephalus induced by aneurismal subarachnoid hemorrhage (SAH) had been proposed either through the rapid, gradual or intermittent approaches. There are no uniform guidelines for it. Given this, we planned to study the comparative outcome between EVD drainage with intermittent clamping versus EDV followed by Ommaya reservoir. Material and Methods The present retrograde observational study was conducted from July 2018 to March 2021 in the department of neurosurgery with 67 patients who developed hydrocephalus following SAH after aneurysm rupture. We divided the patients into two groups. Group 1 had only EVD placed for CSF drainage with intermittent clamping before the placement of the ventriculoperitoneal (VP) shunt, and, in group 2, an Ommaya reservoir was placed after EVD before the shunt. Result There were 38 patients in group 1 and 29 in group 2. They were age-matched, with a mild male predominance in group 1. Shunt dependency was significantly reduced in group 2 patients (p » 0.011), along with reduced length of stay in ICU (p » 0,001) and length of stay in Hospital (p » 0.019). We found improved Glasgow outcome score in group 2 patients (p » 0.006) together with reduced incidence of infarct (p » 0.0095). Conclusion We may infer from the present study that continuous drainage through EVD, initially, in hydrocephalus induced by SAH following aneurysm rupture, increases cerebral perfusion pressure (CPP) and decreases intracranial pressure (ICP) leading to decreased infarct rate and intermittent drainage through Ommaya following EVD reservoir, decreases shunt dependency, reduces ICU and hospital stay, with improved Glasgow outcome score on follow-up, but these findings need to be validated in a prospective randomized control trial.
Introdução O desmame da drenagem ventricular externa (DVE) do líquido cefalorraquidiano (LCR) na hidrocefalia induzida por hemorragia subaracnóidea aneurismática (HSA) foi proposto pelas abordagens rápida, gradual ou intermitente. Não há diretrizes uniformes para isso. Diante disso, planejamos estudar o resultado comparativo entre drenagem DVE com pinçamento intermitente versus DVE seguido de reservatório de Ommaya. Materiais e métodos O presente estudo observacional retrógrado foi realizado de julho de 2018 a março de 2021 no departamento de neurocirurgia com 67 pacientes que desenvolveram hidrocefalia após HSA consequente de ruptura de aneurisma. Dividimos os pacientes em dois grupos. O grupo 1 teve apenas DVE colocado para drenagem do líquor com pinçamento intermitente antes da colocação da derivação ventrículo-peritoneal (VP) e, no grupo 2, um reservatório de Ommaya foi colocado após a DVE antes da derivação. Resultado Havia 38 pacientes no grupo 1 e 29 no grupo 2. Eles eram pareados por idade, com leve predominância do sexo masculino no grupo 1. A dependência de shunt foi significativamente reduzida nos pacientes do grupo 2 (p » 0,011), juntamente com menor tempo de internação na UTI (p » 0,001) e tempo de permanência no Hospital (p » 0,019). Encontramos melhora no escore de Glasgow nos pacientes do grupo 2 (p » 0,006) juntamente com redução da incidência de infarto (p » 0,0095). Conclusão Podemos inferir do presente estudo que a drenagem contínua por DVE, inicialmente, na hidrocefalia induzida por HSA após ruptura de aneurisma, aumenta a pressão de perfusão cerebral (PPC) e diminui a pressão intracraniana (PIC) levando à diminuição da taxa de infarto e drenagem intermitente por Ommaya após DVE reservatório, diminui a dependência do shunt, reduz a permanência na UTI e no hospital, com melhora do escore de Glasgow no acompanhamento, mas esses achados precisam ser validados em um estudo prospectivo randomizado de controle.
RESUMO
Tuberculosis is an infectious disease that involves any organ. However, the primary pituitary tuberculosis is an extremely rare disease. Intracranial tuberculomas account for 0.15-5% of intracranial space-occupying lesions, of which, pituitary as the primary site is unusual, and easily misdiagnosed as pituitary adenoma. In this setting, the late diagnosis can result in permanent endocrine dysfunction. We report the case of a 50-year-old woman who presented to the neurosurgery outpatient department with complaints of progressively increasing headache and diminished vision over the last year. On the clinical examination, the patient was conscious and oriented. The routine hematological and biochemical workup showed an increased erythrocyte sedimentation rate (ESR) and increased prolactin levels. The radiological working diagnosis was consistent with pituitary macroadenoma. No other radiological and/or clinical clue that could elicit the suspicion of pulmonary or extrapulmonary lesions of tuberculosis was found. The transsphenoidal endonasal tumor excision was done. The histopathology showed numerous epithelioid cell granulomas, Langhans giant cells along with scant necrosis. Ziehl Neelsen staining demonstrated acid-fast bacilli, and the final diagnosis of pituitary tuberculoma was made. We report this rare case of pituitary lesion that may be included in the differential diagnosis of sellar lesions to avoid unnecessary surgical interventions, especially in regions where the disease is endemic.
RESUMO
Tuberculosis is an infectious disease that involves any organ. However, the primary pituitary tuberculosis is an extremely rare disease. Intracranial tuberculomas account for 0.15-5% of intracranial space-occupying lesions, of which, pituitary as the primary site is unusual, and easily misdiagnosed as pituitary adenoma. In this setting, the late diagnosis can result in permanent endocrine dysfunction. We report the case of a 50-year-old woman who presented to the neurosurgery outpatient department with complaints of progressively increasing headache and diminished vision over the last year. On the clinical examination, the patient was conscious and oriented. The routine hematological and biochemical workup showed an increased erythrocyte sedimentation rate (ESR) and increased prolactin levels. The radiological working diagnosis was consistent with pituitary macroadenoma. No other radiological and/or clinical clue that could elicit the suspicion of pulmonary or extrapulmonary lesions of tuberculosis was found. The transsphenoidal endonasal tumor excision was done. The histopathology showed numerous epithelioid cell granulomas, Langhans giant cells along with scant necrosis. Ziehl Neelsen staining demonstrated acid-fast bacilli, and the final diagnosis of pituitary tuberculoma was made. We report this rare case of pituitary lesion that may be included in the differential diagnosis of sellar lesions to avoid unnecessary surgical interventions, especially in regions where the disease is endemic.