RESUMO
BACKGROUND: Neonatal intraventricular hemorrhage (IVH) may evolve into posthemorrhagic hydrocephalus and cause neurodevelopmental impairment, becoming a common complication of premature infants, occurring in up to 40% of preterm infants weighing less than 1,500 g at birth. Around 10 to 15% of preterm infants develop severe (grades III-IV) IVH. These infants are at high risk of developing posthemorrhagic hydrocephalus. Neuroendoscopic lavage (NEL) is a suitable alternative for the management of this pathology. In this study, an endoscopic surgical approach directed toward the removal of intraventricular hematoma was evaluated for its safety and efficacy. METHODS: Between August 2016 and December 2019 (29 months), 14 neonates with posthemorrhagic hydrocephalus underwent NEL for removal of intraventricular blood by a single senior neurosurgeon. Complications such as reintervention and ventriculoperitoneal (VP) shunt placement were evaluated prospectively with an 18-month follow-up on average. RESULTS: In total, 14 neonates with IVH grades III and IV were prospectively recruited. Of these, six neonates did not need a VP shunt in the follow-up after neuroendoscopy (group 1), whereas eight neonates underwent a VP shunt placement (group 2). Nonsignificant difference between the groups was found concerning days after neuroendoscopy, clot extraction, third ventriculostomy, lamina terminalis fenestration, and septum pellucidum fenestration. In group 2, there was shunt dysfunction in five cases with shunt replacement in four cases. CONCLUSION: NEL is a feasible technique to remove intraventricular blood degradation products and residual hematoma in neonates suffering from posthemorrhagic hydrocephalus. In our series, endoscopic third ventriculostomy (ETV) + NEL could be effective in avoiding hydrocephalus after hemorrhage (no control group studied). Furthermore, patients without the necessity of VP-shunt had a better GMFCS in comparison with shunted patients.
Assuntos
Hidrocefalia , Neuroendoscopia , Lactente , Recém-Nascido , Humanos , Ventriculostomia/efeitos adversos , Recém-Nascido Prematuro , Estudos Prospectivos , Seguimentos , Irrigação Terapêutica/efeitos adversos , Resultado do Tratamento , Hidrocefalia/cirurgia , Hidrocefalia/complicações , Hemorragia Cerebral/complicações , Hemorragia Cerebral/diagnóstico por imagem , Hemorragia Cerebral/cirurgia , Hematoma/cirurgia , Estudos RetrospectivosRESUMO
Toxoplasma gondii is a parasite that is estimated to infect one-third of the world's population. It is acquired by ingesting contaminated water and food specially undercooked meat, contact with domestic or wild feline feces, and during pregnancy by transplacental transmission.Immunocompetent hosts are usually asymptomatic, and infection will be self-limited, while those patients whose immune system is debilitated by HIV infection, immunosuppressive therapy, long-term steroid treatment, and fetuses infected during gestation will show evidence of systemic activity which is more severe in the central nervous system and eyes due to insufficient immune response caused by their respective blood barriers. Congenital toxoplasmosis has an estimated incidence of 8% in mothers who were seronegative at the beginning of their pregnancy. Infection in the first trimester may result in spontaneous abortion or stillbirth; however, it is estimated that the highest risk for vertical transmission is during the second and third trimesters when blood flow and placenta thickness favor parasitic transmission.Congenital toxoplasmosis can be detected with periodic surveillance in endemic areas, and with appropriate treatment, the risk of vertical transmission can be reduced, and the severity of the disease can be reversed in infected fetuses.While most infected newborns will show no evidence of the disease, those who suffer active intrauterine complications will present with cerebral calcifications in 8-12% of cases, hydrocephalus in 4-30%, and chorioretinitis in 12-15%. Also, seizure disorders, spasticity, and varying degrees of neurocognitive deficits can be found in 12%.Four distinct patterns of hydrocephalus have been described: aqueductal stenosis with lateral and third ventricle dilatation, periforaminal calcifications leading to foramen of Monro stenosis with associated asymmetrical ventricle dilatation, a mix of aqueductal and foramen of Monro stenosis, and overt hydrocephalus without clear evidence of obstruction with predominant dilatation of occipital horns (colpocephaly).While all patients diagnosed with congenital toxoplasmosis should undergo pharmacological treatment, those presenting with hydrocephalus have traditionally been managed with CSF shunting; however, there are reports of at least 50% success when selected cases are treated with endoscopic third ventriculostomy. Successful hydrocephalus management with appropriate treatment leads to better intellectual outcomes.
Assuntos
Infecções por HIV , Hidrocefalia , Neurocirurgia , Terceiro Ventrículo , Toxoplasma , Toxoplasmose Congênita , Gravidez , Criança , Feminino , Humanos , Recém-Nascido , Gatos , Animais , Toxoplasmose Congênita/diagnóstico , Toxoplasmose Congênita/parasitologia , Toxoplasmose Congênita/cirurgia , Infecções por HIV/complicações , Infecções por HIV/cirurgia , Constrição Patológica/cirurgia , Terceiro Ventrículo/cirurgia , Hidrocefalia/etiologia , Hidrocefalia/cirurgia , Ventriculostomia/efeitos adversosRESUMO
Introduction: Treatment options for hydrocephalus related to posterior fossa tumors have been extensively studied in the pediatric population, but the value of endoscopic third ventriculostomy in hydrocephalus secondary to vestibular schwannoma in adults, is controversial. A systematic search of the medical literature was carried out in Pubmed/Medline and SciElo for the identification and inclusion of articles, in addition to the preprint servers bioRxiv and medRxiv. The following descriptors were used: hydrocephalus and vestibular schwannomas or acoustic neuromas or acoustic neurinomas and endoscopic third ventriculostomy. The initial search found 195 articles. After selection, 5 articles were chosen for the study. Objective: To specify the role of the endoscopic third ventriculostomy in hydrocephalus secondary to vestibular schwannomas. Development: The articles included a total of 82 patients, in which an improvement of the symptoms was achieved in 86.6 percent of the cases. The decrease in ventricular diameter was reported in 82.9 percent of the cases and was only found explicit in 3 articles. Although the failure criteria used were varied, 2 of them predominated: the persistence of progressive symptomatic hydrocephalus and/or the need for shunt placement. Endoscopic third ventriculostomy failure only represented 14.6 percent. Conclusions: Third ventriculostomy is an acceptable technique with relative success for the treatment of symptomatic obstructive hydrocephalus secondary to vestibular schwannomas(AU)
Introducción: Las opciones de tratamiento para la hidrocefalia relacionada con tumores de fosa posterior han sido ampliamente estudiadas en la población pediátrica, pero es controvertido el valor de la tercer ventriculostomía endoscópica, en la hidrocefalia secundaria a schwanoma vestibular en adultos, previo a la resección del tumor. Se realizó una búsqueda sistemática de la literatura médica en Pubmed/Medline y SciElo para la identificación e inclusión de artículos, además de los servidores de preprint bioRxiv y medRxiv. Se utilizaron los siguientes descriptores: hydrocephalus y vestibular schwannomas o acoustic neuromas o acoustic neurinomas y endoscopic third ventriculostomy. La búsqueda inicial encontró 195 artículos. Después de la selección, se eligieron 5 artículos para el estudio. Objetivo: Especificar el papel de la tercer ventriculostomía endoscópica en la hidrocefalia secundaria a schwanomas vestibulares. Desarrollo: Los artículos incluyeron un total de 82 pacientes, en los que se logró una mejoría de los síntomas en el 86,6 por ciento de los casos. La disminución del diámetro ventricular se reportó en el 82,9 por ciento de los casos y solo se encontró explícita en 3 artículos. Aunque los criterios de fracaso utilizados fueron variados, predominaron dos de ellos: la persistencia de hidrocefalia sintomática progresiva o la necesidad de colocación de derivación. La falla de la tercer ventriculostomía endoscópica solo representó el 14,6 por ciento. Conclusiones: La tercera ventriculostomía endoscópica es una técnica aceptable y con relativo éxito para el tratamiento de la hidrocefalia obstructiva sintomática secundaria a schwanomas vestibulares(AU)
Assuntos
Humanos , Ventriculostomia/métodos , Neuroma Acústico , Hidrocefalia/tratamento farmacológicoRESUMO
OBJECTIVE: To demonstrate the feasibility and preliminary results of percutaneous fetal endoscopic third ventriculostomy (ETV) in human fetuses (pfETV) with isolated progressive and/or severe bilateral cerebral ventriculomegaly (IPSBV). METHODS: The initial results of pfETV for IPSBV were described. Perioperative, perinatal and postnatal variables were described. The Ages and Stages Questionnaire (ASQ-3), 3rd edition (ASQ-3) was used for follow-up of all infants. RESULTS: Successful pfETV was performed in 10/11 (91%) fetuses, at a median gestational age (GA) of 28.7 weeks (25.3-30.7). There were no perioperative complications. After pfETV, 70% (7/10) of the fetuses had a decreased or stabilized lateral ventricle atria|lateral ventricle's atria. The median GA at delivery was 38.2 weeks (35.9-39.3). There were no perinatal complications. The postnatal ventriculoperitoneal shunt rate was 80% (8/10). Among neonates/infants who had prenatal stabilization or a decrease in the LVAs, 4 (4/7: 57.1%) had abnormal scores on the ASQ-3. Among neonates/infants that experienced prenatal increases in the LVAs, all of them (3/3: 100%) had abnormal scores on the ASQ-3. CONCLUSION: Percutaneous ETV is feasible in human fetuses with progressive and/or severe cerebral ventriculomegaly and seems to be a safe procedure for both the mother and the fetus.
Assuntos
Hidrocefalia , Terceiro Ventrículo , Lactente , Recém-Nascido , Gravidez , Feminino , Humanos , Ventriculostomia/efeitos adversos , Ventriculostomia/métodos , Terceiro Ventrículo/diagnóstico por imagem , Terceiro Ventrículo/cirurgia , Estudos Retrospectivos , Hidrocefalia/diagnóstico por imagem , Hidrocefalia/cirurgia , Hidrocefalia/complicações , Feto/cirurgia , Resultado do TratamentoRESUMO
OBJECTIVE: To determine if differences exist in postoperative communication patterns or healthcare use among English-speaking patients (ESPs) and Spanish-speaking patients (SSPs) with childhood hydrocephalus. STUDY DESIGN: A single-institution, retrospective cohort study was conducted. Through simple random sampling, 50 ESPs and 50 SSPs (<18 years old) who underwent a ventriculoperitoneal shunt or endoscopic third ventriculostomy were identified. Demographics, communication with clinic (eg, number of calls or messages postoperatively), and healthcare use were collected. Multiple linear regressions assessed the significance of predictors on communication frequency and use. RESULTS: SSPs were more likely to have a comorbidity and ventriculoperitoneal shunt than ESPs. SSPs had longer median postoperative length of stay (P < .01) and 30-day readmission rate (P < .01) than ESPs. Only 18% of SSPs communicated with clinic; 11 total calls or messages were from SSPs vs 57 from ESPs (P < .01). The most common reason for outreach among both cohorts was a new symptom. ESP outreach most frequently resulted in reassurance or medical course changes on an outpatient basis (30% ESPs vs 0% SSPs; P = .04), whereas SSP outreach most frequently resulted in guidance to present to the emergency department (3% ESPs vs 36% SSPs; P < .01). Language remained a significant predictor for number of calls or messages, even after adjusting for comorbidity, operation type, and insurance (P < .01). CONCLUSIONS: Despite having more complex disease, only 18% of SSPs communicated with the neurosurgical team postoperatively and were more frequently sent to the emergency department for management. Future research will explore communication barriers and preferences to ensure postoperative care is timely and patient centered.
Assuntos
Comunicação , Hidrocefalia , Criança , Humanos , Adolescente , Estudos Retrospectivos , Hidrocefalia/cirurgia , Hidrocefalia/etiologia , Idioma , Ventriculostomia/métodos , Derivação Ventriculoperitoneal/métodos , Complicações Pós-Operatórias/etiologiaRESUMO
Choroid plexus papillomas (CPPs) are rare benign neoplasms which are particularly uncommon in the posterior fossa in children. We herein present a case series of five patients treated at a tertiary care hospital. A comprehensive literature review was also carried out. The patients treated at the tertiary care hospital were aged between 4 and 16 years. Gross total resection (GTR) was initially achieved in two patients. All patients showed clinical improvement. Moreover, 27 articles published between 1975 and 2021 were selected for the literature review, totaling 46 patients; with the 5 patients previously described, the total sample was composed of 51 cases, With a mean age was 8.2 years. The lesions were located either in the fourth ventricle (65.3%) or the cerebellopontine angle (34.7%). Hydrocephalus was present preoperatively in 66.7% of the patients, and a permanent shunt was required in 31.6% of the cases. The GTR procedure was feasible in 64.5%, and 93.8% showed clinical improvement. For CPPs, GTR is the gold standard treatment and should be attempted whenever feasible, especially because the role of the adjuvant treatment remains controversial. Neuromonitoring is a valuable tool to achieve maximal safe resection. Hydrocephalus is common and must be recognized and promptly treated. Most patients will need a permanent shunt. Though there is still controversy on its efficacy, endoscopic third ventriculostomy is a safe procedure, and was the authors' first choice to treat hydrocephalus.
Os papilomas do plexo coroide (PPCs) são neoplasias benignas raras e, na população pediátrica, são particularmente incomuns na fossa posterior. Apresentamos uma série de casos de cinco pacientes atendidos em um hospital terciário. Além disso, foi realizada uma ampla revisão da literatura. Os pacientes atendidos no hospital terciário tinham entre 4 e 16 anos. Ressecção macroscópica total (RMT) foi inicialmente realizada em dois pacientes. Todos os pacientes apresentaram melhora clínica. Além disso, 27 artigos publicados entre 1975 e 2021 foram selecionados para a revisão da literatura, totalizando 46 pacientes. Somados à série de casos atuais, encontramos 51 pacientes, com média de idade de 8,2 anos. As lesões localizavam-se no quarto ventrículo (65,3%) ou no ângulo pontocerebelar (34,7%). Hidrocefalia estava presente no pré-operatório em 66,7% dos pacientes, e derivação ventricular permanente foi necessária em 31,6% dos casos. A RMT foi possível em 64,5%, e 93,8% tiveram melhora clínica. Para os CPPs, a RMT é o tratamento padrão-ouro e deve ser tentado sempre que possível, especialmente porque ainda existem controvérsias quanto ao papel do tratamento adjuvante. A neuromonitorização é uma ferramenta importante para se atingir a máxima ressecção segura. A hidrocefalia é comumente vista nesses pacientes e deve ser identificada e tratada. A maioria dos pacientes irá precisar de uma derivação permanente. Apesar de persistirem controvérsias sobre sua eficácia, a terceiro-ventriculostomia endoscópica foi a primeira escolha para tratar a hidrocefalia na experiência dos autores e é uma opção segura.
Assuntos
Neoplasias Encefálicas , Hidrocefalia , Papiloma , Terceiro Ventrículo , Criança , Humanos , Pré-Escolar , Adolescente , Hidrocefalia/etiologia , Hidrocefalia/cirurgia , Papiloma/cirurgia , Papiloma/complicações , Ventriculostomia/efeitos adversos , Ventriculostomia/métodos , Neoplasias Encefálicas/complicações , Terceiro Ventrículo/cirurgia , Resultado do TratamentoRESUMO
BACKGROUND: Ventricular puncture is a common procedure in neurosurgery and the first that resident must learn. Ongoing education is critical to improving patient outcomes. However, training at the expense of potential risk to patients warrants new and safer training methods for residents. METHODS: An augmented reality (AR) simulator for the practice of ventricular punctures was designed. It consists of a navigation system with a virtual 3D projection of the anatomy over a 3D-printed patient model. Forty-eight participants from neurosurgery staff performed two free-hand ventricular punctures before and after a training session. RESULTS: Participants achieved enhanced accuracy in reaching the target at the Monro foramen after practicing with the system. Additional metrics revealed significantly better trajectories after the training. CONCLUSION: The study confirms the feasibility of AR as a training tool. This motivates future work towards standardising new educative methodologies in neurosurgery.
Assuntos
Realidade Aumentada , Neurocirurgia , Treinamento por Simulação , Humanos , Ventriculostomia/educação , Simulação por Computador , Procedimentos Neurocirúrgicos , Treinamento por Simulação/métodosRESUMO
BACKGROUND: The main treatments for hydrocephalus due to posterior fossa tumors are tumor resection with or without an external ventricular drain, ventriculoperitoneal shunt (VPS), and endoscopic third ventriculostomy. Although preoperative cerebrospinal fluid diversion by any of these techniques improves clinical outcomes, evidence comparing the efficacy of these techniques is scarce. Therefore, we aimed to retrospectively evaluate each treatment modality. METHODS: This single-center study analyzed 55 patients. Treatments were classified as successful (hydrocephalus resolution with a single surgical event) or failed and compared with a χ2 test. Kaplan-Meier curves and log-rank tests were employed. A Cox proportional hazard model was used to determine relevant covariates predicting outcomes. RESULTS: Mean patient age was 36.3 years, 43.4% of patients were men, and 50.9% of patients presented with uncompensated intracranial hypertension. Mean tumor volume was 33.4 cm3, and extent of resection was 90.85%. Tumor resection with or without an external ventricular drain was successful in 58.82% of cases, VPS was successful in 100%, and endoscopic third ventriculostomy was successful in 76.19% (P = 0.014). Mean follow-up time was 15.12 months. Log-rank test found statistically significant differences between survival curves of treatments (P = 0.016) favoring the VPS group. Postoperative surgical site hematoma was a significant covariate in the Cox model (hazard ratio = 17; 95% confidence ratio, 2.301-81.872; P = 0.004). CONCLUSIONS: This study favored VPS as the most reliable treatment of hydrocephalus due to posterior fossa tumors in adult patient; however, several factors influence clinical outcomes. We proposed an algorithm based on our findings and other authors' findings to facilitate the decision-making process.
Assuntos
Neoplasias Encefálicas , Hidrocefalia , Neoplasias Infratentoriais , Terceiro Ventrículo , Masculino , Humanos , Adulto , Feminino , Estudos Retrospectivos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/cirurgia , Neoplasias Encefálicas/cirurgia , Neoplasias Infratentoriais/complicações , Neoplasias Infratentoriais/diagnóstico por imagem , Neoplasias Infratentoriais/cirurgia , Hidrocefalia/etiologia , Hidrocefalia/cirurgia , Ventriculostomia/métodos , Derivação Ventriculoperitoneal/métodos , Terceiro Ventrículo/diagnóstico por imagem , Terceiro Ventrículo/cirurgia , Resultado do TratamentoRESUMO
La punción ventricular transorbitaria (PTO) es una técnica rápida y sencilla aunque poco utilizada en la actualidad. Como puede realizarse en la cama del paciente, resulta ideal en aquellos con hidrocefalia aguda rápidamente evolutiva o con enclavamiento transtentorial inminente o reciente, en quienes el acceso expeditivo a las cavidades ventriculares puede salvarles la vida. Revisamos aquí el desarrollo histórico de la técnica desde su descripción original en 1933. Por último, presentamos el caso de una paciente con hidrocefalia aguda secundaria a edema cerebeloso, en quien el empleo de la PTO dio tiempo para implementar el tratamiento definitivo. La técnica utilizada por nosotros consistió en un ingreso transpalpebral, por detrás del reborde orbitario superior y a nivel mediopupilar, con una trayectoria dirigida hacia la sutura sagital, dos a tres traveses de dedo por detrás de la sutura coronal(AU)
Transorbital ventricular puncture (TOP) is a fast and simple but poorly understood technique. As it can be performed at the patient's bedside, it is ideal in patients with rapidly evolving acute hydrocephalus or with imminent or recent transtentorial herniation, in whom expeditious access to the ventricular cavities can be life-saving. We review the historical development of the technique since its original description in 1933. Finally we present the case of a patient with acute hydrocephalus secondary to cerebellar edema, in whom the use of TOP allowed time to implement definitive treatments. The technique used by us consisted of an entry point through the upper eyelid, behind the superior orbital rim, and at the midpupillary line, with a trajectory aimed towards the sagittal suture two to three finger widths behind the coronal suture(AU)
Assuntos
Ventriculostomia , Cirurgia Geral , Punções , Encefalocele , HidrocefaliaRESUMO
PURPOSE: Neurocysticercosis (NCC) is considered a neglected infectious disease, but the most common parasitic disease of the central nervous system (CNS). Due to oral tendencies in childhood, it is hypothesized that individuals are infected around this age and develop symptoms as lately as during young adulthood. Although it is considered a benign disease, it may cause great impact in the patient's quality of life due to epilepsy, visual symptoms, and hydrocephalus, which eventually requires frequent hospitalizations. The treatment of hydrocephalus is the main challenge for neurosurgeons. METHODS: We performed a concise review on neurocysticercosis in children and the main presentations of NCC in the neurosurgery practice and a systematic review on hydrocephalus secondary to extraparenchymal NCC. RESULTS: Our review showed a rate of complete resolution of hydrocephalus secondary to NCC of around 80% with the first attempt of surgical treatment combined with medication therapy. Endoscopic removal of the intraventricular cysts with third ventriculostomy was the most common treatment modality. Patients previously managed with ventricular shunts are likely to have worse outcomes and complications. CONCLUSION: Endoscopic approach is the gold standard surgical treatment for hydrocephalus secondary to neurocysticercosis.