ABSTRACT
Displacement of distal ventriculo-atrial (VA) shunt is not uncommon. However, misplacement of the distal catheter of VA shunt in the internal jugular vein is a possibility, especially when conducted without intraoperative monitoring. We describe a patient in whom a VA shunt was performed due to failure of ventriculo-peritoneal shunt and the distal catheter of the shunt was found to be misplaced in the left internal jugular vein. Endovascular intervention via femoral vein was used to retrieve the distal catheter.
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Humans , Catheters , Displacement, Psychological , Femoral Vein , Hydrocephalus , Jugular Veins , Monitoring, Intraoperative , Ventriculoperitoneal ShuntABSTRACT
<p><b>BACKGROUND</b>To ascertain the effect of chemotherapy combined with radiosurgery therapy on the brain metastasis of lung cancer.</p><p><b>METHODS</b>Twenty-four non-small cell lung cancer patients with brain metastasis who received radiosurgery and chemotherapy were prospectively observed. Main parameters of treatment program included:(1)brain tumor size range from 1.9 to 26.2m³; (2)median iso-center numbers being 3 (1-7); (3)margin dose being 13.6-22.0 Gy. Chemotherapy regimen consisted of Teniposide (VM26), CCNU and carboplatin (CBP), with VM-26 100mg IV d1-3, CCNU 80mg po d1 and CBP 300mg/m² IV d1, repeated every 4 weeks for 2-4 cycles (CCNU used only in cycle 1 and 3).</p><p><b>RESULTS</b>(1)Major neurological improvement rate was 87.0%; (2)Objective response rate of brain lesions was 58.3%; (3)Relapse rate of new lesions of the brain metastasis during 3-6 months after radiosurgical treatment was 70.8%; (4)Median survival duration was 10 months (range from 3 to 34 months); (5)l-year survival rate was 37.5%.</p><p><b>CONCLUSIONS</b>(1)Chemotherapy combined with radiosurgery in the treatment of brain metastasis of non-small cell lung cancer might be an effective regimen with modest side effect; (2)Relapsing and new lesions in the brain can not be controlled with this treatment.</p>
ABSTRACT
Objective To assess the value of 18 F-FDG PET imaging in the localization of epileptic foci.Methods 18 F-FDG PET were performed in 22 patients with medically intractable epilepsy (15 males,7 females,mean years:19.0 years,mean duration:8.2 years). The open skull operations were undergone in 21 patients according to the results of 18 F-FDG PET, combining with scalp EEG and CT or/and MRI. 1 patient was refered for stereotactic operation. During operation,EcoG was detected for identifying the site of epileptogenic focus and lobectomy was performed . All specimens were examninated with the pathological tests. All patients were followed up for the curative effects. Results PET showed abnormalities in 21 patients(95.5%). Among them,single or multiple focal hypometabolisms were found in 20 patients and focal hypermetabolism in 1 patient. The scalp EEGs showed abnormalities in 17 patients(77.3%),but 8 of them did not showed clear latreralizing manifestations.The abnormalities were found on MR or/and CT in only 5 cases (22.7%).The epileptogenic foci detected by PET were consistent well with EcoG in 18cases(85.7%), consistent approximately in 2 cases and not consistent in 1 cases .Among 19 patients with abnormal PET findings , the pathological abnormalities were found in 18 cases (94.7%).No pathological abnormality was found in the patients with nomal PET imaing. After the open skull operations, 9 patients (42.9%) becomed seizure free . 9 patients (42.9%) had more than 50% seizure reduction and 3 patients (14.3%)showed no improvement. The patient treated with stereotactic operation also showed no significant improvement.Conclusion 18 F-FDG PET imaging is a sensitive and accurate modality to localizate the epileptic foci and has important clinical value in surgical therapy.
ABSTRACT
Objective To treat the patients suffering from intractable epilepsy after brain injury with low-dosage linac accelerator stereotactic radiosurgery through positron emission tomography (PET) localization. Methods PET examination based on 18 F-2-fluorine-2-deglucose (FDG) was carried out in 32 patients in order to localize epileptogenic foci followed by radiosurgery with peripheral radiation dose of 9-13 Gy. The follow-up was conducted over one year. The seizure frequency of epilepsy was recorded to evaluate the therapeutic effect. Results The PET imaging showed that the cortical area around the cerebromalacia caused by primary injury presented low metabolic change. The metabolic changes in different injury areas mainly concentrated in the epileptic foci. In some cases,the low metabolic areas not only was localized at the part of impact lesion but also at the part of contrecoup lesion. The seizure frequency gradually decreased after radiosurgical treatment in most patients,with obvious statistical significance compared with pretreatment. According to Wieser's classification of operative effect,the cases at the grades Ⅰ-Ⅱ accounted for 44% (14/32),grades Ⅲ-Ⅳ for 41% (13/32) and grades Ⅴ-Ⅵ for 16%(5/32). No fresh complications were found in all the cases. Conclusions Low-dosage stereotactic radiosurgery with the PET localization is a safe,effective and minimally invasive surgical approach to intractable posttraumatic epilepsy.