Complications and failures of endoscopic third ventriculostomy: perception of their avoidance

Endoscopic third ventriculostomy [ETV] has been shown to be a sufficient alternative in the surgical treatment of occlusive hydrocephalus. The purpose of this study is to evaluate complications and failures of ETV and to define the factors that can minimize their occurrence or effects. A retrospective analysis was conducted for 40 patients [16 female and 24 male patients] in whom ETV was performed. Their age ranged from 6 months to 65 years [mean age, 9 years]. Hydrocephalus was caused by aqueductal stenosis in 23 patients [10 with previous shunts], and posterior fossa lesions in 17 patients. Endoscopic third ventriculostomy was performed in all patients using a freehand method. Forty-three ETVs were attempted in 40 cases and were completed in 42. There were no fatal outcomes related to ETV. The overall success rate was 72.5%. Complications were observed in 15 cases. Complicateions were CSF leak, fever, meningitis, transient diabetes insipidus, pseudomeningocele, pneumocephalus, haemorrhage and failures. Many complications can be avoided by determining the correct diagnosis and using suitable technique. Most complications can be managed conservatively and do not produce long-term morbidity. The complication rate decreases markedly with surgical experience, indicating a steep learning curve

Laser acupuncture in treatment of idiopathic carpal tunnel syndrome

Objectives: To evaluate the effect of low level laser therapy applied to acupuncture points [laser acupuncture] in the treatment of idiopathic carpal tunnel syndrome

Patients and methods: This study was carried out on 40 hands of patients with minimal, mild and moderate idiopathic CTS. All patients received sessions of laser therapy for 1.5 months, 3 times a week. The red beam laser was applied to shallow acupuncture points on the affected fingers and hand and to deep acupuncture points located on the elbow, shoulder, upper back and cervical paraspinal areas on the affected side. Clinical and electrophysiological evaluations were done before, after 1.5 months of treatment and 2 months later as follow up. Forty healthy volunteers [80 hands] matched in age and sex were considered as a control group for the electrophysiological studies

Results: The results of this study revealed significant improvement of all clinical parameters including pain, parasthesias, awakening at night and both Tinel's and Phalen's signs. There was also significant improvement of distal motor latency and sensory conduction velocity of median nerve. These improvements were maintained through the follow up period

Conclusion: Laser acupuncture is a new conservative modality recommended for the treatment of mild and moderate cases of idiopathic CTS