Diagnosis and treatment of negative pressure hydrocephalus: analysis of 5 cases and literature review / 中国综合临床

Objective:To investigate the clinical manifestations, pathogenesis,diagnosis and treatment of negative pressure hydrocephalus (NPH).Methods:A retrospective analysis was performed on the 5 patients with NPH admitted to the Department of Neurosurgery, Tianjin Huanhu Hospital from January 2019 to December 2021. All of the patients underwent lumbar puncture and ventricular puncture to test the pressure. Three patients underwent endoscopic third ventriculostomy (ETV), the outcome of the patients was observed.Results:The pressure of subarachnoid was not equal to intraventricular, and the pressure of intraventricular was negative. Cisternography showed cerebrospinal fluid circulation obstruction in all 5 cases. The symptoms of 1 patient were improved after external negative pressure drainage, 3 patients were improved after further ETV and 1 patient had pulmonary infection without further surgical treatment.Conclusion:With the obstruction of cerebrospinal fluid circulation, the pressure of lateral ventricle and subarachnoid is different, when the pressure of brain or subarachnoid drop, the ventricular expansion under the effect of pressure gradient, intraventricular pressure drop even for the negative pressure. CT cisternography provides strong evidence for the diagnosis of this disease. External ventricular drainage with negative pressure and ETV are effective treatment methods.

O papel da membrana de Liliequist na terceiro ventriculostomia endoscópica / The role of the Liliequist membrane in endoscopic third ventriculostomy

A Terceiro Ventriculostomia Endoscópica (TVE) é operação intracerebral que trata a hidrocefalia. Para sua realização é necessário conhecimento da anatomia cirúrgica da membrana aracnoidea de Liliequist, que deve ser aberta durante o procedimento. Porém, a anatomia do ponto de vista neuroendoscópico é pouco conhecida, já que os ângulos de abordagem são diferentes da anatomia descritiva clássica e mesmo da anatomia cirúrgica microscópica. Há discrepância na literatura quanto a eficácia da TVE, sobretudo em crianças, em que pode ocorrer a não abertura completa da membrana de Liliequist (ML). Para compreensão do comportamento da ML, a sua associação com o Tuber Cinereo (TC) e o assoalho do III Ventrículo (IIIVT) e outras peculiaridades, foi realizada, prospectivamente, a observação sistemática destas características durante 57 operações. Os dados foram registrados após o procedimento e posteriormente estudados. Os objetivos eram sistematizar as características anatômicas destas estruturas do ponto de vista neuroendoscópico, avaliar se as alterações seguiam algum padrão e se interferiam no procedimento técnico, correlacionando com a evolução. Pela análise dos dados percebeu-se que as características da ML são variáveis e dificultam, em uma percentagem considerável de vezes, a sua interpretação e seu manejo pelo neurocirurgião. Também, que o TC alterado e separado da ML são fatores associados à maior dificuldade de realização da TVE. Que as TVE realizadas nas hidrocefalias por malformações congênitas, processos inflamatórios e pós sangramento (prevalentes na infância) estão associadas a maior dificuldade de manejar a ML e podem explicar o índice de insucesso maior observado na literatura em crianças abaixo de 2 anos.

Endoscopic Third Endoscopic (ETV) is a neurosurgical procedure to treat hydrocephalus. To be fully performed it is necessary opening an arachnoid structure, the Liliequist Membrane (LM). However the LM surgical anatomy from the neuroendoscopic point of view is not yet completely studied, since approach angles are different from classics descriptive and microsurgical anatomies. There is a literature discrepancy regarding the ETV efficacy, especially in children over 2 years old, which may be due to LM incomplete opening. In order to understand the LM anatomical behavior, the relationship with tuber cinereo (TC), the floor of the III Ventricle and other peculiarities, a systematic prospective observation of these characteristics was performed during the 57 surgeries. Data were recorded after the procedure and studied. Objectives were to systematize LM anatomical characteristics from neuroendoscopic perspective, understand if anatomical changes follows a pattern interfering on the procedure, and if there is correlation with patients evolution. The data analysis shows that LM characteristics are variable, making difficult the neurosurgeon management. Whenever TC anatomy modifies, or when TC and ML are separated, difficulty to perform ETV increases. When hydrocephalies are due to congenital malformations, inflammatory processes and post bleeding (prevalent in childhood), LM management is much harder, witch may explain the higher failure rate in children under 2 years of age observed in literature.

Observation of cerebrospinal fluid circulation of fistula after ETV in obstructive hydrocephalus by PC-cine MRI / 实用放射学杂志

Objective To observe the feasibility of PC-cine MRI for estimating the cerebrospinal fluid circulation of fistula after endoscopic third ventriculostomy (ETV)in obstructive hydrocephalus.Methods 25 cases with obstructive hydrocephalus were scanned with routine MR protocol and PC-cine sequence before and after ETV.Qualitative and quantitative evaluation of the cerebro-spinal fluid flow through the fistula were performed and the results were compared with 25 cases of healthy volunteers.Results One week after operation,the cerebrospinal fluid flow through the fistula showed obviously positive in 23 patients,while negative in the other 2 patients,and the waveform was similar to that in the normal midbrain aqueduct.The outflow and inflow peak velocity of the cerebrospinal fluid through the fistula were lower than that in normal midbrain aqueduct(P<0.05),while the quantity of outflow,inflow and netflow were much higher(P<0.05).6 patients showed ventricular narrowing one week after operation and 17 cases maintained the same finding.During follow-up of half year,the ventricular size still showed no obvious narrowing in 14 patients.Ventricular expanding was observed in 2 post-operative patients.Conclusion PC-cine MRI can provide intuitive and reliable evidences in evaluation of ETV for obstructive hydrocephalus.

"Somewhere up there": A case of pineal gland tumor in a 20-year-old male

BACKGROUND: Pineal region tumor is a rare and reportable case. Incidence rate adults is 0.025 in 10,000 hence there is no established guidelines among adults  for diagnosis and management of this case.CASE: A case of a 20-year-old male with a two-month history of  intermittent  headache,  occipital  area  with  VAS  5/10,increasing in severity. Until two days prior to admission with severe headache VAS 9-10/10, occipital, and nonradiating.Patient  noted  episodes  of  projectile  vomiting  hence,admitted. Patient presented with non-lateralizing symptoms but  noted  papilledema  and  parinaud  syndrome.Cranial  MRI with contrast revealed a 2.5cm pineal gland tumor with obstructive  hydrocephalus.  Serum  AFP  (alpha-fetoprotein  )  and  beta-HCG  (beta subunit of human chorionic gonadotropin) were requested and revealed elevated levels.The patient underwent endoscopic third ventriculostomy but no biopsy was done due to high risk of bleeding. Patient underwent series of radiotherapy and was advised to undergo chemotherapy but patient refused. Patient had improved upward gaze but with residuals, no recurrence of headache or vomiting, had normalization of the serum tumor markers but noted increase in size of the tumor despite radiotherapy.CONCLUSION: Case  reports  of  pineal  region  tumors  will  help doctors  in  the  primary  hospitals  diagnose  such  cases  and differentiate it from benign causes of headache. This will aid in early referral to specialists and early intervention.

“Somewhere up there”: A case Of pineal gland tumor in a 20-year-old male

@#<p style="text-align: justify;"><strong>BACKGROUND:</strong> Pineal region tumor is a rare and reportable case. Incidence rate adults is 0.025 in 10,000 hence there is no established guidelines among adults  for diagnosis and management of this case.<br /><strong>CASE:</strong> A case of a 20-year-old male with a two-month history of  intermittent  headache,  occipital  area  with  VAS  5/10,increasing in severity. Until two days prior to admission with severe headache VAS 9-10/10, occipital, and nonradiating.Patient  noted  episodes  of  projectile  vomiting  hence,admitted. Patient presented with non-lateralizing symptoms but  noted  papilledema  and  parinaud  syndrome.Cranial  MRI with contrast revealed a 2.5cm pineal gland tumor with obstructive  hydrocephalus.  Serum  AFP  (alpha-fetoprotein  )  and  beta-HCG  (beta subunit of human chorionic gonadotropin) were requested and revealed elevated levels.The patient underwent endoscopic third ventriculostomy but no biopsy was done due to high risk of bleeding. Patient underwent series of radiotherapy and was advised to undergo chemotherapy but patient refused. Patient had improved upward gaze but with residuals, no recurrence of headache or vomiting, had normalization of the serum tumor markers but noted increase in size of the tumor despite radiotherapy.<br /><strong>CONCLUSION:</strong> Case  reports  of  pineal  region  tumors  will  help doctors  in  the  primary  hospitals  diagnose  such  cases  and differentiate it from benign causes of headache. This will aid in early referral to specialists and early intervention.</p>

"Somewhere up there": A case of pineal gland tumor in a 20-year-old male

BACKGROUND: Pineal region tumor is a rare and reportable case. Incidence rate adults is 0.025 in 10,000 hence there is no established guidelines among adults  for diagnosis and management of this case.CASE: A case of a 20-year-old male with a two-month history of  intermittent  headache,  occipital  area  with  VAS  5/10,increasing in severity. Until two days prior to admission with severe headache VAS 9-10/10, occipital, and nonradiating.Patient  noted  episodes  of  projectile  vomiting  hence,admitted. Patient presented with non-lateralizing symptoms but  noted  papilledema  and  parinaud  syndrome.Cranial  MRI with contrast revealed a 2.5cm pineal gland tumor with obstructive  hydrocephalus.  Serum  AFP  (alpha-fetoprotein  )  and  beta-HCG  (beta subunit of human chorionic gonadotropin) were requested and revealed elevated levels.The patient underwent endoscopic third ventriculostomy but no biopsy was done due to high risk of bleeding. Patient underwent series of radiotherapy and was advised to undergo chemotherapy but patient refused. Patient had improved upward gaze but with residuals, no recurrence of headache or vomiting, had normalization of the serum tumor markers but noted increase in size of the tumor despite radiotherapy.CONCLUSION: Case  reports  of  pineal  region  tumors  will  help doctors  in  the  primary  hospitals  diagnose  such  cases  and differentiate it from benign causes of headache. This will aid in early referral to specialists and early intervention.

Embriología del sistema ventricular cerebral / Cerebral ventricular system embryology

El Sistema Ventricular Cerebral se desarrolla de forma paralela al resto del Sistema Nervioso Central, facilitando la circulación del Líquido Cefalorraquídeo, desde su separación del líquido amniótico a nivel embrionario. Este desarrollo es necesario para entender correctamente la anatomía ventricular y facilitar el abordaje para patologías intraventriculares. El objetivo de esta revisión es reconocer los puntos más importantes en la embriología ventricular para facilitar el aprendizaje de la anatomía quirúrgica ventricular.

The cerebral ventricular system is developed in parallel with the rest of the central nervous system, facilitating the circulation of cerebrospinal fluid, from the amniotic fluid separation in the embryonic phases. This development is necessary to correctly understand the ventricular anatomy and facilitate approach to intraventricular pathologies. The objective of this review is to recognize the most important points in the ventricular embryology and in the intraventricular endoscopic vision to facilitate learning of the ventricular surgical anatomy.

Choroid plexus coagulation for pediatric hydrocephalus: review of historical aspects and rebirth

This study aims to review historical aspects and rebirth of the endoscopic choroid plexus coagulation (CPC) for pediatric hydrocephalus. The first CPC procedure goes back to early 1930s. After the development of other treatment methods and the understanding of CSF dynamics, the application of CPC dramatically decreased by 1970s. In 2000s, there was a rebirth of CPC in combination with endoscopic third ventriculostomy (ETV), and remains one of the options for the treatment of pediatric hydrocephalus in selected cases. CPC might provide a temporary reduction in CSF production to allow the further development of CSF absorption in infant, and adding to ETV for infants with communicating hydrocephalus may increase the shunt independent rate thus avoiding the consequence of late complication related to the shunt device. This is important for patients who are difficult to be followed up, due to geographical and/or socioeconomic difficulties. And also adding CPC to ETV for obstructive hydrocephalus in infants younger than 1 year of age may also increase the successful rate. Furthermore, CPC may be an option for cases with high chance of shunt complication such as multiloculated hydrocephalus, extreme hydrocephalus and hydranencephaly. In comparison with the traditional treatment of CSF shunting, the role of CPC needs to be further evaluated in particular concerning the neurocognitive development.

The Efficacy Analysis of Endoscopic Third Ventriculostomy in Infantile Hydrocephalus

OBJECTIVE: To investigate the efficacy of endoscopic third ventriculostomy (ETV) for infantile hydrocephalus. METHODS: Retrospectively reviewed the 17 infantile hydrocephalus cases who were treated with ETV between July 2009 and June 2013. The study includes 17 patients (4 Han and 13 Hui) between the ages of 51 and 337 days. Five cases with encephalitis history and 2 cases with cerebral hemorrhage, with the remaining 10 cases congenital hydrocephalus. ETVs were performed for all patients with 1 case failing because the severe ventricle inflammatory adhesion, excessive exudation, and vague basilar artery. RESULTS: Among the 16 successful cases 7 cases improved remarkably : heads and ventricles reduced and cerebral cortexes thickening morphologically. The ventricles of the remaining cases were unchanged. CONCLUSION: The ethnic minority account for the majority of the patients in this study. ETV is effective for infantile obstructive hydrocephalus.

Neurodevelopmental outcomes in pediatric patients of different ages undergoing endoscopic third ventricu- lostomy for the treatment of congenital obstructive hydrocephalus / 中国神经精神疾病杂志

Objective To investigate the effect of endoscopic third ventriculostomy(ETV)on congenital obstruc? tive hydrocephalus in pediatric patients. Methods We prospectively evaluated the postoperative neurodevelopmental out? comes in 33 children with congenital obstructive hydrocephalus who underwent endoscopic third ventriculostomy at differ? ent ages from June 2011 to Jan 2014. According to their ages at the time of surgery, we categorized them into two groups: ETV≤6 months of live group(n=17)and ETV>6 months of live group(n=16). We assessed postoperative neurodevelop? mental outcomes using Gesell developmental diagnosis schedule which included gross motor, fine motor, adaptive, linguis? tic and personal-social functions. Results There was statistical significance in neurodevelopmental outcomes between two groups(P ﹤0.05). Patients in ETV>6 months of live group presented better outcome scores in all assessed domains than those in ETV≤6 months of live group (23.00±3.62 vs. 48.81±6.81; 25.94±3.07 vs.55.56±8.40; 15.00±3.06 vs. 40.94±6.69; 20.00±3.06 vs. 45.81±6.81; 21.12±3.22 vs. 45.88±7.22 ). Sixteen (100%) patients in ETV≤6 months of live group had severe neurodevelopmental disability whereas only one (6.25%) patient in ETV>6 months of live group had se? vere neurodevelopmental disability. Conclusions Endoscopic third ventriculostomy on infants with obstructive hydroceph?alus before six month of ages is associated with low operative success rate and poor neurodevelopmental outcomes.

Membrana de Liliequist: avaliação radiológica e suas implicações clínicas e terapêuticas / Liliequist membrane: radiological evaluation, clinical and therapeutic implications

A membrana de Liliequist, de maneira simplista e sucinta, pode ser entendida como uma projeção formada pela aracnoide que se estende do dorso da sela turca aos corpos mamilares. Apesar de se tratar de uma estrutura anatômica bem conhecida pelos neurocirurgiões, muitos radiologistas não a conhecem ou não valorizam seu estudo. A avaliação por imagem desta membrana é factível e pode ser interessante para o melhor planejamento pré-operatório, avaliação pós-operatória de terceiro-ventriculostomias e entendimento dos cistos aracnoides suprasselares e hemorragias perimesencefálicas. Ilustramos neste artigo os aspectos anatômicos da membrana, sobretudo do ponto de vista de imagem, além de suas possíveis implicações clinicocirúrgicas.

In a simplistic and succinct way, Liliequist membrane may be understood as a projection formed by an arachnoid membrane extending from the dorsum sellae to the mammillary bodies. In spite of being well known to neurosurgeons, many radiologists neither know this anatomical structure nor give importance to its study. The imaging evaluation of this membrane is feasible and may be interesting for a better preoperative planning; postoperative evaluation of third ventriculostomies; and understanding of suprasellar arachnoid cysts and perimesencephalic hemorrhage. The present article illustrates the anatomy of the membrane, with emphasis on imaging findings, besides describing its possible clinical and surgical implications.

Endoscopic third ventriculostomy is a safe and effective procedure for the treatment of Blake's pouch cyst / Terceiroventriculostomia endoscopica e um procedimento efetivo e seguro para o tratamento dos cistos da bolsa de Blake

OBJECTIVE: Blake's pouch cyst (BPC) is a midline cystic malformation of the posterior fossa, within Dandy-Walker's complex (DWC), often associated with hydrocephalus. Endoscopic third ventriculostomy (ETV) has been an alternative to conventional methods for BPC treatment. This study aimed at reporting our experience with ETV in a series of patients with BPC. METHODS: Of 33 patients diagnosed with midline posterior fossa cyst, 26 met the protocol criteria for DWC, and eight subjects with BPC were selected (aged one month to two years old). All cases were treated with ETV. RESULTS: Five patients were male; and three were prenatally diagnosed. They had hydrocephalus and motor deficiencies. Motor assessment at a five-year follow-up yielded normal findings. All patients improved, and only one had residual cognitive dysfunction, despite overall neurological improvement. There were no complications. CONCLUSIONS: ETV was a safe and effective procedure, reducing risks and morbidity associated with open surgery and shunt-related problems. .

OBJETIVO: O cisto da bolsa de Blake (CBB) é uma malformação cística mediana da fossa posterior, dentro do complexo de Dandy-Walker (CDW), frequentemente associada à hidrocefalia. A terceiroventriculostomia endoscópica (TVE) tem sido considerada uma alternativa aos métodos convencionais de tratamento do CBB. Este estudo teve como objetivo relatar nossa experiência com TVE em uma série de pacientes com CBB. MÉTODOS: Dos 33 pacientes diagnosticados com cisto mediano da fossa posterior, 26 preencheram os critérios do protocolo para CDW, dos quais oito foram selecionados com CBB (idades variando entre um mês a dois anos). Todos os casos foram tratados com TVE. RESULTADOS: Cinco pacientes eram do sexo masculino, três tiveram diagnóstico no pré-natal; e todos apresentavam hidrocefalia e alterações motoras. A avaliação motora após cinco anos apresentou resultados normais. Todos os pacientes melhoraram, e apenas um apresentou um leve déficit cognitivo, apesar da melhora neurológica geral. Não houve complicações. CONCLUSÕES: A TVE foi um procedimento seguro e eficaz, reduzindo riscos e morbidade associados à cirurgia aberta e a problemas relacionados aos shunts.

Neuroendoscopic surgery in children: an analysis of 200 consecutive procedures / Neuroendoscopia em crianças: uma análise de 200 procedimentos consecutivos

Neuroendoscopic surgery in children has particular features and is associated with different success rates (SR). The aim of this study was to identify putative factors that could influence the outcome in pediatric patients.

Clinical data of 177 patients under 18 years of age submitted to 200 consecutive neuroendoscopic procedures from January 2000 to January 2010 were reviewed. The overall success rate was 77%. Out of the patients with successful outcomes, 46% were under six months, 68% were between six months and one year of age, and 85% older than one year. Neuroendoscopic techniques provide very good results for a wide number of indications in children. Tumor-related cerebrospinal fluid (CSF) circulation problems and aqueductal stenosis seem to be particularly well suited to neuroendoscopic treatment regardless of the patient's age. Patients' age and etiology of hydrocephalus were associated with a different outcome. In all cases, surgical experience is extremely important to reduce complications. .

A cirurgia neuroendoscópica em crianças apresenta particularidades e está associada a diferentes taxas de sucesso (TS). O objetivo deste estudo consistiu em identificar fatores que pudessem influir no resultado do tratamento em pacientes pediátricos. Dados clínicos de 177 pacientes com idade inferior a 18 anos submetidos a 200 procedimentos neuroendoscópicos consecutivos entre janeiro de 2000 e janeiro de 2010 foram revisados. A taxa de sucesso global foi de 77%. Os pacientes com idade inferior a seis meses apresentaram taxa de sucesso de 46%; pacientes entre seis meses e um ano de vida obtiveram êxito em 68% dos casos; dentre os maiores de um ano, 85% dos procedimentos foram bem-sucedidos. Técnicas neuroendoscópicas proporcionam muito bons resultados para uma grande variedade de indicações em crianças. Independentemente da faixa etária, o tratamento endoscópico apresenta-se particularmente adequado para problemas da circulação liquórica relacionados a tumores e à estenose aquedutal. A faixa etária dos pacientes e a etiologia da hidrocefalia estão associadas a diferentes resultados. Em todos os casos, experiência neurocirúrgica é extremamente importante para a redução das complicações. .

Effect of endoscopic third ventriculostomy in treating severe obstructive hydrocephalus in premature infant / 中华实用儿科临床杂志

Objective To discuss the treatment and the clinical effect of endoscopic third ventriculostomy on severe obstructive hydrocephalus in premature infant.Methods Eleven patients were operated,ultrasound,CT and MRI showed severe obstructive hydrocephalus and cerebral spinal fluid absorption was normal.The technique was that endoscope was inserted through the foramen of Monro into the third ventricle,then perforating the floor of the third ventriculostomy.Comparison before and after surgery of ventricular system ultrasonic measurement about the change of lateral ventricle and the MRI and CT imaging changes were performed.The complications,operation effect and security were observed.The bailey baby scale and Peabody movement function scale was used to assess the patient's neurologic system status.Results The follow-up time was 6 months and 6 years after operation,an excellent operative result was got in 9 cases.The ventricular width of 1 patient was mild ventriculomegaly,but stayed stabilily.No change of ventricular width was found in 1 case.Additional shunt were needed in 1 case.No severe complications were found.The left and right lateral ventricle measured by ultrasonic before operation were (9.60 ± 3.52) mm and (8.63 ± 3.10) mm before operation,and (5.50 ± 2.20) mm and (4.90 ± 2.70) mm after operation.The 11 cases of lateral ventricle side edema were disappeared,the follow-up time in 9 cases were more than 12 months,obstructive hydrocephalus clinical symptoms were relieved.Conclusions Ventricular mirror operation significantly improve severe hydrocephalic short and longterm poor prognosis,it is a safe,effective and less complications of minimally invasive surgery.

An Acute Postoperative Intractable Hyperventilation after an Endoscopic Third Ventriculostomy

This report describes a rare case of postoperative hyperventilation attack after an endoscopic third ventriculostomy in a 46-year-old woman. About 60 min after the termination of the operation, an intractable hyperventilation started with respiratory rate of 65 breaths/min and EtCO2, 16.3 mm Hg. Sedation with benzodiazepine, thiopental sodium, fentanyl, and propofol/remifentanil infusion was tried under a rebreathing mask at a 4 L/min of oxygen. With aggressive sedative challenges, ventilation pattern was gradually returned to normal during the 22 hrs of time after the surgery. A central neurogenic hyperventilation was suspected due to the stimulating central respiratory center by cold acidic irrigation solution during the neuroendoscopic procedure.

Endoscopic Third Ventriculostomy in Patients with Shunt Malfunction

OBJECTIVE: This paper presents data from a retrospective study of endoscopic third ventriculostomy (ETV) in patients with shunt malfunction and proposes a simple and reasonable post-operative protocol that can detect ETV failure. METHODS: We enrolled 19 consecutive hydrocephalus patients (11 male and 8 female) who were treated with ETV between April 2001 and July 2010 after failure of previously placed shunts. We evaluated for correlations between the success rate of ETV and the following parameters : age at the time of surgery, etiology of hydrocephalus, number of shunt revisions, interval between the initial diagnosis of hydrocephalus or the last shunt placement and ETV, and the indwelling time of external ventricular drainage. RESULTS: At the time of ETV after shunt failure, 14 of the 19 patients were in the pediatric age group and 5 were adults, with ages ranging from 14 months to 42 years (median age, 12 years). The patients had initially been diagnosed with hydrocephalus between the ages of 1 month 24 days and 32 years (median age, 6 years 3 months). The etiology of hydrocephalus was neoplasm in 7 patients; infection in 5; malformation, such as aqueductal stenosis or megacisterna magna in 3; trauma in 1; and unknown in 3. The overall success rate during the median follow-up duration of 1.4 years (9 days to 8.7 years) after secondary ETV was 68.4%. None of the possible contributing factors for successful ETV, including age (p=0.97) and the etiology of hydrocephalus (p=0.79), were statistically correlated with outcomes in our series. CONCLUSION: The use of ETV in patients with shunt malfunction resulted in shunt independence in 68.4% of cases. Age, etiology of hydrocephalus, and other contributing factors were not statistically correlated with ETV success. External ventricular drainage management during the immediate post-ETV period is a good means of detecting ETV failure.

Acute respiratory alkalosis occurring after endoscopic third ventriculostomy: A case report / 대한마취과학회지

An endoscopic third ventriculostomy was performed in a 55-year-old man with an obstructive hydrocephalus due to aqueductal stenosis. The vital signs and laboratory studies upon admission were within the normal limits. Anesthesia was maintained with nitrous oxide in oxygen and 6% desflurane. The patient received irrigation with approximately 3,000 ml normal saline during the procedure. Anesthesia and operation were uneventful. However, he developed postoperative hyperventilation in the recovery room, and arterial blood gas analysis revealed acute respiratory alkalosis. We report a rare respiratory alkalosis that occurred after an endoscopic third ventriculostomy.

Ventricular Endoscopy for Obstructive Hydrocephalus: Report of 33 Cases / 中国微创外科杂志

Objective To discuss the techniques of ventricular endoscopy for obstructive hydrocephalus.Methods A total of 33 patients with obstructive hydrocephalus were treated by ventriculostomy using ventricular endoscopy from June 2003 to December 2006.The patients had received CT,MRI,and 99mTc-DTPA cistern SPECT before the surgery.Results Endoscopic third ventriculostomy was performed successfully in 32 patients,the other patient died of hemorrhage under the third ventricle fistula.Postoperative fever occurred in 13 patients.One patient developed bilateral chronic subdural hematoma 6 months after the operation,and was cured by drill and drainage.Three patients developed subdural hydroma 6 months postoperation without showing symptoms.They were monitored without any treatment.The 32 patients were followed up for 2-42 months(mean,16.7 months),all of them achieved clinical relieve.In the patients,the intracranial pressure(ICP) was 26(16-39) cm H2O before the operation,and was significantly decreased to 22(12-28) cm H2O 7 days after the operation(t=2.903,0.005

Endoscopic third ventriculostomy: An outcome analysis of 30 pediatric cases

OBJECTIVE: Endoscopic third ventriculostomy (ETV) has been shown to be a sufficient alternative in the surgical treatment of hydrocephalus. Our goal in this retrospective study is to analyze our results with the use of ETV in our first 30 cases that it may provide us with selection criteria as to who among our patients will benefit most from this procedure.METHODOLOGY: Thirty ETVs were performed in 30 patients. Their ages ranged from 2-155 months. Hydrocephalus was caused by aqueductal stenosis in 17 patients, tumors in 7, post-infectious in 3, Dandy-Walker malformation in 2 and arachnoid cyst in 1 patient. The outcome of ETV was evaluated in 26 of the cases that were available for follow-up RESULTS: The overall success rate was 69.2 percent. Patients with non-communicating hydrocephalus from post-infectious causes, tumors and aqueductal stenosis had high success rates. Patients less than 6 months of age had a poor outcome. Complications included ventriculitis in 1 patient CONCLUSION: ETV is a viable treatment option for non-communicating hydrocephalus secondary to post-infectious cause, aqueductal stenosis and tumors. A successful outcome is more likely if ETV is done in patients more than 6 months of age Patients who have previously undergone shunting and who have non-communicating hydrocephalus should undergo ETV at the time of shunt failure. These patients showed good outcome.

Outcome of Endoscopic Third Ventriculostomy

OBJECTIVE: The authors review 17 cases of obstructive hydrocephalus treated with endoscopic third ventriculostomy to elucidate the adequate age, indication, surgical technique and radiologic criteria. METHODS: From March 1998 to August 2002, 17 endoscopic third ventriculostomies were performed(11 male and 6 female patients). The operation records and neuroimaging studies of the patients were reviewed retrospectively. RESULTS: The age of the patients ranged from 2 months to 70 years(mean age 21 years). Hydrocephalus was caused by aqueductal stenosis in 8 patients, tumor in 8(pineal mass: 5, cystic mass in third ventricle: 2 cerebellar mass: 1), cavernous angioma in 1. The overall success rate was 64.7%(11/17). In the present study, the preoperative increased intracranial pressure symptom was a reliable indicator of surgical outcome. The lateral ventricular size and the III ventricle width reduction, the presence of a signal void on the third ventricle floor appeared to correlate with clinical success. But the cystic mass in the third ventricle was less likely to benefit. Complications were bleeding in 3, infections in 2 and transient III and VI nerve palsy in one case, but there was no permanent morbidity or mortality. CONCLUSION: Endoscopic third ventriculostomy is a safe, simple, effective alternative treatment option of obstructive hydrocephalus in appropriate patient selection.