Predictors and prediction scores of shunt-dependent hydrocephalus in patients with aneurismal subarachnoid hemorrhage / 国际脑血管病杂志

Shunt-dependent hydrocephalus (SDHC) is a common and serious complication of aneurismal subarachnoid hemorrhage (aSAH). The incidence of SDHC after aSAH was 9%-36%, and it is associated with the poor outcome of patients. This article reviews the predictors and prediction scores of SDHC after aSAH.

Avances recientes en el diagnóstico imagenológico de la hidrocefalia en niños. Revisión de la literatura de los últimos seis años / Recent advances of the imagological diagnosis of hydrocephalus in children. Review of the literature of the last six years

Resumen La hidrocefalia es un problema de salud frecuente en pediatría, en particular durante el primer mes de vida. La incidencia en América Latina es una de las más altas del mundo. En Colombia no existen datos representativos sobre la incidencia real de esta enfermedad. Recientes hallazgos relacionados con la dinámica del líquido cefalorraquídeo permitieron proponer nuevos modelos sobre la fisiopatología de la hidrocefalia que, junto con los hallazgos en la Resonancia Magnética, han llevado a tener una mejor comprensión de la enfermedad. El objetivo de este articulo es realizar una revisión de la información disponible en la literatura sobre los avances en la fisiopatología de la enfermedad y los hallazgos en neuroimágenes, además de realizar una breve revisión sobre el papel de estas en el diagnóstico y seguimiento de los pacientes. Se realizó una revisión bibliográfica con términos MeSH, en las bases de datos de PUBMED, OVID y SCOPUS con artículos publicados en los últimos 6 años, seleccionado un total de 30 artículos que abordaron el tema de forma integral. Los nuevos hallazgos descritos como lo son el sistema glinfático y el papel de las AQP4 y los avances en las neuroimágenes, sobre todo de la resonancia magnética, han ayudado a comprender mejor esta entidad, apoyando el desarrollo de un nuevo modelo de la dinámica del líquido cefalorraquídeo y a partir de él diferentes explicaciones sobre la fisiopatología. MÉD.UIS.2022;35(1): 17-29.

Abstract Hydrocephalus is a frequent health problem in pediatrics, particularly during the first month of life. The incidence in Latin America is one of the highest in the world. In Colombia there are no representative data. Recent findings related to the dynamics of cerebrospinal fluid allowed proposals of new models on the pathophysiology of hydrocephalus that, along with new findings on MRI, have led to a better understanding of the disease. The aim of this work is to review the information available in the literature about the progress in the pathophysiology of the disease and neuroimaging findings, in addition to conducting a brief review on the role of these in the diagnosis and follow-up of patients. A bibliographic review with MeSH terms was carried out in PUBMED, OVID and SCOPUS databases, with articles published in the last 6 years. 30 articles that dealt with the theme in a comprehensive way were included. New findings described as the glymphatic system and the role of AQP4, along with advances in neuroimaging, especially MRI, have helped to better understand hydrocephalus, supporting the development of a new model of cerebrospinal fluid dynamics, and based on it, different explanations regarding its pathophysiology. MÉD.UIS.2022;35(1): 17-29.

Historical Clinical Outcomes of Children with Myelomeningocele Meeting the Criteria for Fetal Surgery: A Retrospective Cohort Survey of Brazilian Patients / Resultados clínicos históricos de crianças com mielomeningocele com critérios para cirurgia fetal: Um estudo de coorte retrospectivo de pacientes brasileiros

Abstract Objective To analyze the historical clinical outcomes of children with myelomeningocele (MMC) meeting the criteria for fetal surgery, but who underwent postnatal primary repair. Methods Data from children undergoing postnatal MMC repair between January 1995 and January 2015 were collected from the Neurosurgery Outpatient Clinic's medical records. Children were included if they had ≥1 year of postoperative follow-up andmet the criteria for fetal surgery. The children's data were then stratified according to whether they received a shunt or not. The primary outcome was mortality, and secondary outcomes were educational delays, hospitalization, recurrent urinary tract infections (UTIs), and renal failure. Results Over the 20-year period, 231 children with MMC were followed up. Based on clinical data recorded at the time of birth, 165 (71.4%) qualify of fetal surgery. Of the 165 patients, 136 (82.4%) underwent shunt placement. The mortality rate was 5.1% in the group with shunt and 0% in the group without, relative risk (RR) 3.28 (95% confidence interval, 95% CI, 0.19-55.9). The statistically significant RRs for adverse outcomes in the shunted group were 1.86 (95% CI, 1.01-3.44) for UTI, 30 (95% CI, 1.01-537) for renal failure, and 1.77 (95% CI, 1.09-2.87) for hospitalizations. Conclusion Children with MMC qualifying for fetal surgery who underwent shunt placement were more likely to have recurrent UTIs, develop renal failure, and be hospitalized. Since approximately half of the shunt procedures could be avoided by fetal surgery, there is a clinical benefit and a possible financial benefit to the implementation of this technology in our setting.

Resumo Objetivo Analisar os resultados clínicos históricos de crianças commielomeningocele (MMC) com critérios para cirurgia fetal,mas que foram submetidas a cirurgia pós-natal. Métodos Dados de crianças submetidas à correção deMMCpós-natal entre janeiro de 1995 e janeiro de 2015 foram coletados nos prontuários do Ambulatório de Neurocirurgia. Foram incluídas crianças se tivessem ≥ 1 ano de acompanhamento pósoperatório e atendessem os critérios para cirurgia fetal. As informações dessas crianças foram então estratificadas de acordo com se receberam ou não derivação do líquido cefalorraquidiano. O desfecho primário foi a mortalidade e os desfechos secundários foram atrasos educacionais, hospitalização, infecções recorrentes do trato urinário einsuficiência renal. Resultados Durante o período de 20 anos, 231 crianças com MMC foram acompanhadas. Com base nos dados clínicos registrados no momento do nascimento, 165 (71,4%) atendiam critérios para a cirurgia fetal. Dos 165 pacientes, 136 (82,4%) foram submetidos à colocação de derivação do líquido cefalorraquidiano. A taxa de mortalidade foi de 5,1% no grupo com derivação do líquido cefalorraquidiano e 0% no grupo sem risco relativo (RR) 3,28 (intervalo de confiança 95%, IC 95%, 0,19-55,9). Os RRs estatisticamente significativos para resultados adversos no grupo com derivação do líquido cefalorraquidiano foram 1,86 (IC 95%, 1,01-3,44) para infecção do trato urinário, 30 (IC 95%, 1,01-537) para insuficiência renal e 1,77 (IC 95%, 1,09-2,87) para hospitalizações. Conclusão Crianças com MMC com critérios para cirurgia fetal submetidas à colocação de derivação do líquido cefalorraquidiano eram mais propensas a ter infecções recorrentes do trato urinário, desenvolver insuficiência renal e serem hospitalizadas. Como aproximadamente metade dos procedimentos de derivação poderiam ser evitados por cirurgia fetal, há um benefício clínico e um possível benefício financeiro com a implementação dessa tecnologia em nosso meio.

Relationships between intracranial compartment volumes and clinical symptoms in patients with idiopathic normal pressure hydrocephalus before and after cerebrospinal fluid shunt surgery / 中华老年医学杂志

Objective@#To investigate the relationships of intracranial compartment volumes with the severity of clinical symptoms before surgery, and the degree of symptom improvement one year after cerebrospinal fluid(CSF)shunt surgery in patients with idiopathic normal pressure hydrocephalus(iNPH).@*Methods@#Twenty-one patients meeting the diagnosis criteria of international guidelines of iNPH and undergoing CSF shunt surgery in Department of Neurosurgery in our hospital from 2016 to 2017 were included.All patients underwent brain MRI measurement before surgery, and were evaluated by using 3-meter timed up and go test(TUG), minimum mental state examination(MMSE), idiopathic normal pressure hydrocephalus grading scale(iNPHGS)and modified Rankin scale(mRS)before and one year after CSF shunt procedures.The ventricular volume, brain volume, pericerebral CSF volume, total intracranial volume and Evans' index were measured in the pre-operative imaging of the brain.The following four pre-operative intracranial compartment volumes were calculated: the relative ventricular volume, brain volume ratio, pericerebral CSF volume ratio and the ratio of ventricular volume to pericerebral CSF volume.@*Results@#The scores of gait, cognitive function and urinary function were improved after surgery in iNPH patients(all P<0.05). There were no significant difference in the correlation of intracranial compartment volumes(the relative ventricular volume, brain volume ratio, pericerebral CSF volume ratio and the ratio of ventricular volume to pericerebral CSF volume)and Evans' index with the severity of clinical symptoms including gait, cognitive function and urinary function before surgery, and with the degree of symptom improvement one year after surgery in iNPH patients(all P>0.05). There was no significant difference in intracranial compartment volumes between patients having improvement in mRS, TUG, MMSE and iNPHGS and patients having no improvement one year after surgery in iNPH patients(all P>0.05).@*Conclusions@#Patients with iNPH can benefit from CSF shunt surgery and have improvements of clinical symptoms including gait, cognitive function and urinary function.Preoperative intracranial compartment volumes(the relative ventricular volume, brain volume ratio, pericerebral CSF volume ratio and the ratio of ventricular volume to pericerebral CSF volume)and Evans' index have no correlations with the severity of clinical symptoms before surgery, and have no correlations with the degree of symptom improvement one year after surgery in iNPH patients.For this reason, preoperative intracranial compartment volumes and Evans' index cannot be used to predict whether or not CSF shunt surgery can improve specific clinical symptoms.

Relationships between intracranial compartment volumes and clinical symptoms in patients with idiopathic normal pressure hydrocephalus before and after cerebrospinal fluid shunt surgery / 中华老年医学杂志

Objective To investigate the relationships of intracranial compartment volumes with the severity of clinical symptoms before surgery,and the degree of symptom improvement one year after cerebrospinal fluid(CSF)shunt surgery in patients with idiopathic normal pressure hydrocephalus (iNPH).Methods Twenty-one patients meeting the diagnosis criteria of international guidelines of iNPH and undergoing CSF shunt surgery in Department of Neurosurgery in our hospital from 2016 to 2017 were included.All patients underwent brain MRI measurement before surgery,and were evaluated by using 3-meter timed up and go test(TUG),minimum mental state examination(MMSE),idiopathic normal pressure hydrocephalus grading scale (iNPHGS) and modified Rankin scale (mRS) before and one year after CSF shunt procedures.The ventricular volume,brain volume,pericerebral CSF volume,total intracranial volume and Evans' index were measured in the pre-operative imaging of the brain.The following four pre-operative intracranial compartment volumes were calculated:the relative ventricular volume,brain volume ratio,pericerebral CSF volume ratio and the ratio of ventricular volume to pericerebral CSF volume.Results The scores of gait,cognitive function and urinary function were improved after surgery in iNPH patients (all P ＜ 0.05).There were no significant difference in the correlation of intracranial compartment volumes(the relative ventricular volume,brain volume ratio,pericerebral CSF volume ratio and the ratio of ventricular volume to pericerebral CSF volume)and Evans' index with the severity of clinical symptoms including gait,cognitive function and urinary function before surgery,and with the degree of symptom improvement one year after surgery in iNPH patients (all P ＞ 0.05).There was no significant difference in intracranial compartment volumes between patients having improvement in mRS,TUG,MMSE and iNPHGS and patients having no improvement one year after surgery in iNPH patients(all P＞0.05).Conclusions Patients with iNPH can benefit from CSF shunt surgery and have improvements of clinical symptoms including gait,cognitive function and urinary function.Preoperative intracranial compartment volumes(the relative ventricular volume,brain volume ratio,pericerebral CSF volume ratio and the ratio of ventricular volume to pericerebral CSF volume)and Evans' index have no correlations with the severity of clinical symptoms before surgery,and have no correlations with the degree of symptom improvement one year after surgery in iNPH patients.For this reason,preoperative intracranial compartment volumes and Evans' index cannot be used to predict whether or not CSF shunt surgery can improve specific clinical symptoms.

Repercussão de intervenção educativa no conhecimento da equipe de enfermagem sobre os cuidados no uso da derivação ventricular externa em pediatria / Repercussion of an educational intervention on the knowledge of the nursing team regarding the use of external ventricular drains in pediatrics / Repercusión de la intervención educativa en el conocimiento del personal de enfermería sobre cuidados en el manejo del drenaje ventricular externo en pediatría

Objetivo: este estudo objetivou analisar a repercussão de intervenção educativa no conhecimento teórico da equipe de Enfermagem sobre os cuidados no uso da derivação ventricular externa em Pediatria. Trata-se de estudo de intervenção não controlado, com delineamento do tipo antes e depois. Método: procedeu-se à aplicação de pré e pós-teste para a coleta de informações sobre os conhecimentos dos profissionais sobre os cuidados aos pacientes pediátricos com derivação ventricular externa. Entre o pré e o pós-teste realizou-se intervenção educativa usando-se a simulação clínica como estratégia de ensino. Participaram do estudo 41 profissionais de Enfermagem. Constatou-se mais assertividade após a intervenção educativa, principalmente na questão que versa sobre o uso da técnica asséptica para esvaziamento da bolsa coletora (p=0,021). As análises de correlação no préteste revelaram que o maior número de erros não esteve correlacionado a qualquer das variáveis sociodemográficas. Contudo, no pós-teste, identificou-se correlação significativa entre o número de erros com a idade dos profissionais (rho=0,340; p=0,015); tempo de formação dos profissionais (rho= 0,414; p=0,004); e tempo de atuação na unidade (rho=0,428; p=0,004). O resultado sinaliza, portanto, que profissionais com idades mais elevadas, mais tempo de profissão e de atuação na unidade tiveram menos aproveitamento da intervenção educativa, apresentando maior número de erros. A intervenção educativa usando a estratégia da simulação clínica possibilitou incremento no conhecimento dos participantes, podendo ser utilizado para a educação permanente, melhorando a qualidade da assistência.(AU)

Objective: This study aimed to analyze the repercussion of an educational intervention on the theoretical knowledge of the Nursing team regarding the use of external ventricular drains in Pediatrics. This is an uncontrolled intervention study, with a before and after study design. Method: A pre- and post-test was applied to collect information on the nurses' knowledge regarding the care of pediatric patients with external ventricular drains. Between the pre- and post-test, an educational intervention was performed using clinical simulation as a teaching strategy. 41 nursing professionals participated in the study. The professionals were more assertive after the educational intervention, especially regarding the use of an aseptic technique for emptying the collection bag (p=0.021). Correlation analyses in the pre-test revealed that the greatest number of errors was not correlated to any of the socio-demographic variables. However, in the post-test, a significant correlation was identified between the number of errors and the participants' age (rho=0.340; p=0.015); years since graduation (rho=0.414; p=0.004); and years of professional experience in the unit (rho=0.428; p=0.004). Therefore, the result shows that older professionals, with more...(AU)

Objetivo: analizar la repercusión de la intervención educativa en el conocimiento teórico del personal de enfermería sobre cuidados en el manejo del drenaje ventricular externo en pediatría. Estudio de intervención no controlado, con diseño antes ­ después. Método: se aplicó la prueba antes y después para la recogida de datos sobre el conocimiento de los profesionales acerca de los cuidados de pacientes pediátricos con drenaje ventricular externo. Entre las pruebas antes y después se realizó la intervención educativa con simulación clínica como estratégia de enseñanza. En el estudio participaron 41 profesionales de enfermería. Se constató más asertividad después de la intervención educativa, principalmente en lo referente al uso de la técnica aséptica para realizar el vaciado de la bolsa recolectora (p=0,021). Los análisis de correlación de la prueba anterior revelaron no haber ninguna correlación entre la cantidad de errores y alguna de las variables sociodemográficas. Sin embargo, en la prueba posterior se identificó la correlación significativa entre la cantidad de errores y la edad de los profesionales (rho=0,340; p=0,015); el tiempo de graduación (rho= 0,414; p=0,004); y el tiempo de trabajo en la unidad (rho=0,428; p=0,004). El resultado indica que los profesionales con más edad, más tiempo de profesión y de trabajo en la unidad aprovecharon menos la intervención educativa y que cometieron más errores. La intervención educativa usando la estrategia de la simulación clínica ha permitido aumentar el conocimiento de los participantes y podría adoptarse en la educación permanente con miras a mejorar la calidad asistencial.(AU)

Infecciones asociadas a sistemas de derivación de líquido cefalorraquídeo en pediatría: análisis epidemiológico y de factores de riesgo de mortalidad / Cerebrospinal fluid shunt-associated infections in pediatrics: Analysis of the epidemiology and mortality risk factors

Introducción. La infección es de las complicaciones más frecuentes de los sistemas de derivación ventricular de líquido cefalorraquídeo. El objetivo fue describir las características clínicas, microbiológicas y evolutivas de niños con infección asociada a sistemas de derivación ventricular de líquido cefalorraquídeo y analizar los factores de riesgo, relacionados con la mortalidad. Población y métodos. Estudio descriptivo, retrospectivo, llevado a cabo en el Hospital "Prof. Dr. Juan P. Garrahan" de la Ciudad de Buenos Aires. Se evaluaron todos los pacientes internados desde el 1/1/2012 y el 31/12/2015 compatibles con ventriculitis y cultivo de líquido cefalorraquídeo positivo. Resultados. Se incluyeron 49 pacientes con 57 infecciones. La mediana de edad fue de 62 meses (rango intercuartílico: 19-114). Predominó el sexo masculino: 34 (70%). El tumor del sistema nervioso central fue la enfermedad de base más frecuente: 20 (40%). Se aisló estafilococo coagulasa negativo en 26 (46%), Staphylococcus aureus en 13 (23%), bacilos Gramnegativos en 11 (19%) y otros en 7 (12%). En 55 (97%) de las infecciones, se realizó tratamiento quirúrgico con retiro del sistema de derivación ventricular más antibioticoterapia. La mortalidad fue del 9%. Los únicos factores asociados a la mortalidad estadísticamente significativos fueron hemocultivos positivos (p= 0,04), fiebre al ingreso (p= 0,04) y shock séptico (p= 0,0006). Conclusiones. El estafilococo coagulasa negativo fue el germen más frecuente. El retiro de la válvula, junto con la antibioticoterapia, fue el tratamiento más utilizado. La presencia de fiebre al ingreso, hemocultivos positivos y shock séptico fueron predictores de mortalidad.

Introduction. Infections are the most common complications of ventricular cerebrospinal fluid shunts. The objective of this study was to describe the clinical, microbiological, and evolutionary characteristics of children with ventricular cerebrospinal fluid shunt-associated infections and analyze the risk factors for mortality. Population and methods. Descriptive, retrospective study carried out at Hospital "Prof. Dr. Juan P. Garrahan" in the Autonomous City of Buenos Aires. All patients hospitalized between January 1st, 2012 and December 31st, 2015 who were compatible with ventriculitis and had a positive cerebrospinal fluid culture were assessed. Results. A total of 49 patients with 57 infections were included. Their median age was 62 months (interquartile range: 19-114). Males predominated: 34 (70%). A central nervous system tumor was the most common underlying disease: 20 (40%). Coagulase-negative Staphylococcus was isolated in 26 (46%); Staphylococcus aureus, in 13 (23%); Gram-negative bacilli, in 11 (19%); and other microorganism, in 7 (12%). Treatment consisted of removal of ventricular shunt plus antibiotic therapy for 55 (97%) infections. The mortality rate was 9%. The only statistically significant factors associated with mortality were positive blood cultures (p= 0.04), fever at the time of admission (p= 0.04), and septic shock (p= 0.0006). Conclusions. Coagulase-negative Staphylococcus was the most common microorganism. Valve removal plus antibiotic therapy was the most frequently instituted treatment. Fever at the time of admission, positive blood cultures, and septic shock were predictors of mortality.

Surgical Management of Syringomyelia Associated with Spinal Adhesive Arachnoiditis, a Late Complication of Tuberculous Meningitis: A Case Report / 대한신경손상학회지

Syringomyelia associated with tuberculous meningitis is an extremely rare condition. Only a few studies have reported clinical experience with syringomyelia as a late complication of tuberculous meningitis. Twenty-six years after a tuberculous meningitis episode, a 44-year-old man presented with progressively worsening spastic paresis of the lower limbs and impaired urinary function for 2 years. Radiological examination revealed syringomyelia extending from the level of C2 to T9 and arachnoiditis with atrophy of the spinal cord between C2 and T3. We performed laminectomy from C7 to T1, dissected the arachnoid adhesion and placed a syringo-pleural shunt via keyhole myelotomy. One year after the operation, his neurological condition improved. The postoperative control magnetic resonance imaging revealed the correctly located shunt and significantly diminished syringomyelia cavities. We aim to discuss the mechanism of syrinx formation following tuberculous meningitis and to share our surgical therapeutic experience with this rare disease entity.

Shunt Overdrainage Caused by Displacement of the Pressure Control Cam after Pressure Adjustment / 대한신경손상학회지

Although the Codman-Hakim programmable valve is one of most popular shunt systems used in the clinical practice for the treatment of hydrocephalus, malfunctions related with this system have been also reported which lead to underdrainage or overdrainage of the cerebrospinal fluid. While obstruction of the ventricular catheter by tissue materials or hematoma and catheter disconnection are relatively common, the malfunction of the valve itself is rare. Herein, we report on a rare case of shunt overdrainage caused by displacement of the pressure control cam after pressure adjustment. A 57-year-old female, who underwent a ventriculoperitoneal shunt eight years ago, experienced aggravating symptoms of shunt overdrainage after pressure adjustment. Displacement of the pressure control cam was revealed on the X-ray, and a shunt revision was performed. The purpose of this report is to provide a working knowledge of the valve structure and to enhance the ability to interpret the valve setting on an X-ray for diagnosis of valve malfunction.

Síndrome de Hakim Adams: evaluación de la calidad de vida luego de la cirugía / Hakim Adams syndrome: assessment of quality of life after surgery

Introducción: el síndrome de Hakim Adams, o hidrocefalia normotensiva, es un cuadro progresivo que se caracteriza por presentar alteración de la marcha, trastornos esfinterianos y demencia, y que afecta principalmente a pacientes añosos. Si bien existen publicaciones sobre los resultados del tratamiento quirúrgico, estos trabajos suelen evaluar la mejoría sintomática pero no la calidad de vida de los pacientes. Objetivo: Conocer el impacto del tratamiento en pacientes con síndrome de Hakim Adams tratados con derivación de LCR. Material y Métodos: Realizamos un estudio retrospectivo de una serie de 8 pacientes. Se realizó una encuesta para la evaluación preoperatoria y postoperatoria; con un tiempo transcurrido no menor a 6 meses luego del procedimiento. Se utilizó la escala de Barthel para la funcionalidad, y una escala numérica simple para la calidad de vida. Resultados: Previo a la cirugía, 7 casos presentaban alteraciones de la marcha y/o problemas para deambular; 6 casos alteraciones esfinterianas; y 5 casos algún tipo de alteración neurocognitiva. Luego de la cirugía, todos los pacientes refirieron un cambio significativo en la calidad de vida; y también en la funcionalidad, logrando 6 pacientes una independencia absoluta. Conclusión: Aunque nuestra comunicación tiene las debilidades de una serie pequeña de casos analizados en forma retrospectiva, los resultados son concluyentes en cuanto a mejora en la calidad de vida y funcionalidad en el postoperatorio. Creemos que esta modalidad de evaluación puede ayudar a los pacientes y/o familiares de pacientes en el proceso de toma decisiones del tratamiento quirúrgico.

Introduction: the Hakim Adams’ syndrome is a chronic hydrocephalus of the elderly with normal or low CSF pressure that clinically have gait disturbances, urinary incontinence and dementia. Although there are some publications about the surgical results in terms of the relief of symptoms, they don’t usually evaluate the patients’ quality of life. Material and Methods: We are reporting a retrospective study of a series of 8 patients with diagnosis of Hakim Adams’ syndrome that was performed to assess the influence of CSF shunting on their quality of life. A survey was performed to record the preoperative status, with at least 6-months after surgery. Functional results were evaluated with Barthel’s scale; and the quality of life with a simple numeric scale. Results: Before surgery, 7 cases had gait disturbances; 6 cases had urinary incontinence; and 5 cases had neurocognitive impairment. Postoperatively, all patients reported a significative change in their quality of life, and also in the functional scale; 6 cases obtained total independence. Conclusion: Although our communication has the weakness of the small number of cases evaluated in a retrospective manner, the results are conclusive in terms of functionality improvement and quality of life. This kind of assessment may help to our patients and/or patients’ family in the decision making process of shunting procedures.

Derivação ventriculoatrial percutânea – Nota técnica / Derivation percutaneous atrial ventricle - Technical Note

Descrição passo a passo de técnica de derivação ventriculoatrial utilizando punção cervical percutâneapor técnica de Seldinger. O objetivo é demonstrar e difundir entre os neurocirurgiões brasileiros umaforma alternativa segura, rápida e e'caz de introdução e instalação de cateter venoso até o átrio direito,sem necessidade de dissecção venosa convencional. São vantagens a redução do tempo cirúrgico eo melhor resultado cosmético, sem aumento signi'cativo do custo...

Step-by-step technique using ventriculoatrial shunt through percutaneous cervical puncture by Seldinger’s technique. The goal is to demonstrate and spread among Brazilian neurosurgeons an alternative safe, fast and effective way to introduce and install venous catheter up to the right atrium without the need for conventional venous dissection. Advantages of the method are shorter surgical time and better cosmetic results, without significant increase in the cost...

Compressão medular decorrente de hiperdrenagem de derivação ventriculoperitoneal: uma rara complicação / Spinal cord compression caused by ventriculoperitoneal shunt overdrainage: a rare complication

A derivação ventriculoperitoneal (DVP) representa uma forma importante e comum de tratamento da hidrocefalia. Entretanto, pode ocorrer uma série de complicações durante a sua instalação ou por causa de seu mau funcionamento, como infecção, obstrução e hiperdrenagem liquórica. Nesse trabalho, descrevemos uma rara complicação em que um paciente submetido à DVP evoluiu com tetraparesia progressiva. Investigação posterior evidenciou hiperdrenagem da válvula, levando a diminuição do retorno venoso intracraniano, dilatação do plexo venoso epidural e consequente compressão medular no nível da junção bulbomedular. Após o diagnóstico, fizemos o ajuste no nível de desempenho da válvula, e o paciente evoluiu com melhora clínica. Concluímos que o conhecimento desse tipo de complicação associada à disfunção de DVP pode levar a um diagnóstico mais precoce e melhor resposta ao tratamento. O tratamento envolve a correção do fator causal, ou seja, a hiperdrenagem...

The ventriculoperitoneal shunt represents an important and common treatment of hydrocephalus. However, there may be a number of complications during installation or due to a malfunction, such as infection, obstruction and overdrainage. In this paper, we described a rare complication in a patient submitted to a shunt who evolved to progressive tetraparesis. Further investigation showed valve overdrainage, leading to a decrease in venous return, intracranial epidural venous plexus dilatation and consequent cord compression at cervicomedullary junction. After the diagnosis, we adjusted the level of performance of the valve and the patient clinically improved. We concluded that the knowledge of this kind of complication related to shunt dysfunction may take to an early diagnosis and a better treatment response. The treatment involves correcting the causative factor which is the overdrainage...

Infecção relacionada à derivação ventricular externa em hospital de neurocirurgia / Infección relacionada con derivación ventricular externa en hospital de neurocirugía / Infection related to the external ventricular shunt in a neurosurgery hospital

Objective: Identify the factors co-responsible for infection related to external ventricular shunt (EVS). Method: This is a retrospective study with quantitative data analysis developed at the Medical Archive Service of a public hospital which is a reference in neurosurgery in Pernambuco, Brazil. The sample consisted of 140 patients who underwent the insertion of external ventricular shunt. Data were collected through a semi-structured questionnaire and analyzed using the software Statistical Package for the Social Sciences (SPSS), version 13.0. Results: Predominance of males (39.7%); age between 20 and 39 years (52%); length of hospital stay over 60 days (72.7%); multiple EVS placed (100%); length of EVS use over 30 days (96.2%). Conclusion: Statistical significance for the factors: prolonged length of hospital stay; number of EVS placed; length of EVS use; and the development of infection. Nursing actions are emerging and they're aimed at ensuring patient safety in the hospital environment

Objetivo: Identificar os fatores corresponsáveis de infecção relacionada à derivação ventricular externa (DVE). Método: Trata-se de estudo retrospectivo com análise quantitativa dos dados desenvolvido no Serviço de Arquivo Médico de um hospital público que é referência em neurocirurgia em Pernambuco. A amostra foi constituída por 140 pacientes submetidos a inserção de derivação ventricular externa. Os dados foram coletados por meio de um questionário semiestruturado e analisados com o programa Statistical Package for the Social Sciences (SPSS), versão 13.0. Resultados: Predominância do sexo masculino (39,7%); idade entre 20 e 39 anos (52%); tempo de internamento acima de 60 dias (72,7%); múltiplas DVEs colocadas (100%); tempo de uso da DVE acima de 30 dias (96,2%). Conclusão: Significância estatística para os fatores: tempo de internação prolongado; número de DVEs colocadas; tempo de uso da DVE; e o desenvolvimento de infecção. As ações de enfermagem são emergentes e visam a garantir a segurança do paciente no ambiente hospitalar

Objetivo: Identificar los factores co-responsables de infección relacionada con la derivación ventricular externa (DVE). Método: Esto es un estudio retrospectivo con análisis cuantitativo de datos desarrollado en el Servicio de Archivo Médico de un hospital público que es referencia en neurocirugía en Pernambuco, Brasil. La muestra consistió de 140 pacientes que se sometieron a inserción de una derivación ventricular externa. Los datos fueron recogidos por medio de un cuestionario semi-estructurado y analizados con el programa Statistical Package for the Social Sciences (SPSS), versión 13.0. Resultados: Predominio del sexo masculino (39,7%); edad entre 20 y 39 años (52%); tiempo de hospitalización mayor que 60 días (72,7%); múltiples DVEs colocadas (100%); tiempo de utilización de la DVE mayor que 30 días (96,2%). Conclusión: Significancia estadística para los factores: tiempo prolongado de hospitalización; número de DVEs colocadas; tiempo de utilización de la DVE; y el desarrollo de infección. Las acciones de enfermería están surgiendo y tienen el fin de garantizar la seguridad del paciente en el entorno hospitalario

Programmable valve represents an efficient and safe tool in the treatment of idiopathic normal-pressure hydrocephalus patients / Válvula de pressão programável representa uma ferramenta eficaz e segura no tratamento de pacientes com hidrocefalia de pressão normal idiopática

Idiopathic normal pressure hydrocephalus (iNPH) is characterized by gait disturbance, dementia and /or urinary incontinence, dilation of the ventricular system and normal opening cerebrospinal fluid pressure. Shunt surgery is the standard treatment of iNHP. Diversions with programmable valves are recommended, once drainage pressure can be changed. However, well-defined protocols still lack guiding the steps to attain proper pressure for each patient. Methods: In our study, we reported the experience of shunting 24 patients with iNPH using Strata® (Medtronic) valve, following a protocol based on a positive Tap Test. Results: We observed clinical improvement in 20 patients and stability/worsening in 4 patients. Complications occurred in five patients, including one death. The results display improvement, and complications occurred at a lower rate than reported in other studies. Conclusions: The Strata® valve used in the proposed protocol represents an efficient and safe tool in the treatment of iNPH. .

A hidrocefalia de pressão normal idiopática (iNPH) é caracterizada por alterações na marcha, demência e/ou incontinência urinária, além de dilatação dos ventrículos com pressão normal de abertura no líquido cefalorraquidiano. A cirurgia de derivação é o principal tratamento da iNHP. São recomendadas válvulas programáveis, pois a pressão de drenagem pode ser alterada. Embora as válvulas programáveis sejam utilizadas, não há protocolos para atingir a pressão adequada de cada paciente. Métodos: Neste estudo, relatamos nossa experiência com 24 pacientes com iNPH que usaram a válvula Strata® (Medtronic), seguindo protocolo baseado em um Tap test positivo. Resultados: Observamos melhora em 20 pacientes e estabilidade ou piora em 4. Ocorreram complicações em cinco pacientes, tendo um deles falecido. Houve importante melhora clínica, e as complicações ocorreram em taxa mais baixa do que as relatadas em outros estudos. Conclusões: A válvula Strata® utilizada no protocolo proposto representa uma ferramenta eficiente e segura no tratamento de iNPH. .

Shunt-Responsive Idiopathic Normal Pressure Hydrocephalus Patient with Delayed Improvement after Tap Test

The cerebrospinal fluid tap test (CSFTT) is recommended as a key step in the diagnosis of idiopathic normal pressure hydrocephalus (iNPH). While there is no generally accepted evaluation period for ascertaining a CSFTT responder, a substantial number of patients are evaluated only once within 24 hours of the test for improvement in gait. We report an iNPH patient with a favorable response to shunt surgery, who was first judged a non-responder by this standard, though subsequently was judged a responder in virtue of repetitively testing gait over 7 days. A 68-year-old man presented with progressive impairment of gait, balance, and memory. He was diagnosed as iNPH with an Evans' ratio of 0.35. At first hospitalization, change in gait was evaluated 24 hours after the CSFTT. He didn't show any significant improvement and was judged as a non-responder. However, at the second CSFTT, we repetitively tested his change in gait over seven days. Forty-eight hours after the tap, he showed significant improvement in his gait. He was then confirmed as a responder. After the operation, the gait difficulties were almost fully resolved. Further studies developing the standard procedure of the CSFTT should be considered.

Performance of fixed-pressure valve with antisiphon device SPHERA® in hydrocephalus treatment and overdrainage prevention / Desempenho da válvula de pressão fixa com antissifão SPHERA® no tratamento da hidrocefalia e na prevenção da ocorrência de hiperdrenagem

Patients with hydrocephalus and risk factors for overdrainage may be submitted to ventricular shunt (VS) implant with antisiphon device. The objective of this study was to prospectively evaluate for two years the clinical and tomographic results of the implant of fixed-pressure valves with antisiphon device SPHERA® in 35 adult patients, with hydrocephalus and risk factors for overdrainage. Of these, 3 had congenital hydrocephalus in adult patients with very dilated ventricles (Evans index >50%), 3 had symptomatic overdrainage after previous VS implant (subdural hematoma, hygroma or slit ventricle syndrome), 1 had previous chronic subdural hematoma, 15 had normal pressure hydrocephalus with final lumbar pressure <5 cm H2O after tap test (40 mL), 6 had pseudotumor cerebri, and 7 had hydrocephalus due to other causes. Clinical improvement was observed and sustained in 94.3% of the patients during the two-year period with no computed tomography (CT) evidence of hypo or overdrainage, and no immediate early or late significant complications.

Pacientes com hidrocefalia e fatores de risco para hiperdrenagem podem ser submetidos ao implante de derivação ventricular (VS) com mecanismo antissifão. O objetivo deste trabalho foi avaliar prospectivamente os resultados clínicos e tomográficos do implante de válvulas de pressão fixa com antissifão SPHERA® em 35 pacientes adultos, com hidrocefalia e risco de hiperdrenagem, acompanhados por dois anos. Destes, 3 apresentavam hidrocefalia congênita em adulto, com ventrículos muito dilatados (índice de Evans >50%); 3 tinham hiperdrenagem sintomática pós-derivação ventricular prévia (hematoma subdural, higroma ou síndrome dos ventrículos colabados; 1 apresentava hematoma subdural crônico pregresso; 15 apresentavam hidrocefalia de pressão normal com pressão lombar final <5 cm H2O após tap test (40 mL); 6 apresentavam pseudotumor cerebral; e 7, devido a outras causas. A melhoria clínica foi detectada e sustentada em 94,3% dos pacientes no período de dois anos, sem indícios tomográficos de hipo ou hiperdrenagem e sem complicações significativas imediatas, precoces ou tardias.

The Risk Factors of External Ventricular Drainage-Related Infection at Hospital Kuala Lumpur: An Observational Study

Background: External ventricular drainage (EVD) has been widely used for the purpose of cerebrospinal fluid (CSF) diversion at Hospital Kuala Lumpur (HKL). Method: This prospective observational study was conducted in HKL from December 2006 to December 2008 among patients who were subjected for EVD, following strict inclusion and exclusion criteria. Results: The frequency of EVD-related infection was as high as 32.2% (95% CI 23.3% to 42.57%) among 87 patients studied. This study clearly demonstrates that tunnelling the catheter for more than 5 cm under the scalp, from the burr hole to the exit site of the skin, carried a significantly lower risk of infection compared with tunnelling the catheter for 5 cm or less (OR = 0.184, 95% CI 0.083 to 0.406, P < 0.001). The majority of cases (19 out of 28) with EVD-related infection occurred among patients catheterised for more than 10 days (OR = 0.334, 95% CI 0.171 to 0.652, P < 0.001). Conclusion: The technique of subgaleal tunnelling of more than 5cm and the duration of the ventricular catheterisation of 10 days and less should be implemented as standardised protocol at health institutions to reduce the risk of EVD-related infections.

Therapeutic effect of microinvasive operation treatment 40 patients with cerebral hemorrhage broken into ventricles of brain / 中国基层医药

Objective To study the therapeutic method and effects of spontaneous cerebral hemorrhage broken into ventricles of brain.Methods 40 cases of cerebral hemorrhage broken into ventricles of brain were treated by only puncturing and draining the hematoma,unilateral or bilateral lateral ventricle and the hematoma plus lateral ventricle,and the urokinase and discharging the cerebrospinal fluid by lumbar puncture were used after operation.Results The treatment of 26 cases(65%) had notable progress,6(14%) had progress and 2(5%) had no progress or exacerbation and 6 cases(15%) were dead.Tota leffective rate was 80%.Conclusion The methods used in this study are simple,practical and have definitive curative effects.

Derivación ventrículo-receso suprahepático: Otra opción / Derivation ventricle-recess suprahepático. Another option

Se reporta que la hidrocefalia constituye una afección frecuente, al igual que las reintervenciones causadas por fallos de los sistemas de derivación empleados, hecho que motivó la introducción en el Servicio de Neurocirugía del Hospital Provincial Clinicoquirúrgico Docente "Manuel Ascunce Domenech" de Camagüey, de esta técnica. Se hizo análisis sobre la utilidad de la derivación ventrículo-receso suprahepático, y se determinó la frecuencia de reintervenciones después de este método, entre otras variables. Se practicó un estudio retrospectivo de los 4 pacientes a los cuales se les aplicó esta técnica. Los datos se obtuvieron a partir de una encuesta y se practicó el procesamiento estadístico mediante el programa MICROSTAD. El origen de la hidrocefalia fue con mayor frecuencia la estenosis adquirida idiopática del acueducto de Silvio. A 3 de los pacientes se les habían realizado ya derivaciones al peritoneo y a la aurícula derecha, con múltiples reintervenciones. Durante el seguimiento, 1 solo paciente requirió intervención nuevamente, por obstrucción del extremo ventricular del sistema. En los casos tratados la técnica ha sido de gran utilidad terapéutica. Se recomienda practicar la derivación ventrículo-receso suprahepático después del fallo de la derivación al fondo del saco peritoneal, con excepción de los casos con complicaciones infecciosas(AU)

It is reported that hydrocephalus is a a frequent affection as well as the reoperations caused by failures of the shunt systems used. This fact motivated the introduction of this technique in the Neurosurgery Service of "Manuel Ascunce Domenech" Provincial Clinical and Surgical Hospital of Camagüey. An analysis was made on the usefulness of the ventriculosuprahepatic recess shunt and the frequency of reoperations after using this method was determined, among other variables. A retrospective study of the 4 patients who underwent this pocedure was conducted. Data were obtained from a survey and it was applied the statistical processing by the MICROSTAD program. The commonest origin of hydrocephalus was the acquired idiopathic stenosis of the aqueduct of Sylvius. 3 of the patients had already undergone shunts to the peritoneum and to the right auricle with multiple reoperations. During the follow-up, only 1 patient required a new operation due to the obstruction of the ventricular extreme of the system. This technique has had a great therapeutical usefulness in the treated cases. It is recommended to perform the ventriculosuprahepatic recess shunt after the failure of the shunting to the fundus of the peritoneal sac, excepting those cases with infectious complications(AU)

Four cases of candida meningitis / 대한내과학회지

No abstract available.