Clinical performance of fixed-pressure Sphera Duo® hydrocephalus shunt / Performance clínica da válvula de pressão fixa Sphera Duo®

Abstract Introduction: Cerebral hydrodynamics complications in shunted patients are due to the malfunction of the system. The objective of this retrospective, single-center, single-arm cohort study is to confirm the safety and performance of Sphera® Duo when used in adult patients suffering from hydrocephalus, pseudotumor cerebri or arachnoid cysts. Methods: Data were generated by reviewing 112 adult patient's charts, who were submitted to a ventriculoperitoneal shunt surgery and followed for one year after surgery. Results: The results show us that 76% of patients had their neurological symptoms improved and that the reoperation rate was 15% in the first year following surgery. Discussion: Sphera Duo® shunt system is an applicable shunt option in routine neurosurgical management of hydrocephalus by several causes. It has presented good results while mitigating effects of overdrainage. Overdrainage is especially important in adults with non-hypertensive hydrocephalus and can cause functional shunt failure, which causes subnormal ICP (particularly in the upright position) and is associated with characteristic neurological symptoms, such as postural headache and nausea. Conclusion: Sphera Duo® shunt system is safe when used in adult patients suffering from hydrocephalus, pseudotumor cerebri or arachnoid cyst.

Resumo Introdução: As complicações da hidrodinâmica cerebral em pacientes com derivação ventriculoperitoneal são frequentemente relacionadas ao malfuncionamento do sistema. O objetivo deste estudo retrospectivo de coorte de centro único é avaliar a segurança e performance clínica do Sistema Sphera® Duo quando utilizado em adultos com hidrocefalia, pseudotumor cerebral ou cistos aracnoides. Métodos: Avaliamos os prontuários de 112 pacientes adultos submetidos a cirurgia de derivação ventriculoperitoneal e acompanhados por 1 ano após a cirurgia. Resultados: O resultado mostra que 76% dos pacientes melhoraram dos sintomas neurológicos e a taxa de reoperação foi de 15% no primeiro ano após a cirurgia. Discussão: O sistema de derivação Sphera Duo® é uma opção de shunt adequada a ser usada no tratamento neurocirúrgico da hidrocefalia por causas diversas. Ele demonstrou bons resultados clínicos enquanto reduziu riscos de hiperdrenagem. A hiperdrenagem é especialmente preocupante e mórbida em pacientes adultos com hidrocefalia não hipertensiva e pode levar a prejuízo clínico e disfunção da válvula, com sintomas de hipotensão craniana, como cefaléia ortostática e náuseas. Conclusão: O sistema de derivação Sphera Duo® é seguro para tratamento da hidrocefalia, pseudotumor cerebri ou cistos aracnóides em adultos.

Bariatric surgery as a treatment for pseudotumor cerebri: case study and narrative review of the literature / Cirurgia bariátrica como tratamento para pseudotumor cerebri: estudo de caso e revisão narrativa de literatura

ABSTRACT CONTEXT: Pseudotumor cerebri occurs when there is an increase in intracranial pressure without an underlying cause, usually leading to loss of vision. It is most commonly observed in obese women of child-bearing age. CASE REPORT: A 46-year-old woman presented at our service with idiopathic intracranial hypertension that had been diagnosed two years earlier, which had led to chronic refractory headache and an estimated 30% loss of visual acuity, associated with bilateral papilledema. She presented partial improvement of the headache with acetazolamide, but the visual loss persisted. Her intracranial pressure was 34 cmH2O. She presented a body mass index of 39.5 kg/m2, also associated with high blood pressure. Computed tomography of the cranium with endovenous contrast did not show any abnormalities. She underwent Roux-en-Y gastric bypass with uneventful postoperative evolution. One month following surgery, she presented a 24% excess weight loss. An ophthalmological examination revealed absence of visual loss and remission of the papilledema. There were no new episodes of headache following the surgery. There was also complete resolution of high blood pressure. The intracranial pressure decreased to 24 cmH2O, six months after the surgery. CONCLUSION: Although the condition is usually associated with obesity, there are few reports of bariatric surgery among individuals with pseudotumor cerebri. In cases studied previously, there was high prevalence of resolution or improvement of the disease following bariatric surgery. There is no consensus regarding which technique is preferable. Thus, further research is necessary in order to establish a specific algorithm.

RESUMO CONTEXTO: O pseudotumor cerebri ocorre quando há aumento na pressão intracraniana sem causa subjacente, comumente levando a perda visual. É mais comum em mulheres obesas em idade fértil. RELATO DE CASO: Mulher de 46 anos, foi admitida com hipertensão intracraniana idiopática diagnosticada há dois anos, que levou a cefaleia refratária crônica e perda estimada de 30% da acuidade visual, associada a papiledema bilateral. Apresentou melhora parcial da cefaleia com acetazolamida, mas a perda visual persistiu. A pressão intracraniana era de 34 cmH2O. Apresentava índice de massa corpórea de 39,5 kg/m2, associado a hipertensão arterial. Tomografia computadorizada com contraste endovenoso de crânio não apresentou anormalidades. Foi submetida ao bypass gástrico em Y de Roux, com evolução pósoperatória sem intercorrências. Um mês após a cirurgia, apresentou perda de peso em excesso de 24%. Um exame oftalmológico demonstrou ausência de perda visual e remissão do papiledema; não houve novos episódios de cefaleia após a cirurgia. Houve também resolução completa da hipertensão arterial. A pressão intracraniana caiu para 24 cmH2O após seis meses da cirurgia. CONCLUSÃO: Embora a condição seja usualmente associada à obesidade, há escassos relatos de cirurgia bariátrica em indivíduos com pseudotumor cerebri. Nos casos previamente estudados, há alta prevalência de resolução ou de melhora da doença após a cirurgia bariátrica. Não há consenso sobre qual é a técnica cirúrgica de escolha. Portanto, mais estudos são necessários para estabelecer um algoritmo específico.

Pseudotumor cerebri: protocolo de tratamiento / Pseudotumor cerebri: treatment protocol

Objective: to propose a protocol for the management of patients with pseudotumor cerebri, including medical, ophthalmic, and surgical evaluation, describing the complications associated with the latter and its evolution.Materials and methods: we analyzed our database between 2006 and 2011, determining how many patients who had consulted for pseudotumor cerebri required surgical treatment. We analized how many lumbar punctures (LP) they needed, which was the alternative medical treatment that was applied and what factors led to a surgical procedure. Based on these results, we structured a protocol for the management of these patients at our institution. Results: between 2006 and 2011, 115 patients were diagnosed with pseudotumor cerebri, of whom 11 (10%) required surgical treatment. Regarding medical treatment, acetazolamide and corticosteroids were administered, and up to 10 lumbar punctures were performed, before defining a surgical procedure. Conclusion: pseudotumor cerebri is an entity with a variable and unpredictable response to treatment. It´s essential to follow a protocol for management it. Also it is very important to note that cases unresponsive to medical treatment should be surgically treated to avoid amaurosis, the most severe complication of this disease.

Idiopathic intracranial hypertension: clinical presentation and management

Idiopathic intracranial hypertension [IIH] is an idiopathic increase in intracranial pressure [pressure around the brain] in the absence of a tumor or any other disease. To assess the clinical features and the treatment strategies for patients with IIH. We performed a prospective follow up of patients with IIH diagnosed in our surgical and medical departments. The following data were obtained: age at diagnosis, gender, symptoms of headache, vomiting, visual disturbances, neurological signs, and management. We enrolled 34 patients. A large part of them [44.1%] had an age between 30-39 years and were females [85.3%]. Headache was present in all patients; vomiting interested 23 patients [67.6%]; and papilledema and visual symptoms were seen in 26 subjects [76.5%]. In 20 patients [58.8%] there was no localized neurological symptoms apart from visual symptoms, with fits in 4 [11.8%], meningism in 3 [8.8%] and motor symptoms in 3 [8.8%] as shown in table [2]. Twenty-six cases [76.5%] had a good response to medical treatment. Surgical treatment was performed in 8 subjects [23.5%] as shown in table [3]. Early diagnosis and management are essential in preventing progression of the disease. Fortunately, there appear to be effective treatment strategies available. Headache usually becomes manageable, papilledema regresses, and vision improves in most patients

Cirurgia bariátrica no tratamento do pseudotumor cerebral: relato de caso / Bariatric surgery for treatment of pseudotumor cerebro: a case report

Os autores relatam caso de paciente de 37 anos, obesa mórbida com IMC (índice de massa corporal) de 50 kg/mg apresentando hipertensão intracraniana benigna (pseudotumor cerebral). tratada clinicamente por vários anos sem resposta satisfatória, apresentou remissão total dos sintomas realacionados ao pseudotumor cerebral após cirurgia bariátrica.

An obese woman (body mass index of 50 kg/m²) with benign intracranial hypertension(cerebral pseudotumor) was treated clinically for several years without good results. the patient had total remission of her symptoms after gastric surgery for morbid obesity.

Subarachnoid hemorrhage and intracereebral hematoma following lumboperitoneal shunt for pseudotumor cerebri: a rare complication.

Placement of lumboperitoneal (LP) shunt as a surgical treatment for benign intracranial hypertension (BIH) is generally a safe procedure, with complications like mechanical failure, overdrainage and infections. Subarachnoid hemorrhage and intracerebral hematoma were seen after lumboperitoneal shunt in a patient having BIH. These complications were the cause of the patient's deterioration. After removal of the hematoma and performing a decompressive procedure, patient's neurological condition improved. The clinical features, investigations and clinical course are described and the literature reviewed.

Neurocisticercosis en fase granulomatosa: presentación de un caso / A case report of glanulomatous-phase neurocysticercosis

El 13 de diciembre de 1997 acudió al servicio de urgencias del Hospital Mocel una paciente femenina de 27 años de edad con historia de cefalea de seis meses de evolución. Había sido diagnosticada en otro hospital con neurocisticercosis y tratada médicamente en forma muy irregular. Dos días antes de su ingreso presentó síndrome cráneo-hipertensivo con deterioro del estado de conciencia, hemiparesia derecha y síndrome de babinski bilateral de predominio derecho. Se le practicó una tomografía de cráneo urgente que demostró lesión anular con centro hipodenso, punto pericentral y bordes de hiperdensidad mayor, localizado en la porción anterior del lóbulo frontal izquierdo, hasta la convexidad, compresión del cuerno frontal, gran edema perilesional e importante efecto de masa, motivo por el cual fue sometida a una operación quirúrgica de urgencia

Idiopatthic intracranial hypertension [IIH] a clinical study of diagnosis, therapeutic, and prognostic factors

In this study, forty-two patients with idiopathic intracranial hypertension were diagnosed and managed medically and surgically with emphasizing on the predisposing factors, the presenting symptoms, the clinical signs and the diagnostic procedures [ophthalmological and radiological]. Medical treatment was tried in thirty cases with improvement in twenty cases, no improvement in four cases and deterioration occurred in six cases. Surgery by lumboperitoneal shunting procedure was done in twelve cases with improvement in seven cases, no improvement in three cases and deterioration occurred in two cases

Pseudotumour cerebri. medical and surgical management

A cross sectional study was done for 20 patients with pseudotumour cerebri who were treated at the neurosurgical unit in Mosul Teaching Hospital. All underwent the classical medical treatment by diuretics, corticosteriods, carbonic anhydrase inhibitors and repeated lumbar punctures. Eleven patients underwent surgical treatment by inserting a lumbo-peritoneal shunt in order to stop the progressive deterioration of vision. The aim of this study is to evaluate such methods of treatment and their prognostic value

Cisto de aracnóide e pseudotumor cerebral: relato de caso / Arachnoid cyst and pseudotumor cerebri: case report

Relato do caso de paciente de 12 anos de idade com cisto de aracnóide na fossa craniana posterior e pseudotumor cerebral dependente de derivaçäo cisto-peritoneal previamente instalada. Esta constataçäo corrobora assertivas da literatura que srgerem um mecanismo fisiopatológico em comum para estas duas entidades e que estaria relacionado a defeito no fluxo do líquido cefalorraqueano

Descompressäo da bainha do nervo óptico / Optic nerve sheat decompression

Este trabalho relata nossa experiência com dez pacientes (onze olhos) submetidos à descompressäo da bainha do nervo optico. Cinco eram portadores de pseudotumor cerebral, quatro neuropatia óptica isquêmica anterior, forma progressiva, e um anomalia de Morning Glory com descolamento de retina. Descrevemos a técnica cirúrgica utilizada, as principais indicaçöes, os resultados e as complicaçöes deste procedimento cirúrgico.

Colesteatoma gigante de fosa posterior / Giant cholesteatoma of rear fossa

En un varon de 30 años de edad con cefalea de dos años de evolucion asociada a sindroem cerebeloso izquierdo y sindrome de hipertension endocraneal, se realizo una craneotomia de fosa posterior con la exeresis de un gran tumor con resolucion completa de la enfermedad. El estudio histopatologico reporto un colesteatoma o tumor perlado localizado en la fosa posterior lado izquierdo. La evolucion clinica fue excelente con desaparicion de los sintomas y signos neurologicos. El paciente retorno a su trabajo como conductor de camion

Síndrome de hipertensäo intracraniana / Intracranial hypertension syndrome

Os autores fazem uma revisäo sobre hipertensäo intracraniana enfatizando os aspectos de fisiopatologia e tratamento geral