Endoscopic third ventriculostomy in hydrocephalus secondary to vestibular schwannomas / Tercer ventriculostomía endoscópica en la hidrocefalia secundaria a schwanomas vestibulares

Introduction: Treatment options for hydrocephalus related to posterior fossa tumors have been extensively studied in the pediatric population, but the value of endoscopic third ventriculostomy in hydrocephalus secondary to vestibular schwannoma in adults, is controversial. A systematic search of the medical literature was carried out in Pubmed/Medline and SciElo for the identification and inclusion of articles, in addition to the preprint servers bioRxiv and medRxiv. The following descriptors were used: hydrocephalus and vestibular schwannomas or acoustic neuromas or acoustic neurinomas and endoscopic third ventriculostomy. The initial search found 195 articles. After selection, 5 articles were chosen for the study. Objective: To specify the role of the endoscopic third ventriculostomy in hydrocephalus secondary to vestibular schwannomas. Development: The articles included a total of 82 patients, in which an improvement of the symptoms was achieved in 86.6 percent of the cases. The decrease in ventricular diameter was reported in 82.9 percent of the cases and was only found explicit in 3 articles. Although the failure criteria used were varied, 2 of them predominated: the persistence of progressive symptomatic hydrocephalus and/or the need for shunt placement. Endoscopic third ventriculostomy failure only represented 14.6 percent. Conclusions: Third ventriculostomy is an acceptable technique with relative success for the treatment of symptomatic obstructive hydrocephalus secondary to vestibular schwannomas(AU)

Introducción: Las opciones de tratamiento para la hidrocefalia relacionada con tumores de fosa posterior han sido ampliamente estudiadas en la población pediátrica, pero es controvertido el valor de la tercer ventriculostomía endoscópica, en la hidrocefalia secundaria a schwanoma vestibular en adultos, previo a la resección del tumor. Se realizó una búsqueda sistemática de la literatura médica en Pubmed/Medline y SciElo para la identificación e inclusión de artículos, además de los servidores de preprint bioRxiv y medRxiv. Se utilizaron los siguientes descriptores: hydrocephalus y vestibular schwannomas o acoustic neuromas o acoustic neurinomas y endoscopic third ventriculostomy. La búsqueda inicial encontró 195 artículos. Después de la selección, se eligieron 5 artículos para el estudio. Objetivo: Especificar el papel de la tercer ventriculostomía endoscópica en la hidrocefalia secundaria a schwanomas vestibulares. Desarrollo: Los artículos incluyeron un total de 82 pacientes, en los que se logró una mejoría de los síntomas en el 86,6 por ciento de los casos. La disminución del diámetro ventricular se reportó en el 82,9 por ciento de los casos y solo se encontró explícita en 3 artículos. Aunque los criterios de fracaso utilizados fueron variados, predominaron dos de ellos: la persistencia de hidrocefalia sintomática progresiva o la necesidad de colocación de derivación. La falla de la tercer ventriculostomía endoscópica solo representó el 14,6 por ciento. Conclusiones: La tercera ventriculostomía endoscópica es una técnica aceptable y con relativo éxito para el tratamiento de la hidrocefalia obstructiva sintomática secundaria a schwanomas vestibulares(AU)

Medical therapy using omeprazole in 12 hydrocephalic dogs: clinical, diagnostic, and therapeutic findings / Terapia médica utilizando omeprazol em 12 cães hidrocefálicos: achados clínicos, diagnósticos e terapêuticos

According to experimental studies with healthy dogs, omeprazole might decrease the CSF production by about 26%; therefore, book texts have been suggested the usage of omeprazole in medical protocols for hydrocephalus treatment. However, to the best knowledge of the authors, the usage and medical response of the omeprazole with substantial group of illness dogs, such as hydrocephalic animals, was lacking. This report describes clinical, diagnostic, and therapeutic findings in 12 dogs with hydrocephalus in which omeprazole were used for medical treatment. The diagnosis of hydrocephalus was accomplished by transcranial sonography (TCS) and/or computed tomography. The ventricular measurement was assessed periodically by TCS during medical treatment. Six dogs were diagnosed with non-obstrutive hydrocephalus and in the other 6 cases hydrocephalus occurred with other concomitant anomalous encephalic disease often related with obstructive hysdrocephalus, such as quadrigeminal cist, arachnoid cyst, chiary-like malformation, and syringomyelia. All of them had medical improvement after the use of omeprazole and the most of the cases had ventricular size reduction. In 10 dogs, the omeprazole was used as single drug, and in 2 dogs medical treatment with steroids and/or diuretics was previously being performed, and omeprazole was added because conventional treatment was resulting in mild to unsatisfactory medical control of the neurological status. The results of this paper shown that omeprazole may be used to ameliorate the neurological status in symptomatic hydrocephalic dogs. This work may represent the first description about the use of omeprazole in order to treat a substantial group of affected dogs with suspected increased intracranial pressure by hydrocephalus, probably due to limitation of CSF production.(AU)

O omeprazol diminui a produção do fluido cerebrospinal (FCE) por cerca de 26% de acordo com estudos experimentais em cães saudáveis. Segundo o conhecimento dos autores, embora utilizado na prática clínica e recomendado em livros textos, não há até o momento estudos clínicos em um grupo substancial de animais avaliando a resposta terapêutica ao uso do omeprazol em pacientes enfermos, tais como cães hidrocefálicos sintomáticos. Este trabalho descreve os achados clínicos, diagnósticos e terapêuticos em 12 cães com hidrocefalia que foram submetidos ao tratamento com omeprazol para o manejo médico de hidrocefalia. O diagnóstico de hidrocefalia e doenças neurológicas concomitantes foi realizado por ultrassonografia transcraniana (USTC) e/ou tomografia computadorizada. A mensuração do tamanho ventricular foi realizada pela USTC durante o tratamento médico. Seis cães foram diagnosticados com hidrocefalia não obstrutiva e os outros 6 casos apresentaram hidrofalia concomitante com outras afecções encefálicas anômalas comumente associada à hidrocefalia obstrutiva, tal como cisto quadrigêmio, cisto aracnóide, síndrome de chiari-like e seringomegalia. Em 10 cães o omeprazol foi utilizado como droga única e em 2 cães a terapia inicial foi a convencional utilizando esteroides e diuréticos, e o omeprazol foi adicionado, pois a resposta clínica a terapia convencional foi insatisfatória. Todos os animais obtiveram melhora dos parâmetros neurológicos e a maioria teve uma redução do tamanho ventricular após o uso do omeprazol. Os resultados deste estudo demonstram que o omeprazol pode ser utilizado para melhorar o estado neurológico em cães com hidrocefalia. Este estudo representa a primeira descrição clínica usando o omeprazol para tratar uma série de cães com suspeita de aumento da pressão intracraniana devido à hidrocefalia, provavelmente pela capacidade do fármaco em limitar a produção do FCE.(AU)

Effect of Albendazole Treatment in an Experimental Model of Neurocysticercosis-Induced Hydrocephalus

Hydrocephalus is a major concern in neurocysticercosis (NCC), and its management is more challenging than that of hydrocephalus caused by other etiologies. Even though albendazole is a well-established drug for the treatment of NCC, the death of the parasites may worsen the clinical symptoms and eventually, deteriorate the course of hydrocephalus. The aim of this study was to analyze the effects of treatment with albendazole on the course of hydrocephalus as well as on animal behavior in a ratmodel of NCC-induced hydrocephalus in order to verify whether the course of hydrocephalus and the animal behavior were changed. Ventricle volumes before and after treatment showed a slight but non-statistically significant difference (168.11 mm3 versus 184.98 mm3, p » 0.45). The distribution and location of the cysts were unaffected. In addition, the behavioral patterns before and after the treatment were not significantly different, as assessed by the open field test. On histologic assessment, mononuclear leukocyte infiltration was present in diverse sites, such as the perivascular and peri-ependymal regions, choroid plexus, and meningeal membranes. A positive correlation was found between the degree of ventricle enlargement and tissue damage. Further studies with long-term comparisons are required.

Use of urokinase in the treatment of tuberculous meningitis hydrocephalus

We present a patient with hydrocephalus after tuberculous meningitis successfully treated with urokinase. She presented with multiple episodes of headache, fever, and vomiting. She underwent external ventricular drainage and was treated with urokinase in addition to dexamethasone, acetazolamide, and 4 antituberculous drugs. She was evaluated clinically, radiologically, and by laboratory work-up. On short-term clinical follow-up [3 months], she was asymptomatic after the treatment with urokinase. She was radiologically evaluated 3 weeks after the treatment. An MRI of the brain showed a decrease in ventricular size. Urokinase can be considered as a safe and promising adjunctive treatment for tuberculous meningitis hydrocephalus

Successful treatment of vancomycin-resistant enterococcus ventriculitis in a child

Enterococci are an uncommon cause of CNS infection. A 20 month-old boy, diagnosed with hydrocephalus with ventriculoperitoneal shunt and history of lengthy hospitalization and use of wide spectrum antibiotics, was admitted to the pediatric intensive care unit diagnosed with ventriculitis. On the 14th day of empirical antibiotic therapy (vancomycin and meropenem) the child presented fever while the CSF sample culture evidenced vancomycin-resistant Enterococcus faecium. The patient received intravenous linezolid achieving cerebrospinal fluid sterilization. Conclusion: Intravenous linezolid appears to be a safe and effective therapy for vancomycin-resistant enterococcus ventriculoperitoneal shunt infection.

Hidrocefalia crónica obstructiva por histoplasmosis meningo-cerebral / Chronic obstructive hydrocephalus due to meningeal and cerebral histoplasmosis

El presente caso describe un caso de histoplasmosis del sistema nervioso central con hidrocefalia obstructiva, que ha estado presente durante 8 años sin mayores secuelas o evidencias clínicas de infección activa en otros órganos, en un huésped inmunocompatible. La punción lumbar y el análisis del líquido cefalorraquídeo (LCR) revelaron un elevado nivel de proteínas, linfocitosis e hipoglucorraquia. Los títulos de fijación de complementos séricos y del LCR para histoplasma fueron positivos. La tomografía computada (TC) demostró que existía hidrocefalia y dos lesiones periventriculares con un marcado refuerzo con contraste. Se inició el tratamiento con altas dosis de ketoconazol y a continuación se administró fluconazol con una mejoría parcial del estado clínico y los valores de LCR. Finalmente se le practicó al paciente un tratamiento con anfotericina mostrando una completa remisión clínica, pero sin curación con valores variables en los controles de seguimiento a largo plazo de los títulos de complemento sérico y del LCR. En la actualidad, el paciente permanece asintomático y está tratado con itraconazol oral