ABSTRACT
Presence of the artery of Desproges-Gotteron is extremely rare. It has seldom been mentioned in the literature as well. The authors have dealt with a case of a dural arteriovenous malformation (AVM ) of conus medullaris fed by the artery of Desproges-Gotteron in a young female of 19 years. The patient presented with a tingling sensation of lower limbs, progressive difficulty walking, and incontinence of the bladder. There was weakness in all groups of muscle of both lower limbs and definite sensory level on examination. Magnetic resonance imaging revealed multiple flow voids at the level of conus medullaris. Spinal digital subtraction angiography (DSA) revealed dural AVM at the level of conus. The patient underwent transarterial embolization with 30% Endocryl( n -butyl cyanoacrylate) in two stages, and repeated spinal DSA revealed no evidence of residual AVM. Patient's neurology gradually improved. Almost 2 years down the line, the follow-up revealed gradual but complete motor and sensory deficits recovery except for occasional burning pain in lower limbs. Spinal AVM supplied by the artery of Desproges-Gotteron is a unique variation. Moreover, the authors believe that it is the first reported case in Bangladesh.
ABSTRACT
Background and Objectives: Ventriculoperitoneal Shunt (VPS) and Endoscopic Third Ventriculostomy (ETV) are both gold standard procedures to reduce intracranial pressure (ICP) in patients with obstructive hydrocephalus, which often results in papilledema. This comparative study was carried out at the Department of Neurosurgery of Dhaka Medical College and Hospital to compare the efficacy of VPS and ETV in the resolution of papilledema in 18 patients with obstructive hydrocephalus. Materials and Methods: The success of CSF diversion was evaluated by a decrease in retinal nerve fiber layer (RNFL) thickness by optical coherence tomography (OCT) and modified Frisen grading of papilledema at the same time. The statistical analyses were carried out by using paired sample t test and the Spearman's correlation coefficient test. The level of significance (p value) was set at <0.05. Results: After 7 days, both VPS and ETV were able to reduce RNFL thickness of both eyes with a p value = 0.016 (right eye) and 0.003 (left eye) in group A (VPS) and with a p value <0.001 (both eyes) in group B (ETV). Change of Frisen grading after CSF diversion was not satisfying for both the procedures with p value > 0.05. Further, the inter-group comparison between VPS and ETV showed no difference in decreasing RNFL thickness and modified Frisen grading (p value = 0.56). Conclusion: VPS and ETV procedures both appear very efficient in treating obstructive hydrocephalus, which in turn reduces papilledema in these patients. This paper is preliminary and requires further work.
