ABSTRACT
Reversible vasoconstriction syndrome is a complex of clinical symptoms and angiographic findings, which, while having a mostly benign clinical course, has clinical and imaging overlap with more serious disorders such as vasculitis and aneurysmal SAH and itself includes a minority of patients with fulminant vasoconstriction resulting in severe intracranial complications. Endovascular options for patients with refractory reversible cerebral vasoconstriction syndrome include intra-arterial vasodilator infusion similar to therapy for patients with vasospasm after SAH. To date, only case reports and 1 small series have discussed the utility of intra-arterial vasodilators for the treatment of reversible cerebral vasoconstriction syndrome. We report an additional series of 11 medically refractory cases of presumed or proved reversible cerebral vasoconstriction syndrome successfully treated with intra-arterial verapamil infusion. Furthermore, we propose that the reversal of vasoconstriction, as seen on angiography, could fulfill a diagnostic criterion.
Subject(s)
Cerebrovascular Disorders/drug therapy , Vasoconstriction/drug effects , Vasodilator Agents/administration & dosage , Vasospasm, Intracranial/drug therapy , Verapamil/administration & dosage , Adult , Aged , Female , Humans , Infusions, Intra-Arterial , Male , Middle AgedABSTRACT
Cerebrospinal fluid diversion has become the mainstay treatment in hydrocephalus for over 50 years. As the number of patients with ventricular shunt systems increases, neurointensivists are becoming the first-line physicians for many of these patients. When symptoms of a shunt malfunction are suspected and access to a neurosurgeon is limited or delayed, workup and temporizing measures must be initiated. The article highlights the functional nuances, complications, and management of current programmable shunt valves and their MRI sensitivity.
Subject(s)
Cerebrospinal Fluid Shunts/adverse effects , Cerebrospinal Fluid Shunts/instrumentation , Critical Care/methods , Equipment Failure , Hydrocephalus/surgery , Neurology/methods , Postoperative Complications/therapy , HumansABSTRACT
Neuroendoscopy is an ever-evolving frontier in neurosurgery and its use has spanned decades with safe and efficacious treatment in a variety of cranial procedures. There are areas of technology that are broadening the cranial use of the endoscope. Here we discuss the foundations of cranial neuroendoscopy in the areas of cerebrospinal fluid diversion and tumor biopsy and discuss the recent advancements in the areas of craniosynostosis, endonasal surgery, ventriculo-cisternal approaches, brain parenchymal surgery and skull base surgery. We highlight the ongoing evolution of neuroendoscopic technology and consider the potential future applications that will help to revolutionize the current standards in endoscopy and its use inn neurosurgical practice.
