Subject(s)
Cerebral Veins/pathology , Hematoma, Epidural, Cranial/pathology , Occipital Lobe/pathology , Accidental Falls , Aged , Bicycling/injuries , Cerebral Angiography , Cranial Fossa, Posterior/pathology , Craniocerebral Trauma/diagnostic imaging , Diagnosis, Differential , Diagnostic Errors , Humans , Magnetic Resonance Angiography , Magnetic Resonance Imaging , Male , Tomography, X-Ray Computed , Vertigo/etiologyABSTRACT
We report a case of a rare meningeal melanocytoma in the cerebellopontine angle. One year after tumor gross total removal, the patient suffered a sudden and devastating meningeal melanomatosis. The relevant literature is reviewed looking for the keys to establish preoperative diagnosis and to obtain information about its treatment and postsurgical management.
Subject(s)
Cerebellar Neoplasms/pathology , Cerebellopontine Angle/pathology , Melanocytes/pathology , Meningeal Neoplasms/pathology , Nevus/pathology , Antineoplastic Agents, Alkylating/therapeutic use , Cerebellar Neoplasms/complications , Cerebellar Neoplasms/diagnosis , Cerebellar Neoplasms/drug therapy , Cerebellar Neoplasms/surgery , Cerebellopontine Angle/surgery , Diagnosis, Differential , Disease Progression , Fatal Outcome , Gait Disorders, Neurologic/etiology , Hearing Loss, Sensorineural/etiology , Humans , Magnetic Resonance Imaging , Male , Melanoma/diagnosis , Melanoma/pathology , Meningeal Neoplasms/complications , Meningeal Neoplasms/diagnosis , Meningeal Neoplasms/surgery , Middle Aged , Neoplasm Invasiveness , Neoplasm Recurrence, Local/drug therapy , Neoplasm Recurrence, Local/pathology , Neurilemmoma/diagnosis , Nevus/complications , Nevus/diagnosis , Nevus/drug therapy , Nevus/surgery , Nitrosourea Compounds/therapeutic use , Organophosphorus Compounds/therapeutic useABSTRACT
Se presenta un paciente con un raro melanocitoma meníngeo del ángulo pontocerebeloso que, tras su extirpación quirúrgica radical, evolucionó en el plazo de un año hacia una melanomatosis meníngea fulminante. Se realiza una revisión bibliográfica en busca de las claves para hacer una aproximación diagnóstica preoperatoria de este tipo de tumor y obtener información sobre su tratamiento y manejo postoperatorio (AU)
We report a case of a rare meningeal melanocytoma in the cerebellopontine angle. One year after tumor gross total removal, the patient suffered a sudden and devastating meningeal melanomatosis. The relevant literature is reviewed looking for the keys to establish preoperative diagnosis and to obtain information about its treatment and postsurgical management (AU)
Subject(s)
Humans , Male , Hutchinson's Melanotic Freckle/congenital , Hutchinson's Melanotic Freckle/genetics , Anthrax/complications , Anthrax/metabolism , Cerebellopontine Angle/abnormalities , Cerebellopontine Angle/cytology , Hearing Loss/metabolism , Brain Stem Infarctions/cerebrospinal fluid , Central Nervous System/cytology , Hutchinson's Melanotic Freckle/metabolism , Hutchinson's Melanotic Freckle/pathology , Anthrax/blood , Anthrax/parasitology , Cerebellopontine Angle/injuries , Cerebellopontine Angle/pathology , Hearing Loss/complications , Brain Stem Infarctions/genetics , Central Nervous System/physiologyABSTRACT
BACKGROUND: Delayed complications of radiation therapy comprise cerebral atrophy, radionecrosis and induction of tumors. Recent reports indicate the possibility of the "de-novo" formation of intracranial cavernomas in patients submitted to radiation therapy to the brain. OBJECTIVES: To report three children, two with medulloblastomas and one with a pineal germinoma, treated with radiotherapy that developed intracerebral cavernous hemangiomas some years after treatment. With this work, we aim to draw attention to this occurrence in the neurosurgical community. RESULTS: The patients were two girls and one boy with ages comprised between 2.5 and 7 years (mean 5.2 years). The average interval from irradiation to the appearance of cavernoma was of 5.3 years (range 5-6 years). The lesions were found during the routine neuroimaging studies performed for the follow-up of their primary neoplasms. No patient showed signs or symptoms related to the cavernomas. However, the three children will need both clinical and neuroimaging surveillance to monitor the evolution of these incidentally discovered lesions. CONCLUSIONS: Intracranial cavernomas can occur years after cerebral radiation therapy. In spite of previous reports that show a high incidence of bleeding lesions, cavernomas may be found incidentally during the neuroimaging surveillance studies that are performed to children with brain tumors previously treated with radiotherapy. In these cases, a conservative attitude seems to be advisable, reserving surgery only for those lesions that grow or bleed.
Subject(s)
Brain Neoplasms/complications , Brain Neoplasms/radiotherapy , Hemangioma, Cavernous/etiology , Radiotherapy/adverse effects , Brain Neoplasms/pathology , Child , Child, Preschool , Female , Hemangioma, Cavernous/pathology , Humans , MaleABSTRACT
Antecedentes. Entre las complicaciones tardías dela radioterapia se encuentran la atrofia cerebral, la radio necrosis y el desarrollo de tumores radio inducidos. Se ha descrito recientemente la formación de cavernomas intracraneales en pacientes tratados con radioterapia cerebral. Objetivo. Presentar los casos de tres niños, dos con meduloblastomas y uno con un germinoma pineal, en los que se encontraron cavernomas cerebrales años después del tratamiento con radioterapia, a fin de contribuir al conocimiento de esta eventualidad en el medio neuroquirúrgico. Resultados. Los pacientes fueron dos niñas y un niño entre 2,5 y 7 años de edad (media 5,2 años). El intervalo medio entre la radioterapia y la aparición del cavernoma fue de 5,3 años (extremos 5 y 6 años). Las lesiones fueron encontradas en los estudios de neuroimagen que se realizan habitualmente a estos pacientes para seguimiento de sus tumores originarios. Durante el período de observación, ningún paciente presentó síntomas o signos relacionados con el cavernoma. No obstante, los tres niños requerirán un seguimiento clínico y de neuroimagen para vigilar la evolución clínica de estas lesiones descubiertas accidentalmente. Conclusiones. La presencia de cavernomas intracraneales puede detectarse años después del tratamiento con radioterapia. Al contrario de casos previos publicados en los que fue frecuente su presentación con hemorragia, los cavernomas también pueden ser detectados de manera casual en los estudios de seguimiento que se realizan habitualmente a niños con tumores cerebrales tratados previamente con radioterapia. En este caso, parece aconsejable mantener una actitud conservadora, reservando la cirugía para las lesiones que crecen o sangran
Background. Delayed complications of radiation therapy comprise cerebral atrophy, radionecrosis and induction of tumors. Recent reports indicate the possibility of the de-novo formation of intracranial cavernomas in patients submitted to radiation therapy to the brain. Objectives. To report three children, two with medullo blastomas and one with a pineal germinoma, treated with radiotherapy that developed intracerebral cavernous hemangiomas some years after treatment. With this work, we aim to draw attention to this occurrence in the neurosurgical community. Results. The patients were two girls and one boy with ages comprised between 2.5 and 7 years (mean5.2 years). The average interval from irradiation to the appearance of cavernoma was of 5.3 years (range5-6 years). The lesions were found during the routine neuroimaging studies performed for the follow-up of their primary neoplasms. No patient showed signs or symptoms related to the cavernomas. However, the three children will need both clinical and neuroimaging surveillance to monitor the evolution of these incidentally discovered lesions. Conclusions. Intracranial cavernomas can occur years after cerebral radiation therapy. In spite of previous reports that show a high incidence of bleeding lesions, cavernomas may be found incidentally during the neuroimaging surveillance studies that are performed to children with brain tumors previously treated with radiotherapy. In these cases, a conservative attitude seems to be advisable, reserving surgery only for those lesions that grow or bleed
Subject(s)
Humans , Male , Female , Child, Preschool , Child , Cavernous Sinus/pathology , Brain Neoplasms/radiotherapy , Radiotherapy/adverse effects , Incidental Findings , Germinoma/pathology , Medulloblastoma/pathologyABSTRACT
BACKGROUND: Spinal cord rethetering can occur after the primary surgical repair of myelomeningoceles (MMC) and lipomeningoceles (LMC) and produce devastating physical and psychological consequences. The inadvertent introduction of skin elements at the time of the initial surgery can lead to the growth of intraspinal epidermoid or dermoid cysts. OBJECTIVES: To review the incidence of spinal cord tethering following surgery for open and occult spinal dysraphism and to analyze factors that might influence the appearance of this complication. We also aimed to search technical measures at the time of the primary operation that might prevent the occurrence of symptomatic cord retethering. MATERIAL AND METHODS: We reviewed the medical records of patients submitted to surgical repair of MMC (n=162) or occult spinal dysraphism (n= 54) during the period 1975-2005 who developed symptomatic tethered cord syndrome. RESULTS: Eleven of 162 (6.79%) patients with MMC and 2 of 54 (3.7%) with LMC developed clinical symptoms and signs of spinal cord tethering after intervals ranging from 2 to 37 years after the initial surgical repair of their back lesions. Indications for surgical re-exploration were based mainly on clinical grounds. Postoperative fibrosis was a constant finding in all instances. Other surgical findings included inclusion tumors of cutaneous origin (n=3), lumbar canal stenosis (n= 2), foreign body reactions (n= 2), residual lipoma (n= 1), and a tight hyalinized filum (n=1). Interestingly, 3 of 162 (or 1.85%) myelomeningoceles were found to harbor an intradural epidermoid tumor at the time of spinal cord dethetering, accounting for an incidence of cutaneous inclusion tumors of 27% in cases of post- MMC repair tethering. After a mean follow-up time of 5.5 years, eight patients were improved, two were unchanged and one was worsened. CONCLUSIONS: Neurological deterioration is not a necessary consequence of the natural history of patients with MMC or LMC. Early or late clinical deterioration can be due to spinal cord re-tethering and deserves timely investigation and surgical exploration. Results of surgical intervention were rewarding as 92% of the patients showed improvement or stabilization in their otherwise deteriorating condition. We also report two infrequent causes of spinal cord deterioration: lumbar canal stenosis and intense foreign-body reactions to implanted materials.
Subject(s)
Meningomyelocele/surgery , Reoperation , Spinal Cord/surgery , Spinal Dysraphism/surgery , Adolescent , Adult , Child , Child, Preschool , Female , Humans , Lumbosacral Region , Magnetic Resonance Imaging , Male , Meningomyelocele/epidemiology , Neurosurgical Procedures , Postoperative Complications , Retrospective StudiesABSTRACT
Antecedentes. La médula espinal puede fijarse tras la reparación inicial en pacientes operados demielomeningocele (MMC) y lipomeningocele (LMC), produciendo graves lesiones físicas y psicológicas. Asimismo, la introducción accidental de restos cutáneos durante la reparación de estas lesiones puede dar lugar al desarrollo de tumores intraespinales de estirpe cutánea. Objetivos. Averiguar la incidencia del anclaje medular tras la cirugía de MMC y LMC y analizar los factores que puedan explicar su aparición. También, investigamos las maniobras técnicas durante la operación primaria susceptibles de evitar la aparición del síndrome de médula fijada. Pacientes y métodos. Revisión retrospectiva de las historias de los pacientes operados de MMC (n=162) y de espina bífida oculta (n=54) en el período 1975-2005 que desarrollaron cuadros de anclaje medular sintomático. Resultados. Once pacientes con MMC (6,79%) y dos con LMC (3,7%) presentaron manifestaciones de anclaje medular tras intervalos de 2 a 37 años después de la reparación primaria. Las indicaciones de reintervención se basaron fundamentalmente en criterios clínicos. Un hallazgo constante fue la fibrosiscicatricial que estuvo presente en todos los casos. Otros hallazgos operatorios causantes de la fijación medular consistieron en tumores cutáneos de inclusión (n=3),reacciones de cuerpo extraño (n=2), estenosis del canal lumbar (n=2), restos de lipoma (n=1), y filumhialinizado (n=1). En 3 casos de MMC se encontróademás un quiste epidermoide intradural (1,85% delos MMC), lo que supone una tasa de epidermoides en la reintervención de MMC de 27%. El periodo medio de seguimiento fue de 5,5 años y los resultados fueron: mejoría en 8, dos no experimentaron cambios, y uno sufrió empeoramiento. Conclusiones. El deterioro neurológico de los pacientes operados de MMC o LMC no constituye una consecuencia obligada o parte de la historia natural de estos procesos. El deterioro, precoz o tardío, puede estar motivado por el anclaje posquirúrgico de la médula espinal. Ello hace necesario realizar un seguimiento periódico de estos pacientes, acompañado de los oportunos estudios de neuroimagen y, en su caso, de exploración quirúrgica. Los resultados fueron satisfactorios, ya que el 92% de los pacientes reoperados experimentaron mejoría o estabilización de su enfermedad. Se describen además dos causas infrecuentemente descritas de deterioro tardío: la estenosis del canal y las reacciones fibrosas de cuerpo extraño a materiales implantados
Background. Spinal cord rethetering can occur after the primary surgical repair of myelomeningoceles (MMC) and lipomeningoceles (LMC) and produced evastating physical and psychological consequences.The inadvertent introduction of skin elements at the time of the initial surgery can lead to the growth of intraspinal epidermoid or dermoid cysts. Objectives. To review the incidence of spinal cord tethering following surgery for open and occult spinaldys raphism and to analyze factors that might influence the appearance of this complication. We also aimed to search technical measures at the time of the primary operation that might prevent the occurrence of symptomatic cord retethering. Material and methods. We reviewed the medical records of patients submitted to surgical repair of MMC (n=162) or occult spinal dysraphism (n= 54) during the period 1975-2005 who developed symptomatic tethered cord syndrome. Results. Eleven of 162 (6.79%) patients with MMCand 2 of 54 (3.7%) with LMC developed clinical symptoms and signs of spinal cord tethering after intervals ranging from 2 to 37 years after the initial surgical repair of their back lesions. Indications for surgical re-exploration were based mainly on clinical grounds. Postoperative fibrosis was a constant finding in all instances. Other surgical findings included inclusion tumors of cutaneous origin (n=3), lumbar canal stenosis(n= 2), foreign body reactions (n= 2), residual lipoma (n= 1), and a tight hyalinized filum (n=1). Interestingly,3 of 162 (or 1.85%) myelomeningoceles were found to harbor an intradural epidermoid tumor at the time of spinal cord dethetering, accounting for an incidence of cutaneous inclusion tumors of 27% in cases of post-MMC repair tethering. After a mean follow-up time of 5.5 years, eight patients were improved, two were unchanged and one was worsened. Conclusions. Neurological deterioration is not a necessary consequence of the natural history of patients with MMC or LMC. Early or late clinical deterioration can be due to spinal cord re-tethering and deserves timely investigation and surgical exploration. Results of surgical intervention were rewarding as 92% of the patients showed improvement or stabilization in their otherwise deteriorating condition. We also report two infrequent causes of spinal cord deterioration: lumbar canal stenosis and intense foreign-body reactions to implanted materials
Subject(s)
Humans , Male , Female , Child, Preschool , Child , Adolescent , Adult , Meningomyelocele/surgery , Spinal Cord/surgery , Spinal Dysraphism/surgery , Reoperation , Magnetic Resonance Imaging , Retrospective Studies , Neurosurgical Procedures , Postoperative Complications , Lumbosacral RegionABSTRACT
BACKGROUND: Some reports have documented posterior fossa cysts resulting in syringomyelic obstruction of cerebrospinal fluid (CSF) flow caused by cyst displacement within the foramen magnum. Rarely the syringomyelia is caused by acquired Chiari malformation due to a retrocerebellar arachnoid cyst. OBJECTIVE: To report the case of a 38-year-old man with hydrocephalus and syringomyelia, who was found to have a Chiari malformation secondary to a posterior fossa arachnoid cyst. After endoscopic third ventriculostomy, the patient was submitted to foramen magnum decompression and arachnoid cyst removal that were followed by resolution of both the Chiari malformation and the syringomyelia. DISCUSSION: In most published cases the syringomyelia has been attributed to obstruction of CSF flow at the foramen magnum by the arachnoid cyst itself. There is only one previous report of a posterior fossa arachnoid cyst producing tonsillar descent and syringomyelia. CONCLUSIONS: Posterior fossa arachnoid cysts can result in acquired Chiari malformation and syringomyelia. In our view, the management of these patients should be directed at decompressing the foramen magnum and include the removal of the walls of the coexistent arachnoid cyst as it seems to be the crucial factor that accounts for the development of the syringomyelia that these patients present.
Subject(s)
Arachnoid Cysts , Cerebellar Diseases/etiology , Cranial Fossa, Posterior , Hernia/etiology , Syringomyelia/etiology , Adolescent , Adult , Arachnoid Cysts/complications , Arachnoid Cysts/surgery , Arnold-Chiari Malformation/complications , Arnold-Chiari Malformation/pathology , Child , Cranial Fossa, Posterior/pathology , Cranial Fossa, Posterior/surgery , Female , Humans , Infant , Male , Middle Aged , Review Literature as TopicABSTRACT
Antecedentes. Algunos trabajos han descrito laexistencia de quistes aracnoideos de fosa posterior queproducían siringomielia al obstruir la circulación deliquido cefalorraquídeo (LCR) por bloqueo del agujeromagno ocasionado por el propio quiste. Rara vezla siringomielia asociada a quiste aracnoideo de fosaposterior es producida por malformación de Chiariadquirida.Objetivos. Publicar el caso de un hombre de 38años con hidrocefalia y siringomielia, en el que seencontró descenso de las amígdalas cerebelosas por lapresión ejercida por un quiste aracnoideo retrocerebeloso.Tras tratar primero la hidrocefalia medianteventriculostomía neuroendoscópica, el paciente fueoperado de descompresión del agujero magno yextirpación de las membranas del quiste que condujerona la resolución tanto del Chiari como de lasiringomielia.Discusión. En la mayoría de los casos publicados lasiringomielia se debía a la obstrucción de LCR en el agujeromagno ocasionada por el propio quiste aracnoideo.Hemos encontrado solamente un caso previo en el queel quiste de fosa posterior era causante del descenso delas amígdalas cerebelosas y éste, a su vez, producía lasiringomielia.Conclusiones. Los quistes aracnoideos de fosa posteriorpueden producir descenso de las amígdalas ysiringomielia. En nuestra opinión, el manejo de estospacientes debe de encaminarse no sólo a descomprimirel agujero magno, sino también a comunicar las paredesdel quiste ya que éste parece ser el principal responsabledel complejo cuadro de siringomielia en estos casos
Background. Some reports have documented posteriorfossa cysts resulting in syringomyelic obstruction ofcerebrospinal fluid (CSF) flow caused by cyst displacementwithin the foramen magnum. Rarely the syringomyeliais caused by acquired Chiari malformationdue to a retrocerebellar arachnoid cyst.Objective. To report the case of a 38-year-old manwith hydrocephalus and syringomyelia, who was foundto have a Chiari malformation secondary to a posteriorfossa arachnoid cyst. After endoscopic third ventriculostomy,the patient was submitted to foramen magnumdecompression and arachnoid cyst removal that werefollowed by resolution of both the Chiari malformationand the syringomyelia.Discussion. In most published cases the syringomyeliahas been attributed to obstruction of CSF flow at theforamen magnum by the arachnoid cyst itself. There isonly one previous report of a posterior fossa arachnoidcyst producing tonsillar descent and syringomyelia.Conclusions. Posterior fossa arachnoid cysts canresult in acquired Chiari malformation and syringomyelia.In our view, the management of these patientsshould be directed at decompressing the foramenmagnum and include the removal of the walls of thecoexistent arachnoid cyst as it seems to be the crucialfactor that accounts for the development of the syringomyeliathat these patients present
Subject(s)
Humans , Male , Adult , Arachnoid Cysts/surgery , Arachnoid Cysts/complications , Arnold-Chiari Malformation/complications , Cerebellar Diseases/etiology , Cranial Fossa, Posterior/surgery , Hernia/etiology , Syringomyelia/etiologyABSTRACT
The authors report an infant with clinical and neuroimaging findings of shaken baby syndrome. The pitfalls encountered in the assessment on the cause of the bilateral frontal and interhemispheric subdural hematomas in this child are also briefly discussed. We have called this condition "benign" shaken baby syndrome and emphasize that not always acute subdural hematomas are of non-accidental nature.
Subject(s)
Airway Obstruction , Hematoma, Subdural, Acute , Shaken Baby Syndrome , Child Abuse , Hematoma, Subdural, Acute/etiology , Hematoma, Subdural, Acute/pathology , Humans , Infant , Shaken Baby Syndrome/pathologyABSTRACT
The authors report an infant with clinical and neuroimaging findings of shaken baby syndrome. The pitfalls encountered in the assessment on the cause of the bilateral frontal and interhemispheric subdural hematomas in this child are also briefly discussed. We have called this condition "benign" shaken baby syndrome and emphasize that not always acute subdural hematomas are of non-accidental nature
Los autores describen un lactante con hallazgos clínicos y de neuroimagen sugestivos del síndrome del niño maltratado. Se discuten brevemente las dificultades para la identificación de la causa del hematomasubdural agudo frontal bilateral e interhemisférico que el niño presentaba. Hemos denominado a esta entidad síndrome "benigno" del niño maltratado para destacar que el hallazgo de un hematoma subdural agudo en un niño pequeño no significa necesariamente maltrato infantil
Subject(s)
Infant , Humans , Battered Child Syndrome/complications , Hematoma, Subdural, Acute/etiology , Battered Child Syndrome/diagnosis , Battered Child Syndrome/therapy , Hematoma, Subdural, Acute/diagnosis , Hematoma, Subdural, Acute/therapy , Acute DiseaseABSTRACT
A 4.5 year-old-girl was submitted to subtotal removal of a benign astrocytoma of the left temporal lobe with basal ganglia extension and given radiotherapy. At age 27, she was found to harbor a right posterior frontal meningioma that was totally removed. A recurrence of the right convexity meningioma was again excised after a 4-year interval. The authors report this case to illustrate the possibility of the appearance of radiation-induced meningiomas after an interval of 22 years and briefly discuss 16 previous reports on this occurrence in benign astrocytomas.
Subject(s)
Astrocytoma/radiotherapy , Basal Ganglia , Meningeal Neoplasms/etiology , Meningioma/etiology , Neoplasms, Radiation-Induced/etiology , Supratentorial Neoplasms/radiotherapy , Temporal Lobe , Aphasia/etiology , Astrocytoma/surgery , Basal Ganglia/surgery , Child, Preschool , Craniotomy , Female , Humans , Meningeal Neoplasms/surgery , Meningioma/surgery , Neoplasm Recurrence, Local/surgery , Neoplasms, Radiation-Induced/surgery , Paresis/etiology , Postoperative Complications/etiology , Radiotherapy, Adjuvant , Seizures/etiology , Supratentorial Neoplasms/surgery , Temporal Lobe/surgery , Time FactorsABSTRACT
Se presenta el caso de una niña de 4 años y medio que recibió radioterapia local tras la resección casi total de un astrocitoma benigno temporal izquierdo con extensión a ganglios basales. A los 27 años fue operada con extirpación macroscópica total de un meningioma frontal posterior derecho, que recidivó y fue reoperado 4 años más tarde. El propósito de la comunicación es comentar la posibilidad de la aparición de un meningioma radioinducido 22 años después de la radioterapia y revisar brevemente 16 casos similares de meningioma tras la radioterapia en astrocitomas benignos
A 4.5 year-old-girl was submitted to subtotal removal of a benign astrocytoma of the left temporal lobe with basal ganglia extension and given radiotherapy. At age 27, she was found to harbor a right posterior frontal meningioma that was totally removed. A recurrence of the right convexity meningioma was again excised after a 4-year interval. The authors report this case to illustrate the possibility of the appearance of radiationinduced meningiomas after an interval of 22 years and briefly discuss 16 previous reports on this occurrence in benign astrocytomas
Subject(s)
Female , Child, Preschool , Humans , Astrocytoma/radiotherapy , Basal Ganglia/surgery , Meningioma/etiology , Temporal Lobe/surgery , Meningeal Neoplasms/etiology , Neoplasms, Radiation-Induced/etiology , Supratentorial Neoplasms/radiotherapy , Aphasia/etiology , Astrocytoma/surgery , Craniotomy , Meningioma/surgery , Paresis/etiology , Postoperative Complications/etiology , Radiotherapy, Adjuvant , Time Factors , Meningeal Neoplasms/surgery , Neoplasm Recurrence, Local/surgery , Neoplasms, Radiation-Induced/surgery , Seizures/etiology , Supratentorial Neoplasms/surgeryABSTRACT
Overdrainage in ventricular shunting constitutes a difficult to prevent and to treat complication. The authors reviewed a retrospective series of 512 children submitted to a ventricular shunting procedure aimed at analysing factors influencing this type of complication. The causes for the hydrocephalus were congenital (n=172), post-myelomeningocele (n=123), posthemorrhagic (n=103), tumoral (n=64), postmeningitis (n=40) and posttraumatic (n=10). Eighty-eight children (17.8%) evolved with a complication related to the excessive function of the valve. The authors investigated the relationship between hydrocephalus' etiology and type of overdrainage syndromes. The most frequent complication was ventricular catheter block (n=50), followed by symptomatic slit ventricle syndrome (SVS) (n=19), subdural hematoma (n=10) and trapped fourth ventricle (n=9). There were no statistical differences regarding complications for each etiologic subset of hydrocephalus. SVS occurred in 19 children (3.71%), a low rate according to the current literature. Posthemorrhagic and postinfectious hydrocephalus grouped together showed a higher rate of SVS (p=0.005), a feature that we attributed to the cerebral destruction caused by these two conditions. Treatment of SVS was complex and required diverse procedures, applied in an escalated way, which included five decompressive craniectomies. The authors suggest avoiding, as much as possible, the use of ventricular shunts, and recommend the alternative use of new technology valves and neuroendoscopic procedures.
Subject(s)
Cerebrospinal Fluid Shunts/adverse effects , Hydrocephalus/surgery , Postoperative Complications/epidemiology , Child , Child, Preschool , Female , Humans , Hydrocephalus/diagnostic imaging , Hydrocephalus/pathology , Incidence , Infant , Infant, Newborn , Magnetic Resonance Imaging , Male , Postoperative Complications/classification , Retrospective Studies , Syndrome , Tomography, X-Ray ComputedABSTRACT
El drenaje excesivo de las válvulas constituye una complicación dificil, tanto de prevenir como de tratar. Los autores revisan una serie de 512 niños operados mediante derivación de líquido cefalorraquídeo, de manera retrospectiva, para analizar las causas de esta complicación. La causa de la hidrocefalia fue congénita (n= 172), debida a mielomeningocele (n= 123), posthemorrágica (n=103), tumoral (n= 64), postinfecciosa (n=40) y postraumática (n= 10). Ochenta y ocho niños (17,8%) presentaron alguna complicación por funcionamiento excesivo del sistema valvular. Se analizó la etiología de la hidrocefalia relacionándola con los cuadros de hiperdrenaje. La complicación más frecuente fue la obstrucción del extremo ventricular de la derivación (n= 50), seguida del cuadro de colapso ventricular sintomático (n= 19), de hematoma subdural (n= 10) y de cuarto ventrículo aislado (n=9). Las diversas complicaciones se distribuyeron de manera homogénea entre todos los grupos etiológicos, sin diferencia estadística. El cuadro de colapso ventricular sintomático (CVS) ocurrió en 19 niños (3,71%), cifra menor que la descrita en la bibliografía. Sólo dos grupos de pacientes con hidrocefalia adquirida (postinfecciosa y posthemorrágica) tuvieron una mayor tasa de CVS (p=0,005), lo que se atribuyó a la mayor incidencia en estos niños de procesos destructivos cerebrales. El tratamiento del CVS fue complejo y requirió diversos procedimientos, que se aplicaron de manera escalonada, incluyendo cinco craniectomías descompresivas. Los autores recomiendan evitar, en lo posible, el empleo de válvulas, utilizando en su lugar, y siempre que sea posible, técnicas de neuroendoscopia, o válvulas de nueva tecnología, que supuestamente disminuirán el número de complicaciones de hiperfunción valvular
Overdrainage in ventricular shunting constitutes a difficult to prevent and to treat complication. The authors reviewed a retrospective series of 512 children submitted to a ventricular shunting procedure aimed at analysing factors influencing this type of complication. The causes for the hydrocephalus were congenital (n=172), post-myelomeningocele (n=123), posthemorrhagic (n=103), tumoral (n=64), postmeningitis (n=40) and posttraumatic (n=10). Eighty-eight children (17.8%) evolved with a complication related to the excessive function of the valve. The authors investigated the relationship between hydrocephalus' etiology and type of overdrainage syndromes. The most frequent complication was ventricular catheter block (n=50), followed by symptomatic slit ventricle syndrome (SVS) (n=19), subdural hematoma (n=10) and trapped fourth ventricle (n=9). There were no statistical differences regarding complications for each etiologic subset of hydrocephalus. SVS occurred in 19 children (3,71%), a low rate according to the current literature. Posthemorrhagic and postinfectious hydrocephalus grouped together showed a higher rate of SVS (p=0,005), a feature that we attributed to the cerebral destruction caused by these two conditions. Treatment of SVS was complex and required diverse procedures, applied in an escalated way, which included five decompressive craniectomies. The authors suggest avoiding, as much as possible, the use of ventricular shunts, and recommend the alternative use of new technology valves and neuroendoscopic procedures
