ABSTRACT
INTRODUCTION AND AIMS: One of the therapeutic options for chronic adult hydrocephalus that has become widely used in our service is the lumboperitoneal shunt with low-pressure Spetzler catheter and in an outpatient regimen. We report on the first 30 patients treated in this way with a follow-up of between one and five years. PATIENTS AND METHODS: Diagnosis was reached after studying the patient history and a clinical examination; Hakim and Adams' triad was found to be a primary and highly predictive factor, together with flow magnetic resonance imaging and the use of the ambulatory tap test. Patients who responded to the latter were submitted to placement of a shunt in a short operation performed with local anaesthetic and sedation. An evaluation of the three symptoms was carried out before and after the intervention according to a mixed scale (Rankin-Stein and Langfitt-Vall d'Hebron) and graphic tests based on the minimental test. RESULTS: At three months, 21 patients (70%) had improved and 14 of them (65%) maintained this improvement at three years; eight of these have been monitored for four and five years. Five patients died due to intercurrent illnesses. CONCLUSIONS: After comparing the complications that occurred with other case mixes involving both lumboperitoneal and ventriculoperitoneal shunts, we discuss the usefulness of this method (which is preferred by patients and relatives) in comparison to ventriculoperitoneal shunts, where the complications are more severe because they invade the brain and due to the need for general anaesthesia and longer hospitalisation. In addition, the method is more economical than the alternatives.
Subject(s)
Ambulatory Surgical Procedures , Hydrocephalus/surgery , Ventriculoperitoneal Shunt/methods , Aged , Aged, 80 and over , Chronic Disease , Female , Follow-Up Studies , Humans , Lumbosacral Region , Male , Middle Aged , PeritoneumABSTRACT
Introducción y objetivo. Dentro de las opciones terapéuticas de la hidrocefalia crónica del adulto, ha ido imponiéndoseen nuestro servicio la derivación lumboperitoneal con catéter de baja presión de Spetzler y en régimen ambulatorio.Presentamos los primeros 30 pacientes así tratados con un seguimiento de entre uno y cinco años. Pacientes y métodos. Realizamosel diagnóstico mediante la anamnesis y exploración clínica, constatando la tríada de Hakim y Adams como factor primordialy de gran valor predictivo, así como la resonancia magnética de flujo y el uso de la punción lumbar de prueba (taptest) ambulatoria. Los pacientes que respondieron a ésta fueron sometidos al implante del shunt en una breve intervención conanestesia local y sedación. Se realizó antes y después una valoración de los tres síntomas según una escala mixta (Rankin-Stein y Langfitt-Vall dHebron) y pruebas gráficas basadas en el test minimental. Resultados. A los tres meses habían mejorado21 pacientes (70%) y mantuvieron la mejoría a los tres años 14 pacientes (65%); ocho de éstos han sido controlados cuatroy cinco años. Cinco pacientes fallecieron por enfermedades intercurrentes. Conclusiones. Tras compararse las complicacioneshabidas con otras casuísticas tanto de derivación lumboperitoneal como de derivación ventriculoperitoneal, se comentala utilidad del método, preferido por los pacientes y familiares, frente al de derivación ventriculoperitoneal, donde las complicacionestienen mayor gravedad al invadir el cerebro y ante la necesidad de anestesia general e ingreso más prolongado.El método, además, es más económico que los alternativos(AU)
Introduction and aims. One of the therapeutic options for chronic adult hydrocephalus that has become widely usedin our service is the lumboperitoneal shunt with low-pressure Spetzler catheter and in an outpatient regimen. We report on thefirst 30 patients treated in this way with a follow-up of between one and five years. Patients and methods. Diagnosis wasreached after studying the patient history and a clinical examination; Hakim and Adams triad was found to be a primary andhighly predictive factor, together with flow magnetic resonance imaging and the use of the ambulatory tap test. Patients whoresponded to the latter were submitted to placement of a shunt in a short operation performed with local anaesthetic andsedation. An evaluation of the three symptoms was carried out before and after the intervention according to a mixed scale(Rankin-Stein and Langfitt-Vall dHebron) and graphic tests based on the minimental test. Results. At three months, 21patients (70%) had improved and 14 of them (65%) maintained this improvement at three years; eight of these have beenmonitored for four and five years. Five patients died due to intercurrent illnesses. Conclusions. After comparing thecomplications that occurred with other case mixes involving both lumboperitoneal and ventriculoperitoneal shunts, we discussthe usefulness of this method (which is preferred by patients and relatives) in comparison to ventriculoperitoneal shunts, wherethe complications are more severe because they invade the brain and due to the need for general anaesthesia and longerhospitalisation. In addition, the method is more economical than the alternatives(AU)
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Hydrocephalus/diagnosis , Hydrocephalus/surgery , Ambulatory Surgical Procedures/methods , Dementia/complications , Dementia/diagnosis , Anesthesia, Local/methods , Hydrocephalus/physiopathology , Hydrocephalus , Medical History Taking/methodsABSTRACT
INTRODUCTION: Glucose administration to patients about to undergo neurosurgery must be avoided because perioperative cerebral ischemia in a context of hyperglycemia worsens the neurological prognosis. Furthermore, prolonged hypoglycemia can also provoke lesions that resemble those occasioned by states of ischemia-hypoxia. OBJECTIVES: To evaluate glycemic changes in patients undergoing craniotomy who have not received glucose-containing solutions. PATIENTS AND METHODS: Forty-six patients were enrolled and assigned to two groups according to whether they received perioperative corticoid treatment (CC, n = 24) or not (NCC, n = 22). Fasting was maintained without administration of glucose-containing solutions. We measured glycemia, natremia and potassemia at baseline and 60 minutes after surgery. RESULTS: Demographic characteristics, duration of surgery (5.0 +/- 1.6 h in the CC group and 4.6 +/- 1.4 h in the NCC group) and fasting period (18 +/- 2.3 h in the CC group and 17 +/- 1.9 h in the NCC group) were similar in both groups. Glycemia increased and natremia decreased significantly in both groups, with no clinical repercussions. No case of perioperative hypoglycemia occurred. Initial potassemia in the CC group was significantly higher than in the NCC group, but decreased after surgery with no clinical repercussions. No relation was found between fasting time, duration or surgery and differences in glycemia between the two groups. CONCLUSION: Non-administration of glucose in patients undergoing craniotomy eliminates the risk of hyperglycemia, does not lead to perioperative hypoglycemia and is not affected by perioperative corticoid treatment.
