ABSTRACT
Based on preliminary experiences from the early 1970s, a patient with chronic and severe communicating hydrocephalus has been successfully treated with transposition of an omental pedicle to the lumbar subarachnoidal space. This patient, who suffered from congenital toxoplasmosis, at the age of 29 years had undergone no fewer than 82 shunt revisions. In the 5-year follow-up after treatment, she has had no further surgery or other treatment. She is in excellent condition and has demonstrated definite signs of improved CSF circulation. This case report confirms that a pedicle of the omentum may serve as an effective CSF absorber in patients presenting with persistent failures with conventional treatments of communicating hydrocephalus, avoiding the use of any implanted foreign material.
Subject(s)
Hydrocephalus/surgery , Omentum , Postoperative Complications/surgery , Surgical Flaps , Adult , Cerebrospinal Fluid Shunts , Equipment Failure , Female , Humans , Hydrocephalus/diagnosis , Magnetic Resonance Imaging , Postoperative Complications/diagnosis , Reoperation , Subarachnoid Space , Toxoplasmosis, Congenital/complicationsABSTRACT
Vagus nerve stimulation (VNS) is widely used to treat refractory epilepsy. It is usually safe and has few side effects. Cardiac arrhythmia has been reported during lead tests performed during implantation of the device, but never during regular treatment. We report here a case where vagally induced bradyarrhythmia, perfectly correlated with the stimulation periods, suddenly occurred two years and four months after the VNS implantation. The diagnosis was based on the appearance of syncope-like episodes. No specific cause could be found to explain the appearance of the episodes. To our knowledge, this is the first report on this severe and life-threatening side effect of VNS and should alert clinicians to its possibility. However, considering the large number of VNS implantations performed worldwide, it must be regarded as an extremely rare complication.
Subject(s)
Bradycardia/etiology , Electric Stimulation Therapy/adverse effects , Epilepsy/therapy , Vagus Nerve/physiology , Adolescent , Bradycardia/diagnosis , Electric Stimulation Therapy/methods , Electrodes, Implanted , Electroencephalography/statistics & numerical data , Humans , Male , Syncope/epidemiology , Syncope/etiology , Time FactorsABSTRACT
OBJECTIVE: The discovery of stem cells in the adult human brain and developing stem cell technology open a possible future scenario of autotransplantation, where stem cells are harvested from the patient and propagated in vitro before they are used as transplants. The objectives of this study were: 1) to investigate the feasibility of harvesting tissue containing neural stem cells by endoscopy; 2) to study the possibility of propagating and multiplying stem cells from this tissue efficiently in vitro; and 3) to examine whether the stem cells differentiate into functional neurons. METHODS: In 13 patients with hydrocephalus undergoing routine neurosurgical procedures, we used an endoscope and a 3-mm biopsy forceps (Medtronic) to harvest the small piece of the ventricular wall that is detached by the introduction of the endoscope. Cells were cultured as neurospheres, and after induced differentiation, they were investigated with immunocytochemistry and whole-cell patch-clamp recordings. All cells characterized were propagated under strict clonal conditions. RESULTS: We found it uncomplicated to harvest the part of the lateral ventricular wall that compares with the inner lumen of the endoscope. Single cells, isolated and cultivated in vitro, multiplied to form neurospheres in a serum-free environment. A single stem cell had the potential to give rise to approximately 9 x 10(5) new cells after two passages. The total number of cells produced from a single biopsy was already, after the second passage, far beyond the number required in, for instance, Parkinson's disease. Within 1 week of induced differentiation, cells expressing markers for neurons (beta-III-tubulin or NeuN), oligodendrocytes (RIP or O4), and astrocytes (glial fibrillary acidic protein) appeared. After 3 weeks, cells with a neuronal phenotype showed a firing pattern distinctive of mature neurons, including repetitive, short-lasting, and overshooting action potentials that were blocked by inhibiting voltage-dependent Na+-channels with tetrodotoxin. CONCLUSION: These results indicate that it may be feasible to produce neural tissue for autotransplantation from endoscopically harvested stem cells, but further work is needed in refining culture protocols to control phenotype fate.
