Surgical treatment of cyst of the canal of Nuck and prevention of lymphatic complications: A single-center experience.

The canal of Nuck is a residue of the peritoneal evagination that runs along the round ligament through the inguinal canal in women. Its partial or total patency can lead to a cystic lymphangioma (CL). CL of the canal of Nuck in an adult female is a rare entity and its clinical diagnosis can be difficult or incorrect. Ultrasonography can be useful to identify the nature of groin masses. A potential CL of the canal of Nuck should always be considered in the differential diagnosis of inguinal swelling in adult females. Even if it is possible to consider conservative treatment, the optimal therapeutic option is surgical excision of the cystic mass and closure of the inguinal ring by an anterior approach. In this study, we report a case series of four women affected by a cyst of the canal of Nuck to underline the surgical treatment's therapeutic role of this pathological condition and the importance of preliminary identification of lymphatic vessels with BPV (Blue Patent Violet) in order to prevent lymphatic injuries such as lymphorrea and lymphocele in the groin after surgery due to the disruption of inguinal lymph nodes and lymphatics.

The combination of a programmable valve and a subclavicular anti-gravity device in hydrocephalus patients at high risk for hygromas.

OBJECTIVES: In order to avoid occurrence of post-operative hygromas in specific hydrocephalus patients being at high risk of overdrainage, a combination of programmable valve and anti-gravity device is widely recommended. We analyzed our series of hydrocephalus patients implanted with such a shunt configuration focusing on complications in relation to over-/underdrainage and neurological outcome. METHODS: In 28 hydrocephalic patients (14 women and 14 men; mean age 65 years, range from 14 to 82 years; 11 normal pressure, 7 post-traumatic, and 4 post-hemorrhagic hydrocephalus), a Codman Medos programmable valve combined with a Miethke shunt assistant (SA) was implanted at the Department of Neurosurgery of the Academic Teaching Hospital Feldkirch. Implantation was performed simultaneously in 20 patients during the primary procedure: in five patients, SA was placed during revision surgery, and in three patients, the patent system was completed by additional implantation of an SA. RESULTS: Subdural hematoma occurred in one out of 20 patients with SA implantation during primary procedure and in two out of eight patients with SA implantation as secondary procedure, respectively. Shunt occlusion occurred in one patient out of the patients with SA implantation during primary procedure, but was seen in three patients with pre-existing shunt without SA. Shunt infection occurred in one case. DISCUSSION: Our results suggest the combination of an adjustable valve and SA as an effective treatment for a specific group of hydrocephalus patients being at high risk for overdrainage.

Compensatory parameters of intracranial space in giant hydrocephalus.

BACKGROUND AND PURPOSE: The main goal of the present study is to examine compensatory parameters of intracranial space in giant hydrocephalus. We also assess the early and late outcome and analyse complications in shunted cases. MATERIAL AND METHODS: Nine cases of giant hydrocephalus characterised by the value of Evans ratio > 0.5, ventricular index > 1.5, and the width of the third ventricle > 20 mm were considered. Using the lumbar infusion test and developed software we analysed the intracranial compensatory parameters typical for hydrocephalus. Based on the Marmarou model, the method depended on a repeated search for the best fitting curve corresponding to the progress of the test was used. Eight out of nine patients were therefore shunted. Patients were followed up for 9 months. RESULTS: Five out of eight shunted patients undoubtedly improved in a few days after surgery (62%). Complications (subdural hygromas/haematomas and intracerebral haematoma) developed in 5 (62%) cases in longer follow-up. A definite improvement was noted in 4 out of 8 operated cases (50%). CONCLUSIONS: To get the stable values of compensatory parameters, the duration of the infusion test must at least double the inflexion time of the test curve. All but one considered cases of giant hydrocephalus were characterized by lack of intracranial space reserve, significantly reduced rate of CSF secretion and by various degrees of elevated value of the resistance to outflow. Due to the significant number of complications and uncertain long-term improvement, great caution in decision making for shunting has to be taken.