Assuntos
Anormalidades Múltiplas/fisiopatologia , Aracnodactilia/fisiopatologia , Blefarofimose/fisiopatologia , Contratura/fisiopatologia , Atrofia Muscular/fisiopatologia , Anormalidades Múltiplas/genética , Adolescente , Alelos , Aracnodactilia/genética , Blefarofimose/genética , Contratura/genética , Anormalidades Craniofaciais , Fácies , Feminino , Heterogeneidade Genética , Humanos , Masculino , Atrofia Muscular/genética , Linhagem , Arábia SauditaRESUMO
INTRODUCTION: The effectiveness of continuous intracranial pressure (ICP) monitoring in the adaptation period, after endoscopic third ventriculostomy (ETV), and removal of the failed shunt in the management of CSF shunt failure is assessed. METHODS: Nine patients with active hydrocephalus presenting with CSF shunt obstruction or infection were managed by ETV, removal of the shunt and insertion of an external ventricular drain (EVD) containing an ICP sensor for the purpose of postoperative monitoring of the ICP, and intermittent drainage of CSF. Patient ages ranged from 8 months to 24 years, and six of them were females. Hydrocephalus was obstructive in seven patients, and multiloculated in two. Six patients had an ventriculoperitoneal shunt (VPS), one with a bilateral VPS, one patient had a ventriculoatrial shunt, and one had a VPS and cystoperitoneal shunt (CPS). Shunt failure was caused by obstruction in six patients and infection in three. RESULTS: The post-operative ICP monitoring period ranged from 1-7 days. Intracranial hypertension was persistent in the first day after ETV in 3 patients, and up to 110 mL of CSF were drained to improve its symptoms. ETV was successful in six patients and 3 had permanent VPS. CONCLUSION: Post-operative continuous ICP monitoring and EVD insertion were very useful in the treatment of CSF shunt failure with ETV. This procedure allowed intermittent CSF drainage, relieving symptoms of elevated ICP, and provided accurate assessment of the success of the ETV and patency of the stoma in the early postoperative days by CT ventriculography and can also be used to install antibiotics in cases of infection.
Assuntos
Derivações do Líquido Cefalorraquidiano , Pressão Intracraniana , Monitorização Intraoperatória , Falha de Prótese , Terceiro Ventrículo/cirurgia , Adolescente , Criança , Pré-Escolar , Endoscopia , Feminino , Humanos , Hidrocefalia/cirurgia , Lactente , Masculino , Resultado do Tratamento , Adulto JovemRESUMO
A 24-year-old man presented with cerebral aspergillus fungal granuloma involving the left frontal region secondary to pulmonary aspergillosis. He was otherwise healthy with no evidence of immune-suppression. Because of poor penetration of amphotericin B into the brain and cerebrospinal fluid (CSF), this patient was treated by a combination of systemic and local therapy in addition to surgical excision resulting in a cure with follow up for more than three years. This form of treatment produced no untoward long-term side effects or neurological sequel. On review of the literature on aspergillosis of the central nervous system (CNS), we found that six patients, including the present case, have been reported who survived longer than 1 year; their treatment included local administration of antifungal agent in the abscess cavity or into cerebral ventricles in order to control this devastating, treatment-resistant pathological fungal infection.
