Ventriculo-atrial shunt with occlusion of the internal jugular vein: operative experience and surgical technique.

BACKGROUND: Ventricular shunts are one of the most frequent techniques used for the management of hydrocephalus. The ventriculoperitoneal shunt (VPS) is the most commonly performed procedure, and the ventriculoatrial shunt (VAS) is the second option in most medical centers. The main objective of this study is to introduce and describe a surgical approach for VAS outlining our experience and comparing it with traditional shunting techniques. METHODS: In this retrospective cohort comparison study, we included patients with hydrocephalus treated with a surgical procedure between January 2010 and February 2021 at a single academic institution. We categorized the procedures into two groups: patients with VPS and conventional VAS grouped together into the conventional technique (CT) group, and the second group was patients with whom we performed VAS with complete internal jugular vein occlusion (IJVOT). We compared the surgical time, postoperative complications, and occurrence of shunt failure among the groups by performing univariate analysis using the Fisher exact test. RESULTS: Out of the 106 patients included in the analysis, IJVOT was performed in 66 patients, and CT in 40 patients. The median surgical time was 60 min (IQR 60-90) for IJVOT versus 100 min (IQR 60-120) for CT (p < 0.01). In the follow-up a month after the procedure, 83.3% of patients with IJVOT and 62.5% of patients with CT did not require shunt removal or shunt revision (p < 0.01). Shunt revision rates were 12.5% and 1.5% for CT while 1.5% and 2.5% for IJVOT at 1 and 6 months after the procedure. CONCLUSION: Our findings demonstrate that VAS with IJVOT is a safe method that exhibited shorter surgical times and outcomes comparable to CT. However, since the present study represents the first cohort evaluating IJVOT, it is imperative to conduct larger prospective studies, along with clinical trials, to fully explore and establish efficacy, long-term outcomes, and an in-depth comparison among shunting techniques.

Complicaciones trombóticas y hemorrágicas en pacientes con aneurismas cerebrales tratados por vía endovascular y su relación con el uso de antiagregantes plaquetarios: evaluación descriptiva / Thrombotic and haemorrhagic complications in patients with cerebral aneurysms treated by endovascular approach and their association with the use of antiplatelet agents: Descriptive evaluation

Objetivo: El protocolo de medicación antiplaquetaria óptimo para prevenir las complicaciones trombóticas después de embolización de aneurismas cerebrales no es claro. Nuestro objetivo es describir las características de los pacientes que presentan complicaciones trombóticas o hemorrágicas secundarias al tratamiento endovascular. Métodos: Se realizó un estudio descriptivo de corte transversal. Se incluyó a todos los pacientes que requirieron manejo endovascular de aneurismas cerebrales en el Hospital Universitario San Ignacio desde noviembre del 2007 hasta enero del 2016. Se evaluaron las complicaciones trombóticas o hemorrágicas durante 6 meses de seguimiento, teniendo en cuenta el esquema de premedicación con antiagregantes plaquetarios, localización, tamaño del aneurisma y técnica de embolización utilizada. Resultados: Se evaluó a 122 pacientes en los cuales se realizaron 130 procedimientos para tratamiento endovascular de aneurismas cerebrales. Las complicaciones trombóticas fueron más frecuentes en pacientes que no recibieron premedicación (25%) comparados con aquellos que recibieron algún esquema de antiagregación (estándar 3,87% o carga 8,70%); esta diferencia fue estadísticamente significativa (p=0,043). Conclusiones: Los eventos tromboembólicos son la complicación más frecuente de la embolización de aneurismas cerebrales. Nuestro trabajo, al igual que la literatura revisada, sustenta el uso de terapia antiplaquetaria dual con ácido acetilsalicílico y clopidogrel para disminuir la tasa de complicaciones tromboembólicas sintomáticas independientemente del protocolo de administración

Objective: The protocol for optimal antiplatelet therapy to prevent thrombotic complications following brain aneurysm embolisation is not clear. Our objective is to describe the characteristics of patients presenting with thrombotic or haemorrhagic complications secondary to endovascular treatment. Methods: A cross sectional descriptive study was performed, which included all patients that required endovascular treatment for brain aneurysm at San Ignacio University Hospital from November 2007 to January 2016. Thrombotic and haemorrhagic complications over six months of follow-up were assessed, considering the premedication regimen with antiplatelet agents, location, size of the aneurysm and embolisation technique performed. Results: 122 patients were evaluated, on whom 130 procedures were performed for endovascular treatment of brain aneurysms. Thrombotic complications were more frequent in patients who did not receive premedication (25%) compared to those who did receive an antiplatelet treatment regimen (standard dose 3.87% or loading dose 8.70%), and this difference was statistically significant (P=.043). Conclusions Thromboembolic events are the most common complication of brain aneurysm embolisation. Both our study and the literature suggest that the use of dual antiplatelet therapy with aspirin and clopidogrel lowers the rate of symptomatic thromboembolic complications, regardless of the administration protocol

[Thrombotic and haemorrhagic complications in patients with cerebral aneurysms treated by endovascular approach and their association with the use of antiplatelet agents: Descriptive evaluation]. / Complicaciones trombóticas y hemorrágicas en pacientes con aneurismas cerebrales tratados por vía endovascular y su relación con el uso de antiagregantes plaquetarios: evaluación descriptiva.

OBJECTIVE: The protocol for optimal antiplatelet therapy to prevent thrombotic complications following brain aneurysm embolisation is not clear. Our objective is to describe the characteristics of patients presenting with thrombotic or haemorrhagic complications secondary to endovascular treatment. METHODS: A cross sectional descriptive study was performed, which included all patients that required endovascular treatment for brain aneurysm at San Ignacio University Hospital from November 2007 to January 2016. Thrombotic and haemorrhagic complications over six months of follow-up were assessed, considering the premedication regimen with antiplatelet agents, location, size of the aneurysm and embolisation technique performed. RESULTS: 122 patients were evaluated, on whom 130 procedures were performed for endovascular treatment of brain aneurysms. Thrombotic complications were more frequent in patients who did not receive premedication (25%) compared to those who did receive an antiplatelet treatment regimen (standard dose 3.87% or loading dose 8.70%), and this difference was statistically significant (P=.043). CONCLUSIONS: Thromboembolic events are the most common complication of brain aneurysm embolisation. Both our study and the literature suggest that the use of dual antiplatelet therapy with aspirin and clopidogrel lowers the rate of symptomatic thromboembolic complications, regardless of the administration protocol.

Craniocervical junction diseases treatment with a minimally invasive approach / Abordagem minimamente invasiva para tratamento de lesões da união craniocervical / Abordaje minimamente invasivo para tratamiento de lesiones de la union craneocervical

Objective: To introduce a new minimally invasive surgical approach to anterior and lateral craniocervical junction diseases, preserving the midline posterior cervical spine stabilizing elements and reducing the inherent morbidity risk associated with traditional approaches. Methods: We describe a novel surgical technique in four cases of extra-medullary anterolateral compressive lesions located in the occipito-cervical junction, including infections and intra- and/or extradural tumor lesions. We used a paramedian trasmuscular approach through an anatomical muscle corridor using a micro MaXcess® surgical expandable retractor, with the purpose of reducing morbidity and preserving the posterior muscle and ligamentous tension band. Results: This type of surgical approach provides adequate visualization and microsurgical resection of lesions and reduces muscle manipulation and devascularisation, preserving the tension of the ligament complex. There was minimal blood loss and a decrease in postoperative pain, with rapid start of rehabilitation and shorter hospitalization times. There were no intraoperative complications, and all patients recovered from their pre-operative symptoms. Conclusions: This novel surgical technique is feasible and adequate for the occipito-atlanto-axial complex, with better results than traditional procedures.

Objetivo: Realizamos esforços para desenvolver novas técnicas cirúrgicas para reduzir a morbidade e a mortalidade. Métodos: Descrevemos uma técnica cirúrgica nova em quatro casos de lesões extramedulares compressivas anterolaterais da junção occipitocervical, que incluem infecções e lesões tumorais intra e extradurais. As lesões foram excisadas por uma nova técnica cirúrgica minimamente invasiva, por meio de um corredor anatômico muscular, utilizando-se o afastador expansível MaXcess® (Nuvasive Inc., San Diego, CA, EUA) visando reduzir a morbidade e preservar a banda de tensão músculo-ligamentar. Resultados: Esse tipo de abordagem proporcionou visualização e excisão microcirúrgica adequada das lesões, com redução da manipulação muscular, preservando a tensão do complexo ligamentar nucal. Houve perda de sangue mínima, além da redução da dor pós-operatória, início rápido da reabilitação e pequena estadia hospitalar. Não foram observadas complicações intraoperatórias e os pacientes não tiveram mais os sintomas apresentados no pré-operatório. Conclusões: Essa nova técnica cirúrgica é uma opção de tratamento na região do complexo occipito-atlanto-axial anterolateral, com resultados superiores aos dos procedimentos tradicionais.

Objetivo: Se han realizado esfuerzos por desarrollar nuevas técnicas quirúrgicas que reduzcan morbimortalidad. Métodos: Describimos una novedosa técnica quirúrgica de tratamiento en cuatro casos de lesiones extramedulares compresivas anterolaterales de la unión occipitocervical que incluyen infecciones y lesiones tumorales intra y extradurales. Las lesiones fueron extirpadas por una nueva técnica quirúrgica mínimamente invasiva a través de un corredor anatómico muscular, utilizándose el retractor expansible MaXcess® (Nuvasive Inc., San Diego, CA, EEUU) con el objetivo de reducir la morbilidad y preservar la banda de tensión músculo-ligamentaria. Resultados: Este tipo de abordaje aportó adecuada visualización y resección microquirúrgica de las lesiones, con reducción de la manipulación muscular, preservando la tensión del complejo ligamentario nucal. Hubo mínima pérdida sanguínea además de disminución de dolor post-operatorio, rápido inicio de rehabilitación y corta estancia hospitalaria. No se presentaron complicaciones intraoperatorias y los pacientes se recuperaron de la sintomatología preoperatoria. Conclusiones: Esta nueva técnica quirúrgica se perfila como una opción de tratamiento a nivel del complejo occipito-atlanto-axial anterolateral con resultados superiores a los procedimientos tradicionales.

Abnormal serum concentrations of proteins in Parkinson's disease.

Blood serum was used to identify protein biomarkers for diagnosis of Parkinson's disease (PD) using analytically validated quantitative 2D-gel electrophoresis, and single variable and multivariate statistics. Using banked samples from a first medical center, we identified 57 specific protein spot biomarkers with disease-specific abnormal levels in serum of patients with PD, Alzheimer's disease, amyotrophic lateral sclerosis and similar neurodegenerative conditions (337 samples), when compared to age-matched normal controls (132 samples). To further assess their clinical usefulness in Parkinson's disease, we obtained prospective newly drawn blood serum samples from a second (56 PD, 30 controls) and third (6 PD, 48 controls) medical center. The protein concentrations of the 57 biomarkers were assessed by 2D-gel electrophoresis. Stepwise linear discriminant analysis selected a combination of 21 of the 57 as optimal to distinguish PD patients from controls. When applied to the samples from the second site, the 21 proteins had sensitivity of 93.3% (52 of 56 PD correctly classified), specificity of 92.9% (28 of 30 controls correctly classified); 15 of 15 patients with mild, 28 of 30 with moderate to severe symptoms, and all of the 6 PD patients from the third site were correctly classified. Eleven of the 21 proteins showed statistically significant abnormal concentrations in patients with mild symptoms, and 14 in patients with moderate-severe symptoms. The protein identities reflect the heterogeneity of Parkinson's disease, and thus may provide the capability of monitoring the blood for a diverse range of PD pathophysiological mechanisms: cellular degeneration, oxidative stress, inflammation, and transport.