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1.
M. J. Fritsch M. Bauer C. J. Partsch W. G. Sippell H. M. Mehdorn 《Child's nervous system》2007,23(6):627-631
Objective Endoscopic third ventriculostomy (ETV) is a standard procedure for the treatment of obstructive hydrocephalus in children.
Main part of the procedure is the perforation of the third ventricle floor (tuber cinereum). This structure is part of the
hypothalamic–pituitary neuronal network of cerebral endocrine regulation. There are no systematic data available about the
endocrine status after ETV in children.
Materials and methods We examined 20 children who had undergone ETV. Examination included laboratory tests (adrenocorticotropic hormone, prolactin,
insulin-like growth factor 1 [IGF-1], IGF-binding protein 3 [IGFBP-3], fT3, fT4, thyroid-stimulating hormone [TSH], serum
osmolarity, electrolytes, glucose, urea, follicle-stimulating hormone [FSH] and luteinizing hormone [LH], and testosterone
in selected patients), measurement of weight, height, and head circumference, and physical examination. The study was approved
by the Ethics Committee of the Medical Faculty of Kiel University.
Results In seven patients, prolactin was moderately elevated. One patient demonstrated a significantly increased prolactin (56.3 ng/ml).
In all eight patients, this was the only laboratory value that was out of the normal range; all other parameters were normal.
Three other patients showed one abnormal parameter (decrease in FSH and LH, increase in TSH, decrease in IGF-1 and IGFBP-3).
In nine patients, weight or height was not within the 3rd to 97th centiles for age.
Discussion and conclusion More patients than expected demonstrated endocrine laboratory abnormalities. However, there was no clinical relevance in any
of the studied patients. It remains inconclusive whether ETV contributes to the abnormalities of prolactin levels or to other
endocrine parameters in pediatric patients. Longitudinal studies are necessary to delineate the effect of ETV on endocrine
regulation.
Presented at the Third World Conference of the International Study Group on Neuroendoscopy (ISGNE), Marburg, Germany, 15–18
June 2005. 相似文献
2.
3.
Satoru Osuka Shingo Takano Takao Enomoto Eiichi Ishikawa Koji Tsuboi Akira Matsumura 《Child's nervous system》2007,23(8):897-900
Background Although there have been reports dealing with ventricular diverticulum (VD) analyzed by cisternography and computed tomography
(CT), those focusing on magnetic resonance imaging (MRI) or neuroendoscopic findings are rare.
Case report We present a case of noncommunicating hydrocephalus caused by aqueductal stenosis with cystic lesion located in supracerebellar
region. Third ventriculostomy was performed on this case. The conventional CT and MRI were compatible with usual VD, but neuroendoscopic
examination suggested otherwise. The endoscopic view inside of the cystic lesion demonstrated passing veins and no membrane.
We diagnosed this cystic lesion as a unique subtype of advanced VD mimicking spontaneous ventriculostomy. Endoscopic observation
of the cyst was very useful for accurate diagnosis and safe treatment. 相似文献
4.
Liana Beni-Adani Naresh Biani Liat Ben-Sirah Shlomi Constantini 《Child's nervous system》2006,22(12):1543-1563
Background and objective The classification of hydrocephalus in newborns and in infants is different from the classification in adulthood. This difference
exists due to disparity in the source pathologies that produce the hydrocephalus, and the practical distinctions in prognosis
and treatment choices. The objective of this paper is to present the spectrum of obstructive-communicating hydrocephalus,
which is more complex in the pediatric group, and to propose the relevance of this particular classification to treatment
options.
Materials and methods The authors categorized infants with active hydrocephalus at time of presentation into the following four groups along the
spectrum of communicating vs obstructive HCP. Group 1: patients with a purely absorptive (communicating) HCP. In these patients,
tetraventricular dilatation is usually observed with occasional extraaxial fluid accumulation. An extracranial CSF diversion
(shunt) is the treatment of choice. Group 2: patients with an obstructive component together with a persistent absorptive
component. In these patients, a technically successful endoscopic procedure will not prevent progression of clinical symptoms
of HCP. An extracranial CSF diversion (shunt) should be the treatment of choice even though some of these patients are currently
treated by endoscopy. Group 3: patients with an obstructive component together with a temporary absorptive component. In these
patients, a technically successful ETV should be followed by temporary CSF drainage [via LP, continuous spinal drainage (CLD),
or ventriculostomy] with or without supplemental medical treatment (i.e., Diamox) for several days. Such temporary drainage
may decrease failure rate in this subgroup. Group 4: patients with a purely obstructive HCP. In these patients, an endoscopic
procedure (ETV) is the treatment of choice. According to this spectrum classification, the authors classify different entities
with representative cases and discuss relevancy to treatment options and prognosis.
Results The data suggest that obstructive hydrocephalus in the very young population may be rather a combination of obstructive and
absorptive problem. The outcome of the patient depends mainly not only on the basic pathology causing the hydrocephalus but
also on the treatment that is chosen and its complications. While bleeding and infection represent the major causes for communicating
hydrocephalus, patients with complex pathologies of congenital type and intra- or interventricular obstructions may reflect
obstructive hydrocephalus. Treatment of these patients may be successful by shuntless procedures if the absorptive problem
is not the major component. In transient absorptive hydrocephalus, temporary measures were effective in many cases leading
to successful procedures of ETV and/or posterior-fossa decompression in selected cases.
Conclusions Shuntless procedures are the dream of a pediatric neurosurgeon provided it solves the problem and does not imply unacceptable
risk. However, the benefit has to be evaluated years after the procedure is performed, as only prospective multicenter studies
will truly show which procedure may have the best overall results in the developing child. Until such studies are available,
understanding the basic pathology or the combination of pathologies leading to hydrocephalus in a given child may open the
window of opportunities for other than shunt surgery in many hydrocephalic children with major obstructive component. 相似文献
5.
Summary For many years percutaneous needle and classic burr-hole trephination with insertion of plastic catheters for external ventricular drainage are in use. The shortcomings of the conventional puncture needles were compensated for by the development of a modified instrument in recent years.In this prospective study we tried to define advantages and disadvantages of percutaneous ventriculostomy with this modified needle in a large number of patients. We treated and followed a total number of 200 patients with external ventricular drainage for various reasons (42% obstructive hydrocephalus, 27% haematocephalus, 11% malresorptive hydrocephalus, 11% elevated ICP and 9% infections). The ventriculostomy is performed — after percutaneous trepheication with a 1.5 mm drill and 1.2 mm needle under the local aesthesia as a bedside procedure. The modified blunt needle is provided with markings and a set screw which allows insertion to a prefixed depth and a sharp guide which is withdrawn after penetration of the dura. It is then bent rostrally and fixed by a plaster cast. The mean duration of drainage was 9 days (1–30 days). Mean operating time for the whole procedure including fixation and connection to the drainage system was 20 minutes. Overall complication rate was 13% (N=26). Two intracerebral haemorrhages (1%) occurred, of which one was caused by overdrainage. Five (3%) infections in primarily not infectious cases (N=182) were seen. Only one case of infection occurred without loosing of the needle on day 17. In 19 patients (10%) the needles had loosened. Fifteen times this complication was repaired in time and no infection occurred. The overall complication rate (13%) and the needle related risk of bleeding (0.5%) seem average. The true risk of infection with correct handling (0.5%) is very low despite the very long average duration of drainage. The main risk lies in the markedly high danger of loosening (10%), which entails a disproportionally high demand for nursing care. Nevertheless, we regard percutaneous needle trephination as the ventriculostomy method of choice because of its better practicability and low infection rate. 相似文献
6.
Relative risks of ventriculostomy infection and morbidity 总被引:3,自引:0,他引:3
Summary Ventricular catheter placement is a common procedure for the management of increased intracranial pressure. Hypotheses regarding the etiology of infection of catheters center on two alternative assumptions: 1) contamination leading to infection occurs at the time of catheter insertion, implying that catheter duration has minimal effect on infection risk; and 2) infection of catheters derives from catheter contamination after insertion, suggesting that duration of catheter use may significantly affect infection risk.We have studied the relative complication rate of ventricular catheter insertions using a retrospective approach (n=161 patients and 253 catheter insertion procedures). The overall infection rate was 4.1%, but the daily infection hazard increased exponentially with time, to a maximum daily rate of 10.3% by day 6 of catheter insertion. This increasing risk appears most consistent with the second hypothesis. The risk of non-infectious complications was 5.6%, including hemorrhagic occurrences and misplacement severe enough to require a new catheter insertion. The daily hazard of infection approximately equalled the non-infectious risk of routine catheter replacement by day 5.Additional prospective data on the daily risk of CSF infection and the appropriateness of antibiotic prophylaxis either at the time of ventricular catheter insertion or continued through the catheter's-presence may be required to both definitively identify which hypothesis of infection risk is correct and whether antibiotics can significantly ameliorate this risk. 相似文献
7.
Diffuse Axonal Injury (DAI) is not Associated with Elevated Intracranial Pressure (ICP) 总被引:7,自引:0,他引:7
Summary
Objective. Traditionally, intracranial pressure (ICP) monitoring has been utilized in all patients with severe head injury (Glasgow
coma score of 3–8). Ventriculostomy placement, however, does carry a 4 to 10 percent complication rate consisting mostly of
hematoma and infection. The authors propose that a subgroup of patients presenting with severe head trauma and diffuse axonal
injury without associated mass lesion, do not need ICP monitoring. Additionally, the monitoring data from ICP, MAP, and CPP
for a comparison severe head injury group, and subgroups of DAI would be presented.
Materials and methods. Thirty-six patients sustaining blunt head trauma and fitting our strict clinical and radiographic diagnosis of DAI were enrolled
in our study. Inclusion criteria were severe head injury patients who did not regain consciousness after the initial impact,
and whose CT scan demonstrated characteristic punctate hemorrhages of <10 mm diameter at the greywhite junction, basal ganglia,
corpus callosum, upper brainstem, or a combination of the above. Patients with significant mass lesions and documented anoxia
were excluded. Their intracranial pressure (ICP) and cerebral perfusion pressure (CPP) were compared to a control group of
36 consecutive patients with severe non-penetrating non-operative head injury, using the Analysis for Variance method.
Results. Eighteen (50.0%), six (16.7%), and twelve (33.3%) patients had types I, II, and III DAI, respectively. The admission Glasgow
Coma Score (GCS) was higher for types I and II than for type III DAI. ICP was monitored from 23 to 165 hours, with a mean
ICP for 36 patients of 11.70 mmHg (SEM=75) and a range from 4.3 to 17.3 mmHg. Of all ICP recordings, of which 89.7% (2421/2698)
were ≤20 mmHg. Average mean arterial pressure (MAP) was 96.08 mmHg (SEM=1.69), and 94.6% (2038/2154) of all MAP readings were
greater than 80 mmHg. Average cerebral perfusion pressure (CPP) was 85.16 mmHg (SEM=1.68), and 90.1% (1941/2154) of all CPP
readings were greater than 70 mmHg. This is compared to the control group mean ICP, MAP, and CPP of 16.84 mmHg (p=0.000021),
92.80 mmHg (p=0.18), and 76.49 mmHg (p=0.0012). No treatment for sustained elevated ICP>20 mmHg was needed for DAI patients
except in two; one with extensive intraventricular and subarachnoid hemorrhage who developed communicating hydrocephalus,
and another with ventriculitis requiring intrathecal and intravenous antibiotic treatments. Two complications, one from a
catheter tract hematoma, and another with Staph epidermidis ventriculitis, were encountered.
All patients, except type III DAI, generally demonstrated marked clinical improvement with time. The outcome, as measured
by Glasgow Coma Score (GCS) and Glasgow Outcome Score (GOS) was similarly better with types I and II than type III DAI.
Conclusion. The authors conclude that ICP elevation in DAI patients without associated mass lesions is not as prevalent as other severe
head injured patients, therefore ICP monitoring may not be as critical. The presence of an ICP monitoring device may contribute
to increased morbidity. Of key importance, however, is an accurate clinical history and interpretation of the CT scan. 相似文献
8.
Image Guided Neuroendoscopy for Third Ventriculostomy 总被引:4,自引:0,他引:4
Summary Third ventriculostomy has become an increasing popular procedure for the treatment of hydrocephalus of different aetiologies.
Between october 1997 and october 1998, 17 patients (12 females, 5 males; 12–82 year-old; mean age 43) underwent image-assisted
endoscopic third ventriculostomy for hydrocephalus at the Istituto Nazionale Neurologico “C.Besta” of Milano. There was no
mortality and no long term morbidity. Neuronavigation has been found useful in selecting the safest trajectory to the target
avoiding any traction on the foramen of Monro related structures and allowing the necessary mobility for fine adjustments
under visual and “tactile” control when choosing the safest point to perform the stoma.
According to our experience neuro-endoscopy and neuronavigation seems to be complementary in reaching easy, safe and successful
results in the treatment of hydrocephalus of different origins. 相似文献
9.
神经内镜下行三脑室底造瘘术治疗梗阻性脑积水的并发症分析和防治 总被引:1,自引:0,他引:1
目的:分析神经内镜下三脑室底造瘘术(ETV)的手术并发症原因,探讨其防治要点。方法:通过回顾性分析2004年9月至2006年2月应用ETV连续治疗梗阻性脑积水55例的手术并发症,对ETV的常见并发症的原因做了探讨。结果:54例患者ETV得以完成,术后50例患者恢复良好,脑积水症状明显减轻或消失。4例患者症状复发或加重,行脑室腹腔分流术。术后并发症包括硬膜下积液8例,发热15例,2例伴有脑膜刺激征为颅内感染,癫痫1例,硬膜外出血1例,头皮下积液8例。结论:熟悉三脑室底的解剖结构,选择合适的造瘘方法,并注意手术前后脑脊液动力学的变化,可以减少三脑室底造瘘治疗梗阻性脑积水的手术并发症。 相似文献
10.
目的探讨用脑认知功能评价儿童脑积水三脑室底造瘘术后疗效的价值。方法2007年6月~2012年6月,对20例行三脑室底造瘘术的脑积水患儿于手术前和术后2、6个月进行智能评测(采用Gesell发育诊断量表,包括适应行为、大运动行为、精细运动行为、语言行为和个人-社会行为)及脑室额角宽度测量,进行术后疗效评价。结果术后2、6个月与术前相比智能测定有统计学差异(P〈0.01),分别有8/20和15/20患儿DQ恢复正常。术后脑室大小较术前差异无显著性(P〉0.05)。结论脑发育的改善及脑认知功能的恢复对儿童脑积水三脑室底造瘘术后疗效的评价有重要意义。 相似文献