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Non-Tumor Obstructive Hydrocephalus Treated with Endoscopic Third Ventriculostomy in Cameroon  [PDF]
Aurélien Ndoumbe, Chantal Simeu, Mathieu Motah
Open Journal of Modern Neurosurgery (OJMN) , 2015, DOI: 10.4236/ojmn.2015.54022
Abstract: Objective: In Sub-Saharan Africa, shunt dependence is a real threat for patients. For this reason, any method allowing shunt independence such as endoscopic third ventriculostomy should be promoted. The goal of this study was to show the advantages of neuroendoscopy in treating non-tumor obstructive hydrocephalus in Cameroon. Methods: We retrospectively reviewed the cases of non-tumor obstructive hydrocephalus treated with endoscopic third ventriculostomy in our hospital. Results: Twenty patients (15 males, 5 females) underwent endoscopic third ventriculostomy as first choice treatment for non-tumor obstructive hydrocephalus. Their ages ranged from six months to 41 years (mean 11.96 years, median 20.75 years). Fourteen patients (70%) were children (≤18 years old), 6 were adults, 7 were under age of two years and 3 were below one. Computed tomography scan was the radiological tool used in all cases. None did a magnetic resonance imaging scan. Etiology of hydrocephalus was aqueductal stenosis in 18 cases and stenosis of the foramina of Luschka & Magendie in two. Aqueductal stenosis was associated with myelomeningocele in one case and shunt failure in another one. Endoscopic third ventriculostomy was successful in alleviating clinical symptoms with shunt independence in 19 cases (95%), but failed in one case. ETV success was not related to patient age. Cerebrospinal fluid leak occurred in two patients as post-operative complication (10%). Overall, ETV diminished treatment cost by 600 USD. Conclusion: Even in areas with limited medical equipment like in Sub-Saharan Africa where shunt dependence is a real danger, ETV can be routinely used to successfully treat non-tumor obstructive hydrocephalus.
Evolution of surgical interventions for hydrocephalus: patient preferences and the need for proper information
PO Eghwrudjakpor, AB Allison
Internet Journal of Medical Update - EJOURNAL , 2010,
Abstract: The treatment of hydrocephalus has undergone remarkable transformation since it was first documented over two thousand years ago. Currently, the focus of hydrocephalus research is on minimally invasive techniques of treatment. This article reviews the evolution of hydrocephalus therapy, and examines current attitudes towards modern methods. We relied on journal publications, as well as literature on hydrocephalus obtained from the Internet (Google, Yahoo and PUBMED search) making use of the following search terms: “hydrocephalus: history; treatment; complications”, “cerebrospinal fluid shunt”, “endoscopic third ventriculostomy: indications of; complications of; advantages; disadvantages; successes; failure”. Numerous medical and surgical approaches have been adopted in the treatment of hydrocephalus in the past. However, the breakthrough that ushered in the modern era of hydrocephalus treatment was the introduction of valve-regulated systems in the middle of the last century. Endoscopic third ventriculostomy has evolved to become an alternative to traditional shunts. Cerebrospinal fluid shunt procedures are very effective in the treatment of hydrocephalus and have radically transformed the outcome of the disorder. However, they have a number of limitations. The alternative to shunts, endoscopic third ventriculostomy, is relatively safe, effective and durable. It does not, however, succeed in every patient; and also has some potentially devastating complications. Preoperative counseling is imperative to ensure that patients are properly guided. KEYWORDS: Cerebrospinal fluid shunt; Complications; Endoscopic third ventriculostomy; Hydrocephalus; Indications; Patient selection
Cerebrospinal Fluid Biomarkers in Idiopathic Normal Pressure Hydrocephalus  [PDF]
Ville Leinonen,Lata G. Menon,Rona S. Carroll,Donna Dello Iacono,Jeremy Grevet,Juha E. J??skel?inen,Peter M. Black
International Journal of Alzheimer's Disease , 2011, DOI: 10.4061/2011/312526
Abstract: The diagnosis of idiopathic normal pressure hydrocephalus (iNPH) is still challenging. Alzheimer's disease (AD), along with vascular dementia, the most important differential diagnosis for iNPH, has several potential cerebrospinal fluid (CSF) biomarkers which might help in the selection of patients for shunt treatment. The aim of this study was to compare a battery of CSF biomarkers including well-known AD-related proteins with CSF from patients with suspected iNPH collected from the external lumbar drainage test (ELD). A total of 35 patients with suspected iNPH patients were evaluated with ELD. CSF was collected in the beginning of the test, and the concentrations of total tau, ptau181, Aβ42, NFL, TNF-α, TGFβ1, and VEGF were analysed by ELISA. Twenty-six patients had a positive ELD result—that is, their gait symptoms improved; 9?patients had negative ELD. The levels of all analyzed CSF biomarkers were similar between the groups and none of them predicted the ELD result in these patients. Contrary to expectations lumbar CSF TNF-α concentration was low in iNPH patients. 1. Introduction Normal pressure hydrocephalus (NPH) is characterized by a clinical triad of symptoms including cognitive impairment, gait difficulty, and urinary incontinence along with ventricular enlargement in brain imaging [1]. NPH is considered as idiopathic (iNPH) when there are no known predisposing factors such as subarachnoid haemorrhage or brain trauma [1]. NPH can be treated by shunt [1] but the response rate is highly sensitive for selection of patients [2, 3]. Alzheimer’s disease (AD) is along with vascular dementia (VaD) the most frequent differential diagnosis for iNPH [4]. Several supplementary diagnostic tests of cerebrospinal fluid (CSF) dynamics are used in the selection of patients to shunt surgery. The CSF tap test or external lumbar drainage test (ELD) can predict the shunt response with high specificity and are widely used [5]. Infusion tests where usually RingerR-solution is infused into CSF space with simultaneous CSF pressure monitoring to calculate outflow conductance or outflow resistance are also used [6]. In addition, intracranial pressure monitoring alone [7] or together with cortical brain biopsy to detect AD-related pathological findings [4] has been suggested. CSF biomarkers reflecting ongoing pathophysiological processes might further help in the evaluation of patients with suspected iNPH. Previous reviews have pointed out several potential CSF biomarkers associated with NPH [8] but all of them still requiring further verification [9]. There are numerous
Endoscopic third ventriculostomy in obstructed hydrocephalus  [cached]
Singh D,Gupta V,Goyal A,Singh H
Neurology India , 2003,
Abstract: Forty-three ETV were performed in 46 patients of obstructive hydrocephalus. Study was divided into two groups. Group 1 was with 29 children of less than two years age. Group 2 had seventeen patients of more than 2 years, adolescent and adults. Group 1 had 70% clinical and 63% radiological improvement whereas Group 2 showed 100% clinical and 73% radiological improvement. ETV failed in relieving the symptoms of hydrocephalus in eight patients. They were eventually benefited with VP Shunt. There was one postoperative death, which was not related to the procedure. ETV is an important alternative to VP Shunt in relieving hydrocephalus due to obstruction in CSF pathway.
Evolution of surgical interventions for hydrocephalus: patient preferences and the need for proper information
Dr. P. O. Eghwrudjakpor MBBS, DMS, FICS,Dr. A. B. Allison MBBS, FRCS, FICS
Internet Journal of Medical Update - EJOURNAL , 2010,
Abstract: The treatment of hydrocephalus has undergone remarkable transformation since it was first documented over two thousand years ago. Currently, the focus of hydrocephalus research is on minimally invasive techniques of treatment. This article reviews the evolution of hydrocephalus therapy, and examines current attitudes towards modern methods. We relied on journal publications, as well as literature on hydrocephalus obtained from the Internet (Google, Yahoo and PUBMED search) making use of the following search terms: “hydrocephalus: history; treatment; complications”, “cerebrospinal fluid shunt”, “endoscopic third ventriculostomy: indications of; complications of; advantages; disadvantages; successes; failure”. Numerous medical and surgical approaches have been adopted in the treatment of hydrocephalus in the past. However, the breakthrough that ushered in the modern era of hydrocephalus treatment was the introduction of valve-regulated systems in the middle of the last century. Endoscopic third ventriculostomy has evolved to become an alternative to traditional shunts. Cerebrospinal fluid shunt procedures are very effective in the treatment of hydrocephalus and have radically transformed the outcome of the disorder. However, they have a number of limitations. The alternative to shunts, endoscopic third ventriculostomy, is relatively safe, effective and durable. It does not, however, succeed in every patient; and also has some potentially devastating complications. Preoperative counseling is imperative to ensure that patients are properly guided.
Endoscopic management of hypertensive intraventricular haemorrhage with obstructive hydrocephalus
Yad Yadav, Gaurav Mukerji, Ravikiran Shenoy, Abhijeet Basoor, Gaurav Jain, Adam Nelson
BMC Neurology , 2007, DOI: 10.1186/1471-2377-7-1
Abstract: During a two year period, 25 patients diagnosed as having an intraventricular haemorrhage with obstructive hydrocephalus secondary to hypertension were included in this study. All patients underwent endoscopic evacuation of the haematoma under general anaesthesia. Post operative evaluation was done by CT scan and Glasgow outcome scale.Of the 25 patients, thalamic haemorrhage was observed in 12 (48%) patients, while, 11 (44%) had a putaminal haematoma. Nine (36%) patients had a GCS of 8 or less pre-operatively. Resolution of hydrocephalus following endoscopic evacuation was observed in 24 (96%) patients. No complications directly related to the surgical technique were encountered in our study. At six months follow-up, a mortality rate of 6.3% and 55.5% was observed in patients with a pre-operative GCS of ≥ 9 and ≤ 8 respectively. Thirteen of the 16 (81.3%) patients with a pre-operative GCS ≥ 9 had good recovery.Endoscopic technique offers encouraging results in relieving hydrocephalus in hypertensive intraventricular haemorrhage. Final outcome is better in patient with a pre-operative GCS of >9. Future improvements in instrumentation and surgical techniques, with careful case selection may help improve outcome in these patients.Non-traumatic intracerebral haemorrhage (ICH), an acute and spontaneous extravasation of blood into the brain parenchyma is the second most common cause of stroke [1] and accounts for 30–60% of all stroke admissions into a hospital [2]. Hypertension results in a two to six fold increase in the risk of intracerebral haemorrhage [3,4]. Thirty day mortality for CT confirmed intracerebral haemorrhage has been reported to be between 34 to 50% [5]. The severity of neurologic presentation [Glasgow Coma Scale (GCS)], age of patient, location of haematoma and presence of intraventricular haematoma are considered predictors of 30 day and 1 year mortality, with the older patient with a lower GCS, infratentorial haematoma and an intraventricular haematoma
Hydrocephalus, Ventriculo-Peritoneal shunt and Cerebrospinal fluid ascites
OP Binitie, SA Abdul-Azeim, SH Annobil
West African Journal of Medicine , 2002,
Abstract: A small number of patients with congenital hydrocephalus, who have been treated effectively with ventriculoperitoneal shunts, develop progressive increase in abdominal girth, due to cerebrospinal fluid ascites. This abdominal distension can produce respiratory difficulties that require endotraccheal intubation and ventilator support. The respiratory difficulties and the abdominal distension were eliminated when the ventriculoperitoneal shunt was conterted to a ventriculoatrial shunt in each of the three cases presented in this paper for discussion.
Cerebrospinal fluid absorption disorder of arachnoid villi in a canine model of hydrocephalus  [cached]
Zhao Ke,Sun Hong,Shan Yan,Mao Bo
Neurology India , 2010,
Abstract: Background: Hydrocephalus results from inadequate passage of cerebrospinal fluid (CSF) from its point of production within the cerebral ventricles to its point of absorption into systemic circulation. Aims: The objective of this study was to investigate the disorders of CSF absorption by arachnoid villi during the different phases of hydrocephalus. Materials and Methods: Silicone oil was injected into the fourth ventricle of 15 canines as an experimental group. Saline solution (0.9% NaCl) was injected in another nine canines as a control group. In order to block CSF transport through the cribriform plate, an external ethmoidectomy was performed in five dogs from experimental group and three dogs from control group at three days (acute stage), two weeks (sub-acute stage), and 12 weeks (chronic stage) respectively. Tritiated water was injected into the canines′ cortical subarachnoid space and blood levels were measured at intervals of 1h, 4h, 8h, 16h and 48h respectively. Time-concentration curve of tritiated water was drafted. The area under the curve (AUC) was calculated for variance analysis and t-testing. Results: In the chronic group, the tritiated water concentration rose slowly to a peak at 16h. It was significantly lower than other groups at 1h, 4h, 8h and 16h, but was higher than other groups at 48h. Analysis of the AUC showed significant differences among all the groups (P<0.01). There were no significant differences in the AUC between control groups, the acute group, and the sub-acute group (P>0.05); however, the AUC of the chronic group was significantly lower than other groups (P<0.05). Conclusions: The CSF absorption ability of arachnoid villi is significantly damaged in a long-term state of hydrocephalus.
Unilateral hydrocephalus in paediatric patients, a trial of endoscopic fenestration.  [cached]
Kumar R
Neurology India , 1999,
Abstract: Two uncommon cases of unilateral, asymmetrical hydrocephalus secondary to membranous occlusion of foramen of monro are described. Both the cases presented with clinical features of raised intracranial pressure and their cranial computerized scans (CT) revealed asymmetrical dilatation of lateral ventricles with displacement of septum pellucidum towards the side of smaller ventricle. Neuroendoscopic fenestration of septum pellucidum and foramen of monro was tried in both the cases, which remained successful in first, while the second case required unilateral ventriculoperitoneal shunt, due to failed endoscopic negotiation of narrowed foramen of monro and intraoperative bleeding during endoscopic intervention.
The predictive value of cerebrospinal fluid tap-test in normal pressure hydrocephalus
Damasceno, Benito P.;Carelli, Edmur F.;Honorato, Donizeti C.;Facure, Jose J.;
Arquivos de Neuro-Psiquiatria , 1997, DOI: 10.1590/S0004-282X1997000200003
Abstract: eighteen patients (mean age of 66.5 years) with normal pressure hydrocephalus (nph) underwent a ventriculo-peritoneal shunt surgery. prior to operation a cerebrospinal fluid tap-test (csf-tt) was performed with measurements of gait pattern and psychometric functions (memory, visuo-motor speed and visuo-constructive skills) before and after the removal of 50 ml csfby lumbar puncture (lp). fifteen patients improved and 3 were unchanged after surgery. short duration of disease, gait disturbance preceding mental deterioration, wide temporal horns and small sulci on ct-scan were associated with good outcome after shunting. there was a good correlation between the results of csf-tt and shunt surgery (x2 = 4,11 ,phi = 0.48, p < 0.05), with gait test showing highest correlation (r = 0.99, p = 0.01). in conclusion, this version of csf-tt proved to be an effective test to predict improvement after shunting in patients with nph.
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