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

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中华神经外科杂志(英文) 2024年第2期10卷 1-8页

作者： Quintero Silvia Tatiana Ramirez-Velandia Felipe Moreno Andres Felipe Hortua Vera Lina Rugeles Paula Gonzalez Rafael Augusto Azuero Pontificia Universidad Javeriana Clinica Medilaser S.A.S. Clinica Chicamocha Bucaramanga Santander Colombia Neurology and Neurosurgery Research Group Pontificia Universidad Javeriana Bogotá D.C. Colombia Universidad Industrial de Santander Clinica Chicamocha Bucaramanga Colombia Universidad Autónoma de Bucaramanga Clinica Chicamocha Bucaramanga Colombia Clinica Chicamocha Bucaramanga Santander Colombia

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.

关键词： hydrocephalus Ventriculoatrial shunting Internal jugular vein Operative time Complications Shunt removal

Simultaneous biportal endoscopic management of pineal region tumors in patients with obstructive hydrocephalus:technical notes

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Chinese Neurosurgical Journal 2023年第2期9卷 51-57页

作者： Sultan Al-Saiari Khalid Al Orabi Mohammad Ghazi Abdoh Abdulaziz A.Basurrah Sultan Faez Albalawi Ahmed A.Farag Neurosurgery Department King Abdullah Medical CityP.O 24246MakkahSaudi Arabia

Background The goal of this study is to show the feasibility and benefits of using the simultaneous biportal endoscopic procedure to treat pineal tumors in patients with obstructive hydrocephalus.Methods We retrospectively reviewed three patients with pineal tumors and acute obstructive hydrocephalus who were treated in one session with a frameless stereotactic guided simultaneous biportal endoscopic third ventriculostomy and endoscopic tumor biopsy performed through two separate ports using one rigid ventriculoscope.Results In the three patients,ventriculostomy and endoscopic biopsies were conducted.There was no death or morbidity throughout the 45-min procedure.All of the patients’histological findings were confirmed.Germinoma was diagnosed in two patients who recieved postoperative radiotherapy,and the third patient diagnosed with a pineocytoma.Magnetic resonance imaging with flow-sensitive sequences was used to confirm ventriculostomy patency in all patients 6 months after the surgery.Conclusion Biportal endoscopic approach enables better visual control of both procedures.Furthermore,it allows the surgeon to safely pass the ventriculoscope via the foramen of monro,even if it is narrow.Moreover,during endoscopic tumor biopsy and third ventriculostomy,the intracranial pressure can be smoothly managed using the outlet tubes accessible.This treatment may be an alternative to traditional uniportal endoscopic operations in certain patients.

关键词： Pineal tumors Germinoma hydrocephalus Endoscopic third ventriculostomy Endoscopic biopsy

Chinese expert consensus on the management of aneurysmal subarachnoid hemorrhage-related hydrocephalus

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Chinese Neurosurgical Journal 2023年第2期9卷 138-147页

作者： Jun Pu Yuan-li Zhao Yu-xiang Gu Chun-hua Hang Yong-ping You Mao-de Wang Yan Qu Hua Lu Shuo Wang Chinese Neurosurgical Society Department of Neurosurgery The Second Affiliated Hospital of Kunming Medical UniversityKunmingChina Department of Neurosurgery Beijing Tiantan HospitalCapital Medical UniversityBeijingChina Huashan Hospital Affiliated to Fudan UniversityShanghaiChina Nanjing Drum Tower Hospital Nanjing University Medical CollegeNanjingChina Department of Interventional Neuroradiology Jiangsu Province HospitalNanjingChina First Affiliated Hospital of Xi’an Jiaotong University Xi’anChina Tangdu Hospital Air Force Military Medical UniversityXi’anChina 不详

Aneurysmal subarachnoid hemorrhage-related hydrocephalus(aSAH-H)refers to a clinical syndrome of excessive secretion,obstructive absorption,or circulatory disturbance of cerebrospinal fluid(CSF)with subarachnoid hemorrhage following rupture of aneurysm that leads to excessive accumulation of intracranial CSF and enlargement of ventricles impairing neurological function.aSAH is an important risk factor for hydrocephalus[1,2].According to fluid dynamics,aSAH-H is divided into communicating and obstructive hydrocephalus;according to the time of occurrence.

关键词： hydrocephalus aneurysm hemorrhage

Endoscopic third ventriculostomy:a feasible treatment option for pediatric hydrocephalus in a high-risk cohort–a single-center report

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World Journal of Pediatric Surgery 2022年第3期5卷 176-180页

作者： Stefanie Deininger Julia Küppers Dirk Lehnick Peter Esslinger Hermann Winiker Markus Lehner Department of Neurosurgery University Hospital UlmUlmGermany Department of Pediatric Surgery Luzerner Kantonsspital Kinderspital LuzernLuzernSwitzerland Department of Health Sciences and Health Policy University of LucerneLuzernSwitzerland

Treating hydrocephalus in young childprimarily either byren and infants is still a demanding procedure with a high rate of surgery-related complications.The improvement of technology in pediatric intensive care has increased the chance of survival in very low birthweight infants,and therefore the risk for patients with posthemorrhagic hydrocephalus(PHH)has also increased.During the past 20 years,endoscopic third ventriculostomy(ETV)has become a reasonable option for treating different types of hydrocephalus,especially in the challenging field of PHH after intraventricular hemorrhage(IVH).

关键词： hydrocephalus pediatric surgery

Dscam mutation leads to hydrocephalus and decreased motor function

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Protein & Cell 2011年第8期2卷 647-655页

作者： Yiliang Xu Haihong Ye Yan Shen Qi Xu Li Zhu Jianghong Liu Jane Y.Wu National Laboratory of Medical Molecular Biology Institute of Basic Medical SciencesChinese Academy of Medical Science and Peking Union Medical CollegeTsinghua UniversityBeijing 100084China The State Key Laboratory of Brain and Cognitive Science Institute of BiophysicsChinese Academy of SciencesBeijing 100101China Department of Neurology Center of Genetic MedicineLurie Cancer CenterNorthwestern University Feinberg School of MedicineChicagoIL 60611USA

The nervous system is one of the most complicated organ systems in invertebrates and vertebrates.Down syndrome cell adhesion molecule(DSCAM)of the immunoglobulin(Ig)superfamily is expressed widely in the nervous system during embryonic development.Previous studies in Drosophila suggest that Dscam plays important roles in neural development including axon branching,dendritic tiling and cell spacing.However,the function of the mammalian DSCAM gene in the formation of the nervous system remains unclear.Here,we show that Dscam^(del17) mutant mice exhibit severe hydrocephalus,decreased motor function and impaired motor learning ability.Our data indicate that the mammalian DSCAM gene is critical for the formation of the central nervous system.

关键词： Down syndrome cell adhesion molecule motor function motor learning hydrocephalus

Genetic etiologies associated with infantile hydrocephalus in a Chinese infantile cohort

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World Journal of Pediatrics 2021年第3期17卷 305-316页

作者： Hong-Fang Mei Xin-Ran Dong Hui-Yao Chen Yu-Lan Lu Bing-Bing Wu Hui-Jun Wang Guo-Qiang Cheng Lai-Shuan Wang Yun Cao Lin Yang Wen-Hao Zhou Department of Neonatology Children's Hospital of Fudan UniversityNational Children's Medical CenterShanghaiChina Key Laboratory of Birth Defects Children’s Hospital of Fudan UniversityNational Children’s Medical CenterShanghaiChina Center for Molecular Medicine of Children’s Hospital of Fudan University Institutes of Biomedical SciencesFudan UniversityShanghaiChina Clinical Genetic Center Children’s Hospital of Fudan UniversityNational Children's Medical Center399 Wan Yuan RoadShanghai 201102China

Background Infantile hydrocephalus(IHC)is commonly related to other central nervous system diseases,which may have adverse effects on prognosis.The causes of IHC are heterogeneous,and the genetic etiologies are not fully understood.This study aimed to analyze the genetic etiologies of an IHC cohort.Methods The data for 110 IHC patients who had received exome sequencing at the Clinical Genetic Center of the Children's Hospital of Fudan University between 2016 and 2019 were reviewed and analyzed retrospectively.An exome-wide association analysis(EWAS)was performed within this cohort using IHC as the study phenotype.Results Of the 110 IHC patients,a pathogenic or likely pathogenic variant was identified in 16(15%)patients,spanning 13 genes.The genes were mainly associated with metabolic disorders,brain abnormalities,and genetic syndromes.IHC patients who had unclear clinical etiology were more likely to possess a genetic etiology.Based on previous studies and on our EWAS results,ZEB1,SBF2,and GNAI2 were over-represented among IHC patients and might alfect the signaling pathways involved in IHC formation.Conclusions Our study showed heterogeneous genetic etiologies in an IHC cohort.It is essential to perform genetic testing on IHC patients who have unclear clinical etiology,and genes associated with metabolic disorders,brain abnormalities,and genetic syndromes should he noted.In addition,when aiming to discover IHC susceptibility genes,genes that might influence the signaling pathways involved in IHC formation should be prioritized.

关键词： Etiology Genetic hydrocephalus Infantile

Incidence and outcomes of intracerebral haemorrhage with mechanical compression hydrocephalus

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Stroke & Vascular Neurology 2021年第3期6卷 328-336页

作者： Bryce Owen Omar Akbik Michel Torbey Herbert Davis Andrew P Carlson School of Medicine University of New Mexico School of MedicineAlbuquerqueNew MexicoUSA Neurosurgery University of New MexicoAlbuquerqueNew MexicoUSA Neurology University of New MexicoAlbuquerqueNew MexicoUSA Division of Epidemiology Biostatisticsand Preventive MedicineUniversity of New MexicoAlbuquerqueNew MexicoUSA

Introduction Intracerebral haemorrhage(ICH)within deep structures adjacent to the third ventricle is associated with worse outcomes when compared with lobar ICH due to the critical role of deep nuclei in normal neurological functioning.New evidence suggests another contributing factor to poor outcome is obstruction of cerebrospinal fluid outflow by clot burden causing mechanical compression of the third ventricle.The authors reviewed the incidence and outcomes of mechanical compression ICH in order to identify this high-risk group which may potentially benefit from minimally invasive evacuation.Methods Patients with spontaneous,non-traumatic,supratentorial ICH were identified retrospectively over a 30-month period.CT imaging was reviewed to assess location of the ICH,volume of the ICH,presence of hydrocephalus requiring external ventricular drain(EVD)placement,and time to clearing of the third ventricle.hydrocephalus was then categorised as due to‘primarily intraventricular haemorrhage(IVH)’,‘primarily mechanical compression’or‘mixed’.Functional outcomes at discharge were assessed using the modified Rankin Score(mRS).Results 287 patients met inclusion criteria,of which 39(13.5%)patients developed hydrocephalus that required EVD.EVD patients had significantly higher mRS at discharge(p≤0.001)when compared with the non-EVD group.Lobar location was associated with lower odds of poor outcome compared with thalamic location(OR 0.107-0.560).Mechanical compression hydrocephalus was associated with poor outcome when compared with the primary IVH hydrocephalus subgroup(p=0.037)as well as longer time to clearing of the third ventricle(p=0.006).Conclusions Mechanical obstruction requiring EVD occurs in approximately(21/287)7.3%of all patients with spontaneous supratentorial ICH.It is unknown if the worse morbidity in these subjects is purely related to damage to deep structures surrounding the third ventricle or if secondary damage from hydrocephalus could be mitigated with targeted minimally invasive clot evacuation.

关键词： hydrocephalus damage primarily

Neuroimage-Based Consciousness Evaluation of Patients with Secondary Doubtful hydrocephalus Before and After Lumbar Drainage

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Neuroscience Bulletin 2020年第9期36卷 985-996页

作者： Jiayu Huo Zengxin Qi Sen Chen Qian Wang Xuehai Wu Di Zang Tanikawa Hiromi Jiaxing Tan Lichi Zhang Weijun Tang Dinggang Shen Institute for Medical Imaging Technology Shanghai Jiao Tong UniversityShanghai 200030China Department of Neurosurgery Huashan HospitalShanghai Medical CollegeFudan UniversityShanghai 200030China Neurosurgical Institute of Fudan University Shanghai Clinical Medical Center of NeurosurgeryShanghai Key Laboratory of Brain Function Restoration and Neural RegenerationShanghai 200030China State Key Laboratory of Medical Neurobiology and Ministry of Education Frontiers Center for Brain Science School of Basic Medical Sciences and Institutes of Brain ScienceFudan UniversityShanghai 200030China Department of Radiology Huashan HospitalFudan UniversityShanghai 200030China Department of Radiology and Biomedical Research Imaging Center University of North Carolina at Chapel HillChapel HillNC 27599USA Department of Brain and Cognitive Engineering Korea UniversitySeoul 02841Republic of Korea

hydrocephalus is often treated with a cerebrospinal fluid shunt(CFS) for excessive amounts of cerebrospinal fluid in the brain.However,it is very difficult to distinguish whether the ventricular enlargement is due to hydrocephalus or other causes,such as brain atrophy after brain damage and surgery.The non-trivial evaluation of the consciousness level,along with a continuous drainage test of the lumbar cistern is thus clinically important before the decision for CFS is made.We studied 32 secondary mild hydrocephalus patients with different consciousness levels,who received T1 and diffusion tensor imaging magnetic resonance scans before and after lumbar cerebrospinal fluid drainage.We applied a novel machine-learning method to find the most discriminative features from the multi-modal neuroimages.Then,we built a regression model to regress the JFK Coma Recovery Scale-Revised(CRS-R) scores to quantify the level of consciousness.The experimental results showed that our method not only approximated the CRS-R scores but also tracked the temporal changes in individual patients.The regression model has high potential for the evaluation of consciousness in clinical practice.

关键词： hydrocephalus Disorder of consciousness Structural imaging Feature selection Regression

A 65-year-old man with infratentorial diffuse encephalopathy and hydrocephalus

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Chinese Medical Journal 2011年第11期124卷 1758-1760页

作者： FENG Yan-qing GUO Ning LIU Jun-xiu LAI Rong CHEN Xi HUANG Fan Department of Neurology First Affiliated Hospital of Sun Yat-senUniversity Guangzhou Guangdong 510080 China

Tuberculous encephalopathy （TBE） is an important diagnosis in countries with a high prevalence of tuberculosis. TBE is a life-threatening condition but rarely reported in the modern literature. We reported a case of a man with extensive parenchymal lesions involving the brainstem and right cerebellar hemisphere that resolved after treatment. The clinical, laboratory and pathological features of this case are highlighted and the pathogenesis is discussed.

关键词： tuberculous encephalopathy hydrocephalus