Application of neuroendoscopic surgical techniques in the assessment and treatment of cerebral ventricular infection

Cerebral ventricular infection (CVI) is one of the most dangerous complications in neurosurgery because of its high mortality and disability rates. Few studies have examined the application of neuroendoscopic surgical techniques (NESTs) to assess and treat CVI. This multicenter, retrospective study was conducted using clinical data of 32 patients with CVI who were assessed and treated by NESTs in China. The patients included 20 men and 12 women with a mean age of 42.97 years. NESTs were used to obliterate intraventricular debris and pus, fenestrate or incise the intraventricular compartment and reconstruct cerebrospinal fluid circulation, and remove artificial material. Intraventricular irrigation with antibiotic saline was applied after neuroendoscopic surgery (NES). Secondary hydrocephalus was treated by endoscopic third ventriculostomy or a ventriculoperitoneal shunt. Neuroendoscopic findings of CVI were used to classify patients into Grade Ⅰ(n = 3), Grade Ⅱ(n = 13), Grade Ⅲ(n = 10), and Grade Ⅳ(n = 6) CVI. The three patients with grade ⅠCVI underwent one NES, the 23 patients with grade Ⅱ/Ⅲ CVI underwent two NESs, and patients with grade Ⅳ CVI underwent two (n = 3) or three (n = 3) NESs. The imaging features and grades of neuroendoscopy results were positively related to the number of neurosurgical endoscopic procedures. Two patients died of multiple organ failure and the other 30 patients fully recovered. Among the 26 patients with secondary hydrocephalus, 18 received ventriculoperitoneal shunt and 8 underwent endoscopic third ventriculostomy. There were no recurrences of CVI during the 6- to 76-month follow-up after NES. Application of NESTs is an innovative method to assess and treat CVI, and its neuroendoscopic classification provides an objective, comprehensive assessment of CVI. The study trial was approved by the Institutional Review Board of Beijing Shijitan Hospital, Capital Medical University, China.

Surgical Indications of Exploring Optic Canal and Visual Prognostic Factors in Neurosurgical Treatment of Tuberculum Sellae Meningiomas

Background： Tuberculum sellae meningiomas （TSMs） present a special symptom because of the adherence and compression to the optic nerve, optic artery, and the chiasm. A significant number of patients with TSMs appear visual deficits. This study aimed to investigate the surgical indications of exploring the optic canal and visual prognostic factors in the neurosurgical treatment of TSMs. Methods： Totally 21 patients with TSM, who were operated from September 2007 to August 2011 in the Department of Neurosurgery, Tongren Hospital were enrolled in this study. Results of orbital computed tomography （CT） and magnetic resonance imaging （MRI）, visual acuity, Goldmann visual field test, orbital color Doppler flow imaging （CDI） test in these patients were retrospectively analyzed. Results： Visual deficit and optic canal involvement （OCI） were detected in all the 21 patients. Fourteen patients had bone proliferation within the area of the optic canal. After the operation, visual outcomes were improved in 13 patients, unchanged in 7 patients, and deteriorated in 1 patient. All the 21 patients performed orbital CDI test preoperatively, the results showed that if the peak systolic velocity （PSV） of central retinal artery （CRA） value was 〈8 cm/s, the visual outcome would be better. Conclusions： The surgical indications of exploring optic canal in TSM cases included： （1） The neuroimaging evidences of OCI （CT and/ or MR/）; （2） PSV of CRA in orbital CDI test was ≤8 cm/s; （3） visual acuity was below 0.1 ; （4） visual field deficit. The PSV of CRA in CDI test could be a prognostic factor for visual outcomes of TSMs.

Neuroendoscopic Evaluation and Treatment for Cerebral Ventricular Infection

To the Editor： Cerebral ventricular infection （CVI）, also termed ependymitis, involves an inflammatory response in the cerebral ventricular system. CVI is characterized by leukocytosis in tile cerebrospinal fluid （CSF）, a positive culture result of pathogenic bacteria, and imaging changes in tile ventricles.