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 s...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.展开更多
The goal of this work is to report on the efficacy of endoscopic third ventriculostomy (ETV) for non-tumor obstructive hydrocephalus in children aged two years and below. In the period between June 2007 and December 2...The goal of this work is to report on the efficacy of endoscopic third ventriculostomy (ETV) for non-tumor obstructive hydrocephalus in children aged two years and below. In the period between June 2007 and December 2014, we had performed ETV in 30 patients with hydrocephalus from diverse etiologies. Among them were eight children aged two years or below. Clinical, radiological and outcome data of these children were retrospectively reviewed to assess ETV efficiency in this age group. Eight children (6 boys, 2 girls) with age range from 6 to 24 months (mean 12.5 months, median 15 months) suffering from non-tumor obstructive hydrocephalus underwent ETV as primary treatment. Seven patients (87.5%) were under two years and 3 had less than one year of age at the time of surgery. Macro crania, suture diastasis, scalp vein bulging and sunset gaze were the most common findings on physical examination. Computed tomography scanning was done in all patients but none had magnetic resonance imaging. Hydrocephalus was due to primary (congenital) aqueductal stenosis in all cases and was associated with myelomeningocele in one. ETV was successful in 7 (87.50%) cases but failed in one. Operation time varied from 28 to 35 minutes (mean 31.12 minutes, median 31.5 minutes). No intraoperative complication occurred. The child in whom ETV failed had postoperative CSF leak. No death related to procedure occurred. Hospital stay ranged from 2 to 4 days (mean, 2.87 days, median, 3 days). Follow up range was 5.5 to 86 months (0.46 to 7.16 years);mean, 59.14 months (4.92 years);median, 45.75 months (3.81 years).展开更多
Pseudomonas aeruginosa (P. aeruginosa) frequently causes various infections, some of which are serious and require prompt medical detection and appropriate antibiotic selection. Although P. aeruginosa commonly exists ...Pseudomonas aeruginosa (P. aeruginosa) frequently causes various infections, some of which are serious and require prompt medical detection and appropriate antibiotic selection. Although P. aeruginosa commonly exists within the nasal cavity, meningitis or ventriculitis following transsphenoidal surgery to relieve P. aeruginosa has been reported only occasionally. However, as the endoscopic transnasal approach is more widely utilized for the suprasellar lesions, nosocomical P. aeruginosa infection associated with cerebrospinal fluid (CSF) leakage becomes more common in patients with panhypopituitarism who undergo transsphenoidal surgery. We report a case of a 36-year-old man with an intrasellar craniopharyngioma presenting with an acute obstructive hydrocephalus caused by P. aeruginosa ventriculitis following transsphenoidal surgery. Treatment with optimal antibiotics was initiated immediately after P. aeruginosa was recognized as the pathogen, and was continued for 3 months. After removal of the infected fascia and fat graft used for the closure of CSF leakage and sellar floor reconstruction, endoscopic third ventriculostomy was successfully performed to treat the obstructive hydrocephalus induced by the occlusion of the fourth ventricle outlet, resulting in a positive outcome. Although the obstructive hydrocephalus caused by P. aeruginosa is extremely rare, prompt detection and appropriate treatment should be required once P. aeruginosa ventriculitis happens.展开更多
Among pituitary tumors, prolactin (PRL)-secreting pituitary adenomas are by far the most frequent ones. The development of symptomatic hydrocephalus due to a pituitary adenoma is an exceptional event. The authors desc...Among pituitary tumors, prolactin (PRL)-secreting pituitary adenomas are by far the most frequent ones. The development of symptomatic hydrocephalus due to a pituitary adenoma is an exceptional event. The authors describe a 37-year-old man who had a pituitary adenoma associated with obstructive hydrocephalus that was managed by endoscopic transnasal transsphenoidal surgery. Postoperative CT and MRI scans showed resolution of the obstructive hydrocephalus and the foramen of Monro was open. Postoperatively, the patient had visual and headache improvement. Subsequently, the patient is a candidate for cranial surgery or medical therapy to complete the treatment. The present case highlights the fact that pituitary adenomas with obstructive hydrocephalus should be distinguished from other tumors especially colloid cysts.展开更多
目的回顾性总结经内镜第三脑室底造瘘术(ETV)治疗梗阻性脑积水的手术技巧、疗效及术后颅内压(ICP)的变化规律及动态ICP监护的价值。方法经内镜行ETV治疗梗阻性脑积水共146例,病因包括导水管狭窄98例、颅内肿瘤48例(第三脑室及松果体区肿...目的回顾性总结经内镜第三脑室底造瘘术(ETV)治疗梗阻性脑积水的手术技巧、疗效及术后颅内压(ICP)的变化规律及动态ICP监护的价值。方法经内镜行ETV治疗梗阻性脑积水共146例,病因包括导水管狭窄98例、颅内肿瘤48例(第三脑室及松果体区肿瘤)。术后行动态ICP监护53例(导水管狭窄36例、肿瘤17例),平均监护时长96 h。结果随访8个月至6年,术后脑积水明显缓解或消失138例(94.5%),8例脑积水缓解不明显或无效(5.5%),改行脑室腹腔分流术。ICP监护显示:术后6 h内平均ICP明显下降,低于10 mm Hg,此后缓慢轻度上升,96 h稳定于12 mm Hg;单纯导水管狭窄性脑积水平均ICP上升较缓慢、波动较小,最后达到10 mm Hg;而肿瘤性脑积水上升较快、波动较大,最后达到15 mm Hg。并发症28例(19.2%):术后发热22例,双额部硬膜外血肿1例、切口脑脊液漏2例、脑室少量积血2例、硬膜下积液1例。本组无死亡。结论 1第三脑室底造瘘治疗梗阻性脑积水(尤其是导水管狭窄脑积水)安全、有效,应作为其首选治疗手段;2术后行ICP动态监护,不仅可监测颅内压的变化,判断手术是否有效,同时可以观察有无脑室继发性出血等并发症及指导术后用药。展开更多
文摘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.
文摘The goal of this work is to report on the efficacy of endoscopic third ventriculostomy (ETV) for non-tumor obstructive hydrocephalus in children aged two years and below. In the period between June 2007 and December 2014, we had performed ETV in 30 patients with hydrocephalus from diverse etiologies. Among them were eight children aged two years or below. Clinical, radiological and outcome data of these children were retrospectively reviewed to assess ETV efficiency in this age group. Eight children (6 boys, 2 girls) with age range from 6 to 24 months (mean 12.5 months, median 15 months) suffering from non-tumor obstructive hydrocephalus underwent ETV as primary treatment. Seven patients (87.5%) were under two years and 3 had less than one year of age at the time of surgery. Macro crania, suture diastasis, scalp vein bulging and sunset gaze were the most common findings on physical examination. Computed tomography scanning was done in all patients but none had magnetic resonance imaging. Hydrocephalus was due to primary (congenital) aqueductal stenosis in all cases and was associated with myelomeningocele in one. ETV was successful in 7 (87.50%) cases but failed in one. Operation time varied from 28 to 35 minutes (mean 31.12 minutes, median 31.5 minutes). No intraoperative complication occurred. The child in whom ETV failed had postoperative CSF leak. No death related to procedure occurred. Hospital stay ranged from 2 to 4 days (mean, 2.87 days, median, 3 days). Follow up range was 5.5 to 86 months (0.46 to 7.16 years);mean, 59.14 months (4.92 years);median, 45.75 months (3.81 years).
文摘Pseudomonas aeruginosa (P. aeruginosa) frequently causes various infections, some of which are serious and require prompt medical detection and appropriate antibiotic selection. Although P. aeruginosa commonly exists within the nasal cavity, meningitis or ventriculitis following transsphenoidal surgery to relieve P. aeruginosa has been reported only occasionally. However, as the endoscopic transnasal approach is more widely utilized for the suprasellar lesions, nosocomical P. aeruginosa infection associated with cerebrospinal fluid (CSF) leakage becomes more common in patients with panhypopituitarism who undergo transsphenoidal surgery. We report a case of a 36-year-old man with an intrasellar craniopharyngioma presenting with an acute obstructive hydrocephalus caused by P. aeruginosa ventriculitis following transsphenoidal surgery. Treatment with optimal antibiotics was initiated immediately after P. aeruginosa was recognized as the pathogen, and was continued for 3 months. After removal of the infected fascia and fat graft used for the closure of CSF leakage and sellar floor reconstruction, endoscopic third ventriculostomy was successfully performed to treat the obstructive hydrocephalus induced by the occlusion of the fourth ventricle outlet, resulting in a positive outcome. Although the obstructive hydrocephalus caused by P. aeruginosa is extremely rare, prompt detection and appropriate treatment should be required once P. aeruginosa ventriculitis happens.
文摘Among pituitary tumors, prolactin (PRL)-secreting pituitary adenomas are by far the most frequent ones. The development of symptomatic hydrocephalus due to a pituitary adenoma is an exceptional event. The authors describe a 37-year-old man who had a pituitary adenoma associated with obstructive hydrocephalus that was managed by endoscopic transnasal transsphenoidal surgery. Postoperative CT and MRI scans showed resolution of the obstructive hydrocephalus and the foramen of Monro was open. Postoperatively, the patient had visual and headache improvement. Subsequently, the patient is a candidate for cranial surgery or medical therapy to complete the treatment. The present case highlights the fact that pituitary adenomas with obstructive hydrocephalus should be distinguished from other tumors especially colloid cysts.
文摘目的回顾性总结经内镜第三脑室底造瘘术(ETV)治疗梗阻性脑积水的手术技巧、疗效及术后颅内压(ICP)的变化规律及动态ICP监护的价值。方法经内镜行ETV治疗梗阻性脑积水共146例,病因包括导水管狭窄98例、颅内肿瘤48例(第三脑室及松果体区肿瘤)。术后行动态ICP监护53例(导水管狭窄36例、肿瘤17例),平均监护时长96 h。结果随访8个月至6年,术后脑积水明显缓解或消失138例(94.5%),8例脑积水缓解不明显或无效(5.5%),改行脑室腹腔分流术。ICP监护显示:术后6 h内平均ICP明显下降,低于10 mm Hg,此后缓慢轻度上升,96 h稳定于12 mm Hg;单纯导水管狭窄性脑积水平均ICP上升较缓慢、波动较小,最后达到10 mm Hg;而肿瘤性脑积水上升较快、波动较大,最后达到15 mm Hg。并发症28例(19.2%):术后发热22例,双额部硬膜外血肿1例、切口脑脊液漏2例、脑室少量积血2例、硬膜下积液1例。本组无死亡。结论 1第三脑室底造瘘治疗梗阻性脑积水(尤其是导水管狭窄脑积水)安全、有效,应作为其首选治疗手段;2术后行ICP动态监护,不仅可监测颅内压的变化,判断手术是否有效,同时可以观察有无脑室继发性出血等并发症及指导术后用药。
