Secondary Hydrocephalus Research Articles

A Dramatic Improvement by Ventriculoperitoneal Shunt Surgery in a Patient With Secondary Normal Pressure Hydrocephalus

A Dramatic Improvement by Ventriculoperitoneal Shunt Surgery in a Patient With Secondary Normal Pressure Hydrocephalus

Clinical analysis of ventriculoperitoneal shunt for secondary normal pressure hydrocephalus

Objective To explore the clinical outcome and complications of ventriculoperitoneal (VP) shunt for secondary normal pressure hydrocephalus. Methods The clinical data of 202 patients with secondary normal pressure hydrocephalus treated with VP shunt at Department of Neurosurgery, the No. 101 Hospital of PLA from January 2012 to November 2016 were retrospectively analyzed. The surgical effect and complications were summarized. The clinical outcome was analyzed using the Black Grading Scale. Results Among 202 patients, the ventricles of 185 (91.6%) cases were narrowed after VP shunt. One week post operation, poor outcomes were reported in 7(3.5%) cases, out of which 2 (1.0%) showed hemorrhage, 2 (1.0%) had intracranial infection and 3 (1.5%) had blocked splitter and underwent shunt again. The mean follow-up duration was 11.2±12.6 months and ranged from 3 to 60 months. During the follow-up, seizures occurred in 23 (11.4%) patients. There were 29 (14.4%) patients who developed shunt-related complications. Among them, 3 (1.5%) had the trapped fourth ventricle, 3 (1.5%) reported intracranial infection, 16 (7.9%) had subdural effusion, 7 (3.5%) had blocked splitter and underwent revision surgery. Five cases died of cardiorespiratory system disorder. Finally, 79.7% (161/202) patients achieved favorable clinical outcome (Black cure rate ≥30%). Multivariate logistic regression analysis showed that lower Glasgow Coma Scale (OR=0.600, 95%CI: 0.501-0.719, P<0.001), no obvious change of consciousness (OR=0.206, 95% CI: 0.086-0.495, P<0.001) and previous history of hypertension (OR=2.690, 95% CI: 1.134-6.378, P=0.025) were risk factors associated with poor outcome. Conclusions VP shunt is suggested to be a safe and efficacious way to treat secondary normal pressure hydrocephalus. Proper selection of surgical candidates could be helpful for favorable outcome. Key words: Hydrocephalus, normal pressure; Ventriculoperitoneal shunt; Treatment outcome; Risk factors

Predicting role of disturbance coefficient in post brain traumatic hydrocephalus

Objective To evaluate the predicting value of disturbance coefficient (DC) of noninvasive brain edema monitoring in patients with secondary hydrocephalus after traumatic brain injury. Methods Non-invasive brain edema monitoring technology was used clinically to perform dynamic monitor of 84 patients with traumatic brain injury admitted to Department of Neurosurgery, Nanfang Hospital, Southern Medical University from December 2016 to January 2018. Among them, 17 had hydrocephalus (hydrocephalus group) and 67 did not (control group). The patient’s age, gender, Glasgow coma scale at admission, brain CT status, DC and hydrocephalus situation were compared between the 2 groups. Results Hydrocephalus occurred in 17 patients and 8 of them had normal pressure hydrocephalus. The median DC of patients with hydrocephalus was decreased by 35.2(25.7-48.1) and that of patients with no hydrocephalus was decreased by 8.3(5.2-11.1). The difference was statistically significant (P=0.008). The DC decrease of more than 18.0 (sensitivity: 92.5%; specificity: 88.2%) indicated the occurrence of hydrocephalus. Conclusions The decrease of DC in non-invasive brain edema monitoring could be used to predict the occurrence of early hydrocephalus. Higher continuous decrease of DC was related to greater probability of occurrence of intracranial hydrocephalus. Key words: Craniocerebral trauma; Hydrocephalus; Disturbance coefficient

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 I CVI 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.

A Dramatic Improvement by Ventriculoperitoneal Shunt Surgery in a Patient With Secondary Normal Pressure Hydrocephalus

A Dramatic Improvement by Ventriculoperitoneal Shunt Surgery in a Patient With Secondary Normal Pressure Hydrocephalus

Normal-pressure hydrocephalus: A critical review.

ABSTRACT.Normal-pressure hydrocephalus (NPH) is a potentially reversible syndrome characterized by enlarged cerebral ventricles (ventriculomegaly), cognitive impairment, gait apraxia and urinary incontinence. A critical review of the concept, pathophysiology, diagnosis, and treatment of both idiopathic and secondary NPH was conducted. We searched Medline and PubMed databases from January 2012 to December 2018 using the keywords “normal-pressure hydrocephalus” / “idiopathic normal-pressure hydrocephalus” / “secondary normal-pressure hydrocephalus” / “NPH” / “ventriculoperitoneal shunt”. The initial search produced 341 hits. After careful selection, a total of 54 articles were chosen and additional relevant studies were included during the process of writing this article. NPH is an important cause of potentially reversible dementia, frequent falls and recurrent urinary infections in the elderly. The clinical and imaging features of NPH may be incomplete or nonspecific, posing a diagnostic challenge for medical doctors and often requiring expert assessment to minimize unsuccessful surgical treatments. Recent advances resulting from the use of non-invasive MRI methods for quantifying cerebral blood flow, in particular arterial spin-labeling (ASL), and the frequent association of NPH and obstructive sleep apnea (OSA), offer new avenues to understand and treat NPH.

Pineal Cyst−Related Aqueductal Stenosis as Cause of Intractable Headaches in Nonhydrocephalic Patients

Pineal cysts (PCs) are histologically benign lesions of the pineal gland. Although the majority of PCs are asymptomatic, some cases are ambiguous and accompanied by nonspecific symptoms of variable severity. We suggested that disabling headache in nonhydrocephalic patients with PCs is associated with cerebral aqueduct (CAq) stenosis. A retrospective analysis was conducted in patients with PCs suffering from headache without secondary hydrocephalus who underwent surgical resection at Burdenko Neurosurgery Center between 1995 and 2016. All available medical records and radiographic images were retrospectively assessed in these patients. The comparison groups included 22 patients with nonoperated PCs and 25 healthy individuals. Specific magnetic resonance imaging measures were selected to assess the morphometry of the CAq and degree of the stenosis. In 25 patients (82%) we observed clinical improvement after surgery in a follow-up period. Among those with improvement, 10 of them (40%) experienced total relief and 15 of them (60%) had marked headache diminishment. In 5 patients the headache remained persistent. The preoperative rostral CAq diameter appeared to be significantly narrower (P= 0.0011045), and the preoperative rostral/caudal diameter ratio (Rd/Cd) was found to be lower (P= 0.004391) in patients who recovered from headache versus those who did not. The results indicate a statistically significant relationship between the changes in the CAq morphometrics and the clinical outcome in postoperative period. Surgical removal of symptomatic pineal cysts in patients without hydrocephalus can be considered as an effective treatment. However, a thorough preoperative examination and patient selection should be conducted in every case.

Experience in the Early Surgical Management of Myelomeningocele in Zanzibar

Neural tube defects are a large health burden for East African countries. Health strategies in the prevention of this disease include nutritional prophylaxis, prenatal diagnosis, and availability of early neonatal neurosurgery. The main objective of this study is to describe our experience in the early surgical management of neural tube defects in the Zanzibar archipelago. From December 2016 to December 2017, we prospectively collected data on all patients admitted with the diagnosis of myelomeningocele. We collected variables regarding demographics, maternal health, preoperative imaging, surgical procedures, and complications at follow-up. We collected data on 19 patients. Mean age was 9.8 ± 18.7 days. Of these patients, 52.6% were male and 47.3% were female; 47.3% patients were from Unguja, 42.0% from Pemba, and 5.2% from mainland Tanzania; 68.4% of all mothers were found to have undergone prenatal ultrasonography and 89.5% of all patients received surgery. Surgical wound infection was present in 29.4% of all surgical patients and 52.9% developed secondary hydrocephalus. Neural tube defects are a prevailing condition in East Africa. We believe that more health initiatives should address its prevention, mainly through maternal nutrition. On the basis of our findings, we consider early neonatal neurosurgery as the most important factor in reducing immediate morbidity and mortality.

Central Sleep Apnea – a Rare Cause for Acute Respiratory Insufficiency in Children. Case Report

Central sleep apnea is characterized by frequent cessation of breathing during sleep, resulting in repetitive episodes of insufficient ventilation and abnormalities of acid-base balance. It may be primary or secondary, and it is uncommon in children, with limited data for this population. We present here the case of a five-year-old girl, known to have thoracolumbar myelomeningocele (for which she underwent a surgical procedure in infancy), secondary hydrocephalus (with a ventriculoperitoneal shunt) and flaccid paralysis, who was admitted in our hospital with prolonged fever syndrome, productive cough, severe dyspnea and perioral cyanosis. Following physical examination, laboratory investigations and thoracic radiography, we established the diagnosis of aspiration pneumonia with acute respiratory failure. Medical treatment with multiple systemic antibiotics, antifungal agents, systemic and inhaled bronchodilator, oxygen therapy and respiratory nursing were initiated, with favorable evolution. During the entire hospitalization, the patient showed nocturnal respiratory rhythm disorders, with sleep apnea crisis of approximately 20 seconds and desaturation, followed by severe hypercapnic respiratory acidosis, manifestations that persisted even after the remission of pulmonary infection, raising the suspicion of an apnea syndrome. After excluding the causes of obstructive apnea, a cerebral CT scan was performed, revealing isolated fourth ventricle compressing the brainstem. The patient underwent neurosurgical intervention and postoperatively, the evolution was favorable, with remission of apnea crisis.

The role of radiosurgery in the acute management of fourth ventricle compression due to brain metastases.

Background:Approximately 20–30% of all intracranial metastases are located in the posterior fossa. The clinical evolution hinges on factors such as tumor growth dynamics, local topographic conditions, performance status, and prompt intervention. Fourth ventricle (V4) compression with secondary life-threatening obstructive hydrocephalus remains a major concern, often requiring acute surgical intervention. We have previously reported on the application of adaptive hypofractionated Gamma Knife Radiosurgery in the acute management of critically located metastases, a technique known to us as rapid rescue radiosurgery (3R). We report the results of 3R in the management of posterior fossa lesions and ensuing V4 decompression.Case Descriptions:Four patients with V4 compression due to posterior fossa metastases were treated with 3R by three separate gamma knife radiosurgical sessions (GKRS) over a period of seven days. Mean V4 volume was 1.02 cm3 at GKRS 1, 1.13 cm3 at GKRS 2, and 1.12 cm3 at GKRS 3. Mean tumor volume during the week of treatment was 10 cm3 at both GKRS 1 and 2 and 9 cm3 at GKRS 3. On average, we achieved a tumor volume reduction of 52% and a V4 size increase of 64% at the first follow-up (4 weeks after GKRS 3). Long-term follow-up showed continued local tumor control, stable V4 volume, and absence of hydrocephalus.Conclusion:For this series, 3R was effective in terms of rapid tumor ablation, V4 decompression, and limited radiation-induced toxicity. This surgical procedure may become an additional tool in the management of intractable posterior fossa metastasis with V4 compression.

Clinical Feature and Outcomes of Secondary Hydrocephalus Caused by Head Trauma.

ObjectivePost-traumatic hydrocephalus (PTH) is a frequent and serious complication following brain injury. The incidence of PTH varies greatly among studies. The purpose of this study was to investigate the incidence and treatment of PTH in patients with head trauma.MethodsWe examined 956 patients with head trauma who visited our center from January 2012 to December 2015. The hydrocephalus diagnosis was based on radiologic findings and clinical features, and patients were classified into the mild (Group 1, Glasgow Coma Scale score [GCS] 13–15), moderate (Group 2, GCS 9–12), or severe (Group 3, GCS 3–8) brain injury group according to their GCS at admission. To compare these groups, we used age, gender, radiologic findings, PTH developmental period, and postoperative results (Glasgow Outcome Scale).ResultsOf the 956 patients, 24 (2.5%) developed PTH. PTH occurred in 11 (1.4%), 3 (5.6%), and 10 (7.0%) patients in Groups 1, 2, and 3, respectively. Of the 24 patients with PTH, 22 (91.7%) developed PTH within 12 weeks post-trauma; the higher the GCS, the later the onset, and the lower the GCS, the earlier the onset (p=0.019). Twenty-one patients underwent ventriculoperitoneal shunting, and 13 had improved symptoms.ConclusionThe incidence of PTH cannot be ignored. The possibility of PTH needs to be considered in patients with head trauma and appropriate follow-up should be undertaken. PTH is a treatable complication and patients' quality of life and neurological status can be improved if the appropriate treatment is selected and applied.

Fluid Distribution Pattern in Adult-Onset Congenital, Idiopathic, and Secondary Normal-Pressure Hydrocephalus: Implications for Clinical Care.

In spite of growing evidence of idiopathic normal-pressure hydrocephalus (NPH), a viewpoint about clinical care for idiopathic NPH is still controversial. A continuous divergence of viewpoints might be due to confusing classifications of idiopathic and adult-onset congenital NPH. To elucidate the classification of NPH, we propose that adult-onset congenital NPH should be explicitly distinguished from idiopathic and secondary NPH. On the basis of conventional CT scan or MRI, idiopathic NPH was defined as narrow sulci at the high convexity in concurrent with enlargement of the ventricles, basal cistern and Sylvian fissure, whereas adult-onset congenital NPH was defined as huge ventricles without high-convexity tightness. We compared clinical characteristics and cerebrospinal fluid distribution among 85 patients diagnosed with idiopathic NPH, 17 patients with secondary NPH, and 7 patients with adult-onset congenital NPH. All patients underwent 3-T MRI examinations and tap-tests. The volumes of ventricles and subarachnoid spaces were measured using a 3D workstation based on T2-weighted 3D sequences. The mean intracranial volume for the patients with adult-onset congenital NPH was almost 100 mL larger than the volumes for patients with idiopathic and secondary NPH. Compared with the patients with idiopathic or secondary NPH, patients with adult-onset congenital NPH exhibited larger ventricles but normal sized subarachnoid spaces. The mean volume ratio of the high-convexity subarachnoid space was significantly less in idiopathic NPH than in adult-onset congenital NPH, whereas the mean volume ratio of the basal cistern and Sylvian fissure in idiopathic NPH was >2 times larger than that in adult-onset congenital NPH. The symptoms of gait disturbance, cognitive impairment, and urinary incontinence in patients with adult-onset congenital NPH tended to progress more slowly compared to their progress in patients with idiopathic NPH. Cerebrospinal fluid distributions and disease progression were significantly different among the patients with adult-onset congenital NPH, idiopathic NPH and secondary NPH. This finding indicates that the pathogenesis of adult-onset congenital NPH may differ from those of idiopathic and secondary NPH. Therefore, adult-onset congenital NPH should be definitively distinguished from the categories of idiopathic and secondary NPH.

ENDOSCOPIC THIRD VENTRICULOSTOMY VERSUS VENTRICULOPERITONEAL SHUNT IN TREATMENT OF OBSTRUCTIVE HYDROCEPHALUS COMPLICATING PEDIATRIC POSTERIOR FOSSA TUMORS

Background:Posterior fossa tumors are the most common solid tumors found in the pediatric population. Approximately, 70–90% of patients with posterior fossa tumors present with hydrocephalus. This presents an interesting problem to pediatric neurosurgeons for which there remains no consensus: What is the best management strategy for hydrocephalus at the time of the initial presentation of the patient? Objective: This multicenter prospective cohort study compared endoscopic third ventriculostomy (ETV) and ventriculoperitoneal shunt (VPS) in the treatment of pediatric patients with secondary obstructive hydrocephalus due to posterior fossa tumors. Patients and Methods: Sixty four patients with posterior fossa tumors (24 medulloblastoma, 12 ependymoma, 27 astrocytoma and 1 schwannoma) associated with secondary hydrocephalus were divided into two equal groups according to the treatment procedure done to the secondary hydrocephalus either ETV or VP shunts, with a follow-up period of 6 months, were prospectively studied in this work. Results: Both procedures (ETV and VP shunt) proved to be effective clinically and radiographically. Endoscopic third ventriculostomy (ETV) proved to be superior due to shorter duration of surgery (17 min versus 58 min), no mortality (0% versus 6.25%), and lower incidence of procedure failure (15.6% versus 21.9%) with highest success rate of 100% was for astrocytomas followed by 80% for ependymomas and 63.6% for medulloblastomas. Conclusion: Both procedures (ETV and VP shunt) proved to be effective clinically and radiographically in the treatment of secondary obstructive hydrocephalus in pediatric patients with posterior fossa tumors. For ETV, the safety, simplicity, a more physiological of internal shunting, a significantly shorter surgery duration, absence of mortality, lower significant complications rate, a lower rate of procedure failure, the significant advantages of not becoming shunt dependent and avoidance of hardware complications (malfunction, obstruction, infection) and making safe handling and resection of the posterior fossa tumors feasible, all the previous factors made the ETV to be recommended as the first choice in the treatment of pediatric patients with obstructive hydrocephalus due to posterior fossa tumors.

Secondary communicating hydrocephalus management by implantation of external ventricular shunt and minimal gradual increase of cerebrospinal fluid pressure.

Background:This paper presents a new management strategy explaining the process used by implantation of external ventricular drainage (EVD) and very gradual increase of intracranial pressure for treatment of acute hydrocephalus. During the last 30 years’ experience in professional practice, the senior author (M.S.) discovered that there are some options of regulations between cerebral spinal fluid (CSF) production and resorption. This theory shows that minimal continuous increase of the CSF pressure as long as the patient general neurological condition is unchanged and appears as normal can lead to definitive treatment of hydrocephalus without needing to set a shunt. Gradual weaning from EVD is used in some neurosurgical centers related to aneurismal subarachnoid hemorrhage only in a way to treat hydrocephalus in the acute phase, but not as an alternative curative treatment for hydrocephalus, and as far as we know this procedure has not been presented to date in medical literature in this form and this purpose.Materials and Methods:Between July 2000 and November 2012, 16 patients suffering from acute secondary hydrocephalus were treated by the method described in the International Neurosciences Institute in Hannover (Germany).Results:The causes of hydrocephalus were brain tumors (12), arteriovenous malformations (2), one cavernoma, and one polytrauma. In 11 patients (68.75%), the procedure led to a complete cure and surgical treatment has been excluded after EVD removal without any risk to the patients.Conclusions:Minimal gradual increase of CSF pressure by EVD implantation for the treatment of secondary acute communicating hydrocephalus used by senior author as an option is a safe alternative treatment of hydrocephalus and may obviate the need for surgical procedures.

Our initial experience with ventriculo-epiplooic shunt in treatment of hydrocephalus in two centers

IntroductionHydrocephalus represents impairment in cerebrospinal fluid (CSF) dynamics. If the treatment of hydrocephalus is considered difficult, the repeated revisions of ventriculo-peritoneal (VP) shunts are even more challenging. ObjectiveThe aim of this article is to evaluate the efficiency of ventriculo-epiplooic (VEp) shunt as a feasible alternative in hydrocephalic patients. Material and methodsA technical modification regarding the insertion of peritoneal catheter was imagined: midline laparotomy 8–10cm long was performed in order to open the peritoneal cavity; the great omentum was dissected between its two layers; we placed the distal end of the catheter between the two epiplooic layers; a fenestration of 4cm in diameter into the visceral layer was also performed.A retrospective study of medical records of 15 consecutive patients with hydrocephalus treated with VEp shunt is also presented. ResultsBetween 2008 and 2014 we performed VEp shunt in 15 patients: 5 with congenital hydrocephalus, 8 with secondary hydrocephalus and 2 with normal pressure hydrocephalus. There were 7 men and 8 women. VEp shunt was performed in 13 patients with multiple distal shunt failures and in 2 patients, with history of abdominal surgery, as de novo extracranial drainage procedure. The outcome was favorable in all cases, with no significant postoperative complications. ConclusionsVEp shunt is a new, safe and efficient surgical technique for the treatment of hydrocephalus. VEp shunt is indicated in patients with history of recurrent distal shunt failures, and in patients with history of open abdominal surgery and high risk for developing abdominal complications.

Effect of intrathecal milrinone injection via lumbar catheter on delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage

OBJECTIVE Delayed cerebral ischemia (DCI) is an important complication after aneurysmal subarachnoid hemorrhage (aSAH). Although intrathecal milrinone injection via lumbar catheter to prevent DCI has been previously reported to be safe and feasible, its effectiveness remains unknown. The goal of this study was to evaluate whether intrathecal milrinone injection treatment after aSAH significantly reduced the incidence of DCI. METHODS The prospectively maintained aSAH database was used to identify patients treated between January 2010 and December 2015. The cohort included 274 patients, with group assignment based on treatment with intrathecal milrinone injection or not. A propensity score model was generated for each patient group, incorporating relevant patient variables. RESULTS After propensity score matching, 99 patients treated with intrathecal milrinone injection and 99 without treatment were matched on the basis of similarities in their demographic and clinical characteristics. There were significantly fewer DCI events (4% vs 14%, p = 0.024) in patients treated with intrathecal milrinone injection compared with those treated without it. However, there were no significant differences between the 2 groups with respect to their 90-day functional outcomes (46% vs 36%, p = 0.31). The likelihood of chronic secondary hydrocephalus, meningitis, and congestive heart failure as complications of intrathecal milrinone injection therapy was also similar between the groups. CONCLUSIONS In propensity score-matched groups, the intrathecal administration of milrinone via lumbar catheter showed significant reduction of DCI following aSAH, without an associated increase in complications.

Incidence of Secondary Hydrocephalus after Excision of Huge Encephaloceles in Neonates: Case Study.

Encephaloceles presents as a protrusion of the cranial contents through a defect in the cranium. The most common sites of occurrence are the occipital and frontonasal regions. The surgical outcome is reported to be satisfactory; however, the incidence of hydrocephalus in patients with encephaloceles is variable in the literature. This study investigated the relationship between the size of the encephaloceles and the occurrence of hydrocephalus. Data of all neonates with encephaloceles who presented to our institution from September 2012 to September 2014 were collected. Surgery was performed during the first 2 weeks of age. Encephaloceles with a maximal diameter > 10 cm were included in the study, and the clinical picture, surgical technique, pre- and postoperative imaging, and follow-up were analyzed. Nineteen cases were included in this study. The mean follow-up period was 7 months. Sixteen cases were occipital; three were frontal. In all patients the maximum diameter was > 10 cm. However, in four patients it was > 18 cm. Postoperative ventriculomegaly occurred in seven cases. Of these, four patients needed a permanent ventriculoperitoneal shunt implantation (21%). Wound dehiscence occurred in two patients who required secondary sutures with a favorable outcome. One patient died 2 weeks after the surgery due to a poor general condition and wound infection. Early surgical excision provides effective treatment of huge encephaloceles. Overall, 21% of cases require cerebrospinal fluid (CSF) diversion afterward depending on associated anomalies. Despite their size, giant encephaloceles can have an excellent prognosis with no need for further treatment or CSF diversion.

脳動脈瘤破裂によるくも膜下出血後の続発性正常圧水頭症併発リスク ─クリッピング術とコイル塞栓術─

脳動脈瘤破裂によるくも膜下出血後の続発性正常圧水頭症併発リスク ─クリッピング術とコイル塞栓術─

Cerebral Hernia Caused By Epidural Hygroma Due to Excessive Drainage of Cerebrospinal Fluid: A Rare Case and Literature Review

The cerebral hernia is usually caused by intracranial hematoma, tumor, abscess. Here, we report a rare case of cerebral hernia caused by severe epidural hygroma. The patient was a 51-year-old male, with a large, right-sided skull defect and severe scalp depression, who had received a decompressive craniectomy for traumatic brain injury and a lumboperitoneal shunt for secondary hydrocephalus 6 months earlier. A cranioplasty with titanium mesh was performed after admitted. Unfortunately, he suffered from a complication of epidural fluid collection. Through repeated local treatment of the hygroma, the patient was not better but rather became more and more serious, and developed to cerebral hernia eventually. However, after finding out the root cause, the patient got dramatically improvement just by elevating the valve pressure of the lumboperitoneal shunt. The case and literature review are instructive to the treatment of patients with skull bone defect associated with hydrocephalus.

IMAGING DIAGNOSIS-MAGNETIC RESONANCE IMAGING OF A NEURONAL HETEROTOPIA IN THE BRAIN OF A CAT.

A domestic shorthair kitten was presented for evaluation and further treatment of seizures. Magnetic resonance imaging of the brain revealed a large multilobulated mass in the third ventricle extending into the right lateral ventricle with secondary obstructive hydrocephalus. The mass was homogeneously isointense to gray matter on T2W, T2-FLAIR, T2* W, T1W, and ADC images, and hyperintense on DW-EPI. There was no appreciable contrast enhancement. Seizures were managed medically and with subsequent ventriculoperitoneal shunt placement. Clinical status later deteriorated and the cat was euthanized. Histopathology confirmed that the mass was the result of neuronal heterotopia. To the authors' knowledge this is the first report of neuronal heterotopia in a cat.