Objective： To evaluate the effect of the treatment modality guided by intraventricular intracranial pressure （ICP） monitoring on patients with severe traumatic brain injury （TBI）. Methods： The clinical data of ...Objective： To evaluate the effect of the treatment modality guided by intraventricular intracranial pressure （ICP） monitoring on patients with severe traumatic brain injury （TBI）. Methods： The clinical data of a group of 136 severely brain-injured patients admitted to Shanghai Neurosurgical Emergency Center from December 2004 to February 2006 were studied. Results： The intraventricular ICP monitor was placed in all the 136 patients via Kocher＇s pathway, Paine＇s pathway or intraoperative opened ventricle. In this series, the probe was placed during the procedure of craniotomy in 98 patients; for other 38 patients, the probe was placed initially to measure or to monitor ICE A stepwise protocol targeting at ICP control （420 mm Hg） and optimal cerebral perfusion pressure （CPP） maintenance （60-90 mm Hg） was deployed.Among them, 76 patients survived with good recovery, 14 with moderate disability, 24 with severe disability, 10 with vegetative state, and 12 died. Complications associated with intraventricular ICP monitoring included hemorrhage and infection. Hemorrhage occurred in 1 patient and infection in 5 patients. There were no unacceptable complications related to ICP monitoring. Conclusions： Ventricular access for 1CP monitoring can be safely and accurately achieved. ICP monitoring via ventriculostomy may facilitate an early and accurate intervention for severely brain-injured patients. The intraventricular ICP monitoring is a low-risk procedure and can yield great benefits for management of patients with severe TBI.展开更多
<strong>Background: </strong>Endoscopic third ventriculocisternostomy (ETV) is the most common neuroendoscopic technique in the treatment of noncommunicating hydrocephalus. Since its introduction, ETV has ...<strong>Background: </strong>Endoscopic third ventriculocisternostomy (ETV) is the most common neuroendoscopic technique in the treatment of noncommunicating hydrocephalus. Since its introduction, ETV has been a safe alternative to ventriculoperitoneal shunt (VP shunt), which has a high complication rate with significant socio-economic consequences. The authors report the results of ETV performed in the neurosurgical department of FANN teaching hospital in Dakar. <strong>Methods: </strong>This retrospective study presents the results of ETV performed in 513 patients with hydrocephalus of various etiologies, ranging from February 2010 to February 2018. We have included in our series from 2010 to 2016, all patients with clinically revealed non-communicating hydrocephalus followed by a brain computed tomography (CT) scan or brain magnetic resonance imaging (MRI) and who have benefited from an ETV, in which the ETV Success Score was evaluated. <strong>Results:</strong> The mean age of our patients was 14.10 years, with 298 (58%) males. The clinical symptomatology varied in both children and adults and manifested in children as macrocrania in 67.8% of the patients, while in adults, it manifested as raised intracranial pressure (ICP) in 87.5% of patients. A brain CT scan was performed in 461 (89.86%) of patients. The causes of hydrocephalus were dominated in 49% of patients by malformative pathologies, followed by tumors in 41% of patients, infections in 2.33% of patients, and normal-pressure hydrocephalus in 3.8% of patients. During the postoperative period, we found 21.41% of various complications. <strong>Conclusions:</strong> The findings in our series were compared to those in the literature and were satisfactory, thus proving the effectiveness and safety of ventriculocisternostomy in our department. In resource-limited countries, ETV can be performed with good results and less mortality and morbidity.展开更多
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
文摘Objective： To evaluate the effect of the treatment modality guided by intraventricular intracranial pressure （ICP） monitoring on patients with severe traumatic brain injury （TBI）. Methods： The clinical data of a group of 136 severely brain-injured patients admitted to Shanghai Neurosurgical Emergency Center from December 2004 to February 2006 were studied. Results： The intraventricular ICP monitor was placed in all the 136 patients via Kocher＇s pathway, Paine＇s pathway or intraoperative opened ventricle. In this series, the probe was placed during the procedure of craniotomy in 98 patients; for other 38 patients, the probe was placed initially to measure or to monitor ICE A stepwise protocol targeting at ICP control （420 mm Hg） and optimal cerebral perfusion pressure （CPP） maintenance （60-90 mm Hg） was deployed.Among them, 76 patients survived with good recovery, 14 with moderate disability, 24 with severe disability, 10 with vegetative state, and 12 died. Complications associated with intraventricular ICP monitoring included hemorrhage and infection. Hemorrhage occurred in 1 patient and infection in 5 patients. There were no unacceptable complications related to ICP monitoring. Conclusions： Ventricular access for 1CP monitoring can be safely and accurately achieved. ICP monitoring via ventriculostomy may facilitate an early and accurate intervention for severely brain-injured patients. The intraventricular ICP monitoring is a low-risk procedure and can yield great benefits for management of patients with severe TBI.
文摘<strong>Background: </strong>Endoscopic third ventriculocisternostomy (ETV) is the most common neuroendoscopic technique in the treatment of noncommunicating hydrocephalus. Since its introduction, ETV has been a safe alternative to ventriculoperitoneal shunt (VP shunt), which has a high complication rate with significant socio-economic consequences. The authors report the results of ETV performed in the neurosurgical department of FANN teaching hospital in Dakar. <strong>Methods: </strong>This retrospective study presents the results of ETV performed in 513 patients with hydrocephalus of various etiologies, ranging from February 2010 to February 2018. We have included in our series from 2010 to 2016, all patients with clinically revealed non-communicating hydrocephalus followed by a brain computed tomography (CT) scan or brain magnetic resonance imaging (MRI) and who have benefited from an ETV, in which the ETV Success Score was evaluated. <strong>Results:</strong> The mean age of our patients was 14.10 years, with 298 (58%) males. The clinical symptomatology varied in both children and adults and manifested in children as macrocrania in 67.8% of the patients, while in adults, it manifested as raised intracranial pressure (ICP) in 87.5% of patients. A brain CT scan was performed in 461 (89.86%) of patients. The causes of hydrocephalus were dominated in 49% of patients by malformative pathologies, followed by tumors in 41% of patients, infections in 2.33% of patients, and normal-pressure hydrocephalus in 3.8% of patients. During the postoperative period, we found 21.41% of various complications. <strong>Conclusions:</strong> The findings in our series were compared to those in the literature and were satisfactory, thus proving the effectiveness and safety of ventriculocisternostomy in our department. In resource-limited countries, ETV can be performed with good results and less mortality and morbidity.
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.
