cyst, the resection of a colloid cyst, and the resection of tumors of the third and lateral ventricles. These videos will illustrate some of the capabilities ofintraventricularneuroendoscopy, and we hope they will inspire and teach. This is the first time Neurosurgical Focus: Video is exclusively devoted tointraventricularendoscopicsurgery. It is noteworthy that the April issue of Neurosurgical Focus deals with adult hydrocephalus. This is especially relevant given that mostintraventricularendoscopicsurgeryis usually undertaken against the backdrop of
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Mark G. Hamilton, Ahmed K. Toma, Charles Teo, Caroline Hayhurst, and Mark Souweidane
Lokendra Singh, Shailesh Kelkar, and Nilesh Agrawal
modified the balloon by implanting a very thin balloon made of silicone elastomer on the ventricular catheter ( Fig. 4 ) for use in futureintraventricularand/or paraventricular tumorsurgeries. Initial filling of the balloon with saline made it much heavier, and would have exerted a mass effect. We later tested it by filling it with 2 L of air. After 7 days there was no evidence of any leak. Regarding the shape of the balloon and cavity, the balloon is extremely light and pliable and therefore takes the shape of the cavity into which it is inserted ( Fig. 5 ). F ig
徐Yuanzhi艾哈迈德•Mohyeldin Ayoze Doniz-Gonzalez,Vera Vigo, Felix Pastor-Escartin, Lingzhao Meng, Aaron A Cohen-Gadol, and Juan C Fernandez-Miranda
点和LPChA是一个有价值的参考surgery, but there are cases of posterior choroidal entrance; 3) most frequently there are 2 or more LPChA trunks, which makes possible the sacrifice of one trunk feeding the tumor while preserving the other that provides supply to relevant structures; 4) coagulation of the LPChA should be performed at the forniceal segment rather than at the cisternal segment, where branches to the thalamus are more frequent; and 5)intraventricularapproaches can be selected based on the tumor location and the LPChA anatomy (lateral
Luca Basaldella, Elisabetta Marton, Alessandro Fiorindi, Bruno Scarpa, Hadi Badreddine, and Pierluigi Longatti
drainage from the ventricular system. In selected cases, surgical evacuation of intraparenchymal andintraventricularhematomas has resulted in decreases in mortality rates and disability. 12 However,surgeryis invasive and is not always feasible. Survival after primary IVH is common, 27 but it is accompanied by considerable morbidity. In general, patients with secondary IVH fare worse than those with primary IVH. 47 When an intracerebral hematoma extends into a portion of the ventricular system, mortality has been reported to be 32%–44%. 14 , 22 When IVH extends
Tamara D. Simon, Kathryn B. Whitlock, Jay Riva-Cambrin, John R. W. Kestle, Margaret Rosenfeld, J. Michael Dean, Richard Holubkov, Marcie Langley, and Nicole Mayer-Hamblett
A lthough placement of CSF shunts successfully treats hydrocephalus in children, shunt failure is common and frequently necessitates subsequentsurgery. 6 , 7 , 17 It is critical for families and care providers to understand which children undergoing CSF shunt placement are at highest risk for subsequentsurgery. In addition, an understanding of the baseline risk factors for subsequentsurgerypermits investigators to account for differences in patient populations, which is necessary when comparing outcomes between neurosurgical centers in research and
Jonathan Stuart Citow, J. Patrick Johnson, Duncan Q. McBride, and Mario Ammirati
Object
Neurocysticercosis (NCC) is the most common parasitic infection of the central nervous system, and its prevalence is continuing to increase in the United States. The diagnosis of intraventricular NCC (IVNCC) may be difficult, and surgery frequently fails to resolve symptoms. A retrospective review of magnetic resonance (MR) imaging characteristics and surgery-related outcomes may improve management strategies of this disease.
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The authors report the presentations, neuroimaging characteristics, surgical management, and outcomes of 30 patients with IVNCC treated over a 10-year period (mean follow-up period 4 years). Cysts were located in the lateral ventricles (five cases), the third ventricle (five cases), and the fourth ventricle (21 cases). One patient had lesions in both the lateral and fourth ventricles. Presenting symptoms were related to hydrocephalus or mass effect from the lesions.
All patients underwent computerized tomography (CT) and MR imaging of the brain. Treatment consisted of shunt implantation or primary excision of an IVNCC lesion. Outcomes after operations and reoperations were evaluated in light of enhancement characteristics on MR imaging.
Computerized tomography scanning demonstrated IVNCC lesions in 10% of cases, and MR revealed lesions in 100% of cases. In patients in whom gadolinium (Gd) enhancement of IVNCC lesions was demonstrated on MR imaging, the surgery-related failure rate was higher and patients required reoperation, and in those in whom gadolinium enhancement was absent the surgery-related failure rate was lower (64 and 19%, respectively; p < 0.0002).
Conclusions
Magnetic resonance imaging is superior to CT scanning for detecting IVNCC lesions. The absence of pericystic Gd enhancement on MR imaging is an indication for excision of the lesions. If pericystic enhancement is present, shunt surgery should be performed, and craniotomy reserved for treatment of those patients with symptomatic lesions secondary to mass effect. A treatment algorithm based on patient symptoms, cyst location, and MR imaging Gd enhancement characteristics is proposed.
r·谢恩Tubbs卢卡。Mohammadali Shoja, John C. Wellons, and Aaron A. Cohen-Gadol
the present study may be of utility to the neurosurgeon practicingintraventricularendoscopy. Such a model could be used multiple times and will allow the trainee to appreciate ventricular anatomy more fully. Disclaimer The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper. References 1 Aboud E , Al-Mefty O , Yaşargil MG : New laboratory model for neurosurgical training that simulates livesurgery. J Neurosurg 97 : 1367 – 1372 , 2002 2 Aggarwal R
Reid Hoshide, Robert C. Rennert, Carlos E. Sanchez, Joel R. Martin, Vincent J. Cheung, Gayle Gyles, and Michael L. Levy
I ntraventricular endoscopicsurgeryrequires periodic irrigation to clear debris and maintain adequate visualization of criticalintraventricularanatomy. Excessiveintraventricularirrigation can nonetheless be dangerous, by causing acute iatrogenic intracranial hypertension if fluid output is not balanced. 1–4 The manipulation of irrigation flow is typically cumbersome and inexact, however, because it is most often achieved through the use of an in-line stopcock or a control clamp. This setup requires manual manipulation, whereby the surgeon has to either
Brian T. Ragel, Samuel R. Browd, and Richard H. Schmidt
systemic antibiotic therapy in the treatment of CSF bacterial infections, including shunt infections. 27 In two studies researchers have examined the administration ofintraventricularvancomycin for prophylaxis against infection in shuntsurgery. The authors of one study found no benefit whenintraventricularvancomycin was used without systemic antibiotic therapy. 31 The other study, a prospective trial, was terminated without significant results because an adequate patient population could not be accrued. 4 We are unaware of any adequately powered studies in which
Marc C. Chamberlain, Patty A. Kormanik, and David Barba
convenient and pharmacologically rational methods for administering chemotherapy. Overall, serious complications requiringsurgeryare infrequent (6% in our series) and most often secondary to catheter infections, Ommaya reservoir exposure, and initial catheter malpositioning. In the majority of instances of Ommaya system infection, the catheter may remain in place and the infection can be managed medically, as can the most common complication ofintraventricularchemotherapy, the induction of an aseptic chemical meningitis. References 1. Ackland SP
