Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery
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Comparative Study
Analysis of TGF-beta2 and TGF-beta3 expression in the hydrocephalic H-Tx rat brain.
Transforming growth factor-beta (TGF-beta) is an important cytokine with modulatory actions in the nervous system. The development of hydrocephalus in mouse models resulting from the overexpression of TGF-beta1 has previously been described, but the mechanism by which this occurs remains obscure. ⋯ These results suggest that TGF-beta2 and TGF-beta3 expression may be modulated differently in the hydrocephalus, and TGF-beta3 may contribute to the development of hydrocephalus in this rat model.
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Comparative Study Clinical Trial
Endoscopic third ventriculostomy in the treatment of hydrocephalus in posterior fossa tumors in children.
The purpose of the present study is to assess the effectiveness of endoscopic third ventriculostomy (ETV) in children with hydrocephalus related to posterior fossa tumors. ⋯ Endoscopic third ventriculostomy should be considered as an alternative procedure to ventriculo-peritoneal shunting and external ventricular draining for the emergency control of severe hydrocephalus caused by posterior fossa tumors, since it can quickly eliminate symptoms, and hence, can delay surgery scheduling if required. Even though ETV does not prevent postoperative hydrocephalus in all cases, it does protect against acute postoperative hydrocephalus due to cerebellar swelling. In addition, it eliminates the risks of cerebrospinal fluid (CSF) infection related to external drainage and minimizes the risk of overdrainage because it provides more physiological CSF drainage than the other procedures. Since postoperative hydrocephalus is very often physically obstructive, ETV should always be considered a possible treatment procedure.
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Comparative Study Clinical Trial
Endoscope-assisted microneurosurgery for anterior circulation aneurysms using the angle-type rigid endoscope over a 3-year period.
The use of the endoscope (fiberscope) to assist the microsurgical clipping of cerebral aneurysm was first reported by Fischer and Mustafa in 1994. The rigid endoscope has been increasingly used during aneurysm surgery in which structures around the aneurysm can be detected with high quality imaging. Our 3 years of its use now allows us to assess the endoscope's efficacy and limits in standard surgery with a pterional approach in aneurysms of the anterior circulation. The endoscope can carry out a supportive role in planning surgical manoeuvres and in verifying whether clipping has been performed correctly or not. In our view, among the aneurysms of the anterior circulation, the endoscope is particularly useful in those of the internal carotid and the anterior communicating arteries. In many cases of these aneurysms the posterior communicating artery, choroidal artery or one of the distal cerebral arteries is hidden behind the aneurysm dome. Dome retraction is often required in order to see these vascular structures with the microscope. Thus an endoscope with a 30 degrees view angle becomes very useful. The concealed areas are identified without retraction, which prevents the possibility of the aneurysm being ruptured and also reduces the use of temporary clipping. From its early use as a supportive measure that is sometimes useful in surgery for "easy" aneurysms, the endoscope has now become almost indispensable for the "difficult" aneurysms, including the large and giant ones before and after clipping. Thus, the endoscope should be kept ready for use in the operating theatre for any eventuality. ⋯ In certain cases endoscopic-assisted microsurgery is an exceptional aid to the surgeon and must become part of the operating theatre equipment and kept on hand ready for use. The endoscope is, in our opinion, particularly useful in certain aneurysm localisations (internal carotid artery-anterior communicating artery [ICA-ACOMA]).
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Comparative Study
Incidence of complications in neuroendoscopic surgery.
This study was undertaken to determine the complication rate in intracranial endoscopic neurosurgery. ⋯ Although the complication rate in endoscopic neurosurgery is low, severe, rarely even life-threatening, complications may occur. The complication rate decreases markedly with surgical experience, indicating a steep learning curve.
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Comparative Study
The evolution of stereotactic guidance in neuroendoscopy.
To evaluate the advantages and limitations of the utilized system in accordance with the operative indications of stereotactic neuroendoscopy. ⋯ No surgical tool, no matter how accurate, can be a substitute for thoughtful and methodical pre-operative planning. Image-guided technologies are applied in order to make endoscopic surgery safer, faster and more easily reproducible. Despite the high initial cost of the equipment, overall expenses are expected to be reduced because of greater operative efficiency and shorter hospital stay.