World Neurosurg
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Treatment of pediatric hydrocephalus in sub-Saharan countries is associated with significant complication rates. The objective of this study is to analyze the management of hydrocephalus and complication rates of surgical intervention in the Ethiopian setting to improve future quality. ⋯ VP shunt insertions had unacceptably high infection rate despite the presence of a protocol for the procedure. Intraoperative guidelines should be developed further and followed strictly to reduce infections. Such measures should include restricting the number of surgeons performing the procedure. In our opinion, one should avoid insertion of a VP shunt as the primary treatment. ETV has proved to be a good alternative in other studies and the decreasing pattern of ETV failure in our study also suggest ETV as a better alternative to VP shunt.
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Neurofibromas are benign nerve sheath tumors that usually affect peripheral nerves and are related to neurofibromatosis type 1; however, they have not been described as a cause of intraparenchymal brain tumor. ⋯ This is a novel presentation of a myxoid neurofibroma. The tumorigenesis mechanisms are likely complex and possibly involve the differentiation of Schwann cells present in adrenergic autonomic nerves in the subarachnoid arterial branches or in trigeminal nerves present in the meningeal convexity.
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Spinal cord herniation (SCH) is rare, is mostly idiopathic, and occurs predominantly in the thoracic spine. SCH is less common in the cervical spine and has been reported after posterior cervical spine surgery associated with the development of pseudomeningoceles. Two cases of SCH have been reported after anterior cervical corpectomies for ossified posterior longitudinal ligament with cerebrospinal fluid (CSF) leaks. We report the third such case, but the first in a patient without ossified posterior longitudinal ligament (degenerative disc disease and pseudarthrosis). ⋯ This is the first reported case of anterior cervical SCH in a patient without ossified posterior longitudinal ligament after multiple anterior cervical fusions including a cervical corpectomy for pseudarthrosis with a CSF leak. We hypothesize that persistent CSF leak causes a pressure gradient across the dura mater through the cage to the lower pressure in the retropharyngeal space, which led to herniation of the spinal cord into the anterior cage. We review the literature and discuss the treatment choices for anterior cervical SCH.
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Spontaneous tension pneumocephalus (STP) is a rare but serious complication derived from shunting procedures. Few cases have been published with purely intraventricular location. Treatment options and physiopathology considerations are discussed in this case report. ⋯ A high-resolution CT scan of the skull base is useful to localize the point where the air enters into the intracranial cavity in STP cases. Coexistent or preceding otologic symptoms might direct the suspicion toward an otogenic origin. Shunt removal, or adjusting the opening pressure, if feasible, is recommended. Otherwise, dural repair and covering of the bone defect have acceptable rates of success and should be performed before any other more aggressive techniques to avoid the risk of hearing loss.
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Controlled Clinical Trial
Membrane surface-area:volume ratio in Chronic Subdural Haematomas.'Critical size' and potential post-operative target.
It is unknown why some chronic subdural hematomas (CSDHs) grow and require surgery, whereas others spontaneously resolve. Although a relatively small CSDH volume (V) reduction may induce resolution, V percent reduction is often unreliable in predicting resolution. Although CSDHs evolve distinctive inner neomembranes and outer neomembranes (OMs), the OM likely dominates the dynamic growth-resorption equilibrium. If other factors remain constant, one previous hypothesis is that resorption could fail as the surface area (SA) to V ratio decreases when CSDHs exceed a critical size. We aimed to identify a critical size and an ideal target, which implies resolution without recurrence. ⋯ Because surgical total SA to V ratio was ≈2:1, one neomembrane may indeed dominate the dynamic growth-resorption equilibrium. CSDH critical size therefore appears to be when SAOM ≈ V, which is intuitive. Practically, subtotal CSDH evacuation which approximately doubles total SA to V ratio or SAOM to V ratio implies CSDH resolution without recurrence. This could guide subdural drain removal timing, discharge, or transfer. Prospective validation studies are required.