Neurologia medico-chirurgica
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Neurol. Med. Chir. (Tokyo) · Oct 2009
Case ReportsMigration of the distal end of a ventriculoperitoneal shunt into the abdominal wall in an obese patient: case report.
A 64-year-old obese woman underwent ventriculoperitoneal shunting for hydrocephalus associated with subarachnoid hemorrhage. On the 10th postoperative day, the distal end of the peritoneal catheter migrated into the abdominal wall and she developed a cyst filled with cerebrospinal fluid around the migrated catheter. ⋯ We attribute the migration to increased intra-abdominal pressure due to obesity, the use of a low friction hydrogel-processed peritoneal catheter, and the presence of a large dead space around the catheter. The laparotomy must be closed meticulously to prevent this type of migration.
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Neurol. Med. Chir. (Tokyo) · Oct 2009
Case ReportsSerial angiography of dynamic changes of traumatic middle meningeal arteriovenous fistula: case report.
A 48-year-old woman suffered head trauma and presented with an acute epidural hematoma with a linear fracture of the right temporal bone across the middle meningeal groove. Initial angiography demonstrated no vascular abnormalities. Eight months later, she again suffered head trauma and computed tomography demonstrated traumatic subarachnoid hemorrhage. ⋯ Histological examination of the drainer revealed an arterialized vein. The serial angiographic evaluations revealed dynamic changes of the traumatic middle meningeal AVF, including progressive dilation of the drainers, simplification of the drainage routes, and the formation of venous aneurysms, which presumably represents the entire natural course of traumatic middle meningeal AVF manifesting as hemorrhage. The present case of traumatic middle meningeal AVF with a deteriorating course suggests that surgical removal or embolization of the AVF is strongly indicated if follow-up angiography shows dilation of the drainers, which implies increased shunt flow.
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Neurol. Med. Chir. (Tokyo) · Oct 2009
Limited efficacy of endoscopic third ventriculostomy for hydrocephalus following aneurysmal subarachnoid hemorrhage.
Endoscopic third ventriculostomy (ETV) has not been recognized as a surgical option for hydrocephalus following aneurysmal subarachnoid hemorrhage (SAH), since hydrocephalus following aneurysmal SAH is considered to result from the communicating component. However, obstructions in the ventricular system may exist, so ETV could help resolve the condition. The present study evaluated the efficacy of ETV for hydrocephalus appearing within one month after aneurysmal SAH. ⋯ ETV for hydrocephalus following aneurysmal SAH is likely to help manage intracranial pressure. ETV may improve cognitive impairment in some patients, but whether the maximum resolution is obtained only with ETV remains uncertain. VP shunt implantation should be the main treatment for hydrocephalus after aneurysmal SAH, but ETV can be employed as a temporary intervention in certain conditions, such as during the waiting period for the clearance of aneurysmal SAH.