Re: Percutaneous fetoscopic spina bifida repair: effect on ambulation and need for postnatal cerebrospinal fluid diversion and bladder catheterization

2021 ◽  
Vol 58 (6) ◽  
pp. 958-959
Author(s):  
A. Macedo ◽  
M. Cruz
Keyword(s):  
Cerebrospinal Fluid ◽  
Spina Bifida ◽  
Bladder Catheterization ◽  
Cerebrospinal Fluid Diversion

scholarly journals Neurosurgical experience of managing optic pathway gliomas

2021 ◽  
Author(s):  
Ciaran Scott Hill ◽  
Mehdi Khan ◽  
Kim Phipps ◽  
Katherine Green ◽  
Darren Hargrave ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Surgical Resection ◽  
Visual Function ◽  
Optic Pathway ◽  
Who Grade ◽  
Radiographic Findings ◽  
Surgical Interventions ◽  
Hypothalamic Dysfunction ◽  
Cerebrospinal Fluid Diversion ◽  
Optic Pathway Gliomas

Abstract Background Optic pathway gliomas (OPGs), also known as visual pathway gliomas, are debilitating tumors that account for 3–5% of all pediatric brain tumors. They are most commonly WHO grade 1 pilocytic astrocytomas and frequently occur in patients with neurofibromatosis type 1. The location of these tumors results in visual loss and blindness, endocrine and hypothalamic dysfunction, hydrocephalus, and premature death. Their involvement of the visual pathways and proximity to other eloquent brain structures typically precludes complete resection or optimal radiation dosing without incurring significant neurological injury. There are various surgical interventions that can be performed in relation to these lesions including biopsy, cerebrospinal fluid diversion, and partial or radical resection, but their role is a source of debate. This study catalogues our surgical experience and patient outcomes in order to support decision-making in this challenging pathology. Methods A retrospective review of all cases of OPGs treated in a single center from July 1990 to July 2020. Data was collected on patient demographics, radiographic findings, pathology, and management including surgical interventions. Outcome data included survival, visual function, endocrine, and hypothalamic dysfunction. Results One hundred twenty-one patients with OPG were identified, and 50 of these patients underwent a total of 104 surgical procedures. These included biopsy (31), subtotal or gross total resection (20 operations in 17 patients), cyst drainage (17), Ommaya reservoir insertion (9), or cerebrospinal fluid diversion (27). During the study period, there was 6% overall mortality, 18% hypothalamic dysfunction, 20% endocrine dysfunction, and 42% had some cognitive dysfunction. At diagnosis 75% of patients had good or moderate visual function in at least one eye, and overall, this improved to 83% at the end of the study period. In comparison the worst eye had good or moderate visual function in 56%, and this reduced to 53%. Baseline and final visual function were poorer in patients who had a surgical resection, but improvements in vision were still found—particularly in the best eye. Discussion/conclusion OPG are debilitating childhood tumor that have lifelong consequences in terms of visual function and endocrinopathies/hypothalamic dysfunction; this can result in substantial patient morbidity. Decisions regarding management and the role of surgery in this condition are challenging and include cerebrospinal fluid diversion, biopsy, and in highly select cases cystic decompression or surgical resection. In this paper, we review our own experience, outcomes, and surgical philosophy.

From the heart to the bladder—particularities of ventricular shunt topography and the current status of cerebrospinal fluid diversion sites

2018 ◽  
Vol 43 (3) ◽  
pp. 847-860
Author(s):  
Cezar Octavian Morosanu ◽  
Gabriela Adriana Filip ◽  
Liviu Nicolae ◽  
Ioan Stefan Florian
Keyword(s):  
Cerebrospinal Fluid ◽  
Current Status ◽  
Cerebrospinal Fluid Diversion

Physical characteristics of catheters used for subarachnoid drainage

2015 ◽  
Vol 8 (8) ◽  
pp. 865-867 ◽  
Author(s):  
A Ian Wong ◽  
Shengqiang Gao ◽  
Mark D Bain ◽  
Brian Fitzsimons ◽  
Ferdinand K Hui
Keyword(s):  
Tensile Strength ◽  
Cerebrospinal Fluid ◽  
Fracture Resistance ◽  
Foreign Bodies ◽  
Clinical Applications ◽  
Routine Procedure ◽  
Laboratory Equipment ◽  
Cerebrospinal Fluid Diversion ◽  
Patient Morbidity ◽  
Break Load

BackgroundCerebrospinal fluid diversion through lumbar drainage catheters is a routine procedure that is used in a variety of clinical applications. Fracture of catheters during insertion or removal may result in retained foreign bodies that may lead to patient morbidity with potential legal ramifications. Fracture resistance is an important component of drain selection.ObjectiveTo analyze catheter integrity to determine which commercially available catheters are most robust and resistant to fracture.MethodsPhysical properties of the commercially available drainage catheters that can be advanced through a Touhy needle were assessed using laboratory equipment and reported. Five types of catheter were analyzed for break load, tensile strength, extension at break, and shear strength.Results and conclusionsOf the five types of catheter, the Arrow catheter showed the greatest resistance to fracture. Of the drainage catheters, the Codman catheter showed the greatest resistance to fracture.

Anesthesia for Neonatal Myelomeningocele

2021 ◽  
pp. 209-214
Author(s):  
Anna Clebone
Keyword(s):  
Spinal Cord ◽  
Cerebrospinal Fluid ◽  
Spina Bifida ◽  
Neural Tube ◽  
Fetal Development ◽  
Vertebral Column ◽  
Bony Defect ◽  
Spinal Nerves ◽  
Spina Bifida Aperta ◽  
Human Fetal Development

Myelomeningocele, also known as spina bifida aperta (often shortened to the nonspecific name “spina bifida”) is a congenital disorder of the spine. In infants with a myelomeningocele, the neural tube has not closed, and the vertebral arches have not fused during development, leading to spinal cord and meningeal herniation through the skin. Because of the high potential for injury and infection of the exposed spinal cord, which could lead to lifetime disability, these lesions are typically repaired within 24 to 48 hours after birth. A myelomeningocele occurs before day 28 of human fetal development and is an abnormality in which the posterior neural tube closes incompletely. The outcome is a vertebral column deformity, through which the meningeal-lined sac herniates. After the bony defect is created, the hypothesized mechanism of meningeal herniation is that the pulsations of cerebrospinal fluid act progressively to balloon out the spinal cord. If the sac is filled with spinal nerves or the spinal cord, it is known as a myelomeningocele; if the sac is empty, it is called a meningocele.

External Ventricular Drainage

2018 ◽  
pp. 165-172
Author(s):  
Nitin Agarwal ◽  
Andrew F. Ducruet
Keyword(s):  
Traumatic Brain Injury ◽  
Cerebrospinal Fluid ◽  
Neurological Disease ◽  
External Ventricular Drain ◽  
Management Strategies ◽  
External Ventricular Drainage ◽  
Postoperative Management ◽  
Ventricular Drainage ◽  
Cerebrospinal Fluid Diversion ◽  
Lumbar Drain

External ventricular drainage, or ventriculostomy, refers to surgical placement of a catheter into the ventricle to achieve temporary cerebrospinal fluid diversion and remains one of the most frequently performed neurosurgical interventions. External ventricular drainage is an essential therapeutic strategy for a myriad of neurological disease processes causing hydrocephalus or increased intracranial pressure including traumatic brain injury, subarachnoid hemorrhage, and intracranial hemorrhage with intraventricular extension. In select cases, lumbar drains may provide a suitable alterative to an external ventricular drain (EVD). Complications related to both EVD and lumbar drain placement include malfunction, infection, and hemorrhage. This chapter reviews the indications, surgical technique, postoperative management strategies, and potential complications associated with external ventricular drainage.

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