scholarly journals Visual Disturbance Following Shunt Malfunction in a Patient With Congenital Hydrocephalus

2012 ◽  
Vol 52 (11) ◽  
pp. 835-838 ◽  
Author(s):  
Hirofumi OYAMA ◽  
Kenichi HATTORI ◽  
Akira KITO ◽  
Hideki MAKI ◽  
Tomoyuki NODA ◽  
...  
Keyword(s):  
Visual Disturbance ◽  
Shunt Malfunction ◽  
Congenital Hydrocephalus

Prolactinoma causing visual disturbance in pregnancy - a multidisciplinary management conundrum

2019 ◽  
Author(s):  
Sultana Azam ◽  
Rebecca Scott ◽  
Chioma Izzi-Engbeaya ◽  
Sheba Jarvis ◽  
Suhaniya Samarasinghe ◽  
...  
Keyword(s):  
Visual Disturbance ◽  
Multidisciplinary Management ◽  
In Pregnancy

A CASE OF FETAL DYSTOCIA DUE TO CONGENITAL HYDROCEPHALUS WITH MICROMELIA IN A PUG AND ITS MANAGEMENT

2019 ◽  
Vol 11 (1) ◽  
pp. 058
Author(s):  
M.S. Bawaskar ◽  
S.K. Sahatpure ◽  
S.S. Bawaskar ◽  
G.S. Nalkande ◽  
V.U. Takle ◽  
...  
Keyword(s):  
Congenital Hydrocephalus

Reliability of the radiopharmaceutical shunt flow study for the detection of a CSF shunt malfunction in the presence of stable ventricular size

2020 ◽  
Vol 26 (4) ◽  
pp. 364-370
Author(s):  
Jeffrey J. Quezada ◽  
J. Gordon McComb
Keyword(s):  
Ct Scan ◽  
Operative Intervention ◽  
Shunt Malfunction ◽  
Shunt Revision ◽  
Csf Shunt ◽  
Technical Failure ◽  
Ventricular Size ◽  
Shunt Flow ◽  
Programmable Valve ◽  
Flow Study

OBJECTIVEThe authors sought to determine the reliability of a radiopharmaceutical (RP) shunt flow study for the detection of a CSF-diverting shunt malfunction in the presence of stable ventricular size.METHODSAfter the authors obtained IRB approval, all CSF RP shunt flow studies done between January 1, 2014, and January 1, 2019, in pediatric patients at Children’s Hospital Los Angeles were identified. Included in the study were only those patients in whom an MRI or CT scan was done during the hospital admission for shunt malfunction and showed no increase in ventricular size compared with the most recent prior MRI or CT scan when the patient was asymptomatic. Data recorded for analysis were patient age and sex, etiology of the hydrocephalus, shunt distal site, nonprogrammable versus programmable valve, operative findings if the shunt was revised, and follow-up findings for a minimum of 90 days after admission. The RP shunt flow study consisted of tapping the reservoir and injecting technetium-99m DTPA according to a set protocol.RESULTSThe authors identified 146 RP flow studies performed in 119 patients meeting the above criteria. Four of the 146 RP studies (3%) were nondiagnostic secondary to technical failure and were excluded from statistical analysis. Of the 112 normal flow studies, operative intervention was not undertaken in 102 (91%). The 10 (9%) remaining normal studies were performed in patients who underwent operative intervention, in which 8 patients had a proximal obstruction, 1 had a distal obstruction, and 1 patient had no obstruction. Of the 30 patients with abnormal flow studies, symptoms of shunt malfunction subsided in 9 (30%) patients and these patients did not undergo operative intervention. Of the 21 (70%) operated patients, obstruction was proximal in 9 patients and distal in 5, and for 7 patients the shunt tubing was either fractured or disconnected. Regression analysis indicated a significant association between the flow study interpretation and the odds for shunt revision (OR 27, 95% CI 10–75, p < 0.0001). No other clinical variables were significant. The sensitivity of a shunt flow study alone for detection of shunt malfunction in cases with stable ventricular size was the same as a shunt flow study plus an MRI or CT (70% vs 70%), but performing a shunt flow in addition to MRI or CT did increase the specificity from 92% to 100% and the accuracy from 87% to 94%.CONCLUSIONSRP shunt flow studies were of definite value in deciding whether to operatively intervene in patients with symptoms of shunt malfunction in whom no change in ventricular size was detected on current MRI or CT scans compared to scans obtained when the patients were asymptomatic.

scholarly journals Reconstruction of a Combined Frontal Bone and Orbital Roof Defect With Associated Meningoencephalocele Using 3D Modeling and 3D Navigation

2021 ◽  
Vol 6 ◽  
pp. 247275122110233
Author(s):  
Rory C. O’Connor ◽  
Sead Abazi ◽  
Jehuda Soleman ◽  
Florian M. Thieringer
Keyword(s):  
3D Modeling ◽  
Road Traffic ◽  
Treatment Algorithm ◽  
Visual Disturbance ◽  
High Energy ◽  
Frontal Bone ◽  
3D Navigation ◽  
Orbital Roof ◽  
Close Observation ◽  
Orbital Roof Fractures

Introduction: Orbital roof fractures are uncommon and normally associated with high energy trauma in which multiple other injuries are present. Most can be managed non-operatively with close observation. However, in a small proportion the defect is such that it permits the development of a meningoencephalocele, which can cause exophthalmos, a reduction in visual acuity and pain, all of which are unlikely to improve without surgical treatment. In light of their scarcity and the potential of serious risks with surgery that includes meningitis and visual disturbance (or even loss), thorough planning is required so that the meningoencephalocele can be reduced safely and the orbital roof adequately reconstructed. Methods: We report a case of a patient with a frontal bone defect, orbital roof fracture and associated meningoencephalocele that presented years after being involved in a road traffic accident in another country, who complained of a significant headache and orbital pain. The use of 3D modeling to help plan the surgery, and intraoperative 3D navigation to help negotiate the anterior skull base are described along with the reconstruction of the frontal bone and orbital roof using titanium mesh contoured on the 3D model. Conclusions: Although conservative management of orbital roof fractures predominates; those that are symptomatic, have associated neurologic symptoms or pose a risk to the eyesight warrant a surgical approach. The methods of repair, which center around separating the intracranial and intraorbital contents, are described in the context of this patient and previous cases, and a treatment algorithm is proposed.

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