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https://www.readbyqxmd.com/read/28329191/management-of-ventriculoperitoneal-shunt-infections-in-adults-analysis-of-risk-factors-associated-with-treatment-failure
#1
Iván Pelegrín, Jaime Lora-Tamayo, Joan Gómez-Junyent, Nuria Sabé, Dolors García-Somoza, Andreu Gabarrós, Javier Ariza, Pedro Fernández Viladrich, Carmen Cabellos
Background.: Little is known regarding the optimal treatment of ventriculoperitoneal (VP) shunt infections in adults. Our aim was to assess the efficacy of treatment strategies and to identify factors that predict failure. Methods.: Retrospective, observational study of patients aged ≥12 years with VP shunt infections (1980 -2014). Therapeutic approaches were classified under 4 headings: only antibiotics (OA), one-stage shunt replacement (OSSR), two-stage shunt replacement (TSSR), and shunt removal without replacement (SR)...
March 10, 2017: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
https://www.readbyqxmd.com/read/28320134/post-hemorrhagic-hydrocephalus-recent-advances-and-new-therapeutic-insights
#2
REVIEW
Qianwei Chen, Zhou Feng, Qiang Tan, Jing Guo, Jun Tang, Liang Tan, Hua Feng, Zhi Chen
Post-hemorrhagic hydrocephalus (PHH), also referred to as progressive ventricular dilatation, is caused by disturbances in cerebrospinal fluid (CSF) flow or absorption following hemorrhage in the brain. As one of the most serious complications of neonatal/adult intraventricular hemorrhage (IVH), subarachnoid hemorrhage (SAH), and traumatic brain injury (TBI), PHH is associated with increased morbidity and disability of these events. Common sequelae of PHH include neurocognitive impairment, motor dysfunction, and growth impairment...
April 15, 2017: Journal of the Neurological Sciences
https://www.readbyqxmd.com/read/28300715/operative-learning-curve-after-transition-to-endoscopic-transsphenoidal-pituitary-surgery
#3
Tasneem Shikary, Norberto Andaluz, Jareen Meinzen-Derr, Collin Edwards, Philip Theodosopoulos, Lee A Zimmer
OBJECTIVES: No clear consensus yet defines the endpoints for operative learning curves in the transition to minimally invasive endoscopic techniques. This retrospective review of our first 202 patients who underwent endoscopic pituitary resection examines the statistical learning curve related to operative times--a measure of our surgical team's efficiency and complication rates, a reflection of surgical skill and maturity. METHODS: Retrospective chart review included patient demographics, tumor type, operative times, complication rates, and follow-up...
March 11, 2017: World Neurosurgery
https://www.readbyqxmd.com/read/28291547/remote-cerebellar-haemorrhage-after-placement-of-an-external-ventricular-drainage-for-acute-hydrocephalus-a-case-report
#4
I Caldeira, J Lavrador, G Basílio, R Sousa, S Reimão
INTRODUCTION: Remote cerebellar haemorrhage (RCH) is a rare complication following a craniotomy. This generally benign phenomenon is an identifiable complication of supratentorial craniotomies and should not be mistaken with other pathologies. The most common presenting symptom is a decrease in the level of consciousness but in some cases the RCH may be asymptomatic and accidentally discovered in follow-up CT scans. CASE REPORT: A 70-year-old man was admitted to our emergency department with sudden mental status deterioration...
March 10, 2017: Neuro-Chirurgie
https://www.readbyqxmd.com/read/28286280/over-drainage-secondary-to-ventriculosinus-shunt-a-case-report
#5
Tianyuan Zhao, Wei Ouyang, Shaobing Wang, Peitao Wu
BACKGROUND: Shunting to the cranial venous sinus represents a novel treatment strategy for hydrocephalus. To our knowledge, overdrainage as a complication following shunting to the cranial venous sinus has not previously been reported in the clinical literature. Here we report the case of a 50-year-old man who suffered from overdrainage after a ventriculosinus shunt insertion. CASE DESCRIPTION: A 50-year-old man was admitted to our hospital with recurring fever and gait difficulty 4 months after a ventriculoperitoneal shunt (VPS) insertion for primary communicating hydrocephalus...
March 9, 2017: World Neurosurgery
https://www.readbyqxmd.com/read/28285405/the-effects-of-blood-and-blood-products-on-the-arachnoid-cell
#6
Eric A Hansen, Liudmila Romanova, Christopher Janson, Cornelius H Lam
After traumatic brain injury (TBI), large amounts of red blood cells and hemolytic products are deposited intracranially creating debris in the cerebrospinal fluid (CSF). This debris, which includes heme and bilirubin, is cleared via the arachnoid granulations and lymphatic systems. However, the mechanisms by which erythrocytes and their breakdown products interfere with normal CSF dynamics remain poorly defined. The purpose of this study was to model in vitro how blood breakdown products affect arachnoid cells at the CSF-blood barrier, and the extent to which the resorption of CSF into the venous drainage system is mechanically impaired following TBI...
March 11, 2017: Experimental Brain Research. Experimentelle Hirnforschung. Expérimentation Cérébrale
https://www.readbyqxmd.com/read/28277450/intracranial-pressure-values-are-highly-variable-after-cerebral-spinal-fluid-drainage
#7
Michael Rogers, Sonja E Stutzman, Folefac D Atem, Samarpita Sengupta, Babu Welch, DaiWai M Olson
Intracranial pressure (ICP) is often obtained via external ventricular drain (EVD) placement and is discussed as a key vital sign in neuroscience. Nurses are most often delegated the task of observing, adjudicating, and documenting ICP. Cerebrospinal fluid drainage requires that the transducer connected to the EVD is open to drain, prohibiting ICP monitoring. There are no recent data to support an evidence-based standard for the period an ICP waveform should be observed, after the EVD is clamped, to be able to adjudicate a value that represents the patient's status...
April 2017: Journal of Neuroscience Nursing: Journal of the American Association of Neuroscience Nurses
https://www.readbyqxmd.com/read/28259041/trunk-sway-in-idiopathic-normal-pressure-hydrocephalus-quantitative-assessment-in-clinical-practice
#8
Tomas Bäcklund, Jennifer Frankel, Hanna Israelsson, Jan Malm, Nina Sundström
BACKGROUND: In diagnosis and treatment of patients with idiopathic normal pressure hydrocephalus (iNPH), there is need for clinically applicable, quantitative assessment of balance and gait. Using a body-worn gyroscopic system, the aim of this study was to assess postural stability of iNPH patients in standing, walking and during sensory deprivation before and after cerebrospinal fluid (CSF) drainage and surgery. A comparison was performed between healthy elderly (HE) and patients with various types of hydrocephalus (ventriculomegaly (VM))...
February 24, 2017: Gait & Posture
https://www.readbyqxmd.com/read/28243999/physiological-effects-of-early-incremental-mobilization-of-a-patient-with-acute-intracerebral-and-intraventricular-hemorrhage-requiring-dual-external-ventricular-drainage
#9
Sowmya Kumble, Elizabeth K Zink, Mackenzie Burch, Sandra Deluzio, Robert D Stevens, Mona N Bahouth
BACKGROUND: Recent trials have challenged the notion that very early mobility benefits patients with acute stroke. It is unclear how cerebral autoregulatory impairments, prevalent in this population, could be affected by mobilization. The safety of mobilizing patients who have external ventricular drainage (EVD) devices for cerebrospinal fluid diversion and intracranial pressure (ICP) monitoring is another concern due to risk of device dislodgment and potential elevation in ICP. We report hemodynamic and ICP responses during progressive, device-assisted mobility interventions performed in a critically ill patient with intracerebral hemorrhage (ICH) requiring two EVDs...
February 27, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/28230605/microscopic-transnasal-transsphenoidal-surgery-for-pediatric-pituitary-adenomas
#10
Wei Jiao, Yimin Huang, Wei Sun, Ting Lei
Microscopic transnasal transsphenoidal surgery (MTTS) has been a time-confirmed effective treatment for pituitary adenomas; however, the data supporting its use in pediatric patients is limited. In this study, the authors summarize the authors' 5-year experience of pituitary adenomectomy via MTTS in a pediatric population. The authors retrospectively reviewed the medical records of 35 patients aged ≤18 years who underwent microscopic transnasal transsphenoidal approach for pituitary adenomas between January 2011 and December 2015...
February 22, 2017: Journal of Craniofacial Surgery
https://www.readbyqxmd.com/read/28230563/implementation-of-an-early-mobility-pathway-in-neurointensive-care-unit-patients-with-external-ventricular-devices
#11
Megan Moyer, Bethany Young, Joseph Borst, William Pino, Marisa Hart, Jesse LoBreglio, Derek Zaleski, Isaira Leonor, David Kung, Michelle Smith, Eric Zager, M Sean Grady, Monisha Kumar
BACKGROUND: Patients with an external ventricular drain (EVD) may not be readily mobilized because of concerns of catheter dislodgment and/or inappropriate cerebrospinal fluid drainage. Delayed mobilization may result in longer hospital stays and an increased risk for complications related to immobility. We aimed to determine the safety, feasibility, and outcome of an EVD mobilization protocol in patients with subarachnoid hemorrhage (SAH). METHODS: A multidisciplinary group developed a formal algorithm for the mobilization of patients with SAH with EVDs...
February 23, 2017: Journal of Neuroscience Nursing: Journal of the American Association of Neuroscience Nurses
https://www.readbyqxmd.com/read/28229571/transnasal-transsphenoidal-brain-injury-by-a-fencing-foil-an-unusual-case-report-and-brief-literature-review
#12
Rafet Özay, Mehmet S Balkan, Çağhan Tönge, Zeki Şekerci
BACKGROUND: In this report, the authors present an unusual case of a 10-year-old child who suffered a severe headache and rhinorrhea that occurred as a result of fencing foil sports injury via transnasal-transsphenoidal (TNTS) pathway. METHODS: Following to trauma, the child had shown neurological symptoms such a pupil dilatation, change in consciousness and mild hemiparesia. Imaging demonstrated destruction of bone structures including posterior wall of sphenoid sinus and anterosuperior part of sella turcica, and also a contusion at right thalamic region...
February 22, 2017: Journal of Sports Medicine and Physical Fitness
https://www.readbyqxmd.com/read/28228623/elucidation-of-mechanism-of-blood-brain-barrier-damage-for-prevention-and-treatment-of-vascular-dementia
#13
Masaki Ueno
It is well-known that the blood-brain barrier (BBB) plays significant roles in transporting intravascular substances into the brain. The BBB in cerebral capillaries essentially impedes the influx of intravascular compounds from the blood to the brain, while nutritive substances, such as glucose, can be selectively transported through several types of influx transporters in endothelial cells. In the choroid plexus, intravascular substances can invade the parenchyma as fenestrations exist in endothelial cells of capillaries...
February 22, 2017: Rinshō Shinkeigaku, Clinical Neurology
https://www.readbyqxmd.com/read/28216365/automated-pressure-controlled-cerebrospinal-fluid-drainage-during-open-thoracoabdominal-aortic-aneurysm-repair
#14
Yamume Tshomba, Marco Leopardi, Daniele Mascia, Andrea Kahlberg, Andrea Carozzo, Silvio Magrin, Germano Melissano, Roberto Chiesa
OBJECTIVE: Perioperative cerebrospinal fluid (CSF) drainage is a well-established technique for spinal cord protection during thoracoabdominal aortic aneurysm (TAAA) open repair and is usually performed using dripping chamber-based systems. A new automated device for controlled and continuous CSF drainage, designed to maintain CSF pressure around the desired set values, thus avoiding unnecessary drainage, is currently available. The aim of our study was to determine whether the use of the new LiquoGuard automated device (Möller Medical GmbH, Fulda, Germany) during TAAA open repair was safe and effective in maintaining the desired CSF pressure values and whether the incidence of complications was reduced compared with a standard catheter connected to a dripping chamber...
February 16, 2017: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/28203407/thoracoabdominal-aortic-replacement-for-crawford-extent-ii-aneurysm-after-thoracic-endovascular-aortic-repair
#15
Haiou Hu, Tie Zheng, Junming Zhu, Yongmin Liu, Ruidong Qi, Lizhong Sun
BACKGROUND: The surgical treatment of Crawford extent II aneurysms after thoracic endovascular aortic repair (TEVAR) remains challenging, because of the need to remove the failed endograft and the complexity of the aortic reconstruction. We retrospectively reviewed our experience with surgical management of Crawford extent II aneurysms after TEVAR using thoracoabdominal aortic replacement (TAAR). METHODS: Eleven patients (10 males, 1 female) with Crawford extent II aneurysm after TEVAR were treated with TAAR between August 2012 and May 2015...
January 2017: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/28193123/ventriculoportal-shunt-a-new-transomphalic-extraperitoneal-surgical-technique-in-treatment-of-hydrocephalus
#16
Valentin Titus Grigorean, Aurelia Mihaela Sandu, Mihai Popescu, Victor Strambu
AIM: The aim of this article was to report a new transomphalic extraperitoneal surgical technique for treatment of hydrocephalus, called ventriculoportal shunt. MATERIALS AND METHODS: We performed ventriculoportal shunt on an experimental animal (pig). The particularity of ventriculoportal shunt consists in the fact that the distal end of the catheter is inserted transomphalic extraperitoneally in the portal system through reopened umbilical vein. We present technical details regarding this new surgical technique...
February 1, 2017: Surgical Innovation
https://www.readbyqxmd.com/read/28187815/principles-of-intracranial-pressure-monitoring-and-treatment
#17
REVIEW
M Czosnyka, J D Pickard, L A Steiner
Intracranial pressure (ICP) is governed by volumes of intracranial blood, cerebrospinal fluid, and brain tissue. Expansion of any of these volumes will trigger compensatory changes in the other compartments, resulting in initially limited change in ICP. Due to the rigid skull, once compensatory mechanisms are exhausted, ICP rises very rapidly. Intracranial hypertension is associated with unfavorable outcome in brain-injured patients. This chapter discusses the pathophysiology of raised ICP, as well as typical waveforms, monitoring techniques, and clinical management...
2017: Handbook of Clinical Neurology
https://www.readbyqxmd.com/read/28187809/management-of-bacterial-central-nervous-system-infections
#18
REVIEW
M C Brouwer, D van de Beek
Bacterial infections of the central nervous system present as a medical emergency, thus requiring rapid diagnosis and immediate treatment. The most prevalent bacterial infections seen in the intensive care unit can be summarized as acute bacterial meningitis, subdural empyema, intracerebral abscess, and ventriculitis, which all commonly involve the brain parenchyma. The infections can either be community-acquired or hospital-acquired, e.g., after neurosurgical intervention, as a complication of severe neurotrauma or related to indwelling cerebrospinal fluid drains...
2017: Handbook of Clinical Neurology
https://www.readbyqxmd.com/read/28175991/spontaneous-cerebrospinal-fluid-leaks-in-the-anterior-skull-base-secondary-to-idiopathic-intracranial-hypertension
#19
Gabriel Martínez-Capoccioni, Ramón Serramito-García, Maria Martín-Bailón, Alfredo García-Allut, Carlos Martín-Martín
Spontaneous cerebrospinal fluid (CSF) leaks represent a clinical entity in which CSF rhinorrhea occurs in the absence of any inciting event. Spontaneous CSF leaks are associated with elevated intracranial pressure (ICP) or have underlying idiopathic intracranial hypertension (IIH). We report a cohort of patients who have undergone nasal endoscopic repair for spontaneous CSF leaks. We review our perioperative complications and the effectiveness of the nasal endoscopic approach to repair spontaneous CSF leaks...
February 7, 2017: European Archives of Oto-rhino-laryngology
https://www.readbyqxmd.com/read/28163520/penetrating-anterior-skull-base-fracture-inflicted-by-a-cow-s-horn
#20
Adomas Bunevicius, Karolis Bareikis, Laimutis Kalasauskas, Arimantas Tamasauskas
Farm workers are at increased risk for animal-inflicted head injuries that are associated with significant morbidity and occasionally may be fatal. These injuries may cause permanent eye damage with or without concomitant skull base fracture. Here, we present a male farmer who suffered a cow attack that resulted in perforating orbital injury with comminuted frontobasal cranial fracture caused by a cow's horn. The next day, the patient developed nasal and orbital cerebrospinal fluid (CSF) leak. Computed Tomography cisternography revealed CSF leakage to frontal and maxillary sinuses...
December 2016: Journal of Neurosciences in Rural Practice
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