Endoscopic third ventriculostomy : effectiveness of the procedure for obstructive hydrocephalus with different etiology in adults

INTRODUCTION: After a time of domination of shunt placement, endoscopic third ventriculostomy (ETV) has been increasingly applied in treatment of obstructive hydrocephalus. AIM: To assess the effectiveness of ETV in treatment of adults with three-ventricle hydrocephalus of different etiology. MATERIAL AND METHODS: Ninety-six patients with obstructive hydrocephalus were studied: 24 with primary aqueductal stenosis, 61 with brain tumor, and 2 with basilar tip aneurysm. In 9 patients the etiology of hydrocephalus remained undetermined. The assessment of treatment results was based on clinical and radiological criteria. RESULTS: Clinical improvement was observed in 74 (77.1%) patients, and radiological improvement in 52 (54.2%). One patient died. Follow-up of 24 patients with primary aqueductal stenosis has shown that in 20 (83.3%) of them clinical improvement has been stable, and in 14 (58.3%) radiological improvement has been observed. Two patients required shunt placement due to hydrocephalus recurrence 12–24 months after the ETV procedure. Among 9 patients with undefined hydrocephalus, 3 required shunt placement within 6 months after ETV (2 shunted previously). Endoscopic third ventriculostomy treatment in a patient with hydrocephalus caused by basilar tip aneurysm succeeded. The assessment of ETV effectiveness in oncological patients has been indirect in view of the underlying disease. CONCLUSIONS: The best results of ETV treatment have been demonstrated for patients with primary aqueductal stenosis. Ventricle size cannot determine the effectiveness of treatment as an individual requirement. Endoscopic third ventriculostomy is effective in previously shunted patients although the prediction of outcome should be cautious. Endoscopic third ventriculostomy enables preparation for further therapy and is palliative treatment in oncological patients with secondary hydrocephalus

Early reoperations in chronic subdural hematoma

Background: The recurrence rate of chronic subdural hematoma (cSDH) is high and early reoperation is often required. Aim: The aim of this study was to evaluate prognostic factors for early reoperation of chronic subdural hematomas (cSDH) treated by classical and minimally invasive approach. Materials and Methods: We retrospectively analyzed the medical history of 355 cSDH patients treated with formal craniotomy and minimally invasive burr hole craniostomy. We determined the potential predictors of early reoperations. Results: A total of 33 (9.3%) patients required early reoperation. Those patients more often underwent craniotomies instead of burr hole craniostomies (36.4% vs. 62.7%, p < 0.01) and took steroids before hospitalization (3.0% vs. 0.3%, p = 0.04) than non-reoperated patients. Patients who had surgery on the right side were less likely to be reoperated (51.9% vs. 33.3%, p = 0.04). On multivariate analysis the frontal (OR = 5.284, 95% CI: 1.293–21.76, p = 0.019) and large craniotomy (OR = 2.297, 95% CI: 1.004–5.258, p = 0.048) remained independent risk factors for early reoperation of cSDH. Conclusions: Neurosurgeons should consider the evacuation of a cSDH with help of minimally invasive burr hole craniostomy in most of the cases, as well as avoid large and frontal and craniotomies in order to prevent early reoperation of cSDH

Quantitative immunohistochemical assessment of clinically non-functioning pituitary adenomas

Introduction. Immunohistochemical staining is currently the gold standard of diagnostic and classification of pituitary adenomas. However, there are some discrepancies between immunohistochemical staining results and the clinical picture of pituitary adenomas. Pituitary adenomas with positive immunohistochemical reaction might not cause any endocrinological symptoms or changes in serum pituitary hormone levels. Such a discordance may be caused partly by clinically non-functioning pituitary adenomas (CNFPAs). The aim of our study was to establish the frequency of CNFPAs and identify their histological types using quantitative immunohistochemical assessment. Materials and methods. We enrolled in the study 72 patients with pituitary adenoma, and their medical history was evaluated retrospectively. The immunohistochemical panel of anterior pituitary hormones was introduced in all cases. The immunoreactivity index was calculated manually for each specimen. Results. 36.1% patients of the evaluated group presented as CNFPAs. Among the CNFPA patients we found 38.46% cases with positive immunohistochemical reaction for one or more anterior pituitary lobe hormones. In 23.07% of cases the adenomas were monohormonal, and in 15.38% they were plurihormonal. Conclusions. The morphometric method utilising the immunoexpression index introduced in this study provided a very precise recognition of pituitary adenoma pathology. In the case of CNFPAs the immuno-histochemical staining often reveals a positive reaction also for multiple pituitary hormones. Quantitative assessment limits the subjectivity of the examiner and allows objective results comparison, so it should become a standard in histopathological assessment of pituitary adenomas