Spontaneous third ventriculostomy in obstructive hydrocephalus with composed aetiology : a case report

Third ventriculostomy (TV) is the most common neuroendoscopic procedure for restoration of near physiological circulation of cerebrospinal fluid in obstructive hydrocephalus. Among 70 adults operated on using this technique, the authors encountered one case of spontaneous TV. Only a few case reports of spontaneous ventriculostomy revealed by ventriculography, flow-sensitive phase-contrast cine magnetic resonance imaging (MRI) or at autopsy have been published. A 43-year-old woman with symptoms of hydrocephalus and signs of chronic obstructive hydrocephalus secondary to aqueductal stenosis on MRI was qualified for TV. Enlarged infundibulo-mammillary triangle with perforation was noted intraoperatively. During the postoperative course, the condition of the patient partially improved although radiological appearance remained unchanged. Three weeks later symptoms of hydrocephalus recurred and the patient underwent an infusion test which revealed increased cerebrospinal fluid outflow resistance. Implantation of a ventriculo-peritoneal shunt yielded stable improvement. Spontaneous TV should be taken into consideration during selection of patients for TV, especially in cases with chronic obstructive hydrocephalus

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

Endovascular management of carotid artery dissections with the use of new generation stents and protection systems

Dissection of the internal carotid artery (ICA) is a rare disease, but in young patients is responsible for about 20% of cerebral events. We presented three different cases of ICA dissection, including one iatrogenic and two spontaneous ones, which were successfully managed endovascularly, with the use of different techniques, different protection devices and stents. In this article, the clinical management and details of procedures were described

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

Endovascular management of carotid artery dissections with the use of new generation stents and protection systems

Dissection of the internal carotid artery (ICA) is a rare disease, but in young patients is responsible for about 20% of cerebral events. We presented three different cases of ICA dissection, including one iatrogenic and two spontaneous ones, which were successfully managed endovascularly, with the use of different techniques, different protection devices and stents. In this article, the clinical management and details of procedures were described