Endoscopic third ventriculostomy for hydrocephalus: a review of indications, outcomes, and complications

Endoscopic third ventriculostomy (ETV) has been in vogue for the past two decades, as a tool in the armamentarium of the neurosurgeon, for the management of hydrocephalus. Its utility has been proven consistently in congenital / acquired aqueductal stenosis, although the outcomes in communicating hydrocephalus as well as hydrocephalus secondary to other etiologies have not been as impressive. It is a relatively safe procedure with the appropriate selection of patients with a low rate of permanent morbidity. This review aims to define the current indications, management outcomes, and complications of ETV

Development of glioblastoma multiforme following traumatic cerebral contusion: case report and review of literature

Background: Diagnostic criteria for posttraumatic brain tumors were formulated in the pre-CT (computerized tomography) era. We propose that radiologic criteria incorporating imaging data be added to the existing criteria. Case description: We report a case of a 56-year-old man who presented with history of raised intracranial pressure of 20 days' duration. Imaging showed a large left frontal intra-axial mass lesion. He had history of head injury 5 years prior with CT evidence of bilateral basifrontal contusions. There was no contrast enhancement at the site of the contusions in an intervening CT scan done 18 months after the trauma. He underwent radical excision of the mass, and the histopathology was reported as glioblastoma multiforme. We formulated additional radiologic criteria for tumors that may present following trauma. A review of the literature of posttraumatic gliomas is also presented. Conclusion: Fulfillment of the additional radiologic criteria proposed by us will help distinguish a tumor that developed following trauma from that which was present before the occurrence of the injury

Management of brain abscess: an overview

Recent advances in neuroimaging have resulted in a marked decrease in morbidity and death due to brain abscesses. The advent of computed tomography–guided stereotaxy has reduced morbidity in patients with deep-seated abscesses. Empirical therapy is best avoided in the present era, particularly given the availability of stereotactic techniques for aspiration and confirmation of diagnosis. Despite these advances, management of abscesses in patients with cyanotic heart disease and in immunosuppressed patients remains a formidable challenge. Unusual as well as more recently recognized pathogens are being isolated from abscesses in immunosuppressed patients. The authors provide an overview of the management of brain abscesses, highlighting their experience in managing these lesions in patients with cyanotic heart disease, stereotactic management of brain abscesses, and management of abscesses in immunosuppressed patients

Brain abscess in a non-penetrating traumatic intracerebral hematoma: Case report and review of literature

We report a 57-year-old man who presented one month after sustaining a traumatic right temporal intracerebral hematoma with history of headache, left hemiparesis and altered sensorium of two days duration. A diagnosis of right temporal resolving hematoma was made on computed tomography scan. However, his sensorium progressively deteriorated and he underwent craniotomy and partial excision of an abscess. He was treated with appropriate antibiotics for six weeks despite of which he did not improve and died nine months later. We conclude that there should be a high index of suspicion for brain abscess in patients with traumatic intracerebral hemorrhage if the clinical and radiological picture is different from the expected course of a resolving hematoma

Quantitative changes in gait parameters after central corpectomy for cervical spondylotic myelopathy

Object: In this study, quantitative gait analysis is used to describe the changes in the kinematic and kinetic parameters of gait after central corpectomy in patients with cervical spondylotic myelopathy (CSM). Methods: Six men with CSM that was categorized preoperatively as Nurick Grade 3 or 4 were assessed using quantitative gait analysis. The values of various kinematic and kinetic parameters, physiological cost index, and range of motion (ROM) in the lower-limb joints were computed preoperatively as well as at follow-up review 12 months or more postoperatively. Patients also received scores based on the Nurick and Japanese Orthopaedic Association (JOA) lower-limb functional scales pre- and postoperatively. The mean Nurick grade improved from 3.3 to 2 (p = 0.02) and the mean JOA lower-limb score improved from 4.2 to 6 (p = 0.02). The forward ground reaction force showed a statistically significant increase from 10.8 ± 4.1% body weight to 12.1 ± 3.6% body weight (p = 0.04). There was a significant improvement in the ROM at the knees, from 48.6 ± 7.7° to 54.2 ± 5.2°(p = 0.03). There was an increase in the mean walking speed, stride length, percentage of single-limb support time, vertical and backward ground reaction forces, and ROM at the hips in the postoperative gait analysis. These results indicate an improved stability of gait as well as greater flexibility in the knee after decompression of the spinal cord. These changes correlated with an improvement in the functional status of patients with CSM after central corpectomy. Conclusions: Gait analysis can be used as a quantitative tool in the pre- and postoperative evaluation of patients with CSM

Choroid plexus papilloma presenting as a non-contrast-enhancing fourth ventricular mass in a child

Choroid plexus papilloma (CPP) is a rare benign tumor of the central nervous system with a propensity for location within the lateral ventricle in children. We report a case of a 14-year-old girl who presented with transient facial paresis and ataxia. Her imaging showed a non-enhancing intra fourth ventricular mass, the histology of which was reported as CPP. The atypical clinical and radiological features in this case are discussed. Choroid plexus papillomas should be considered in the differential diagnosis of non-enhancing fourth ventricular masses

Assessment of memory and new learning ability following stereotaxy-guided transcortical resection of anterior third ventricular colloid cysts

In a prospective study, memory and new learning ability functions were assessed pre-operatively (17 patients) and in the early post-operative period (22 patients) at 7-26 days following surgery in patients undergoing stereotactic transcortical excision of their colloid cysts. Pre-operative assessment detected impaired memory in 5 patients, 2 of whom had no memory-related complaints. Impaired new learning ability was detected pre-operatively in 7 patients. There was a statistically non-significant trend towards improvement in the dysfunction scores post-operatively in most patients. No correlation was detected between the cyst size, presence of raised intracranial pressure at presentation, hydrocephalus and the pre-operative dysfunction scores. Stereotactic transcortical resection of colloid cysts does not impair these functions in the majority of patients and might improve these functions in some. In the absence of clinical or radiological predictors of dysfunction of memory and new learning ability, pre-operative neuropsychological assessment has a role in detecting impaired memory and new learning ability in patients with anterior third ventricular colloid cysts who may not even complain of them

A computed tomography-based localizer to determine the entry site of the ventricular end of a parietal ventriculoperitoneal shunt

Background: One of the major principles of shunt insertion into the brain involves choosing an entry site that avoids eloquent cortex. Objetive: We describe a novel tool to accurately locate the burr hole for insertion of the ventricular end of a catheter during parietal ventriculoperitoneal shunt surgery. Methods: Computed tomography (CT)-based measurements in 2 dimensions were used to mark the entry point with the help of an indigenously designed Vellore burr hole localizer (VL). Patients underwent surgery with either the conventional method to localize the burr hole (Keen point; group A; n = 28) or the VL (group B; n = 28). An independent observer determined the accuracy of shunt placement on postoperative CT scans. The VL is designed with a fixed horizontal arm that can be aligned with the CT or magnetic resonance reference plane and a vertical arm with a flexible sliding horizontal arm that is attached to it with an adjustable screw. By manipulating the flexible arm along the contour of the skull and using the scale provided on both the vertical and horizontal arms, we can mark the burr hole site for placement of a parietal ventriculoperitoneal shunt. Results: Overall accuracy in group A was 32.1%, whereas in group B, an accuracy of 82.1% could be achieved (P < .01). Conclusion: Placement of a burr hole guided by the VL increases the accuracy of the desired entry point of the ventricular catheter