Clinical Outcomes of Shunting in Normal Pressure Hydrocephalus. A Multicenter Prospective Observational Study

Background: Normal pressure hydrocephalus (NPH) is characterized by the triad of dementia, gait disturbance and urinary incontinence, all potentially reversible following a ventricu-loperitoneal shunt (VPS). This study aims to evaluate the clinical outcomes of shunting in normal pressure hydrocephalus following a new standardized protocol. Methods: This study is designed according to the STROBE guidelines. Demographical, clinical, surgical and radiological data were collected from May 2015 to November 2019. Gait, balance and incontinence data based on the NPH European scale were collected before and after one, six and twelve months of treatment with a VPS. Clinical symptoms and changes of the stoke volume, measured on phase-contrast MRI, were used to evaluate improvement after VPS surgery. Results: One hundred and eighty-one consecutive patients met the inclusion criteria. The mean age was 73.1 years (59–86) and mean follow-up was 38.3 months (13–50). The gait (58.5 ± 14.3 to 70.1 ± 13.4, p < 0.001), the balance (66.7 ± 21.5 to 71.7 ± 22.1, p = 0.001), continence domain (69.9 ± 20.5 to 76 ± 20, p = 0.002) scores and neuropsychological scales showed a statistically significant improvement over the follow-up. The overall improvement after 12 months was present in 91.2% of patients. An overall complication rate of 8.8% and a reoperation rate of 9.4% were recorded, respectively. Conclusions: Surgical treatment by VPS for NPH improves symptoms in most patients, when accurately selected. A standardized protocol and a multidisciplinary team dedicated to this disorder is needed to achieve an early and correct diagnosis of NPH. Follow-up with stroke volume measurement is a valuable tool for the early diagnosis of shunt malfunction or the need for valve adjustment

Anterior corpectomy and plating with carbon-peek instrumentation for cervical spinal metastases: clinical and radiological outcomes

Background: Anterior cervical corpectomy and plating has been recognized as a valuable approach for the surgical treatment of cervical spinal metastases. This study aimed to report the surgical, clinical and radiological outcomes of anterior carbon-PEEK instrumentations for cervical spinal metastases. Methods: Demographical, clinical, surgical and radiological data were collected from 2017 to 2020. The Neck Disability Index (NDI) questionnaire for neck pain, EORTC QLQ-C30 questionnaire for quality of life, Nurick scale for myelopathy and radiological parameters (segmental Cobb angle and cervical lordosis) were collected before surgery, at 6 weeks postoperatively and follow-up. Results: Seventeen patients met inclusion criteria. Mean age was 60.9 ± 7.6 years and mean follow-up was 12.9 ± 4.0 months. The NDI (55.4 ± 11.7 to 25.1 ± 5.4, p < 0.001) scores and the EORTC QLQ-C30 global health/QoL significantly improved postoperatively and at the last follow-up. The segmental Cobb angle (10.7◦ ± 5.6 to 3.1◦ ± 2.2, p < 0.001) and cervical lordosis (0.9◦ ± 6.7 to −6.2 ± 7.8, p = 0.002) significantly improved postoperatively. Only one minor com-plication (5.9%) was recorded. Conclusions: Carbon/PEEK implants represent a safe alternative to commonly used titanium ones and should be considered in cervical spinal metastases management due to their lower artifacts in postoperative imaging and radiation planning. Further larger comparative and cost-effectiveness studies are needed to confirm these results

changes in aqueductal csf stroke volume and progression of symptoms in patients with unshunted idiopathic normal pressure hydrocephalus

BACKGROUND AND PURPOSE: Idiopathic normal pressure hydrocephalus (iNPH) represents a diagnostic challenge, given its variable presentation and progression. Stroke volume (SV), defined as the mean volume of CSF passing through the aqueduct during both systole and diastole, greater than or equal to 42 μL, serves as a selection criterion for patients with good probabilities of improvement after ventriculoperitoneal shunt surgery (VPS). In this study, we evaluated the changes in SV during the progression of clinical symptoms in patients with suspected NPH. MATERIALS AND METHODS: Nine patients who presented with clinical and radiologic evidence of NPH, but refused treatment with VPS, were evaluated every 6 months for up to 2 years for progression in their clinical symptoms and changes in their SV, as measured by phase-contrast cine MR imaging (PCCMR). RESULTS: SV seems to increase between the onset of the symptoms and the following 18 to 20 months, then seems to plateau, followed in the next 18 to 20 months by a slight decline, and finally to a more precipitous drop in the next 12 months. During this time, however, the patient9s clinical symptoms progressively worsen. CONCLUSION: Patients with a low SV have not necessarily had brain atrophy and can show, in the following months, a progressive increase in SV, which qualifies them as good candidates for VPS. The progressive reduction of the SV in untreated patients with worsening clinical symptoms may be a sign of a progressive cerebral ischemic injury, which renders the NPH irreversible

A professional and cost effective digital video editing and image storage system for the operating room

We propose an easy-to-construct digital video editing system ideal to produce video documentation and still images. A digital video editing system applicable to many video sources in the operating room is described in detail. The proposed system has proved easy to use and permits one to obtain videography quickly and easily. Mixing different streams of video input from all the devices in use in the operating room, the application of filters and effects produces a final, professional end-product. Recording on a DVD provides an inexpensive, portable and easy-to-use medium to store or re-edit or tape at a later time. From stored videography it is easy to extract high-quality, still images useful for teaching, presentations and publications. In conclusion digital videography and still photography can easily be recorded by the proposed system, producing high-quality video recording. The use of firewire ports provides good compatibility with next-generation hardware and software. The high standard of quality makes the proposed system one of the lowest priced products available today

Intracranial meningioma containing metastatic colon carcinoma

Tumour-to-tumour metastasis is a rare pathological entity. Meningioma is the most common intracranial tumour to host metastases, the majority of which arise from breast and lung cancers. We present the first report of a colonic cancer metastasis within an intracranial meningioma. A 76-year-old woman presented with a one month history of partial seizures. Her medical history included resection of an adenocarcinoma of the descending colon followed by adjuvant chemotherapy 1 year before our evaluation. Magnetic resonance imaging revealed a homogeneously enhancing lesion in the right frontal convexity. A well capsulated tumour attached to the frontal dura was surgically removed. The pathological examination demonstrated a mixture of fibrous meningioma and colloid adenocarcinoma. Possible explanations for the development of a cohesive chimeric mass of composite pathology are investigated. © 2007 Springer-Verlag

Radiation leukoencephalopathy associated with moderate hydrocephalus: Intracranial pressure monitoring and results of ventriculoperitoneal shunting

Delayed neurological sequelae of radiotherapy have several manifestations; leukoencephalopathy is one of the most common. Pathogenetic relationships between radiation leukoencephalopathy and other findings of diffuse radiation injury (brain atrophy and progressive ventriculomegaly) are not well defined. Moreover, no guidelines have been established for the treatment of hydrocephalus when associated with radiation leukoencephalopathy. Our study reports intracranial pressure (ICP) monitoring in two patients with radiation leukoencephalopathy with moderate hydrocephalus. High intraventricular mean pressure and high peaks were found, and marked improvement of clinical status after shunting was achieved. This study, although restricted to only two patients, shows that ventriculoperitoneal shunting insertion is useful in radiation-induced hydrocephalus, when ICP monitoring detects high mean pressure. A hypothesis is advanced concerning radiation-induced hydrocephalus with high ICP, emphasizing periventricular astrocytosis and its connections with cerebral compliance

Fenestration of peritoneal catheter to avoid abdominal pseudocyst formation after ventriculoperitonealshunts. A technical note

Ventriculoperitoneal shunt (VPS) is a well-known procedure in the neurosurgical field. However, it has high complication and reoperation rates. Abdominal pseudocyst (APC) formation is a rare complication of VPS with reports in the literature varying from 4 to 10%. In this article, we report a simple and effective technique, with no additional cost, to avoid APC formation by making small multiple slits along the length of the peritoneal catheter

Tethered cervical spinal cord due to a hamartomatous stalk in a young adult: Case report

The authors report on an unusual case of a congenital tethered cervical spinal cord in young man who presented with progressive tetraparesis. Neuroradiological evaluation of the spine revealed a discrete exophitic cervical spinal cord mass with a stalk of tissue that extended from the mass and terminated in the muscle tissue. The patient underwent a laminectomy with intradural exploration. A stalklike lesion was discovered and excised. Pathological examination showed that the stalk was formed of hamartomatous tissue. The patient improved following surgery, which suggested that tethering of the cervical spinal cord was responsible for his symptoms