Neuroendoscopic Techniques in the Treatment of Hydrocephalus

Neuroendoscopic techniques have been used to treat hydrocephalus for more than 100 years. With the personalized design of surgical approaches, increased knowledge of ventricular anatomy, and improved neuroendoscopic equipment, the last 20 years have witnessed tremendous advances in the development of neuroendoscopic technology, especially in the treatment of hydrocephalus. Except for obstructive hydrocephalus, the application of neuroendoscopic technology in the field of hydrocephalus is also expanding and has received good results, mainly in the fields of pediatric hydrocephalus and communicating hydrocephalus. Additionally, many scholars have achieved satisfactory results in the application of ventriculoscopy to complex hydrocephalus. Among neuroendoscopic techniques, the third ventricular floor fistula and cyst wall fistula methods are commonly used in the treatment of hydrocephalus and are highlighted in this chapter. Undoubtedly, neuroendoscopic technology has become one of the key treatment methods for hydrocephalus, with its high success rate, few complications, and accurate long-term efficacy

New Progress in Imaging of Pituitary Diseases

In the last 20 years, there have been advances in imaging techniques for pituitary diseases. Magnetic resonance imaging (MRI) particularly presents high-quality structural images and the essential information needed to authorize surgery, radiation therapy, and/or drug therapy. These images can assist in monitoring long-term outcomes. Recent technological advances, such as the advent of 7-Tesla MRI, have been used for measuring tumor consistency in pituitary adenomas. Microadenomas and other pituitary incidentaloma have been more recognized in the presence of golden-angle radial sparse parallel imaging and conventional dynamic contrast-enhanced techniques. However, standard structural (anatomical) imaging, mainly in the form of MRI, acts inadequately to identify all tumors, especially microadenomas (< 1 cm diameter), recurrent adenomas, and several incidentalomas. In this respect, nuclear isotope (radionuclide) imaging promotes tumor detection beneficially. All these imaging improvements may play a central role in clinical practice, especially when considering diagnosis, differential diagnosis, or definitive intervention. They further form accurate diagnosis, advise surgery, and decrease the risk of disrupting normal pituitary function

What is the best strategy for craniovertebral junction (CVJ) anomalies associated with posterior fossa arachnoid cyst and hydrocephalus: An extremely rare case report

Occurrence of craniovertebral junction (CVJ) anomalies in association with posterior fossa arachnoid cyst and hydrocephalus is extremely rare; no such prior cases have been documented in the literature. There are no definitive guidelines for the management of such lesions. Management strategy should account for high intracranial pressure, compression of the brain stem and cervical cord, as well as for the craniospinal instability. We report the first such case and describe the management procedure. Staged surgical intervention was carried out. The patient developed serious complications after the first staged operation, although the final outcome was good. The authors emphasize the importance of fixation and decompression for patients with such complex lesions. Our experience may provide a treatment strategy for similar cases and even for all craniovertebral junction (CVJ) anomalies associated with posterior fossa lesions

Risk factor analysis of progressive spinal deformity after resection of intramedullary spinal cord tumors in patients who underwent laminoplasty: A report of 105 consecutive cases

OBJECTIVE Laminoplasty has been used in recent years as an alternative approach to laminectomy for preventing spinal deformity after resection of intramedullary spinal cord tumors (IMSCTs). However, controversies exist with regard to its real role in maintaining postoperative spinal alignment. The purpose of this study was to examine the incidence of progressive spinal deformity in patients who underwent laminoplasty for resection of IMSCT and identify risk factors for progressive spinal deformity. METHODS Data from IMSCT patients who had undergone laminoplasty at Beijing Tsinghua Changgung Hospital between January 2014 and December 2016 were retrospectively reviewed. Univariate tests and multivariate logistic regression analysis were used to assess the statistical relationship between postoperative spinal deformity and radiographic, clinical, and surgical variables. RESULTS One hundred five patients (mean age 37.0 ± 14.5 years) met the criteria for inclusion in the study. Gross-total resection (\u3e 95%) was obtained in 79 cases (75.2%). Twenty-seven (25.7%) of the 105 patients were found to have spinal deformity preoperatively, and 10 (9.5%) new cases of postoperative progressive deformity were detected. The mean duration of follow-up was 27.6 months (SD 14.5 months, median 26.3 months, range 6.2–40.7 months). At last follow-up, the median functional scores of the patients who did develop progressive spinal deformity were worse than those of the patients who did not (modified McCormick Scale: 3 vs 2, and p = 0.04). In the univariate analysis, age (p = 0.01), preoperative spinal deformity (p \u3c 0.01), extent of tumor involvement (p \u3c 0.01), extent of abnormal tumor signal (p = 0.02), and extent of laminoplasty (p \u3c 0.01) were identified as factors associated with postoperative progressive spinal deformity. However, in subsequent multivariate logistic regression analysis, only age ≤ 25 years and preoperative spinal deformity emerged as independent risk factors (p \u3c 0.05), increasing the odds of postoperative progressive deformity by 4.1- and 12.4-fold, respectively (p \u3c 0.05). CONCLUSIONS Progressive spinal deformity was identified in 25.7% patients who had undergone laminoplasty for IMSCT resection and was related to decreased functional status. Younger age (≤ 25 years) and preoperative spinal deformity increased the risk of postoperative progressive spinal deformity. The risk of postoperative deformity warrants serious reconsideration of providing concurrent fusion during IMSCT resection or close follow-up after laminoplasty