PubMed · 14609182
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Vitaly Siomin, Shlomi Constantini. 2003. Third ventriculostomy.. https://doi.org/10.3171/jns.2003.99.5.0940
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OBJECT: Choroid plexus surgery, which had been discarded as a treatment for hydrocephalus, was brought back into use with the development of modern neuroendoscopic technology. The object of this article is to describe the author's experience of the surgery with special emphasis on the surgical indication. METHODS: Three infants underwent endoscopic choroid plexus coagulation as a treatment for hydrocephalus. Standard procedure for the surgery was unilateral transparietal insertion of a flexible neuroendoscope and electrical coagulation of the choroid plexus. The results showed the release of increased intracranial pressure in two infants, while the other, whose hydrocephalus was rather progressive, later required a VP shunt. CONCLUSION: Choroid plexus surgery for hydrocephalus seems to be effective in some patients. Advanced modern technology has enabled the application of a neuroendoscope for this procedure. From our limited experience, the key to the success of endoscopic choroid plexus coagulation is the selection of patients. Favorable candidates for the surgery seem to be those who suffer from the slow progressive, severe form of hydrocephalus and who lack the septum pellucidum.
CASES: Two patients with myelomeningoceles (MMC) and shunt-treated hydrocephalus are reported. At 5 and 7 years respectively, when they began presenting mental deterioration and behavioural disorders, sleep EEG showed continuous spike-waves during slow sleep (CSWS). DISCUSSION: These are the first cases of CSWS described in patients with MMC. The mechanisms of CSWS are considered. The role of hydrocephalus and the thalamic injuries found in one of the patients is discussed in detail. The usefulness of monitoring sleep EEG in patients with hydrocephalus or thalamic lesions is stressed, considering the effects of CSWS on the cognitive competencies and the soft or subclinical course that epilepsy complicated with CSWS may follow.
BACKGROUND: There is no agreement on the best diagnostic criteria for selecting patients with normal pressure hydrocephalus (NPH) for CSF shunting. The primary objective of the present study was to provide a contemporary survey on diagnostic algorithms and therapeutic decision-making in clinical practice. The secondary objective was to estimate the incidence of NPH. METHOD: Standardized questionnaires with sections on the incidence of NPH and the frequency of shunting, evaluation of clinical symptoms, and signs, diagnostic studies, therapeutic decision-making and operative techniques, postoperative outcome and complications, and the profiles of different centers, were sent to 82 neurosurgical centers in Germany known to participate in the care of patients with NPH. FINDINGS: Data were analyzed from 49 of 53 centers which responded to the survey (65%). The estimated annual incidence of NPH was 1.8 cases/100.000 inhabitants. Gait disturbance was defined as the most important sign of NPH (61%). There was a wide variety in the choice of diagnostic tests. Cisternography was performed routinely only in single centers. Diagnostic CSF removal was used with varying frequency by all centers except one, but the amount of CSF removed by lumbar puncture differed markedly between centers. There was poor agreement on criteria for evaluation of continuous intracranial pressure recordings regarding both the amplitude and the relative frequency of B-waves. Both periventricular and deep white matter lesions were present in about 50% of patients being shunted, indicating that vascular comorbidity in NPH patients has gained more acceptance. Programmable shunts were used by more than half of the centers, and newer valve types such as gravitational valves have become more popular. CONCLUSIONS: According to the present survey, new diagnostic and therapeutic concepts on NPH have penetrated daily routine to a certain extent. Wide variability, however, still exists among different neurosurgical centers.