Neuroendoscopic stent placement for cerebrospinal fluid pathway obstructions in adults.

OBJECTIVE Since its revival in the early 1990s, neuroendoscopy has become an integral component of modern neurosurgery. Endoscopic stent placement for treatment of CSF pathway obstruction is a rarely used and underestimated procedure. The authors present the first series of neuroendoscopic intracranial stenting for CSF pathway obstruction in adults with associated results and complications spanning a long-term follow-up of 20 years.

Predictors of subsequent overdrainage and clinical outcomes after ventriculoperitoneal shunting for idiopathic normal pressure hydrocephalus.

Background: Little is known about variables associated with overdrainage complications and neurofunctional and health-related quality of life outcomes in idiopathic normal-pressure hydrocephalus (iNPH) patients after shunt surgery.

Objective: To identify candidate demographic and disease-specific predictors of overdrainage and patient-related outcomes, allowing for more personalized care of patients with iNPH.

Methods: This was a secondary analysis of the dataset of the SVASONA study, a multicenter randomized trial comparing gravitational and conventional gravitational valves for treating iNPH.

Safety and efficacy of gravitational shunt valves in patients with idiopathic normal pressure hydrocephalus: a pragmatic, randomised, open label, multicentre trial (SVASONA).

Objectives: To investigate whether gravitational valves reduce the risk of overdrainage complications compared with programmable valves in ventriculoperitoneal (VP) shunt surgery for idiopathic normal pressure hydrocephalus (iNPH).

Background: Patients with iNPH may benefit from VP shunting but are prone to overdrainage complications during posture changes. Gravitational valves with tantalum balls are considered to reduce the risk of overdrainage but their clinical effectiveness is unclear.

Endoscopic aqueductoplasty and stenting.

Objective: This paper discusses indications for and the technique of endoscopic aqueductoplasty with stenting.

Methods: We review and summarize the clinical experience with endoscopic aqueductoplasty gained over the last 15 years on pediatric and adult patients.

Results: Endoscopic aqueductoplasty with stenting presents a safe procedure.

Experiences with a gravity-assisted valve in hydrocephalic children. Clinical article.

Object: Over the past decade, a gravity-assisted valve (GAV) has become a standard device in many European pediatric hydrocephalus centers. Because past comparative clinical outcome studies on valve design have not included any GAV, the authors in this trial evaluated the early results of GAV applications in a pediatric population.

Methods: For a minimum of 2 years the authors monitored 169 of 182 hydrocephalic children who received a pediatric GAV at their first CSF shunt insertion (61.

Primary diffuse leptomeningeal gliomatosis in a 2-year-old girl.

Background: Primary diffuse leptomeningeal gliomatosis is a rare tumor disease affecting the leptomeninx of the CNS. It is thought to originate from subarachnoidal glial cell nests. The symptoms are often rather unspecific.

Posterior fossa tumors in children: how long does it take to establish the diagnosis?

Objective: The aim of this study is to evaluate, for our patient population, the time interval from the first chart-documented symptom to the radiological diagnosis in children and infants with posterior fossa tumors.

Materials And Methods: We retrospectively analyzed 50 consecutive children (36 men, 14 women) with posterior fossa tumor treated at our department between January 1999 and December 2003. The mean age at time of diagnosis was 98 months (6 months-16 years).

Diagnosis and management of cerebral salt wasting (CSW) in children: the role of atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP).

Objective: The aim of this study is to report our experience with diagnosis and management of cerebral salt wasting (CSW) in children and to evaluate the role of atrial natriuretic peptide/brain natriuretic peptide (ANP/BNP) in pediatric patients.

Materials And Methods: We present nine children suffering from prevalent cerebral disease--seven of whom underwent anesthesia and surgical procedures--with features of CSW, seen within a 22-month period. The symptoms, patient characteristics (including hormone status), monitoring, treatment protocol, and outcome are described.

Endoscopic third ventriculostomy in infants.

Object: The failure rate following endoscopic third ventriculostomy (ETV) in infants younger than 1 year of age has been reported to be higher compared with that of older children. The authors present results of ETVs in such infants and advocate that success or failure of the procedure depends not on the age of the patient but on the cause of the hydrocephalus.

Methods: The authors retrospectively reviewed the management and outcome of 18 ETVs in infants for the treatment of hydrocephalus.

Hydrocephalus in children with posterior fossa tumors: role of endoscopic third ventriculostomy.

Object: Controversy exists regarding the indication for endoscopic third ventriculostomy (ETV) in children with hydrocephalus caused by posterior fossa tumors. The authors present their treatment modalities and discuss the role of ETV in the management of hydrocephalus.

Methods: The authors retrospectively reviewed the cases of 58 children who were admitted to their clinic consecutively with posterior fossa tumors between January 1999 and December 2003.

Management of tectal glioma in childhood.

Tectal glioma is a topographical diagnosis including tumors of different histology, mainly low-grade astrocytomas. Clinical symptoms are usually associated with increased intracranial pressure. This report discusses the management of this rare tumor in children.

Endoscopic aqueductoplasty and interventriculostomy for the treatment of isolated fourth ventricle in children.

Objective: There are different approaches for the treatment of isolated fourth ventricle in children, including a suboccipital ventriculoperitoneal shunt, suboccipital craniotomy with microsurgical fenestration, and endoscopic fenestration. We discuss the indications, surgical methods, and outcome of 18 patients who underwent endoscopic treatment for isolated fourth ventricle.

Methods: We retrospectively reviewed the medical histories of 18 patients with an isolated fourth ventricle.

Endoscopic aqueductoplasty: stent or not to stent?

Objective: The aim of this study is to evaluate if the long-term interventricular communication following aqueductoplasty is determined by the etiology of the aqueductal stenosis (AS).

Methods: We retrospectively analyzed 27 patients who underwent endoscopic aqueductoplasty or endoscopic interventriculostomy with or without a stent for the treatment of AS or isolated fourth ventricle. Surgeries were performed between July 1997 and June 2003.

Cerebral edema leading to decompressive craniectomy: an assessment of the preceding clinical and neuromonitoring trends.

The aim of this study was to examine the pre-operative clinical and neuromonitoring courses in patients with a decompressive craniectomy to assess and to compare clinical and neuromonitoring signs indicating extensive cerebral edema. We conducted a retrospective analysis of the clinical signs and courses of simultaneous monitoring of intracranial pressure (ICP) and cerebral oxygenation (PtiO2) in 26 consecutive patients who were sedated and treated with a decompressive craniectomy due to extensive cerebral edema after aneurysmal subarachnoid hemorrhage (SAH) (n = 20) or severe head injury (SHI) (n = 6). Pathological monitoring trends always preceded clinical deterioration.

Endoscopic intraventricular surgery for treatment of hydrocephalus and loculated CSF space in children less than one year of age.

Controversy exists regarding whether children under 1 year of age have a higher risk of treatment failure after neuroendoscopic procedures for the treatment of hydrocephalus than older children. We retrospectively reviewed the surgical management and clinical outcome of 15 infants who underwent neuroendoscopic surgery for the treatment of CSF space loculation and hydrocephalus. We performed 8 third ventriculostomies, 3 endoscopic arachnoid cyst fenestrations, 2 aqueductoplasties, 1 septostomy and in 1 patient, three endoscopic fenestrations for isolated ventricular compartments.