1
|
Oliveira LDB, Welling LC, Viegas FAF, Ribas LRC, Junior EOM, Wesselovicz RM, Batista S, Bertani R, Palavani LB, Rabelo NN, Figueiredo EG. Incidence and nature of complications associated with ventriculoatrial shunt placement: A systematic review and single-arm meta-analysis. Clin Neurol Neurosurg 2023; 233:107950. [PMID: 37673013 DOI: 10.1016/j.clineuro.2023.107950] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 08/22/2023] [Accepted: 08/22/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND Ventriculoatrial shunt (VAS) is considered the second option for treating hydrocephalus, but there remains a lack of robust evidence regarding its complications profile. PURPOSE Evaluate the complications associated with VAS. METHODS Adhering to PRISMA guidelines, the authors searched Embase, PubMed, and Web of Science databases to identify articles reporting on the complications of VAS. Eligible articles were required to report whether complications occurred in a cohort of at least four patients. The extraction process focused on various outcome measures, including overall complications, pulmonary complications, cardiac complications, mortality, shunt revisions, glomerulonephritis, intracranial hemorrhage, and hygroma. Complications were defined as any adverse events related to the procedure, including revisions. RESULTS After retrieving a total of 2828 articles, 53 studies met the predefined criteria, involving 2862 patients. The overall complication rate was estimated at 33 % (95 % CI: 25-42 %), while the long-term complications rate was found to be 49 % (95 % CI: 32-67 %). Among the pediatric population, the complication rate was calculated to be 53 % (95 % CI: 39-68 %). The overall revision rate was estimated at 32 % (95 % CI: 23-41 %), with an infection rate of 5 % (95 % CI: 3-7 %). Notably, in the pediatric group, the infection rate was 10 % (95 % CI: 6-13 %). The random analysis indicated an estimated risk of 0 % for glomerulonephritis, intracranial hemorrhage, hygroma, cardiac complications, pulmonary complications, and shunt-related mortality. CONCLUSION VAS is a safe alternative when ventriculoperitoneal shunting is not feasible. Risk of classic severe complications is minimal. Nevertheless, caution is required when shunting critical patients. Further randomized studies are warranted to establish the ideal shunt for different patients.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Savio Batista
- Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Raphael Bertani
- Department of Neurosurgery, University of São Paulo, São Paulo, Brazil
| | | | | | | |
Collapse
|
2
|
Ventriculoatrial Shunt Under Locoregional Anesthesia: A Technical Note. World Neurosurg 2022; 166:135-140. [PMID: 35870783 DOI: 10.1016/j.wneu.2022.07.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 07/12/2022] [Accepted: 07/13/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Ventriculoatrial shunt is routinely performed under general anesthesia and is used to treat various kinds of hydrocephalus. Idiopathic normal pressure hydrocephalus patients are generally elderly and can have high comorbidities; in such patients, avoiding general anesthesia and limiting opioid administration could be beneficial. We started to perform ventriculoatrial shunt under locoregional anesthesia, in order to make this procedure more truly "minimally invasive". METHODS Demographic data, American Society of Anesthesiologists (ASA) score and vital signs, Ramsay sedation scale, and procedural duration were collected. All procedures were performed combining sedation with cervical plexus and scalp block. After internal jugular vein cannulation, a catheter was inserted and connected with a programmable valve and then with the ventricular catheter. Outcome was assessed by the Idiopathic Normal Pressure Hydrocephalus Grading Scale and complications were recorded at 3-month follow-up. RESULTS Ten consecutive patients were enrolled; the mean age was 74 years, 8 were male, ASA score median value was 3. Opioids were administered only in 4 patients, in 6 patients the value of Ramsay scale was 5. The average duration of surgery was 59.5 minutes. No procedure was converted to general anesthesia. CONCLUSIONS Our preliminary experience with ventriculoatrial shunt under locoregional anesthesia demonstrates that this technique is feasible, is not associated with an increase in operating times or complications, can avoid general anesthesia, and helps to limit opioid administration in the elderly. It can therefore represent a valid option in order to improve treatment quality in these complex patients.
Collapse
|
3
|
Zervos TM, Kutschman K, Frisoli T, Mansour TR, Schwalb JM. Techniques for management and avoidance of ventriculoatrial shunt disconnection: illustrative cases. JOURNAL OF NEUROSURGERY: CASE LESSONS 2022; 3:CASE21654. [PMID: 35734610 PMCID: PMC9204925 DOI: 10.3171/case21654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 02/18/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Ventriculoatrial (VA) shunt disconnection can result in distal catheter migration into the cardiopulmonary vasculature. There is little guidance in the current literature on how to prevent and manage this uncommon yet potentially serious complication. The authors reviewed the existing literature and described three instances of distal shunt migration VA shunts and offered insight on methods to mitigate such complications. OBSERVATIONS Eighteen patients were identified with VA shunts. Of these patients, seven were identified as having a connector in the neck, three of which were associated with distal disconnection and migration. In all three cases, the distal catheter was retrieved via an endovascular approach in conjunction with transesophageal echocardiography to assess for retrieval feasibility. LESSONS The authors recommended the avoidance of a straight connector when performing VA shunt placement. When distal catheter migration occurs, collaboration with interventional cardiology is advisable when possible.
Collapse
|
4
|
Segura-Hernández A, Hakim F, Ramón JF, Jiménez-Hakim E, Mejía-Cordovez JA, Quintero-Rueda D, Araque-Puello Y, Pedraza-Ciro C, Leal-Isaza JP, Mendoza-Mantilla J, Robles V, Gonzalez M, Jaramillo-Velásquez D, Gómez DF. Ventriculo-atrial shunt. Comparison of an ultrasound-guided peel-away technique versus conventional technique in the management of normal pressure hydrocephalus: A retrospective cohort. Surg Neurol Int 2021; 12:531. [PMID: 34754581 PMCID: PMC8571261 DOI: 10.25259/sni_613_2021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 09/14/2021] [Indexed: 11/21/2022] Open
Abstract
Background: Normal pressure hydrocephalus (NPH) is a common neurodegenerative syndrome among the elderly characterized by ventriculomegaly and the classic triad of symmetric gait disturbance, cognitive decline and urinary incontinence. To date, the only effective treatment is a cerebrospinal fluid shunting procedure that can either be ventriculo-atrial, ventriculo-peritoneal, or lumbo-peritoneal shunt. The conventional ventriculo-atrial shunt uses venodissection, whereas the peel-away is a percutaneous ultrasound (US)-guided technique that shows some advantages over conventional technique. We sought to compare perioperative complication rates, mean operating time and clinical outcomes for both techniques in NPH patients at our institution. Methods: A retrospective cohort-type analytical study was conducted, using clinical record data of patients diagnosed with NPH and treated at our center from January 2009 to September 2019. Parameters to be compared include: Perioperative complication rates, intraoperative bleeding, mortality, and mean operating time. Perioperative complication rates are those device-related such as shunt infection, dysfunction, and those associated with the procedure. Complications are further classified in immediate (occurring during the first inpatient stay), early (within the first 30 days of surgery), and late (after day 30 of surgery). Results: A total of 123 patients underwent ventriculo-atrial shunt. Eighty-two patients (67%) underwent conventional venodissection technique and 41 patients (33%) underwent a peel-away technique. Immediate complications were 3 (3.6%) and 0 for conventional and peel-away groups, respectively. Early complications were 0 and 1 (2.4%) for conventional and peel-away groups, respectively. Late complications were 5 (6.1%) and 2 (4.9%) for conventional and peel-away groups, respectively. Mean operating time was lower in the peel-away group (P = 0.0000) and mortality was 0 for both groups. Conclusion: Ventriculo-atrial shunt is an effective procedure for patients with NPH. When comparing the conventional venodissection technique with a percutaneous US-guided peel-away technique, the latter offers advantages such as shorter operating time and lower perioperative complication rates.
Collapse
Affiliation(s)
- Andrés Segura-Hernández
- Department of Neurosurgery, Hospital Universitario Fundación Santa Fé de Bogotá, Bogotá, Cundinamarca, Colombia
| | - Fernando Hakim
- Department of Neurosurgery, Hospital Universitario Fundación Santa Fé de Bogotá, Bogotá, Cundinamarca, Colombia
| | - Juan F Ramón
- Department of Neurosurgery, Hospital Universitario Fundación Santa Fé de Bogotá, Bogotá, Cundinamarca, Colombia
| | - Enrique Jiménez-Hakim
- Department of Neurosurgery, Hospital Universitario Fundación Santa Fé de Bogotá, Bogotá, Cundinamarca, Colombia
| | - Juan A Mejía-Cordovez
- Department of Neurosurgery, Hospital Universitario Fundación Santa Fé de Bogotá, Bogotá, Cundinamarca, Colombia
| | - Diego Quintero-Rueda
- Department of Neurosurgery, Hospital Universitario Fundación Santa Fé de Bogotá, Bogotá, Cundinamarca, Colombia
| | - Yessid Araque-Puello
- Department of Neurosurgery, Hospital Universitario Fundación Santa Fé de Bogotá, Bogotá, Cundinamarca, Colombia
| | - Camila Pedraza-Ciro
- Department of Neurosurgery, Hospital Universitario Fundación Santa Fé de Bogotá, Bogotá, Cundinamarca, Colombia
| | - Juan P Leal-Isaza
- Department of Neurosurgery, Hospital Universitario Fundación Santa Fé de Bogotá, Bogotá, Cundinamarca, Colombia
| | - Juliana Mendoza-Mantilla
- Department of Neurosurgery, Hospital Universitario Fundación Santa Fé de Bogotá, Bogotá, Cundinamarca, Colombia
| | - Vanesa Robles
- Department of Neurosurgery, Hospital Universitario Fundación Santa Fé de Bogotá, Bogotá, Cundinamarca, Colombia
| | - Martina Gonzalez
- Department of Neurosurgery, Hospital Universitario Fundación Santa Fé de Bogotá, Bogotá, Cundinamarca, Colombia
| | - Daniel Jaramillo-Velásquez
- Department of Neurosurgery, Hospital Universitario Fundación Santa Fé de Bogotá, Bogotá, Cundinamarca, Colombia
| | - Diego F Gómez
- Department of Neurosurgery, Hospital Universitario Fundación Santa Fé de Bogotá, Bogotá, Cundinamarca, Colombia
| |
Collapse
|
5
|
Baro V, Zadra N, Sartori L, Denaro L. Ultrasound-guided percutaneous brachiocephalic vein cannulation for ventriculoatrial shunt placement in a child. Childs Nerv Syst 2020; 36:3099-3102. [PMID: 32909070 DOI: 10.1007/s00381-020-04875-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 08/31/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE As far as the ventriculoatrial shunt placement in children is concerned, the percutaneous approach to the internal jugular vein under ultrasonographic control has been hitherto strongly recommended. Unfortunately, children still represent a challenge, having them peculiar characteristics for which the internal jugular vein cannulation shows some disadvantages. METHODS In this manuscript, we describe a percutaneous placement of ventriculoatrial shunt via right brachiocephalic vein under intraoperative ultrasonographic control. CONCLUSIONS Brachiocephalic vein cannulation in surgery provides notable advantages in paediatric population and it may be considered as the first choice in younger children.
Collapse
Affiliation(s)
- Valentina Baro
- Academic Neurosurgery, Department of Neurosciences, University of Padova, Via Giustiniani 2, 35128, Padova, Italy.
| | - Nicola Zadra
- Department of Anesthesia and Intensive Care, Azienda Ospedaliera di Padova, University of Padova, Padova, Italy
| | - Luca Sartori
- Academic Neurosurgery, Department of Neurosciences, University of Padova, Via Giustiniani 2, 35128, Padova, Italy
| | - Luca Denaro
- Academic Neurosurgery, Department of Neurosciences, University of Padova, Via Giustiniani 2, 35128, Padova, Italy
| |
Collapse
|
6
|
McCracken JA, Bahl A, McMullan J. Percutaneous ultrasound-guided insertion of ventriculo-atrial shunts. Br J Neurosurg 2016; 30:411-3. [PMID: 27025913 DOI: 10.3109/02688697.2016.1161169] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Ventriculo-atrial (VA) shunts have been in use for >60 years but less frequently so of late. This is due to a combination of the risk of cardiac complications, lack of expertise and a lengthy operation. We present our consecutive prospective series of 10 VA shunts inserted using a percutaneous method employing the Sonowand Invite™ neuronavigation system for both the distal and proximal catheters, over a 13-month period. We had two complications of cases needing revision, but our series highlights a safe and reproducible method of inserting a VA shunt. About 30% of the procedures were carried out by a trainee as the primary surgeon. This technique does not necessarily require the expertise of a complex hydrocephalus surgeon and is thus able to be in the armoury of any neurosurgeon needing to do a VA shunt procedure. The indications, operative data and outcomes of our patients are discussed.
Collapse
Affiliation(s)
| | - Anuj Bahl
- b Department of Neurosurgery , Sheffield Teaching Hospitals , Sheffield , UK ;,c Department of Neurosurgery , Hull and East Yorkshire Hospitals , Hull , UK
| | - John McMullan
- b Department of Neurosurgery , Sheffield Teaching Hospitals , Sheffield , UK
| |
Collapse
|
7
|
Sheth SA, McGirt M, Woodworth G, Wang P, Rigamonti D. Ultrasound guidance for distal insertion of ventriculo-atrial shunt catheters: technical note. Neurol Res 2013; 31:280-2. [DOI: 10.1179/174313209x380784] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
|
8
|
Santos-Franco JA, Dávila-Romero J, Sandoval-Balanzario MA, Saavedra-Andrade R, Rangel-Morales C, Escobar-Molina O, López-López R. [Device for percutaneous insertion of a distal catheter in ventriculo-atrial shunt. Technical report]. Neurocirugia (Astur) 2012; 23:145-50. [PMID: 22796296 DOI: 10.1016/j.neucir.2012.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Accepted: 04/09/2012] [Indexed: 11/27/2022]
Abstract
INTRODUCTION AND OBJECTIVES A ventriculo-atrial shunt is indicated for the treatment of some hydrocephalus cases. The distal catheter is usually inserted into the right atrium through cervical venous dissection. Percutaneous insertion has been described with success; however its use is not widespread. The aim of this work is to describe modifications in the distal catheter of a ventriculo-atrial shunt, the technique for its percutaneous insertion and the clinical outcome of the process. MATERIAL AND METHODS The distal catheter was modified after its use in 4 animal specimens. It was designed «over the wire», with its flexibility being reduced and accessories being added. The device was subsequently used in humans, with slight modifications of the jugular vein catheterization technique. We evaluated complications, surgical time and outcome during 6months. RESULTS In the course of one year, 6adult patients in whom the peritoneum was no longer receiving cerebrospinal fluid were treated for hydrocephalus. The mean operating time was 34minutes (including proximal catheter insertion). There were no complications and ventricular size improved. CONCLUSIONS The percutaneous technique has proved useful: it reduces surgical time and has a very low rate of complications. Apparently, modifications made in the distal catheter caused no complications and avoided the use of other materials designed for other purposes. More cases are required to perform a definitive analysis.
Collapse
Affiliation(s)
- Jorge Arturo Santos-Franco
- Servicio de Neurocirugía, Hospital de Especialidades, Centro Médico Nacional La Raza, Universidad Nacional Autónoma de México, México DF, México
| | | | | | | | | | | | | |
Collapse
|
9
|
Improved ventriculoatrial shunt for cerebrospinal fluid diversion after multiple ventriculoperitoneal shunt failures. ACTA ACUST UNITED AC 2009; 72 Suppl 1:S29-33; discussion S33-4. [DOI: 10.1016/j.surneu.2008.03.040] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2007] [Accepted: 03/09/2008] [Indexed: 11/19/2022]
|
10
|
Metellus P, Hsu W, Kharkar S, Kapoor S, Scott W, Rigamonti D. Accuracy of percutaneous placement of a ventriculoatrial shunt under ultrasonography guidance: a retrospective study at a single institution. J Neurosurg 2009; 110:867-70. [DOI: 10.3171/2008.10.17674] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The authors report their experience using preoperative chest radiography and intraoperative ultrasonography for percutaneous positioning of the distal end of the catheter when placing ventriculoatrial (VA) shunts in patients with hydrocephalus. The distal portion of VA shunt catheters were percutaneously placed into the internal jugular vein with the aid of intraoperative ultrasonography in 14 consecutive adults. In all cases, the technique was easy, there were no postoperative complications, and postoperative chest radiography demonstrated good positioning of the distal catheter tip. One patient presented with a shunt infection and needed a shunt replacement. The authors therefore conclude that percutaneous placement of a VA shunt under preoperative radiographic guidance and ultrasonographic monitoring is a safe, effective, and reliable technique that is simple to learn.
Collapse
Affiliation(s)
| | | | | | | | - William Scott
- 2Radiology, Johns Hopkins Hospital, Baltimore, Maryland
| | | |
Collapse
|
11
|
Abstract
The surgical management of hydrocephalus has undergone incredible changes over the past generation of neurosurgeons, including dramatic improvements in imaging, especially computed tomographic scanning and magnetic resonance imaging, and remarkably innovative advances in cerebrospinal fluid valve technology, complex computer models, and endoscopic equipment and techniques. In terms of overall patient outcomes, however, one could conclude that things are a little better, but "not much." This frustrating yet fascinating dichotomy between technological advancements and clinical outcomes makes hydrocephalus, first described by the ancients, as one of the most understated and complex disorders that neurosurgeons treat. The challenge to the next generation of neurosurgeons is to solve this vexing problem through better understanding of the basic science, improved computer models, additional technological advances, and, most importantly, a broad-based, concerted multidisciplinary attack on this disorder. This review focuses on the evolution of surgery for hydrocephalus over the last 30 years, the current state of the art of hydrocephalus treatment, and what appear to be the most promising future directions.
Collapse
Affiliation(s)
- James M Drake
- Division of Neurosurgery, Hospital for Sick Children, University of Toronto, Toronto, Canada.
| |
Collapse
|
12
|
Ellegaard L, Mogensen S, Juhler M. Ultrasound-guided percutaneous placement of ventriculoatrial shunts. Childs Nerv Syst 2007; 23:857-62. [PMID: 17375310 DOI: 10.1007/s00381-007-0304-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2006] [Indexed: 10/23/2022]
Abstract
INTRODUCTION In accordance with the literature on ventriculoatrial (VA) shunts, a percutaneous approach to the internal jugular vein is preferable to surgical preparation of the vein before catheter placement. Inspired by the above and the problems still remaining in the percutaneous method and successful results from anaesthesiology with the use of ultrasound-guided placement of central venous catheters, we have implemented an ultrasound-guided percutaneous technique for placement of VA shunts including pre- and intraoperative ultrasound guidance. METHODS Data on 26 VA shunt operations were collected and analysed with special reference to the applicability of the method to pediatric patients, surgical complications and differences between revisions and first-time VA shunts. CONCLUSIONS All patients with VA shunt indications were operated successfully with this technique including children down to the age of 5 years. The ultrasound-guided percutaneous technique results in a safe, quick and easy procedure with preoperative knowledge of the diameter of the vein, no accidental carotid artery puncture or pneumothorax, a minimal blood loss, a short operative time, few infectious complications and a good cosmetic result. Results for all parameters were identical in first-time VA shunt operations and revisions.
Collapse
Affiliation(s)
- L Ellegaard
- Department of Neurosurgery, Rigshospitalet, 2092, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | | | | |
Collapse
|
13
|
Machinis TG, Fountas KN, Hudson J, Robinson JS, Troup EC. Accurate placement of the distal end of a ventriculoatrial shunt with the aid of real-time transesophageal echocardiography. Technical note. J Neurosurg 2006; 105:153-6. [PMID: 16871892 DOI: 10.3171/jns.2006.105.1.153] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Ventriculoatrial (VA) shunts remain a valid option for the treatment of hydrocephalus, especially in patients in whom ventriculoperitoneal (VP) shunts fail. Correct positioning of the distal end of the catheter in the right atrium is of paramount importance for maintaining shunt patency and reducing the incidence of VA shunt-associated morbidity. The authors present their experience with real-time transesophageal echocardiography (TEE) monitoring for the accurate placement of the distal catheter of a VA shunt. METHODS Four patients underwent conversion of a VP shunt to a VA shunt under the guidance of intraoperative fluoroscopy and TEE between May 2003 and December 2004. After induction of general anesthesia, the TEE transducer was advanced into the esophagus. A cervical incision was made and the external jugular vein was visualized. An introducer was passed through an opening in the jugular vein and a guidewire was placed through the introducer. Under continuous TEE guidance, the guidewire was carefully advanced into the superior vena cava. A distal shunt catheter overlying a J-wire was then passed to the superior vena cava, again under TEE guidance. The catheter was advanced to the right atrium after removing the guidewire. Final visualization with TEE and fluoroscopy revealed a good position of the catheter in the right atrium in all four cases. The mean duration of the operation was 91 minutes (range 65-120 minutes) and the mean operative blood loss was 23 ml (range 10-50 ml). No procedure-related complication was noted. CONCLUSIONS Real-time TEE is a safe and simple technique for the accurate placement of the distal catheter of a VA shunt.
Collapse
Affiliation(s)
- Theofilos G Machinis
- Department of Neurosurgery, Medical Center of Central Georgia, School of Medicine, Mercer University, Macon, Georgia, USA
| | | | | | | | | |
Collapse
|
14
|
Tohma Y, Hasegawa M, Nakau H, Yamashita J. Obstructive hydrocephalus associated with arachnoid cyst in the elderly. J Clin Neurosci 2004; 11:542-4. [PMID: 15177407 DOI: 10.1016/j.jocn.2003.07.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2003] [Accepted: 07/22/2003] [Indexed: 10/26/2022]
Abstract
We present a case of a symptomatic frontal arachnoid cyst associated with hydrocephalus in an elderly patient. It is well known that symptomatic arachnoid cysts usually develop at an early age. This condition is rarely observed in the elderly. The authors hypothesized that compression of the brain and obstructive hydrocephalus caused the arachnoid cyst to become symptomatic.
Collapse
Affiliation(s)
- Yasuo Tohma
- Department of Neurosurgery, Graduate School of Medical Science, Kanazawa University, Japan.
| | | | | | | |
Collapse
|
15
|
Tomatir E. Percutaneous ventriculoatrial shunts. J Neurosurg 1998; 88:1124-5. [PMID: 9609315 DOI: 10.3171/jns.1998.88.6.1124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
|