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12 Wochen/m – rezidivierendes Erbrechen und Kopfumfangszunahme. Monatsschr Kinderheilkd 2022. [DOI: 10.1007/s00112-021-01410-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Tuniz F, Fabbro S, Piccolo D, Vescovi MC, Bagatto D, Cramaro A, Skrap M. Long-Standing Overt Ventriculomegaly in Adults (LOVA): Diagnostic Aspects, CSF Dynamics with Lumbar Infusion Test and Treatment Options in a Consecutive Series with Long-Term Follow-Up. World Neurosurg 2021; 156:e30-e40. [PMID: 34425295 DOI: 10.1016/j.wneu.2021.08.068] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 08/12/2021] [Accepted: 08/13/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Long-standing overt ventriculomegaly in adults is a chronic form of hydrocephalus without a clear pathophysiological description and a consensus about the treatment. We present the results of endoscopic third ventriculostomy (ETV) in a consecutive series with a mean follow-up of 79 ± 23 months, highlighting how the preoperative lumbar infusion test could facilitate understanding the pathophysiology of the disease. METHODS We retrospectively collected data regarding clinical assessment, neuroradiological findings, and preoperative lumbar infusion tests in 22 symptomatic patients. RESULTS In the majority of cases, patients reported imbalance and gait disorders, and 8 subjects had headaches. The preoperative lumbar infusion test demonstrated a mean opening pressure of 13.95 ± 2.88 mm Hg, with plateau values ranging from 22 to 39 mm Hg. The resistance to outflow was 11.21 ± 2.00 mm Hg/mL/min. After the procedure, all patients reported improvement or halted progression in their presenting symptoms, whereas no significant reduction was demonstrated in Evans' index. One subject underwent a second ETV procedure after more than 2 years because of the failure of the endoscopic approach. CONCLUSIONS A progressive exhaustion of brain compliance plays an important role in explaining the dichotomy between severe ventriculomegaly and mild clinical symptoms in patients with long-standing overt ventriculomegaly in adults. The role of the aqueductal stenosis as a diagnostic criterion might be reconsidered. The preoperative infusion test data support this observation. Preoperative assessment should include not only clinical and neuroradiological evaluation but also the study of cerebrospinal fluid dynamics. ETV should be considered the treatment of choice because of its safety and efficacy. Long-term follow-up is mandatory.
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Affiliation(s)
- Francesco Tuniz
- Department of Neurosurgery, ASUFC Santa Maria della Misericordia, Udine, Italy
| | - Sara Fabbro
- Department of Neurosurgery, ASUFC Santa Maria della Misericordia, Udine, Italy.
| | - Daniele Piccolo
- Department of Neurosurgery, ASUFC Santa Maria della Misericordia, Udine, Italy
| | | | - Daniele Bagatto
- Department of Neuroradiology, ASUFC Santa Maria della Misericordia, Udine, Italy
| | - Antonio Cramaro
- Department of Neurosurgery, ASUFC Santa Maria della Misericordia, Udine, Italy
| | - Miran Skrap
- Department of Neurosurgery, ASUFC Santa Maria della Misericordia, Udine, Italy
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The surgical results of endoscopic third ventriculostomy in long-standing overt ventriculomegaly in adults with papilledema. Clin Neurol Neurosurg 2019; 183:105366. [DOI: 10.1016/j.clineuro.2019.05.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 05/09/2019] [Accepted: 05/13/2019] [Indexed: 11/24/2022]
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Trelles M, Ahmed AK, Mitchell CH, Josue-Torres I, Rigamonti D, Blitz AM. Natural History of Endoscopic Third Ventriculostomy in Adults: Serial Evaluation with High-Resolution CISS. AJNR Am J Neuroradiol 2018; 39:2231-2236. [PMID: 30442699 DOI: 10.3174/ajnr.a5861] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 08/17/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Endoscopic third ventriculostomy is a well-accepted treatment choice for hydrocephalus and is used most frequently with a known impediment to CSF flow between the third ventricle and basal cisterns. However, there are scarce data on the imaging evolution of the defect in the floor of the third ventricle and how this affects patency rates and clinical outcomes. The purpose of this study was to assess whether, and how, the endoscopic third ventriculostomy defect changes in size with time. MATERIALS AND METHODS All high-resolution endoscopic third ventriculostomy protocol MRIs performed between 2009 through 2014 were retrospectively identified. Two fellowship-trained neuroradiologists, blinded to clinical information, independently reviewed all retrospective cases. RESULTS A total of 98 imaging studies were included from 34 patients. The average change in the area throughout the studied period was 0.02 mm2/day (7.5 mm2/year), with a higher increase in size noted in the first 3 postsurgical months, with a gradual decrease in the degree of defect-size change. Use of the NICO Myriad device was correlated with the area of the endoscopic third ventriculostomy defect on the last follow-up, demonstrating a larger final defect size in patients in whom the surgical technique included debridement of the endoscopic third ventriculostomy defect walls with the NICO Myriad device (28.21 versus 11.25 mm, P < .05). CONCLUSIONS High-resolution MR imaging with sagittal CISS images is useful in the postoperative evaluation of endoscopic third ventriculostomies. Such findings may prove useful in determining the optimal duration of follow-up with MR imaging of patients who have undergone endoscopic third ventriculostomy.
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Affiliation(s)
- M Trelles
- From the Departments of Radiology and Radiological Sciences (M.T., A.M.B.)
| | - A K Ahmed
- Neurosurgery (A.K.A., I.J.-T., D.R.)
| | - C H Mitchell
- Neurology (C.H.M.), Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | | | - A M Blitz
- From the Departments of Radiology and Radiological Sciences (M.T., A.M.B.)
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Balevi M. Endoscopic Third Ventriculostomy in Normal Pressure Hydrocephalus and Symptomatic Long-standing Overt Ventriculomegaly. Asian J Neurosurg 2017; 12:605-612. [PMID: 29114272 PMCID: PMC5652084 DOI: 10.4103/ajns.ajns_54_15] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Objectives: The aim of this study is to define the role and effectiveness for an endoscopic third ventriculostomy (ETV) in patients with seconder normal pressure hydrocephalus(SNPH), idiopathic normal pressure hydrocephalus (INPH) and symptomatic longstanding overt ventriculomegaly (SLOVA). Materials and Methods: 3 patients with SLOVA, 3 patients with INPH and 3 patients with SNPH underwent ETV were studied retrospectively. The patients had a follow-up of 1-6 years. Preoperative CT or/and MRI of the brain was done in all cases. Tap test was done in all cases. Clinical examination finding were classified according to the by Japanese Committee for Scientific Research (JCSS) on intractable Hydrocephalus. Patients were studied to evaluate of the patency of ventriculosthomy and aqueduclus slyvius by a Cine PC MR and CSF_DRİVE T2 Sequence MRI after 1-6 years. Results: Headache, gait disturbance and pollakiuria improved in three patients with SNPH underwent ETV, but dementia didn’t improve in one patient. Pollakiuria and headache improved in three patients with INPH underwent ETV but preoperative gait disturbance grade three remained unchanged in one patient. Headache improved in three patients with SLOVA underwent ETV. Preoperative gait disturbance grade 3 remained unchanged in one patient, but improved pollakiuria. We confirmed the patency of a third ventriculostomy and decreasing degrees of CSF flow into the aquaductus sylvius. Conclusions: In properly selected patients with SNPH, SLOVA and INPH who had headache, slight gait disturbance and pollakiuria, mainly those with a short duration of symptoms, ETV may provide good results.
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Affiliation(s)
- Mustafa Balevi
- Department of Neurosurgery, Konya Numune Hospital, Konya, Turkey
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Ved R, Leach P, Patel C. Surgical treatment of long-standing overt ventriculomegaly in adults (LOVA). Acta Neurochir (Wien) 2017; 159:71-79. [PMID: 27807671 PMCID: PMC5177667 DOI: 10.1007/s00701-016-2998-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 10/13/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND Longstanding overt ventriculomegaly in adults (LOVA) is characterised by chronic hydrocephalus presumed to begin during infancy, but arresting before becoming clinically detectable. Later in life clinical features of hydrocephalus ensue, typically in the 5th or 6th decades. Only a relatively small number of LOVA case series have been published, and ambiguity remains regarding optimal management. This case series describes a series of patients with LOVA treated successfully at a single neurosurgical institution using endoscopic third ventriculostomy (ETV). METHODS A series of 14 patients were diagnosed with LOVA using established clinical and radiological criteria. All patients underwent an ETV and their clinical conditions were followed up for up to 5 years post-operatively. RESULTS Fourteen patients (100 %) reported either improvement or halt of progression in their presenting symptoms 3 months after ETV; 93 % of patients (n = 13) did not require any further surgical intervention. One patient (7 %) reported deterioration in symptoms beyond 3 months post-operatively, which necessitated further surgery (ventriculoperitoneal shunt). These promising outcomes after ETV are mirrored in numerous other LOVA case series. Other works have analysed the value of CSF shunting procedures in LOVA, with mixed results. A direct, prospective comparison of outcomes after shunt procedures and ETV, with a specific focus on LOVA patients, is yet to be completed. A minority of patients fail to respond, or develop recurrence of symptoms, months or years after initial surgical intervention. CONCLUSIONS ETV is an attractive option for surgical treatment of LOVA. After surgical treatment for LOVA, long-term follow-up should be considered to screen for late recurrence of the condition.
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Affiliation(s)
- Ronak Ved
- University Hospital of Wales, Cardiff, CF14 4XW, UK.
| | - Paul Leach
- University Hospital of Wales, Cardiff, CF14 4XW, UK
| | - Chirag Patel
- University Hospital of Wales, Cardiff, CF14 4XW, UK
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Rodis I, Mahr CV, Fehrenbach MK, Meixensberger J, Merkenschlager A, Bernhard MK, Schob S, Thome U, Wachowiak R, Hirsch FW, Nestler U, Preuss M. Hydrocephalus in aqueductal stenosis--a retrospective outcome analysis and proposal of subtype classification. Childs Nerv Syst 2016; 32:617-27. [PMID: 26922081 DOI: 10.1007/s00381-016-3029-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 01/27/2016] [Indexed: 10/22/2022]
Abstract
UNLABELLED Treatment of aqueductal stenosis (AQS) has undergone several paradigm shifts during the past decades. Currently, endoscopic ventriculostomy (ETV) is recommended as treatment of choice. Several authors have addressed the issue of variable ETV success rates depending on age and pathogenetic factors. However, success rates have usually been defined as "ETV non-failure." The aim of the study was a retrospective analysis of radiological and neurological treatment response after ETV or VP-shunting (VPS) in age-dependent subtypes of AQS. PATIENTS AND METHODS Eighty patients (median age 12.0 years, range 0-79 years) have been treated for MRI-proven aqueductal stenosis. Neurological treatment success was defined by neurological improvement and, in childhood, head circumference. Radiological response was measured as Evan's index in follow-up MRI. Initial signs and symptoms, type of surgery, and complications were analyzed. RESULTS Four types of AQS have been defined with distinct age ranges and symptomatology: congenital type I (n = 24), chronic progressive (tectal tumor-like) type II (n = 23), acute type III (n = 10), and adult chronic (normal-pressure hydrocephalus-like) type IV (n = 23). Retrospective analysis of neurological and radiological outcome suggested that congenital type I (<1 years of age) may be more successfully treated with VPS than with ETV (81 vs. 50 %). Treatment of chronic juvenile type II (age 2-15) by ETV 19 % compared to 57 % after VP-shunt, but similar neurological improvement (>80 %). There has been no influence of persistent ventriculomegaly in type II after ETV in contrast to VPS therapy for neurological outcome. Adult acute type III (age > 15 years) responded excellent to ETV. Chronic type IV (iNPH-like) patients (age > 21) responded neurologically in 70 % after ETV and VPS, but radiological response was low (5 %). CONCLUSION AQS can be divided into four distinct age groups and types in regards of clinical course and symptomatology. Depending on the AQS type, ETV cannot be unequivocally recommended. Congenital type I AQS may have a better neurological outcome with VP-shunt whereas acute type III offers excellent ETV results. Chronic progressive type II still requires prospective investigation of long-term ETV outcome, especially when ventriculomegaly persists. Late chronic type IV seems to result in similar outcome after VP-shunt and ETV.
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Affiliation(s)
- Imke Rodis
- Department of Neurosurgery Pediatric Neurosurgery, University Hospital Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany
| | - Cynthia Vanessa Mahr
- Department of Neurosurgery Pediatric Neurosurgery, University Hospital Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany
| | - Michael K Fehrenbach
- Department of Neurosurgery Pediatric Neurosurgery, University Hospital Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany
| | - Jürgen Meixensberger
- Department of Neurosurgery Pediatric Neurosurgery, University Hospital Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany
| | | | | | - Stefan Schob
- Division of Neuroradiology, University Hospital Leipzig, Leipzig, Germany
| | - Ulrich Thome
- Department of Neonatology, University Hospital Leipzig, Leipzig, Germany
| | - Robin Wachowiak
- Department of Pediatric Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Franz W Hirsch
- Department of Pediatric Radiology, University Hospital Leipzig, Leipzig, Germany
| | - Ulf Nestler
- Department of Neurosurgery Pediatric Neurosurgery, University Hospital Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany
| | - Matthias Preuss
- Department of Neurosurgery Pediatric Neurosurgery, University Hospital Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany.
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Abstract
The following patients with multiple complex diagnoses define the adult hydrocephalus population: (1) transition patients (previously treated for hydrocephalus as children), (2) adults with previously untreated congenital hydrocephalus, (3) adults with acquired hydrocephalus with an identifiable etiology, and (4) patients with suspected or proven idiopathic normal pressure hydrocephalus. Restricting the outpatient care or hydrocephalus clinic definition to a single hydrocephalus patient subpopulation limits our understanding of these patients and effectively abandons the remaining adult patients with hydrocephalus to a less focused and potentially less effective healthcare arrangement. A comprehensive adult hydrocephalus clinic model is described and recommended to advance our understanding of this diverse patient population, which will ultimately lead to the development and provision of a better standard of patient care.
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Affiliation(s)
- Mark G Hamilton
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.
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Canu EDG, Magnano I, Paulus KS, Piras MR, Conti M, Costantino S, Nuvoli S, Aiello I. Neuropsychophysiological findings in a case of long-standing overt ventriculomegaly (LOVA). Neurosci Lett 2005; 385:24-9. [PMID: 15936143 DOI: 10.1016/j.neulet.2005.05.026] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2005] [Revised: 03/31/2005] [Accepted: 05/06/2005] [Indexed: 11/29/2022]
Abstract
Long-standing overt ventriculomegaly in adults (LOVA) is a clinical entity characterized by chronic hydrocephalus with infant onset, slow evolution and clinical disturbances during adulthood. Few cases are reported in literature describing the evident contrast between the severity of hydrocephalus and the relatively spared neurological functioning and cognitive aspects. The authors describe a 59-year-old man with congenital hydrocephalus complaining of persistent gait impairment. Neurological examination showed a mild paraparesis, severe higher cortical function impairment but relatively sparing of daily living activity. Computed tomography (CT) and magnetic resonance imaging (MRI) revealed a very remarkable ventriculomegaly compressing the brain cortex but sparing the cerebellum and the brainstem. Brain Single Photon Emission Computer Tomography (SPECT) showed a prevalent cerebellar perfusion as well. Neuropsychological testing was consistent with severe cognitive deterioration and attention disorders. Language and praxis functions seemed to be preserved. Auditory oddball ERPs (P300) showed morphological abnormalities especially of late components. This case report demonstrates in vivo the level of adaptation to which human brain can reach under chronic mechanic stress conditions. The striking poor cerebral parenchyma representation and the relatively spared language and praxic abilities account for a functional reorganization of residual structures due to the neural plasticity.
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