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Najafpour Z, Shayanfard K, Aghighi N, Saadati N. Fetoscopic laser versus amnioreduction, septostomy, and expected management for the treatment of twin-twin transfusion syndrome (TTTS): an economic evaluation analysis in Iran. Cost Eff Resour Alloc 2024; 22:39. [PMID: 38724993 PMCID: PMC11080211 DOI: 10.1186/s12962-024-00551-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 04/26/2024] [Indexed: 05/13/2024] Open
Abstract
BACKGROUND Twin-twin transfusion syndrome (TTTS) affects 10-15% of monochorionic twin pregnancies. Without treatment, their mortality rates would be considerable. There are differences in survival rate between different therapeutic modalities. This study aims to compare the cost-effectiveness of Fetoscopic laser versus amnioreduction, septostomy, and expected management in the treatment of twin-to-twin transfusion syndrome (TTTS). METHODS This is a cost-effectiveness analysis of the treatment strategies in patients with TTTS. A decision tree model was used to estimate the clinical and economic outcomes with a pregnancy period time horizon. Medical direct costs were extracted in a quantitative study, and survival rates were determined as effectiveness measures based on a review. A probabilistic sensitivity analysis was used to measure the effects of uncertainty in the model parameters. The TreeAge, Excel and R software were used for analyzing data. RESULTS In the first phase, 75 studies were included in the review. Based on the meta-analysis, a total of 7183 women treated with Fetoscopic laser, the perinatal survival of at least one twin-based pregnancy was 69%. In the second phase, the results showed that expected management and amnioreduction have the lowest (791.6$) and highest cost (2020.8$), respectively. Based on the decision model analysis, expected management had the lowest cost ($791.67) and the highest rate in at least one survival (89%), it was used only in early stages of TTTS. Fetoscopic laser surgery, with the mean cost 871.46$ and an overall survival rate of 0.69 considered the most cost-effectiveness strategy in other stages of TTTS. CONCLUSION Our model found Fetoscopic laser surgery in all stages of TTTS to be the most cost-effective therapy for patients with TTTS. Fetoscopic laser surgery thus should be considered a reasonable treatment option for TTTS.
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Affiliation(s)
- Zhila Najafpour
- Department of Health Care Management, School of Public Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
| | - Kamran Shayanfard
- Physics and Materials Science Research Unit, University of Luxembourg, Luxembourg, Luxembourg
| | - Negar Aghighi
- Vice Chancellor of Treatment, Health Services Management, Hamedan University of Medical Sciences, Hamedan, Iran
| | - Najmieh Saadati
- Department of Obstetrics and Gynecology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Sattout GIA, Wardeh AM, Alhassoun A, Zain Aldain RN, Alshraikey AM. Idiopathic bilateral occlusion of Foramen of Monro treated by septostomy with unilateral foraminoplasty: a rare case report. Ann Med Surg (Lond) 2023; 85:5816-5819. [PMID: 37915630 PMCID: PMC10617907 DOI: 10.1097/ms9.0000000000001391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 09/29/2023] [Indexed: 11/03/2023] Open
Abstract
Introduction Idiopathic occlusion of the Foramen of Monro is extremely rare in adults. The occlusion is classified into four types, with the first being the most infrequent. This condition induces noncommunicating hydrocephalus with the ensuing increased intracranial pressure symptoms. Headache is usually the chief complaint. Presentation of the case The authors present a case of a 28-year-old female who presented with a chronic headache that was unresponsive to analgesics. No other neurological deficits were present. Fundoscopic examination revealed the presence of bilateral papillary edema. Computed tomography scan results showed bilateral enlargement of the lateral ventricles of the brain. A subsequent MRI scan ruled out secondary causes of occlusion, such as colloid cysts, meningiomas, or choroid plexus tumors, which entailed an idiopathic etiology.Treatment options include ventriculoperitoneal shunt insertion and septostomy with foraminoplasty. The former option is currently the treatment of choice, yet it is notorious for its ramifications, including foreign body reaction, breakage, and mechanical problems. The latter option is free of these risks; however, it requires meticulousness and precision to avoid damaging the fornix, which leads to impaired memory function. Conclusion Septostomy with unilateral foraminoplasty could yield better outcomes if it is performed fastidiously.
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Cave DGW, Lillitos PJ, Lancaster R, Bentham JR, Barwick S. Out-of-hours versus in-hours delivery of antenatally diagnosed transposition of the great arteries: outcomes from a United Kingdom Tertiary Centre. Cardiol Young 2023; 33:1873-1878. [PMID: 36325964 DOI: 10.1017/s1047951122003250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To study the impact of out-of-hours delivery on outcome for neonates with antenatally diagnosed transposition of the great arteries. SETTING Tertiary paediatric cardiology centre (Yorkshire, United Kingdom), with co-located tertiary neonatal unit. PATIENTS Neonates with antenatally diagnosed simple transposition of the great arteries delivered out-of-hours (Monday to Friday 17:00-08:00 and weekends) versus in-hours between 2015 and 2020. OUTCOME The primary outcome was survival to hospital discharge. Secondary outcomes included neurological morbidity, length of stay, and time to balloon atrial septostomy. RESULTS Of 51 neonates, 38 (75%) were delivered out-of-hours. All neonates born in the tertiary centre survived to discharge. Time to balloon atrial septostomy was slightly longer for out-of-hours deliveries compared to in-hours (median 130 versus 93 mins, p = 0.33). Neurological morbidity occurred for nine (24%) patients in the out-of-hours group and one (8%) in-hours (OR 3.72, 95% CI: 0.42-32.71, p = 0.24). Length of stay was also similar (18.5 versus 17.3 days, p = 0.59). Antenatal diagnosis of a restrictive atrial septum was associated with a lower initial pH (7.03 versus 7.13; CI: 0.03-0.17, p = 0.01), longer length of stay (22.6 versus 17.3 days; CI: 0.37-10.17, p = 0.04), and increased neurological morbidity (44% versus 14%; OR 4.80, CI 1.00-23.15, p = 0.05). A further three neonates were delivered in surrounding hospitals, with a mortality of 67% (versus 0 in tertiary centre; OR 172, CI 5-5371, p = 0.003). CONCLUSION Neonates with antenatally diagnosed transposition of the great arteries have similar outcomes when delivered out-of-hours versus in-hours. Antenatal diagnosis of restrictive atrial septum is a significant predictor of worse outcomes. In our region, delivery outside the tertiary cardiac centre had a significantly higher risk of mortality.
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Affiliation(s)
- Daniel G W Cave
- Leeds Congenital Heart Unit, Leeds Children's Hospital, Great George Street, Leeds, West Yorkshire, UK
- University of Leeds, Leeds, West Yorkshire, UK
| | - Peter J Lillitos
- Leeds Congenital Heart Unit, Leeds Children's Hospital, Great George Street, Leeds, West Yorkshire, UK
| | - Rebecca Lancaster
- Leeds Congenital Heart Unit, Leeds Children's Hospital, Great George Street, Leeds, West Yorkshire, UK
| | - James R Bentham
- Leeds Congenital Heart Unit, Leeds Children's Hospital, Great George Street, Leeds, West Yorkshire, UK
| | - Shuba Barwick
- Leeds Congenital Heart Unit, Leeds Children's Hospital, Great George Street, Leeds, West Yorkshire, UK
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Layoun VR, Sohaey R, Edwards E, Sun RC, Chon AH. Diagnosis and Management of 2 Cases of Spontaneous Septostomy: Monochorionic/Dichorionic Hybrid Twin Gestation and Dichorionic Triamniotic Triplet Gestation. Fetal Diagn Ther 2023; 51:30-38. [PMID: 37751716 DOI: 10.1159/000534234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 09/11/2023] [Indexed: 09/28/2023]
Abstract
INTRODUCTION Spontaneous septostomy is a rare complication of multiple gestations. Related complications include cord entanglement and preterm delivery. Limited data exist to guide the management of these high-risk patients. The majority of spontaneous septostomy cases have been reported in monochorionic diamniotic twins. We present 2 cases of spontaneous septostomy occurring in a monochorionic/dichorionic hybrid twin gestation (chorionicity transitions from dichorionicity to monochorionicity within the placenta) and in a dichorionic triamniotic triplet gestation. CASE PRESENTATION Case 1 was a monochorionic/dichorionic hybrid twin gestation with a septostomy complicated by fetal parts of one twin protruding into the co-twin's sac as well as symptomatic polyhydramnios. Fetal magnetic resonance imaging confirmed the septostomy. Case 2 was a dichorionic triamniotic triplet gestation with septostomy and cord entanglement. Both patients were managed akin to a pseudo-monoamniotic gestation with serial ultrasound surveillance and eventual inpatient admission for heightened fetal monitoring. Case 1 underwent elective scheduled cesarean delivery at 33 weeks, and case 2 underwent emergent cesarean delivery for fetal heart rate decelerations at 28 weeks. CONCLUSION With a high degree of clinical suspicion, spontaneous septostomy can be diagnosed in uncommon settings such as hybrid twin gestations and higher order multiples. Management of such patients is individualized and may include a combination of heightened outpatient and inpatient surveillance.
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Affiliation(s)
- Vanessa R Layoun
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, Oregon, USA
| | - Roya Sohaey
- Department of Diagnostic Radiology, Oregon Health and Science University, Portland, Oregon, USA
| | - Emily Edwards
- Department of Diagnostic Radiology, Oregon Health and Science University, Portland, Oregon, USA
| | - Raphael C Sun
- Divison of Pediatric Surgery, Department of Surgery, Oregon Health and Science University, Portland, Oregon, USA
| | - Andrew H Chon
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, Oregon, USA
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Xing C, Wang X, Pan X, Yu J, Wang C, Li Y, Shen L, He B. Outcomes of atrial septostomy and effect on long-term survival in patients with idiopathic pulmonary arterial hypertension: A single-center cohort. Int J Cardiol 2023; 373:118-23. [PMID: 36476671 DOI: 10.1016/j.ijcard.2022.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 11/19/2022] [Accepted: 12/01/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Pulmonary arterial hypertension (PAH) is a chronic progressive disease that may lead to right heart failure (RHF) and early death. Balloon atrial septostomy (BAS) may be used for the palliative treatment of RHF from PAH. We present our contemporary institutional experience of utilizing BAS in idiopathic PAH (IPAH) patients with refractory RHF to investigate the effect on the safety, efficacy and long-term survival. METHODS This retrospective analysis included 12 IPAH patients with severe RHF from March 2017 to May 2019 who were assessed as high risk. All patients received standard treatment including combination of PAH-specific drugs. Graded BAS was performed on these patients due to unsatisfactory clinical response. Clinical, functional and hemodynamic variables before and immediately after the procedure were collected. 1-year follow-up outcomes and 3-year survival rate were further analyzed. RESULTS Successful septostomy was achieved in cases with no procedure-related complications. All patients obtained hemodynamic improvement immediately after the procedure. The WHO functional class and exercise endurance improved at 1-year follow-up, 7 of 12 patients achieved intermediate-low risk status, while the rest remained at intermediate-high risk. 2 patients died at 18 and 20 months due to malignant arrhythmia and advanced heart failure, respectively. Survival at 1 year and 3 years was 100% and 83.3%. CONCLUSIONS In selected IPAH patients with refractory RHF, BAS is an additional therapeutic strategy, especially when PAH-specific drugs could not achieve the treatment target. BAS can improve hemodynamic variables, bring clinical and cardiac functional benefits and increase the 3-year survival.
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Mirone G, Vitulli F, Nastro A, Bernardo P, Ruggiero A, Spennato P, Cinalli G. Neuroendoscopic treatment of symptomatic cyst of the septum pellucidum in children: A case series. Clin Neurol Neurosurg 2021; 207:106671. [PMID: 34098238 DOI: 10.1016/j.clineuro.2021.106671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 03/23/2021] [Accepted: 03/28/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Symptomatic cysts of the septum pellucidum (CSP) are extremely rare in children and surgical indications are not well defined. A very careful clinical and neuroradiologic evaluation is necessary to consider a patient for surgical indication. METHODS We present a surgical series of 7 pediatric patients. Clinical and radiological features of the patients, including clinical presentation, previous treatment, pre, and post-operative MRI, immediate postoperative, neuropsychiatric assessment, and outcomes were reviewed. RESULTS There were 5 males and 2 females (mean age 8 yrs). Five patients presented a history of severe intermittent headaches, two of them were admitted with acute symptoms of raised intracranial pressure. One patient presented Epilepsy and ADHD and one patient had severe psychosis. Overall, psychiatric disorders were diagnosed in six patients, three patients had Intellectual Disability (ID). In all cases, the cyst presented a ballooning feature, with a mean volume of 18,36 cm3 (range 10,62-28,5) and significant lateral bulging of both layers. All were operated on endoscopically without complications. After surgery, a very significant decrease in cyst volume was observed (mean volume 5,68 cm3; range 3,18-10,1) with complete disappearance of the ballooning aspect. Headaches resolved in all patients. In two patients operated in emergency papilloedema and vision improved in the first week after surgery. No recurrence of the cysts was noted during follow-up in all patients. CONCLUSIONS CSP may be associated with behavioral or psychiatric problems also in children. Neuroendoscopic surgery is a safe and effective therapeutic modality to treat CSP presenting with symptoms and signs of intracranial hypertension with good clinical results.
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Affiliation(s)
- Giuseppe Mirone
- Pediatric Neurosurgery Santobono-Pausilipon Children's Hospital, Naples, Italy.
| | - Francesca Vitulli
- Pediatric Neurosurgery Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Anna Nastro
- Pediatric Neuroradiology, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Pia Bernardo
- Department of Neuroscience, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Alessandra Ruggiero
- Department of Neuroscience, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Pietro Spennato
- Pediatric Neurosurgery Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Giuseppe Cinalli
- Pediatric Neurosurgery Santobono-Pausilipon Children's Hospital, Naples, Italy
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7
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Fabbro S, Tuniz F, Piccolo D, Cramaro A. Late-onset occlusion of the Monro foramina after endoscopic third ventriculostomy in adults: Case discussion and review of the literature. Surg Neurol Int 2020; 11:326. [PMID: 33194260 PMCID: PMC7656028 DOI: 10.25259/sni_519_2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 09/11/2020] [Indexed: 11/09/2022] Open
Abstract
Background: Few cases of adult idiopathic occlusion of the foramen of Monro (AIOFM) are described in the literature. The diagnosis of AIOFM after an endoscopic procedure is even more infrequent. Case Description: We described the case of a 50-year-old woman who developed bilateral membranous occlusion of both Monro foramina 20 years after an endoscopic third ventriculostomy (ETV) for triventricular hydrocephalus due to an aqueductal stenosis. The patient underwent an endoscopic treatment (left foraminoplasty and septostomy) to check the patency of the stoma on the floor of the third ventricle. After the endoscopic procedure, the symptoms improved and the postoperative magnetic resonance imaging (MRI) demonstrated the resolution of the biventricular hydrocephalus. Conclusion: Bilateral occlusion of both FM with consequent bilateral lateral ventricles enlargement is an extremely rare condition, especially if we consider the cases of biventricular hydrocephalus after endoscopic procedures. In our opinion, an endoscopic approach should be attempted as first choice procedure, avoiding any intraventricular stent or shunt placement.
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Affiliation(s)
- Sara Fabbro
- Department of Neurosurgery, ASUFC Santa Maria della Misericordia, Piazzale Santa Maria della Misericordia, Udine, Italy
| | - Francesco Tuniz
- Department of Neurosurgery, ASUFC Santa Maria della Misericordia, Piazzale Santa Maria della Misericordia, Udine, Italy
| | - Daniele Piccolo
- Department of Neurosurgery, ASUFC Santa Maria della Misericordia, Piazzale Santa Maria della Misericordia, Udine, Italy
| | - Antonio Cramaro
- Department of Neurosurgery, ASUFC Santa Maria della Misericordia, Piazzale Santa Maria della Misericordia, Udine, Italy
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Desai VR, Jenson AV, Hoverson E, Desai RM, Boghani Z, Lee MR. Stereotactic laser ablation for subependymal giant cell astrocytomas: personal experience and review of the literature. Childs Nerv Syst 2020; 36:2685-2691. [PMID: 32468241 DOI: 10.1007/s00381-020-04638-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 04/22/2020] [Indexed: 12/19/2022]
Abstract
PURPOSE Subependymal giant cell astrocytomas (SEGAs) are rare tumors typically found in tuberous sclerosis patients. They typically grow in the region of the foramen of Monro and can occlude it, leading to hydrocephalus. Currently, gross total resection is the standard of care, with low rates of recurrence but high rates of complication, especially with larger lesions. Laser interstitial thermal therapy (LITT) is a newly emerging treatment modality for a variety of pathologies. Here, we present a case series of SEGAs managed via LITT and endoscopic, stereotactic septostomy. METHODS A retrospective chart review was performed to identify three cases in which SEGAs were treated via LITT and septostomy. Stereotactic ablation was performed via magnetic resonance (MR) thermometry with laser output set to 69% for 2.5 min, with post-ablation scans for visualization of treatment area. RESULTS Average age at surgery was 8.2 years. Pre-operative tumor volumes were 0.43, 1.51, and 3.88 cm3. Post-operative tumor volumes were 0.25, 0.21, and 0.68 cm3. Mean tumor volume reduction was 70%. No complications occurred. CONCLUSION LITT with septostomy should be considered a viable primary or adjunct treatment modality for SEGAs.
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Affiliation(s)
- Virendra R Desai
- Pediatric Neurosurgery, Dell Children's Medical Center, Department of Neurosurgery, The University of Texas at Austin Dell Medical School, Austin, TX, USA. .,Department of Neurosurgery, Houston Methodist Neurological Institute, Houston Methodist Hospital, Scurlock Tower, Suite 944, 6560 Fannin Street, Houston, TX, 77030, USA.
| | - Amanda V Jenson
- Pediatric Neurosurgery, Dell Children's Medical Center, Department of Neurosurgery, The University of Texas at Austin Dell Medical School, Austin, TX, USA.,Department of Neurosurgery, Houston Methodist Neurological Institute, Houston Methodist Hospital, Scurlock Tower, Suite 944, 6560 Fannin Street, Houston, TX, 77030, USA
| | - Eric Hoverson
- Pediatric Neurosurgery, Dell Children's Medical Center, Department of Neurosurgery, The University of Texas at Austin Dell Medical School, Austin, TX, USA
| | - Rajendra M Desai
- Department of Radiology, University of Texas Medical Branch at Galveston, Galveston, TX, USA
| | - Zain Boghani
- Pediatric Neurosurgery, Dell Children's Medical Center, Department of Neurosurgery, The University of Texas at Austin Dell Medical School, Austin, TX, USA.,Department of Neurosurgery, Houston Methodist Neurological Institute, Houston Methodist Hospital, Scurlock Tower, Suite 944, 6560 Fannin Street, Houston, TX, 77030, USA
| | - Mark R Lee
- Pediatric Neurosurgery, Dell Children's Medical Center, Department of Neurosurgery, The University of Texas at Austin Dell Medical School, Austin, TX, USA.,Department of Neurosurgery, The Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, USA
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Togashi S, Maruya J, Abe H, Nishimaki K, Ouchi H, Hara K, Tokairin T, Nishiyama K, Shimizu H. Endoscopic Management for Recurrent Hydrocephalus Associated with Neurosarcoidosis. World Neurosurg 2020; 144:121-124. [PMID: 32890842 DOI: 10.1016/j.wneu.2020.08.177] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 08/25/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Recurrent hydrocephalus may occur as a complication of neurosarcoidosis with chronic inflammation. We present a case that required a combination of multistage endoscopic diversion of the cerebrospinal fluid pathway and shunt surgery. CASE DESCRIPTION A 34-year-old man presented with progressive nausea and vomiting. Magnetic resonance imaging revealed hydrocephalus with leptomeningeal enhancement along the base of the fourth ventricle and the bilateral foramina of Luschka. Concurrent endoscopic third ventriculostomy and biopsy were performed. The diagnosis was neurosarcoidosis. Immediately after the procedure, the endoscopic third ventriculostomy stoma was occluded, and a right ventriculoperitoneal shunt was urgently performed. However, left unilateral hydrocephalus developed during the late phase of immunosuppressive therapy for neurosarcoidosis. Endoscopic septostomy with repositioning of the ventricular catheter was indicated. Intraoperative findings included a white pasty tissue with nodules that covered the ventricular wall close to the foramen of Monro and sealed the side holes of the catheter. Chemotherapy with a tumor necrosis factor-α inhibitor was initiated after the surgical procedure. The patient had an uneventful course without recurrence of hydrocephalus for >6 months. CONCLUSIONS Endoscopic diversion of the cerebrospinal fluid pathway should be actively considered for treating hydrocephalus without a shunt and performing biopsy simultaneously. Even if a subsequent shunt is needed, complex hydrocephalus can be avoided with a combination of endoscopic techniques.
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Affiliation(s)
- Shuntaro Togashi
- Department of Neurosurgery, Akita Red Cross Hospital, Akita, Japan; Department of Neurosurgery, Akita University Graduate School of Medicine, Akita, Japan.
| | - Jun Maruya
- Department of Neurosurgery, Akita Red Cross Hospital, Akita, Japan
| | - Hideaki Abe
- Department of Neurosurgery, Akita Red Cross Hospital, Akita, Japan
| | | | - Haruka Ouchi
- Department of Neurology, Akita Red Cross Hospital, Akita, Japan
| | - Kenju Hara
- Department of Neurology, Akita Red Cross Hospital, Akita, Japan
| | - Takuo Tokairin
- Department of Pathology, Akita Red Cross Hospital, Akita, Japan
| | | | - Hiroaki Shimizu
- Department of Neurosurgery, Akita University Graduate School of Medicine, Akita, Japan
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Qin G, Liang Y, Xu K, Xu P, Ye J, Tang X, Lan S. Neuroendoscopic lavage for ventriculitis: Case report and literature review. Neurochirurgie 2020; 66:127-132. [PMID: 32087178 DOI: 10.1016/j.neuchi.2019.12.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 12/03/2019] [Accepted: 12/15/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Ventriculitis, one of the difficulties in neurosurgical treatment, is a significant cause of death and morbidity in patients with hydrocephalus. Neuroendoscopy is widely used in the treatment of non-communicable hydrocephalus. The advantages of neuroendoscopy may play a decisive role in the treatment of ventriculitis. CASE REPORT AND METHODS We report a 34-year-old male patient with refractory fever and rapid progressive disturbance of consciousness due to ventriculitis caused by intraventricle rupture in a left colliculus abscess. He received intravenous (IV) antibiotics and saline neuroendoscopic lavage (NEL) combined with septostomy and endoscopic third ventriculostomy leading to rapid recovery and remission of symptoms. We also reviewed the use of NEL for ventriculitis in PubMed from 1970 to January 20, 2019. RESULTS In our review, 93 cases (including the present report) were treated with NEL; 91 cases of infection subsided, and 7 patients died. CONCLUSION NEL may be an effective method for the treatment of ventriculitis.
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Affiliation(s)
- G Qin
- Department of Neurosurgery, People's Hospital of Guangxi Zhuang Autonomous Region, 06 Taoyuan Road, 530021 Nanning, China.
| | - Y Liang
- Department of Neurosurgery, People's Hospital of Guangxi Zhuang Autonomous Region, 06 Taoyuan Road, 530021 Nanning, China.
| | - K Xu
- Department of Neurosurgery, People's Hospital of Guangxi Zhuang Autonomous Region, 06 Taoyuan Road, 530021 Nanning, China.
| | - P Xu
- Department of Neurosurgery, People's Hospital of Guangxi Zhuang Autonomous Region, 06 Taoyuan Road, 530021 Nanning, China.
| | - J Ye
- Department of Neurosurgery, People's Hospital of Guangxi Zhuang Autonomous Region, 06 Taoyuan Road, 530021 Nanning, China.
| | - X Tang
- Department of Neurosurgery, People's Hospital of Guangxi Zhuang Autonomous Region, 06 Taoyuan Road, 530021 Nanning, China.
| | - S Lan
- Department of Neurosurgery, People's Hospital of Guangxi Zhuang Autonomous Region, 06 Taoyuan Road, 530021 Nanning, China.
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Li WF, Chao AS, Chang SD, Cheng PJ, Yang LY, Chang YL. Effects and outcomes of septostomy in twin-to-twin transfusion syndrome after fetoscopic laser therapy. BMC Pregnancy Childbirth 2019; 19:397. [PMID: 31675920 PMCID: PMC6824012 DOI: 10.1186/s12884-019-2555-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 10/10/2019] [Indexed: 11/17/2022] Open
Abstract
Background To evaluate the incidence and outcomes of septostomy in twin-to-twin transfusion syndrome (TTTS) after fetoscopic laser therapy. Methods A retrospective analysis of TTTS postlaser septostomy between 2005 and 2018 was performed. Postlaser septostomy was diagnosed using both (1) a free-floating intertwin membrane flap visible on ultrasound examination and (2) the rapid equalization of amniotic fluid maximum vertical pocket in the donor and recipient amniotic sacs observed after laser therapy. Perinatal survival, neonatal brain image anomaly, gestational age at operation and birth, incidence of premature rupture of membranes (PROM) within 3 weeks after operation, pseudoamniotic band syndrome, and cord entanglement were evaluated. Results In the 159 TTTS cases included, 12 had postlaser septostomy. Relative to the group without septostomy, the septostomy group had a lower total fetal survival rate (54.2% vs 73.6%, p = 0.041), an earlier mean gestational age at delivery (27.8 vs 34.4 weeks, p = 0.009), a higher risk of PROMs within 3 weeks after operation (33.3% vs 5.4%, p = 0.004), a higher cord entanglement rate (16.7% vs 0%, p = 0.005), and a higher brain image anomaly rate (23.0% [3/13] vs 5.0% [11/218], p = 0.035). After considering the severe Quintero stages (stage III and IV), postlaser septostomy was the only variable [p = 0.003, odds ratio = 5.1] to predict neonatal brain image anomaly. Postlaser septostomy combined with severe Quintero stages could predict PROMs within 3 weeks after laser therapy [p = 0.001, odds ratio = 14.1 and p = 0.03, odds ratio = 5.4, respectively] and delivery before the gestational age of 28 weeks [p = 0.017, odds ratio = 4.5 and p = 0.034, odds ratio = 2.3, respectively]. The risk of pseudoamniotic band syndrome was not increased by postlaser septostomy in this case series. Conclusions Postlaser septostomy in TTTS was associated with poorer fetal survival and more adverse perinatal outcomes even after considering severe Quintero stages before laser therapy. Efforts should be made to prevent septostomy during laser therapy, and septostomy as the primary method to treat TTTS is not advisable.
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Affiliation(s)
- Wen-Fang Li
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Tao-Yuan, Taiwan
| | - An-Shine Chao
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Tao-Yuan, Taiwan
| | - Shuenn-Dyh Chang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Tao-Yuan, Taiwan
| | - Po-Jen Cheng
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Tao-Yuan, Taiwan
| | - Lan-Yan Yang
- Biostatistics Unit of Clinical Trial Center, Chang Gung Memorial Hospital, Taoyuan, 333, Taiwan
| | - Yao-Lung Chang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Tao-Yuan, Taiwan. .,Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Medical Center, 5, Fu-Shin Street, Kweishan, Taoyuan, 333, Taiwan, Republic of China.
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Deopujari CE, Karmarkar VS, Shaikh ST, Gadgil US. Developing a dynamic simulator for endoscopic intraventricular surgeries. Childs Nerv Syst 2019; 35:621-7. [PMID: 30788583 DOI: 10.1007/s00381-019-04087-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 02/07/2019] [Indexed: 10/27/2022]
Abstract
INTRODUCTION A novel dynamic simulator brain model with hydrocephalus has been developed for endoscopic intraventricular procedures. Detachable components allow enhancement of the walls of the ventricle by choroid plexus, ependymal veins and the membranous floor of the third ventricle which are derived from cadaveric lab animal tissues to give a lifelike appearance. These can be changed for every exercise. Ventricles are filled with injection of saline to give appropriate transparent medium and connected to a device transmitting pulsations creating conditions similar to live surgeries. MATERIAL AND METHODS Thirty-five participants have used this model over the last 1 year and found it to be useful for conducting third ventriculostomy. Further development of the model for septostomy, aqueductoplasty and tumour biopsy has also been recently tested successfully by 12 participants. CONCLUSION It is hoped that this simulator model for intraventricular endoscopy is comprehensive as a learning tool in carrying out most of the the surgical procedures currently practised.
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Schuhmann MU, Kural C, Lalla L, Ebner FH, Bock C, Ludwig HC. Two-Micron Continuous-Wave Laser-Assisted Neuroendoscopy: Clinical Experience of Two Institutions in 524 Procedures. World Neurosurg 2019; 122:e81-8. [PMID: 30244186 DOI: 10.1016/j.wneu.2018.09.064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 08/08/2018] [Accepted: 09/10/2018] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To present the clinical experience of 2 neurosurgical centers with the use of a 2-micron continuous-wave laser (2μ-cwL) system as standard tool in neuroendoscopic procedures and to discuss the safety and efficacy of this system. METHODS In total, 469 patients underwent neuroendoscopic procedures using 2μ-cwL between September 2009 and January 2015. All patient data were retrospectively reviewed. In total, 241 (51%) patients were children and 228 (49%) adults. Mean age was 27.5 years (range: 3 days to 83 years). Intraoperative ultrasonography or neuronavigation were used to guide ventricular or cyst puncture and for intraventricular or intracystic orientation if necessary. RESULTS A total of 524 neuroendoscopic procedures using 2μ-cwL were performed. Laser-assisted endoscopic third ventriculostomy was the most common procedure in 302 (64%) patients. Cyst fenestration was performed in 124 (26%), septostomy in 45, tumor biopsy in 41, tumor resection in 8, and choroid plexus coagulation in 3 patients. There was no intraoperative complication directly attributable to the use of laser and an overall procedural complication rate of 4.8%. CONCLUSIONS This large series of 2μ-cwL as a routine tool in neuroendoscopic procedures demonstrates that 2μ-cwL is safe for endoscopic third ventriculostomy, septostomy, cyst fenestration, and intraventricular tumor biopsy or resection. As a cutting and coagulation tool, it combines the action of mechanical tools like forceps, balloons, and scissors plus those of electric tools. It therefore renders neuroendoscopic procedures more straightforward with a minimum need to change tools.
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Ebrahimzadeh K, Maloumeh EN, Samadian M, Rezaei O. Endoscopic Strategy in Surgical Treatment of Adult Idiopathic Bilateral Occlusion of the Foramen of Monro and Review of the Literature. World Neurosurg 2018; 115:e610-e619. [PMID: 29704695 DOI: 10.1016/j.wneu.2018.04.117] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Revised: 04/12/2018] [Accepted: 04/13/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Endoscopic approach has been used increasingly for the surgical treatment of adult idiopathic bilateral occlusion of the foramen of Monro (AIOFM). The aim of this study is to assess and compare the results of this strategy with other surgical methods of treating AIOFM. METHODS A retrospective study was performed to identify patients with AIOFM treated in our department from 2012 to 2017. We also performed a search of the literature to detect any case of AIOFM reported from 1980 to 2017 to provide a comprehensive assessment of the treatment of this condition. AIOFM was classified as 4 groups, including bilateral true stenosis of the foramen of Monro (FM), bilateral membrane occlusion of the FM, unilateral true FM stenosis with septum deviation, and unilateral membrane occlusion of the FM with septum deviation all assessed and discussed separately. RESULTS We found four patients with AIOFM surgically treated with endoscopic procedures in our department between the years of 2012 to 2017 with an excellent outcome. Fourteen studies were also detected during our review of the literature, most of which involved treatment with neuroendoscopy and excellent outcomes. We found that neuroendoscopy could be the first-line strategy to treat all 4 types of AIOFM. CONCLUSIONS Endoscopic strategy is associated with excellent outcomes and fewer risks in treatment of all types of AIOFM; it is also less invasive compared with ventriculoperitoneal shunt insertion.
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Affiliation(s)
- Kaveh Ebrahimzadeh
- Skull Base Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ehsan Nazari Maloumeh
- Skull Base Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Mohammad Samadian
- Skull Base Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Omidvar Rezaei
- Skull Base Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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15
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Shahjouei S, Habibi Z, Naderi S, Mahmoodi R, Nejat F. Congenital obstruction of foramen of Monro: report of 10 patients and literature review. Childs Nerv Syst 2018; 34:707-715. [PMID: 29209884 DOI: 10.1007/s00381-017-3671-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 11/27/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION A wide spectrum of etiologies can obstruct foramen of Monro (FOM) and result in hydrocephalus. Congenital occlusion of FOM is a rare entity which may present either in childhood or in adulthood. METHODS Between 2007 and 2016, we screened all pediatric patients with hydrocephalus of either one or both lateral ventricles. Congenital occlusion of FOM was confirmed in the absence of masses occupying the FOM, prenatal or postnatal central nervous system (CNS) infections, intraventricular hemorrhage, previous cerebral intervention, or associated CNS anomalies affecting the flow of cerebrospinal fluid (CSF). We have performed a comprehensive literature review of the previously reported cases and provided a tentative embryological pathogenesis of FOM occlusion. RESULTS We introduce 10 new cases of congenital FOM obstruction. The mean age of the patients was 6.65 ± 10.51 months. Two patients underwent ventriculo-peritoneal (VP) shunting as the primary intervention, while endoscopic septostomy was performed in the others. The mean follow-up was 3.05 ± 2.16 years (1-8 years). Although the hydrocephalus was controlled, all patients remained hemiparetic with some degree of developmental and cognitive impairments. Previously, 38 similar cases were reported: 10 of them (26.3%) were adults. Overall, VP shunting was the treatment of choice in 44.7% of patients. While most adults fully recovered, 7.2% of pediatrics remained hemiparetic and 10.7% of them had cognitive and developmental delay. CONCLUSION Ten cases of congenital obstruction of the foramen of Monro have been managed through a period of 9-year study. Details of these patients in addition to 38 previously reported cases are presented in this study.
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Affiliation(s)
- Shima Shahjouei
- Department of Neurosurgery, Children's Medical Center Hospital, Tehran University of Medical Sciences, Gharib, Tehran, 141557854, Iran.,Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Zohreh Habibi
- Department of Neurosurgery, Children's Medical Center Hospital, Tehran University of Medical Sciences, Gharib, Tehran, 141557854, Iran
| | - Soheil Naderi
- Department of Neurosurgery, Children's Medical Center Hospital, Tehran University of Medical Sciences, Gharib, Tehran, 141557854, Iran
| | - Ramin Mahmoodi
- Department of Neurosurgery, Children's Medical Center Hospital, Tehran University of Medical Sciences, Gharib, Tehran, 141557854, Iran.,Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Science, Tehran, Iran
| | - Farideh Nejat
- Department of Neurosurgery, Children's Medical Center Hospital, Tehran University of Medical Sciences, Gharib, Tehran, 141557854, Iran.
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Giannakoulas G, Savvoulidis P, Grosomanidis V, Mouratoglou SA, Karvounis H, Hadjimiltiades S. Atrial septostomy and disease targeting therapy in pulmonary hypertension secondary to neurofibromatosis. BMC Pulm Med 2016; 16:175. [PMID: 27927206 PMCID: PMC5142319 DOI: 10.1186/s12890-016-0337-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Accepted: 11/24/2016] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Neurofibromatosis type 1 (NF1) is a rare multisystem genetic disorder. During the course of the disease it can be rarely complicated with pulmonary hypertension (PH) which confers a dismal prognosis. CASE PRESENTATION We describe the case of a 57-year-old female patient with NF1 complicated by severe precapillary PH despite dual disease-specific oral combination therapy. The patient was treated with initial atrial septostomy followed by administration of high-dose subcutaneous treprostinil with a favorable medium-term clinical and hemodynamic response. CONCLUSIONS PH secondary to NF1 may be successfully treated with the combination of atrial septostomy and PH targeted therapy in selected patients.
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Affiliation(s)
- George Giannakoulas
- Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, Stilp. Kiriakidi 1, Thessaloniki, 54637, Greece.
| | - Panagiotis Savvoulidis
- Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, Stilp. Kiriakidi 1, Thessaloniki, 54637, Greece
| | - Vasilios Grosomanidis
- Department of Anesthesiology and Intensive Care Medicine, AHEPA University Hospital, Aristotle University of Thessaloniki, Stilp. Kiriakidi 1, Thessaloniki, 54637, Greece
| | - Sophia-Anastasia Mouratoglou
- Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, Stilp. Kiriakidi 1, Thessaloniki, 54637, Greece
| | - Haralambos Karvounis
- Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, Stilp. Kiriakidi 1, Thessaloniki, 54637, Greece
| | - Stavros Hadjimiltiades
- Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, Stilp. Kiriakidi 1, Thessaloniki, 54637, Greece
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