Endoscopic surgery is popular in the neurosurgical field. The purpose of this study was to determine the role of endoscopy in obstructive hydrocephalus. From 1989 to 1999, we performed 81 endoscopic third ventriculostomies and 10 septostomies. Seventy-one of 81 operations were performed with endoscopic third ventriculostomy alone and 10 patients had endoscopic third ventriculostomy and ventriculoperitoneal shunt simultaneously. Age distribution varied from 2 months to 62 years of age. Our selection criteria included aqueductal stenosis (39 patients) and obstructive hydrocephalus due to tumor or cyst (42 patients). The most common candidate for endoscopic septostomy was atresia of the foramen of Monro (4 patients). Endoscopic septostomy was also performed to simplify shunting in patient; with multiseptated ventricle due to shunt infection, germinoma, thalamic tumor, craniopharyngioma, cyst and brain abscess. Sixty-five of 71 patients who were treated with endoscopic third ventriculostomy alone showed successful results (91.5%). However, 6 patients had unsatisfactory results and they needed a ventriculoperitoneal shunt. With no mortality, transient surgical complications were observed in 7 patients: 2 transient diabetes insipidus from electrical injury to the pituitary stalk, 1 epidural hematoma from sudden drainage of CSF, 1 delayed intraventricular hemorrhage. 2 obstruction of fenestration site and 1 transient memory disturbance from injury to the fornix. Endoscopic septostomy was useful in simplifying shunting in all cases with complicated hydrocephalus. Endoscopic surgery is straightforward and effective in appropriately selected cases with obstructive by drocephalus.
Adolescence ; Adult ; Child ; Endoscopy* ; Human ; Hydrocephalus/surgery* ; Infant ; Male ; Septum of Brain/surgery* ; Ventriculostomy*

OBJECTIVETo investigate the clinical efficacy of laparoscopic ventriculoperitoneal shunt with temporary external drainage in the treatment of hydrocephalus.

METHODSFifty-two cases of hydrocephalus randomized into two groups to receive laparoscopic assisted ventriculoperitoneal shunt with temporary external drainage (19 male and 7 female patients) and conventional ventriculoperitoneal shunt (20 male and 6 female patients). The catheterization time in the abdominal cavity, release time of intracranial hypertension, average hospital stay, postoperative pains, and postoperative complications were compared between the two groups.

RESULTSLaparoscopic ventriculoperitoneal shunt with temporary external drainage was performed successfully in all the cases without intraoperative conversion to open surgery. Compared with the conventional ventriculoperitoneal shunt, laparoscopic ventriculoperitoneal shunt with temporary external drainage was associated with significantly shortened catheterization time in the abdominal cavity, release time of intracranial hypertension, and average hospital stay (P<0.01) as well as lowered postoperative pain score at 4, 8, 16, and 24 h after the operation. The pain scores at 48 and 72 h postoperatively were comparable between the two groups. During the follow-up 3 months, the patients receiving laparoscopic ventriculoperitoneal shunt were found to have significantly lower rates of peritoneal end obstruction and abdominal cavity infection than those having conventional shunt (3.8% vs 19.2%, P<0.01; 1.0% vs 23.1%, P<0.01).

CONCLUSIONLaparoscopic ventriculoperitoneal shunt with temporary external drainage is feasible and produces better clinical therapeutic effect for management of hydrocephalus.

Abdominal Cavity ; Adult ; Female ; Humans ; Hydrocephalus ; surgery ; Laparoscopy ; Male ; Treatment Outcome ; Ventriculoperitoneal Shunt ; methods

OBJECTIVES: To study the effect of surgical treatment on prognosis in preterm infants with obstructive hydrocephalus. METHODS: A retrospective analysis was performed on the medical data of 49 preterm infants with obstructive hydrocephalus. According to the treatment regimen, they were divided into two groups: surgical treatment ( RESULTS: Among the 49 preterm infants with obstructive hydrocephalus, severe intracranial hemorrhage (37 cases; 76%) and central nervous system infection (10 cases, 20%) were the main causes of hydrocephalus. There was no significant difference in the composition of etiology between the two groups ( CONCLUSIONS Surgical treatment can improve the survival rate of preterm infants with obstructive hydrocephalus and the prognosis of preterm infants with severe intracranial hemorrhage.
Cerebral Hemorrhage ; Humans ; Hydrocephalus/surgery* ; Infant ; Infant, Newborn ; Infant, Premature ; Prognosis ; Retrospective Studies ; Treatment Outcome

OBJECTIVETo observe the therapeutic effect of Ommaya reservoir implantation on hydrocephalus in premature infants following intraventricular hemorrhage (IVH) and to investigate factors influencing the therapeutic effect.

METHODSAn ambispective cohort study was conducted on the clinical and follow-up data of 20 premature infants (gestational age <32 weeks, birth weight <1500 g) who received Ommaya reservoir implantation because of hydrocephalus following IVH. The therapeutic effect of Ommaya reservoir implantation was observed. These patients were divided into cure and treatment failure groups according to their treatment outcomes. The factors influencing therapeutic effects were investigated by univariate analysis.

RESULTSHydrocephalus was relieved significantly at 30 days after Ommaya reservoir implantation. However, some patients showed significantly decreased therapeutic effects since 3 months after operation: during 3-6 months after operation, 7 cases underwent ventriculoperitoneal shunt, 4 cases discontinued treatment because of economic reasons, and 1 case underwent endoscopic third ventriculostomy due to scalp hematoma with skin necrosis. The ventricles of the remaining 8 cases returned to normal size at 12-18 months after operation. As for postoperative complications, secondary IVH was seen in 8 cases, intracranial infection in 2 cases, and scalp hematoma with skin necrosis in 1 case. The univariate analysis revealed significant differences in gestational age, birth weight and duration of hydrocephalus before Ommaya reservoir implantation between the cure and the treatment failure groups (P<0.05).

CONCLUSIONSOmmaya reservoir implantation has a remarkable short-term therapeutic effect on hydrocephalus in premature infants following IVH, but later the effect decreases in some patients. Low gestational age, low birth weight and long duration of hydrocephalus may be the main factors influencing therapeutic effects of Ommaya reservoir implantation.

Cerebral Hemorrhage ; complications ; Cerebrospinal Fluid Shunts ; instrumentation ; Cohort Studies ; Female ; Humans ; Hydrocephalus ; surgery ; Infant, Newborn ; Infant, Premature ; Male

The authors analyzed 174 consecutive shunting procedures for hydrocephalus at Severance Hospital, Yonsei University. There were a total of 65 complications (48.5%) among 134 patients. The most common complications were blockage of the catheters (26.2%) and shunt-related infections (15.4%). Among the different types of shunting technique ventriculoatrial, ventriculoperitoneal and ventriculocisternal routes were most commonly used. The ventriculoatrial route had a greater complication rate (40%) than ventriculoperitoneal shunting (21.8%). Flushing devices are critically reviewed and the disadvantages are discussed. The authors suggested a need for a standardized prospective national data collection system where Procedures and compilations may be assembled in a comparable form.
Bacterial Infections/etiology ; Catheterization/adverse effects ; Cerebrospinal Fluid Shunts*/adverse effects ; Female ; Human ; Hydrocephalus/surgery* ; Infant ; Male

Shunt malfunctions that require surgical intervention during pregnancy and the postpartum period are rare. Furthermore, no study has reported on an acute shunt malfunction immediately after cesarean section. Here, we describe the case of a 32-yr-old woman who became drowsy 12 hr after cesarean section delivery of her second child. She had a ventriculoperitoneal shunt placed to treat hydrocephalus associated with meningitis at 26 yr of age. Marked ventriculomegaly was seen on brain computed tomography and her consciousness recovered temporarily after aspirating cerebrospinal fluid from the flushing device. At surgery, the distal catheter tip was plugged by a blood clot. We believe that the blood spilled over during the cesarean section. The clogged catheter end was simply cut off and the remaining catheter was repositioned in the peritoneal cavity. Her consciousness recovered fully.
Adult ; *Cesarean Section ; *Equipment Failure ; Female ; Humans ; Hydrocephalus/etiology/surgery ; Meningitis/complications ; Pregnancy ; *Ventriculoperitoneal Shunt/adverse effects/instrumentation

OBJECTIVEThe management of secondary normal pressure hydrocephalus (sNPH) is controversial. Many factors may affect the surgery effect. The purpose of this study was to identify the possible factors influencing prognosis and provide theoretical basis for clinical treatment of sNPH.

METHODSA retrospective study was carried out to investigate the results of 31 patients with sNPH who underwent ventriculoperitoneal shunt surgery from January 2007 to December 2011. We processed the potential influencing factors by univariate analysis and the result further by multivariate logistic regression analysis.

RESULTSFactors including age, disease duration and Glasgow coma scale (GCS) score before surgery significantly influenced the prognosis of sNPH (P less than 0.05). Further logistic regression analysis showed that all the three factors are independent influencing factors.

CONCLUSIONAge, disease duration and GCS score before surgery have positive predictive value in estimating favorable response to surgical treatment for sNPH.

Adult ; Female ; Humans ; Hydrocephalus, Normal Pressure ; surgery ; Male ; Middle Aged ; Prognosis ; Retrospective Studies ; Risk Factors ; Treatment Outcome ; Ventriculoperitoneal Shunt

Hamartoma ; complications ; surgery ; Humans ; Hydrocephalus ; etiology ; Hypothalamic Diseases ; complications ; surgery ; Infant ; Male ; Postoperative Complications ; etiology ; Puberty, Precocious ; etiology ; Subdural Effusion ; etiology

OBJECTIVETo summarize and analyze the application of neuroendoscopic techniques in neurosurgery, and to discuss the role and significance of neuroendoscopic techniques in the diagnosis and treatment of neurosurgical diseases.

METHODSWe treated 1300 patients with different neurosurgical diseases by performing endoscopic neurosurgery (EN) and endoscopy-assisted microneurosurgery (EAM). Among 1300 paitents, 522 were treated with pure endoscopic neurosurgery, 260 with endoscopy-assisted microneurosurgery, 79 with endoscope-controlled bur hole trephination neurosurgery, 434 with endoscope transsphenoidial surgery, and 5 with other techniques through which an endoscope was used in conjunction with stereotactic guidance.

RESULTSTotally 362 hydrocephalus patients were treated using EN. Among them, 190 were treated by third ventriculostomy, 30 by V-P shunt, and 142 patients with complicated hydrocephalus and unsymmetry hydrocephalus by endoscopy-controlled pathologic septum fenestration, septum pellucidum fenestration, and treatment of inventricula inflammation. Clinical symptomatic improvement was achieved in 341 of 362 patients (94.2%). Also 160 intracranial cyst patients were treated using EN for resection and partial resection. Eighty-two patients were performed through cyst-ventricula fenestration. Clinical symptomatic improvement was achieved in 76 of 82 patients (92.7%). Seventy patients treated with endoscopy-controlled bur hole neurosurgery and 8 cases with endoscopy-assisted microneurosurgery got better recovery after operation. Among 260 patients with brain tumors, 252 patients were operated with EAM (190 patients with epidermoid cyst), 8 patients with EN (all brain tumors with diameters < 2.5 cm in inventricular). Clinical symptomatic improvement was achieved in 228 of 260 patients (87.7%). Among 49 patients with inventricular and cistern cyst, 40 patients who were treated by EN and 9 patients by endoscopy-controlled bur hole neurosurgery were resected and their clinical symptoms were improved after operation. Among 434 patients with sellar region lesions, 387 patients with pituitary adenomas, 19 patients with repair for CSF leaks, 9 patients with chordoma, and 19 patients with other neurosurgical diseases were performed with endoscopy-controlled transsphenoidial surgery. Clinical symptoms in 88.9% (386/434) of these patients were improved. Another 5 patients were treated with endoscopy combined with navigation and stereotatic guidance with good results. The complications related to operation were found in only 2% of all the patients including hemorrhage, infection, and damage of important structure.

CONCLUSIONSClinical application of neuroendoscopic techniques can decrease the damage caused by pure open surgery operation. It is possible to resect lesions at the utmost and protect normal tissue from lesions for using EN and EAM or endoscopy-controlled microneurosurgery (ECM). It is also helpful to enhance surgical quality and, reduce the complications.

Adolescent ; Adult ; Aged, 80 and over ; Brain Diseases ; surgery ; Child ; Child, Preschool ; Epidermal Cyst ; surgery ; Female ; Humans ; Hydrocephalus ; surgery ; Infant ; Male ; Microsurgery ; methods ; Middle Aged ; Minimally Invasive Surgical Procedures ; Neuroendoscopy ; Neurosurgical Procedures ; methods ; Pituitary Neoplasms ; surgery

Shunting of cerebrospinal fluid into the peritoneal cavity is a well established procedure which has, over the years, enjoyed increasing popularity. A slit valve at the distal end elminated the insinuation of the omentum into the shunting tube and a spring catheter prevented kinking of the shunt tubing. However, the most common cause of failure of the shunting is from the separation, or pulling apart, of the various components of the shunt system with subsequent infection. A one piece spring catheter is sufficient to the necessity. Surgical details are illustrated for installing a one piece spring catheter for hydrocephalus. Four basic steps of surgical procedure using a subcutaneous guide, a leader, a cannula and a cuff are described; firstly passing the guide and the one piece shunt from McBurney's point to the supraclavicular space, secondly passing the guide from the parietal eminence to the supraclavicular space to thread the one piece shunt cephalad. Thirdly, inserting the cannula into the lateral ventricle and threading the ventricular end of the one piece shunt through the cuff into the lateral ventricle and fourthly inserting the peritoneal end into the peritoneal cavity.
Adolescent ; Adult ; Catheterization/methods ; Cerebrospinal Fluid Shunts/instrumentation* ; Cerebrospinal Fluid Shunts/methods ; Child, Preschool ; Human ; Hydrocephalus/surgery ; Infant ; Infant, Newborn ; Peritoneal Cavity