Hydrocephalus, characterized by abnormal cerebrospinal fluid (CSF) accumulation, is commonly treated with ventriculoperitoneal shunting (VPS). Despite its efficacy, VPS is prone to complications, with distal catheter occlusion being a frequent cause of shunt malfunction. This study presents our experience using laparoscopy to manage distal catheter malfunctions in two VPS patients. Postoperative outcomes demonstrated symptom resolution and normalization of imaging parameters without complications. Our findings suggest that laparoscopy is a minimally invasive, effective, and cost-efficient alternative for addressing distal shunt malfunctions, complementing current neurosurgical practices. Additionally, we review the literature on the use of endoscopy and laparoscopy in VPS management and propose an applicable protocol.

The use of a balloon guide catheter (BGC) in the endovascular management of acute ischemic stroke is known to improve the efficacy and efficiency of the procedure by reducing the risk of distal embolization. During the procedure, the balloon of the catheter causes a temporary arrest of cerebral blood flow. However, failure of the balloon to deflate during the BGC procedure can result in catastrophic complications, including aggravated hypoxic damage.
This paper aims to share the resolution and methodological analysis of our experience with BGC balloon deflation failure, which was confirmed by a reproducible experiment under similar conditions.

OBJECTIVES: A few studies have compared REM sleep-dependent obstructive sleep apnea syndrome (REM-OSA) with sleep stage non-dependent apnea syndrome (SND-OSA). Despite that REM-OSA might be more common in women than men, no studies have examined the probable characteristics of women patients with obstructive sleep apnea syndrome (OSAS). This study aimed at finding out the characteristics of REM-OSA in women by comparing it with SND-OSA. METHODS: Fifty-three subjects diagnosed as OSAS (AHI>5; AHI: apnea-hypopnea index) with nocturnal polysomnography at the Center for Sleep and Chronobiology of the Seoul National University Hospital between October 2004 and February 2006 were studied. Of them, 44 subjects with OSAS severity of mild (52 and AHI-NR<15 (AHI-R: AHI during REM sleep, AHI-NR: AHI during non-REM sleep). We compared REM-OSA group with SND-OSA as well as the criteria-determined REM-OSA cases with the visually-determined ones. RESULTS: Among 44 subjects, 28 persons (63.6%) turned out to have REM-OSA by our criteria and 24 persons (54.5%) by visual determination. Statistically significant differences (p<0.05) were found between REM-OSA and SND-OSA groups in AHI, hypopnea index, total sleep time, total wake time, sleep efficiency index, percents of stage 1, 2 and REM sleep, and REM latency. Percent of stage REM sleep (%REM) turned out to have influence on AHI ratio (AHI-R/AHI-NR) (B=0.537, p=0.002). REM-OSA was likely to be diagnosed in milder severity of OSAS (chi-square=13.117, p<0.001) and those with higher %REM (chi-square=11.325, p=0.001). There was no significant difference between the criteria-determined and the visually-determined cases of REM-OSA. CONCLUSION: We suggest that REM-OSA and SND-OSA patients be differentiated in terms of pathophysiology and treatment strategies. Visual determination of REM-OSA might be useful as the screening procedure of REM-OSA. Further studies on women with OSAS and REM-OSA need to be done.
Apnea ; Female ; Humans ; Male ; Mass Screening ; Polysomnography ; Sleep Apnea, Obstructive ; Sleep Stages ; Sleep, REM