Intelligence in children with hydrocephalus, aged 4—15 years: a population-based, controlled study. It should be emphasized that, whereas symptomatic shunt failure proves shunt-dependence, the reverse is not true. Economic analysis of endoscopic third ventriculostomy. Prevention of morbidity requires early diagnosis and treatment of hydrocephalus, but this is often beyond the control of neurosurgeons. Complications and morbidity Data in literature Comment on biases shunt obstruction number of shunt revisions per patient 2. Sainte-Rose Ed: Giuseppe Cinalli Author: W. Endoscopic placement of a stent in the aqueduct is more effective in preventing the repeated occlusion of the aqueduct than aqueductoplasty alone and should be indicated as the initial treatment in each case of compatible anatomy.
It is directed at neurosurgeons, pediatric neurologists and pediatricians and will also be interest to radiologists, pathologists and clinical geneticists. Hydrocephalus in children born in 1999—2002: epidemiology, outcome and ophthalmological findings. What are the ideal modalities of follow-up after endoscopic surgery? It is good to see a discussion on the relative merits of shunt versus endoscopy treatments, thus bringing the newer endoscopic techniques into perspective. Patterns of shunt failure according to the hydrodynamics characteristics of the valve: lessons from the shunt design trial. In-hospital mortality rates after ventriculoperitoneal shunt procedures in the United States, 1998 to 2000: relation to hospital and surgeon volume of care. It draws upon the clinical experience of fifty-eight experts. However, long-term follow-up has rarely been provided and a number of important questions still remain unanswered.
Jones, Cerebrospinal Fluid Research, Vol. Schooling is thus not a faithful reflection of pure cognitive handicap. Ventricular shunt removal: the ultimate treatment of the slit ventricle syndrome. Jones, Cerebrospinal Fluid Research, Vol. It is evaluated quantitatively by outcome and quality of life scales, and by the presence or absence of different sequela binary variables. Although postoperative infection is generally defined as occurring with one month of surgery, the rate of infection should also be evaluated over a longer term, since infection can occasionally occur several years after surgery.
O'Connell,9 in England, also seriously considered this problem. Special concern was paid for the developmental origin of the intraventricular cysts estimated from the postoperative follow-up neuroimagings. In one of these patients restenosis was managed by an endoscopic procedure, during which the aqueduct was reopened and a stent implanted; in the other patient a shunt was placed in the fourth ventricle. Development of the cerebrospinal fluid pathways during embryonic and fetal life in humans. Hydrocephalus was controlled by a single shunt in six cases 86% and by a double shunt in one case.
In fixed brain specimens two areas of relative constriction have been found: one is at the level of the superior colliculus, the other at the level of the intercollicular sulcus; in cross section the lumen is highly changeable, probably owing to the influence of different nuclear masses or fiber tracts surrounding it at different levels. The treatment of hydrocephalus has measureable economic consequences, as does the outcome of such treatment. Hydrocephalus in neurocysticercosis and other parasitic and infectious diseases. It would be preferable, however, that the motivation for this comes from clinicians, rather than be imposed by institutional authority. Whether such a rate justifies routine shunt series or not is debatable. They also should be congratulated for having provided a quite useful addition to the rich literature concerning hydrocephalus.
It forms a gentle concave curve to the base of the skull and is surrounded by the periaqueductal gray matter. What are the determinants of outcome? Actually, the aqueduct of Sylvius connects the third and fourth ventricle: it is a narrow, irregular channel, situated in the dorsal midbrain, with posterior commissure and lamina tecti behind, oculomotor and trochlear nerves nuclei, and medial longitudinal fasciculus and red nuclei in front. They also should be congratulated for having provided a quite useful addition to the rich literature concerning hydrocephalus. Epilepsy, affecting 6 to 30% of patients, has a serious impact on outcome. Finally, for several of these associations, we found no documentation in literature e. Long-term follow-up data from the Shunt Design Trial. The aim of this study was to draw the attention of specialists faced with fetal hydrocephalus in the postnatal period to the possibilities of prenatal diagnosis and further monitoring by studying isolated and syndrome cases in fetuses.
Despite these barriers, we must continue to strive for randomized trials, where appropriate, and to also take steps to make future retrospective and non-randomized prospective studies more useful. Standards have yet to be established regarding the frequency of visits and imaging. Outcome in shunted hydrocephalic children. Because treatment is specific for correctable disorder, assessment of etiology gains importance. Classification of hydrocephalus and prenatal hydrocephalus.
The two final chapters cover the specific complications of endocrine disturbances and epilepsy in hydrocephalic patients. Throughout the book, the text is clearly presented with subheadings and high-quality illustrations. Factors causing acute shunt infection. The editors should be congratulated for having gathered such an excellent group of contributors. Hydrocephalus in neurocysticercosis and other parasitic and infectious diseases. Fenestration was performed based on the intraoperative findings, either ventriculocystostomy, ventriculocystoventriculostomy, or ventriculocystocisternostomy. Because of the multiplicity of causes of hydrocephalus, associated diseases, complications of treatment, and the inherent complexity of the patient population, reliable data on outcomes are difficult to obtain.