1/52. A case of cerebrospinal fluid eosinophilia associated with shunt malfunction.A 3-month-old female patient presented with a meningomyelocele at the lumber region associated with congenital hydrocephalus. She underwent ventriculoperitoneal (V-P) shunt surgery using the Sophy system. The shunt system was replaced due to a malformation. Following replacement, the patient presented with cerebrospinal fluid (CSF) eosinophilia at the age of 8 months. The eosinophilic granulocytosis of the CSF improved dramatically following systemic prednisolone administration. CSF eosinophilia without accompanying inflammation or pyrexia in the present case may have resulted from an allergic response to a foreign material such as the silicone tube pressure valve of the Sophy system or the sutures rather than bacterial or fungal infection. Based on our results, we believe that some patients may experience CSF eosinophilia following postoperative V-P shunt due to an allergic reaction to the shunt equipment. Prompt steroid treatment can produce spontaneous regression in such cases.- - - - - - - - - - ranking = 1keywords = meningomyelocele (Clic here for more details about this article) |
2/52. Migration of the abdominal catheter of a ventriculoperitoneal shunt into the scrotum--case report.A 3-day-old male neonate presented with migration of the ventriculoperitoneal (VP) shunt tip through the patent processus vaginalis resulting in scrotal hydrocele. The association of myelomeningocele with hydrocephalus may have been a predisposing factor in this rare complication. Development of scrotal swelling or hydrocele in a child with VP shunt should be recognized as a possible shunt complication.- - - - - - - - - - ranking = 2.4947909124589keywords = myelomeningocele (Clic here for more details about this article) |
3/52. Symptomatic calcified subdural hematomas.Two unique cases of chronic calcified subdural hematomas are reported in children as a long-term complication of a ventriculoperitoneal shunt. Both the patients had undergone shunt procedures in infancy for congenital hydrocephalus. In one patient, the cause of the hydrocephalus was aqueduct stenosis, while in the second patient, a lumbar meningomyelocele was associated with hydrocephalus. In both these patients, a ventriculoperitoneal shunt was done in infancy. In one of them, following the shunt surgery, a bilateral subdural collection was noticed which required burr hole evacuation. Both the patients remained asymptomatic for 9 years, when they presented to our center with acute raised intracranial pressure and contralateral hemiparesis. Both the patients had a relatively short history and had altered sensorium at admission. Surprisingly, in both the patients, the CT scan showed significant mass effect producing calcified subdural hematomas. The shunt systems were found to be working well at surgery. craniotomy and excision of the calcified subdural hematomas was undertaken. Postoperatively, the patients showed satisfactory recovery, and at discharge the patients were doing well. At the follow-up at the outpatient clinic, the patients were asymptomatic.- - - - - - - - - - ranking = 1keywords = meningomyelocele (Clic here for more details about this article) |
4/52. Once a shunt, always a shunt?Over a period of 15 years, during which some 1000 operations were performed, CSF-drainage systems were able to be removed in 40 of a total of 444 children with communicating hydrocephalus or hydrocephalus associated with myelomeningocele. Shunts were removed from 26 children in the former group, of whom 17 continued to be compensated; in the latter group there were 14 removals, all of whom remained compensated. It is stressed that true compensation can be proven only by continuous measurement of ventricular fluid pressure over periods of several hours or at intervals of days or weeks, and four cases are discussed in which decompensation occurred, in two cases with fatal results.- - - - - - - - - - ranking = 2.4947909124589keywords = myelomeningocele (Clic here for more details about this article) |
5/52. Membranous occlusion of the foramen of Monro following ventriculoperitoneal shunt insertion: a role for endoscopic foraminoplasty.We report two cases of lateral ventricle dilatation due to membranous occlusion of the foramen of Monro following ventriculoperitoneal shunt insertion. Both cases were treated successfully by endoscopic foraminoplasty of the obstructed foramen of Monro and III ventriculostomy. One child had meningomyelocele and hydrocephalus. She had CSF infection after repair of the back lesion. Isolated left lateral ventricle occurred after insertion of a right ventriculoperitoneal shunt for hydrocephalus when the girl was 2 months old. A right ventriculoperitoneal shunt was then inserted. Chronic shunt infection with abdominal pseudocyst was found 8 years later. The shunts were exteriorized. Membranous obstruction of the foramen of Monro was found endoscopically. Fenestration of the membranous obstruction along with a III ventriculostomy was performed. After the endoscopic procedure, the exteriorized ventriculoperitoneal shunt was removed 2 weeks later. The patient was still symptom free without shunting 14 months after the operation. The other child had hydrocephalus after a premature birth and hemorrhage. Repeated ventriculoperitoneal shunt infections contributed to membranous obstruction of bilateral foramen of Monro. After the shunt infection was treated this patient's shunting procedure was simplified by endoscopic foraminoplasty of the left and right foramen of Monro along with a III ventriculostomy. He was symptom free with a new ventriculoperitoneal shunt 9 months after the operation.- - - - - - - - - - ranking = 1keywords = meningomyelocele (Clic here for more details about this article) |
6/52. meningomyelocele and progressive hydromyelia. Progressive paresis in myelodysplasia.Five cases of myelodysplasia with progressive paraparesis are presented. Three of the five patients developed spasticity, but dissociated sensory loss and loss of sphincter control was not a prominent feature. All were found to have compensated hydrocephalus and extensive communicating hydromyelia. The use of myelography and ventriculography in the diagnosis of hydromyelia is discussed. Ventricular drainage led to clinical improvement in two cases and radiological improvement in one. The relationship of compensated hydrocephalus, meningomyelocele, and progressive hydromyelia postnatally may support the hydrodynamic hypothesis of myelodysplasia.- - - - - - - - - - ranking = 1keywords = meningomyelocele (Clic here for more details about this article) |
7/52. Clinical features in patients requiring reoperation after failed endoscopic procedures for hydrocephalus.The aim of this study was to clarify the clinical features of patients at risk of secondary obstruction following endoscopic fenestration. Clinical notes and endoscopic findings for 15 patients treated with endoscopic procedures were retrospectively reviewed. Endoscopic third ventriculostomy (ETV) was performed as initial treatment in 4 patients with non-communicating hydrocephalus, including a neonate with myelomeningocele, and as an alternative to shunt revision in 4 patients. Two patients with non-communicating hydrocephalus caused by tumor or arachnoid cyst were also managed with third ventriculostomy. Four patients with loculated hydrocephalus underwent endoscopic septostomy. A child with an isolated fourth ventricle was treated with endoscopic aqueductoplasty. Of the 15 patients undergoing endoscopic procedure, 4 required reoperation. Of the 10 patients treated with ETV, only the neonate with myelomeningocele required a ventriculoperitoneal shunt because of failure of the initial procedure. Of the 4 patients treated with endoscopic septostomy, 2 children with loculated hydrocephalus following intraventricular hemorrhage (IVH) underwent a second septostomy. In a patient with an isolated fourth ventricle following posthemorrhagic hydrocephalus, recurrence was noted 8 months after the initial procedure. He underwent a second procedure using a stent implanted into the aqueduct to maintain CSF circulation. Sufficient stomal size or implantation of a stent may be required in the under-2-year age group with hydrocephalus accompanied by IVH and associated with myelomeningocele, in whom the risk of secondary obstruction may be high.- - - - - - - - - - ranking = 7.4843727373768keywords = myelomeningocele (Clic here for more details about this article) |
8/52. Chiari I malformation: clinical presentation and management.Chiari malformations are cerebellar anomalies. The four types of Chiari malformations, as described more than 100 years ago by Dr. Hans Chiari, have neither anatomic nor embryologic correlation. Their only commonality is that they all involve the cerebellum. Chiari I malformation consists of herniation of the cerebellar tonsils into the foramen magnum, thus crowding the craniocervical junction. Chiari II malformation is almost exclusively associated with myelomeningocele and hydrocephalus. It consists of herniation of not only the tonsils but also all the contents of the posterior fossa into the foramen magnum. This herniation involves the brainstem, fourth ventricle, and cerebellar vermis. Chiari III and IV malformations are rare. Chiari III represents an encephalocele (external sac containing brainstem and posterior fossa contents); thus, the cerebellum and brainstem are descending not only into the spine, but also into an external sac. Chiari IV consists of cerebellar hypoplasia. The Chiari I malformation has the latest mean age of clinical presentation. A Chiari type I anomaly presenting in adulthood is the focus of this article. Surgery is indicated with neurological dysfunction, symptomatic syrinx, or hydrocephalus. Of all Chiari I patients, 15%-20% will have hydrocephalus. For some of them, the hydrocephalus will resolve with ventriculoperitoneal shunting, alleviating the need for a Chiari decompression. Long-term prognosis for patients with symptomatic Chiari type I malformations who undergo surgical treatment is variable, based on the patients' presenting symptoms and spinal cord cyst response.- - - - - - - - - - ranking = 2.4947909124589keywords = myelomeningocele (Clic here for more details about this article) |
9/52. Postshunt insertion CSF leaks in infants treated by an adjustable valve opening pressure reduction.OBJECTS: cerebrospinal fluid (CSF) leakages through the operation wound following shunt placement are commonly treated by head elevation when the shunt is patent and signs of infection are absent. methods AND RESULTS: In two cases in which the standard therapy of head elevation failed, the leakage was successfully managed by temporary lowering of the opening pressure of the implanted programmable valve. Case 1 was that of a preterm baby with repaired meningomyelocele and shunted hydrocephalus. A shunt infection made shunt removal necessary. Five days after insertion of a new ventriculoperitoneal shunt, transcutaneous CSF flow occurred. The CSF leak was cured by a temporary reduction of the opening pressure from 70 to 30 mm H(2)0. Case 2 was in a 9-month-old child with shunted posthaemorrhagic hydrocephalus. Shunt infection was treated by shunt removal, placement of external ventricular drainage, and antibiotics. CSF leakage through the operation wound developed 24 h after placement of the new ventriculoperitoneal shunt. The CSF leakage was successfully treated by temporarily lowering the opening pressure of the valve from 100 to 50 mm H(2)0. CONCLUSION: The authors assume that head elevation alone did not generate a sufficient difference between the ventricular and the abdominal pressure for the selected opening pressure of the valve to be exceeded, with the result that CSF flowed around the ventricular catheter and through the operation wound. It is believed that reduction of the opening pressure of the valve led to CSF flow through the shunt and made siphoning possible, resulting in cessation of the transcutaneous CSF flow. The authors propose the prophylactic implantation of a programmable valve in children at high risk of postoperative transcutaneous CSF leakage.- - - - - - - - - - ranking = 1keywords = meningomyelocele (Clic here for more details about this article) |
10/52. Segmental spinal cord hypoplasia and meningocele with preservation of medullary function: case report.BACKGROUND: In very rare dysraphic cases, it is not clear whether the primary abnormalities are in the neural elements, or in the bony elements. CASE DESCRIPTION: We describe a case of segmental hypoplasia of the spinal cord, with absent nerve roots in the afflicted segments, and associated meningocele and vertebral abnormalities. We illustrate the arguments for and against the classification of this lesion either as an atypical case of myelomeningocele (MMC) or as a mild case of segmental spinal dysgenesis (SSD). CONCLUSIONS: Possibly, in this exceptional case, the primary defect is in the neural tissue like in more usual cases of MMC and not in the spine, like in segmental spinal dysgenesis.- - - - - - - - - - ranking = 2.4947909124589keywords = myelomeningocele (Clic here for more details about this article) |
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