Objective
Conus region lumbosacral lipomas (LSLs) are highly heterogeneous in their morphology, clinical presentation, and outcome, with an incompletely understood natural history and often ...treacherous surgical anatomy. This systematic review aims to critically evaluate and assess the strength of the current LSL evidence base to guide management strategies.
Methods
According to a systematic review following PRISMA guidelines, a search was conducted using the key term “lumbosacral lipoma” across MEDLINE (OVID), Embase, Cochrane Library, and PubMed databases from January 1951 to April 2021. All studies containing ten or more paediatric conus lipomas were included. Data heterogeneity and bias were assessed.
Results
A total of 13 studies were included, containing 913 LSLs (predominantly transitional type—58.5%). Two-thirds (67.5%) of all patients (treated and non-treated) remained clinically stable and 17.6% deteriorated. Neuropathic bladder was present in 8.6% at final follow-up. Of patients managed surgically, near-total resection vs. subtotal resection deterioration-free survival rates were 77.2–98.4% and 10–67% respectively. 4.5% (0.0–27.3%) required re-do untethering surgery. Outcomes varied according to lipoma type. Most publications contained heterogeneous populations and used variable terminology. There was a lack of consistency in reported outcomes.
Conclusion
Amongst published series, there is wide variability in patient factors such as lipoma type, patient age, and methods of (particularly urological) assessment. Currently, there is insufficient evidence base upon which to make clear recommendations for the management of children with LSL. There is an imperative for neurosurgeons, neuroradiologists, and urologists to collaborate to better standardise the terminology, assessment tools, and surgical interventions for this challenging group of conditions.
Highlights • The presence of DESH sign in NPH demonstrates a high positive predictive value of 77%. • However, it has a negative predictive value of 25%. • DESH sign negative patients should still ...undergo prognostic tests for iNPH. • DESH sign negative patients should not be excluded from shunt insertion.
Background
Delayed cerebral ischaemia (DCI) is a major cause of morbidity and mortality after aneurysmal subarachnoid haemorrhage (aSAH). Chemical angioplasty (CA) and transluminal balloon ...angioplasty (TBA) are used to treat patients with refractory vasospasm causing DCI. Multi-modal monitoring including brain tissue oxygenation (PbtO
2
) is routinely used at this centre for early detection and management of DCI following aSAH. In this single-centre pilot study, we are comparing these two treatment modalities and their effects on PbtO
2
.
Methods
Retrospective case series of patients with DCI who had PbtO
2
monitoring as part of their multimodality monitoring and underwent either CA or TBA combined with CA. PbtO
2
values were recorded from intra-parenchymal Raumedic NEUROVENT-PTO® probes. Data were continuously collected and downloaded as second-by-second data. Comparisons were made between pre-angioplasty PbtO
2
and post-angioplasty PbtO
2
median values (4 h before angioplasty, 4 h after and 12 h after).
Results
There were immediate significant improvements in PbtO
2
at the start of intervention in both groups. PbtO
2
then increased by 13 mmHg in the CA group and 15 mmHg in the TBA plus CA group in the first 4 h post-intervention. This improvement in PbtO
2
was sustained for the TBA plus CA group but not the CA group.
Conclusion
Combined balloon plus chemical angioplasty results in more sustained improvement in brain tissue oxygenation compared with chemical angioplasty alone. Our findings suggest that PbtO
2
is a useful tool for monitoring the response to angioplasty in vasospasm.
•Capturing direct brain tissue oxygen tension (PbtO2) during resuscitation is rare in clinical practice.•We report a case of a patient who had a cardiac arrest and resuscitation with a PbtO2 monitor ...in-situ.•Despite immediate chest compressions there was a rapid development of cerebral hypoxia.•This reinforces the importance of early resuscitation to prevent brain hypoxia.
Foramen magnum decompression (FMD) is a standard neurosurgical procedure, typically utilized to treat Chiari malformation. The aim of this educational project was to develop and validate a low-cost ...FMD simulation training model. Mold-based methods were used to develop a prototype. Feasibility was tested during an FMD training session for 17 neurosurgery trainees. Face and content validity were assessed through a Likert Scale. The perceived training benefit was determined using the Physician Performance Diagnostic Inventory Scale (PPDIS). A total of 87.5% successfully removed the C1 arch, 81.3% successfully performed an FMD, and 68.8% avoided injury to the underlying structures. The model scored highly for visual and tactile realism. The median confidence rating on PPDIS significantly improved from early learner to competent. We demonstrate feasibility, content, and face validity. Furthermore, this is a low-cost, portable model that can be easily replicated and used for simulation training.
Chronic ventriculomegaly in the absence of raised intracranial pressure (ICP) is a known entity in adult hydrocephalus practice. The natural history and indication for treatment is, however, poorly ...defined. A highly heterogeneous group, some adults with ventriculomegaly are asymptomatic, while others have life-threatening deteriorations. The authors hypothesized that the various presentations can be subtyped and represent different stages of decompensation. A cluster analysis was performed on a cohort of patients with chronic ventriculomegaly with the aim of elucidating typical clinical characteristics and outcomes in chronic ventriculomegaly in adults.
Data were collected from 79 patients with chronic ventriculomegaly referred to a single center, including demographics, presenting symptoms, and 24-hour ICP monitoring (ICPM). A statistical cluster analysis was performed to determine the presence of subgroups.
Four main subgroups and one highly dissimilar group were identified. Patients with ventriculomegaly commonly have a perinatal event followed by one of four main presentations: 1) incidental ventriculomegaly with or without headache; 2) highly symptomatic presentation (including reduced consciousness) and raised ICP; 3) early presenting with symptoms of headache and nausea (with abnormal pulsatility); and 4) late presenting with features common to normal pressure hydrocephalus. Each symptomatic group has characteristic radiological features, ICPM, and responses to treatment.
Cluster analysis has identified subgroups of adult patients with ventriculomegaly. Such groups may represent various degrees of decompensation. Surgical interventions may not be equally effective across the subgroups, presenting an avenue for further research. The identified subtypes provide further insight into the natural history of this lesser studied form of hydrocephalus.
Purpose
CSF diversion is a recognised intervention in idiopathic intracranial hypertension (IIH), particularly in the presence of vision-threatening papilledema. Although ventriculo-atrial (VA) ...shunt insertion is a routine neurosurgical procedure, ventriculoperitoneal and lumboperitoneal shunts have been mostly used in this particular indication. This study aims to look at a single centre’s experience with VA shunts in idiopathic intracranial hypertension (IIH).
Methods
Retrospective case series with a review of electronic records over a 10-year period; exclusion criteria were duplication of same shunt insertion, no VA shunt insertion, paediatric patients and indication other than IIH. Notes were reviewed for demographics, shunt survival (defined by time prior to revision) and reasons for revision.
Results
Eight VA shunt procedures were identified in 6 patients (mean age at insertion 34 ± 10 years) with a mean follow-up of 58 ± 25 months. All shunts were secondary procedures; 2 revisions from lumbo-pleural, 2 from ventriculopleural, 2 from ventriculoatrial and one each from ventriculoperitoneal and combined lumbo-/ventriculoperitoneal. At 50 months, 75% of VA shunts had survived, compared to only 58.3% of VPleural shunts in patients with IIH. Revisions were required due to acute intracranial bleed (1 case)—revised at day 1, and thrombus at distal site (1 case)—revised at day 57. Both shunts were later reinserted. From the latest clinic letters, all patients had their treatment optimised with this procedure, although only two patients had documented resolved papilloedema post-procedure.
Conclusions
Ventriculo-atrial shunts are a safe and efficacious alternative option for CSF diversion in IIH. In this series, only 1 shunt was revised for a VA shunt-specific complication.
Ehlers-Danlos syndrome can be associated with cerebrospinal fluid (CSF) disturbances including recurrent CSF leak and Chiari I malformations. Persistent pseudomeningoceles are known to be associated ...with raised intracranial pressure. We present an unusual case of a compressive epidural CSF collection occurring after a computed tomography−guided L5 nerve root block and describe an effective management strategy.
