RESUMO
UNLABELLED: Multiple shunt failure is a challenge in pediatric neurosurgery practice and one of the most feared complications of hydrocephalus. OBJECTIVE: To demonstrate that laparoscopic procedures for distal ventriculoperitoneal shunt failure may be an effective option for patients who underwent multiple revisions due to repetitive manipulation of the peritoneal cavity, abdominal pseudocyst, peritonitis or other situations leading to a "non reliable" peritoneum. METHOD: From March 2012 to February 2013, the authors reviewed retrospectively the charts of six patients born and followed up at our institution, which presented with previous intra-peritoneal complications and underwent ventriculoperitoneal shunt revision assisted by video laparoscopy. RESULTS: After a mean follow-up period of nine months, all patients are well and no further shunt failure was identified so far. CONCLUSION: Laparoscopy assisted shunt revision in children may be, in selected cases, an effective option for patients with multiple peritoneal complications due to ventriculo-peritoneal shunting.
Assuntos
Cavidade Abdominal/cirurgia , Laparoscopia/métodos , Derivação Ventriculoperitoneal/métodos , Cirurgia Vídeoassistida/métodos , Adolescente , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Hidrocefalia/complicações , Masculino , Peritonite/cirurgia , Reprodutibilidade dos Testes , Retratamento , Estudos Retrospectivos , Fatores de Risco , Resultado do TratamentoRESUMO
Multiple shunt failure is a challenge in pediatric neurosurgery practice and one of the most feared complications of hydrocephalus. Objective: To demonstrate that laparoscopic procedures for distal ventriculoperitoneal shunt failure may be an effective option for patients who underwent multiple revisions due to repetitive manipulation of the peritoneal cavity, abdominal pseudocyst, peritonitis or other situations leading to a “non reliable” peritoneum. Method: From March 2012 to February 2013, the authors reviewed retrospectively the charts of six patients born and followed up at our institution, which presented with previous intra-peritoneal complications and underwent ventriculoperitoneal shunt revision assisted by video laparoscopy. Results: After a mean follow-up period of nine months, all patients are well and no further shunt failure was identified so far. Conclusion: Laparoscopy assisted shunt revision in children may be, in selected cases, an effective option for patients with multiple peritoneal complications due to ventriculo-peritoneal shunting. .
Múltiplas disfunções de derivações ventrículo-peritoneais em pacientes crônicos são complicações temidas no tratamento das hidrocefalias e um desafio na prática neurocirúrgica. Objetivo: Demonstrar que a abordagem laparoscópica para o tratamento das obstruções distais das derivações ventrículo-peritoneais é uma opção eficaz em pacientes submetidos a múltiplas revisões, manipulação repetitiva da cavidade abdominal, pseudocisto abdominal, peritonite ou outras complicações indutoras de peritônio “não confiável”. Método: Os autores revisaram retrospectivamente, de março de 2012 a fevereiro de 2013, os prontuários de seis pacientes nascidos e acompanhados em um hospital pediátrico, que apresentaram múltiplas complicações intraperitoneais e tiveram a revisão de derivações ventrículo-peritoneais assistida por videolaparoscopia. Resultados: Todos os pacientes melhoraram clinicamente e nenhuma outra disfunção foi identificada após um período de acompanhamento médio de 9 meses. Conclusão: Revisão distal de derivações ventrículo-peritoneais assistida por videolaparoscopia em crianças é, em casos selecionados, uma opção eficaz para pacientes crônicos com história de múltiplas complicações peritoneais. .
Assuntos
Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Cavidade Abdominal/cirurgia , Laparoscopia/métodos , Derivação Ventriculoperitoneal/métodos , Cirurgia Vídeoassistida/métodos , Seguimentos , Hidrocefalia/complicações , Peritonite/cirurgia , Reprodutibilidade dos Testes , Retratamento , Estudos Retrospectivos , Fatores de Risco , Resultado do TratamentoRESUMO
INTRODUCTION: An unusual case of positive immunological testing for cysticercosis in the cystic fluid obtained from an anaplastic oligoastrocytoma is presented. CASE REPORT: A 15-year-old boy was admitted with multiple brain lesions. The biggest was a cyst with a mural node and neurocysticercosis was suspected. In order to relieve intracranial pressure, the cyst was punctured and the immunological testing for cysticercosis was positive, reinforcing the clinical suspicion and leading to a clinical trial with albendazole and steroids. As the patient deteriorated the cystic lesion was removed and the diagnosis of anaplastic oligoastrocytoma was established. A second lesion was eventually approached and the histopathological diagnosis of both specimens concurred. DISCUSSION: Although some authors believe that chronic inflammatory changes following neurocysticercosis could induce the formation of brain tumors, this association may be a mere coincidence. In our case no clinical evidence of a prior infestation by Cysticercus was found. In fact, an exhaustive examination of the specimens did not reveal any areas of inflammatory reaction. We believe that the similarity of the glioma and cysticercosis antigens may be the cause of the positive reactions in the cystic fluid.
Assuntos
Neoplasias Encefálicas/complicações , Cisticercose/complicações , Oligodendroglioma/complicações , Adolescente , Neoplasias Encefálicas/diagnóstico , Neoplasias Encefálicas/metabolismo , Cisticercose/diagnóstico , Cisticercose/metabolismo , Proteína Glial Fibrilar Ácida/metabolismo , Humanos , Imuno-Histoquímica/métodos , Imageamento por Ressonância Magnética/métodos , Masculino , Oligodendroglioma/diagnóstico , Oligodendroglioma/metabolismo , Tomografia Computadorizada por Raios X/métodosRESUMO
BACKGROUND: Cystic dysraphic lesions of the cervical and upper thoracic region are rare and only a few series have been published about the topic. These malformations can be divided into categories that include both myelocystoceles and the so-called cervical meningoceles or myelomeningoceles. METHODS: A retrospective study of 18 patients was conducted. RESULTS: In 17 patients a squamous or a cicatricial epithelium of variable thickness covered the dome of the lesions, while the base was covered with full-thickness skin. In one case the skin was entirely normal. Four patients displayed associated CNS malformations and three more had systemic congenital anomalies. All patients underwent surgical exploration and the length of time between birth and surgery ranged from 6 h to 9 months. The most frequent surgical finding, seen in 14 patients, was a stalk connecting the dorsal surface of the spinal cord to the cyst. In three patients the findings were consistent with myelocystocele. Only in one case was a true meningocele found. Hydrocephalus and Chiari II malformation were not as consistently associated as in myelomeningoceles. Neurological signs and symptoms were not so marked as in myelomeningoceles and were found in the follow-up of four patients. In two of them there was a non-progressive deficit, probably expressing an imperceptible involvement of the nervous system in the first year of life. The histopathological findings were of three types: neuroglial stalks, fibrovascular stalks and myelocystoceles. CONCLUSIONS: Cystic dysraphisms of the cervical and upper thoracic region differ clinically and structurally from meningomyelocele and have a more favorable outcome. We believe that these malformations have not been properly labeled and propose a classification based on the structures found inside the cyst.
Assuntos
Vértebras Cervicais/anormalidades , Espinha Bífida Cística/patologia , Vértebras Torácicas/anormalidades , Ultrassonografia Pré-Natal , Anormalidades Múltiplas , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/cirurgia , Feminino , Seguimentos , Humanos , Lactente , Recém-Nascido , Masculino , Meningomielocele/diagnóstico por imagem , Meningomielocele/patologia , Meningomielocele/cirurgia , Estudos Retrospectivos , Espinha Bífida Cística/classificação , Espinha Bífida Cística/diagnóstico por imagem , Espinha Bífida Cística/cirurgia , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/cirurgia , Resultado do TratamentoRESUMO
Os autores analisam uma série de 17 crianças portadoras de mielodisplasias que desenvolveram sinais e sintomas da malformaçoes de Chiari do tipo II. De acordo com a idade, dois grupos ficaram bem definidos: Grupo I, crianças no primeiro ano de vida, em que predominaram sinais e sintomas de comprometimento do tronco encefálico e nervos cranianos bulbares (n=13); Grupo II, composto por crianças com idade superior a um ano, em que as principais manifestaçoes foram dor cervical e sinais cerebelares (n=4). O resultado do tratamento cirúrgico nos dois grupos foi distinto: enquanto a mortalidade no Grupo I atingiu 46,1 por cento, nenhum paciente do Grupo II veio a falecer. O tratamento inicial consistiu na manifestaçao ou revisao de derivaçao ventricular, sendo a descompressao crânio-vertebral reservada àqueles que nao se beneficiaram com esses procedimentos. Os autores enfatizam a necessidade do imediato reconhecimento e tratamento do quadro, de modo a se obter resultados satisfatórios.