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OBJECTIVECerebral ventriculitis remains one of the most challenging neurosurgical conditions, with poor outcome and a long course of treatment and duration of hospital stay. Despite the current conventional management plans, i.e., using antibiotics in addition to CSF drainage, the outcome remains unsatisfactory in some cases, with no definitive therapeutic guidelines. This study aims to compare the outcome of ventricular irrigation/lavage (endoscopic irrigation or the double-drain technique) to conventional currently accepted therapy using just drainage and antibiotics.METHODSThe authors conducted a prospective controlled study in 33 patients with cerebral ventriculitis in which most of the cases were complications of CSF shunt operations. Patients were divided into two groups. Removal of the ventricular catheter whenever present was performed in both groups. The first group was managed by ventricular lavage/irrigation, while the other group was managed using conventional therapy by inserting an external ventricular drain. Both systemic and intraventricular antibiotics were used in both groups. The outcomes were compared regarding mortality rate, modified Rankin Scale (mRS) score, and duration of hospital stay.RESULTSThe mean age of the study population was 5.98 ± 7.02 years. The mean follow-up duration was 7.6 ± 3.2 months in the conventional group and 5.7 ± 3.4 months in the lavage group. The mortality rate was 25% (4/16) in the lavage group and 52.9% (9/17) in the nonlavage group (p = 0.1). The mRS score was less than 3 (good outcome) in 68.8% (11/16) of the lavage group cases and in 23.5% (4/17) of the conventional group (p < 0.05). The mean hospital stay duration was 20.5 ± 14.2 days in the lavage group, whereas it was 39.7 ± 16.9 days in the conventional group (p < 0.05).CONCLUSIONSVentricular lavage or irrigation together with antibiotics is useful in the management of cerebral ventriculitis and associated with a better outcome and shorter hospital stay duration compared to current conventional lines of treatment.

BACKGROUND:A paradigm shift toward less radicality in the treatment of craniopharyngioma (CP) has increasingly gained recognition. In selected patients, a less invasive approach aiming at cyst decompression may be suitable.OBJECTIVE:To present our experience with the endoscopic transcortical-transventricular approach (ETTA) for the treatment of CP located in the third ventricle, describe our surgical technique, and explore the results reported in the literature.METHODS:Data for third ventricular CPs treated using ETTA in 2 tertiary medical centers between 2006 and 2020 were retrospectively reviewed. Cystic, mixed lesion, new, and recurrent cases were included. ETTA aimed at cyst fenestration, subtotal or partial tumor resection, managing the hydrocephalus, or a combination of these modalities. Fractionated radiotherapy (RT) was performed (54 Gy in 30 fractions).RESULTS:The described approach was performed in 13 patients with a mean age of 30.2 years. Tumor excision was attempted in 10 patients. Cystic fenestration alone was conducted in 3 patients, followed by intracystic catheter implantation in 2 patients. Permanent diabetes insipidus developed in 3 patients, and 1 patient experienced a surgical site infection. The recurrence rate for ETTA + RT (pre-ETTA in 33.3%) was 2/9 (22.2%) after a mean follow-up of 21.3 months. Four patients did not undergo RT after ETTA, and all these patients experienced recurrences after a mean follow-up of 15.5 months. Hydrocephalus resolved in all 6 patients who presented with accompanying hydrocephalus.CONCLUSION:ETTA combined with adjuvant RT is a safe and effective option in the management of cystic or predominantly cystic CP extending into the third ventricle. This procedure also effectively treats the accompanying hydrocephalus.

Objectives Ventriculoperitoneal (VP) shunting is commonly used to treat pediatric hydrocephalus, but failure rates are high. VP shunt failure in children is mostly caused by infection and/or proximal/distal shunt obstruction. However, to our knowledge, no previous reviews have discussed this topic using only clinical studies when age-related data could be obtained. This systematic review aimed at reevaluating what is already known as the most common causes of shunt failure and to determine the incidence and causes of VP shunt failure during the first 2 years of life as a step to establish solid evidence-based guidelines to avoid VP shunt failure in infants. Methods We performed a search using the search terms “Cerebrospinal Fluid Shunts” (Medical Subject Headings [MeSH]) AND failure [All Fields] AND (“humans” [MeSH] AND English [lang] AND “infant” [MeSH]). Only articles that specifically discussed VP shunt complications in children < 2 years were included. Results We found that the most common causes of VP shunt failure in children < 2 years were shunt obstruction and infection, both observed in a range. Conclusion VP shunt failure is very common in infants, mostly resulting from obstruction and infection. Future studies should focus on methods designed to avoid these complications or on alternative treatments for hydrocephalus.

Resections of petroclival meningiomas are considered to be one of the most challenging skull base surgeries with a high risk of neurological deficits because of its intimate relation to the brain stem and cranial nerves. Extended skull base approaches have been recommended to gain access to these lesions. However, recently, the trend goes more to less-invasive standard craniotomies. 1 We present a 46-year-old female patient who underwent an endoscope-assisted microsurgical resection of a large petroclival meningioma with brainstem compression using a retrosigmoid approach. Symptoms on admission were gait disturbance, mild left-sided facial paresis, and facial numbness. Intraoperatively, severe displacement of the cranial nerves V, VII, and VIII, as well as tumor growth around VI was observed. After initial removal of the tumor with the aid of the operating microscope, a 30°endoscope was used to resect tumor tissue within Meckel's cave which was not visible under the microscope. A small tumor remnant growing en plaque within the internal auditory canal and Meckel's cave was left to preserve cranial nerve function. Postoperative temporary abducens palsy, facial numbness, and deterioration of the preexisting facial palsy resolved completely, but hearing loss persisted. Six months after surgery, the tumor remnants remained stable. With the combination of endoscope and operating microscope, we were able to achieve a safe resection of an extensively growing petroclival meningeoma using a standard retrosigmoid approach. [2][3][4] The patient consented to the procedure and the publication of her image.

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OBJECTIVE Hydrocephalus is the most common brain disorder in children and is more common in low- and middle-income countries. Research output on hydrocephalus remains sparse and of lower quality in low- and middle-income countries compared with high-income countries. Most studies addressing hydrocephalus epidemiology are retrospective registry studies entailing their inherent limitations and biases. This study aimed to investigate child-related, parental, and socioeconomic risk factors of congenital hydrocephalus (CH) in a lower-middle-income country. METHODS An investigator-administered questionnaire was used to query parents of patients with CH and controls who visited the authors’ institution from 2017 until 2021. Patients with secondary hydrocephalus and children older than 2 years of age at diagnosis were excluded. Uni- and multivariable logistic regression was performed to identify the factors affecting CH development. RESULTS Seven hundred forty-one respondents (312 cases and 429 controls) were included in this study. The authors showed that maternal diseases during pregnancy (OR 3.12, 95% CI 1.96–5.03), a lack of periconceptional folic acid intake (OR 1.92, 95% CI 1.32–2.81), being a housewife (OR 2.66, 95% CI 1.51–4.87), paternal illiteracy (OR 1.65, 95% CI 1.02–2.69), parental consanguinity (OR 3.67, 95% CI 2.40–5.69), a history of other CNS conditions in the family (OR 2.93, 95% CI 1.24–7.34), conceiving a child via assisted fertilization techniques (OR 3.93, 95% CI 1.57–10.52), and the presence of other congenital anomalies (OR 2.57, 95% CI 1.38–4.87) were associated with an independent higher odds of a child having CH. Conversely, maternal hypertension (OR 0.22, 95% CI 0.09–0.48), older maternal age at delivery (OR 0.93, 95% CI 0.89–0.97), and having more abortions (OR 0.80, 95% CI 0.67–0.95) were negatively correlated with CH. CONCLUSIONS Multiple parental, socioeconomic, and child-related factors were associated with higher odds for developing CH. These results can be utilized to guide parental counseling and management, and direct social education and prevention programs.

Background: The 12-year collaboration between Greifswald and Cairo Universities in Neurosurgery has recently reached stable steps in post-graduate education represented in the bi-institutional fellowship of Neuro-endoscopy. Aim: We present our new experience of upgrading the level of bi-institutional collaboration to serve for highly skilled undergraduate training. Methods: we started a summer school program for the Egyptian medical students, with the target of allowing better orientation with the specialty Results: 10 candidates (6 males and 4 females) were selected to participate in the program. All candidates successfully finished the summer school and stated they would recommend this activity to their colleagues. Conclusion: We recommend the summer school activities either within the host university or abroad in a collaborate university to the students that would be preselected to fit in the planned program. It is our opinion this would assist the young generations in choosing the suitable career and help in improving the quality of the working teams in Neurosurgery in the future.