The children treated neuroendoscopically needed on average 1.7660 procedures during the entire therapy, and 1.0232 operations a year. The same parameters in the conventionally-treated group were as follows: the total number of procedures was 7.050, and the rate of reoperation was 3.949 procedures a year. The proportion of patients who suffered from complications connected with operative treatment and who had a bad outcome was higher in the conventionally-treated group than in the neuroendoscopic one.
Our intention was to compare the clinical outcome after surgical treatment of chronic hydrocephalus between patients who were subjected to neuroendoscopic third ventriculostomy and patients who underwent shunt implantation. At the Department of Neurosurgery of the Research Institute of Polish Mothers' Memorial Hospital from 1999 to 2001, 29 children, of an average age of 7 years (+/-7.1 years SD), underwent successful neuroendoscopic procedures, and from 1992 to 1994, 59 children, of an average age of 2 months (+/-1.9 months SD), underwent shunt implantation. The size of the ventricular system was described by the Frontal Horn Index and its change after operative procedures by the ratio of the final to the primary Frontal Horn Index. Head circumference was measured in percentiles according to the Kurniewicz-Witczakowa chart for Polish children. The reduction in head circumference after a neuroendoscopic procedure was, on average, significantly less than after a shunt implantation (0.39 percentiles +/-29.6 SD vs 17.93 percentiles +/-19.93 SD). Concerning the change in ventricular size after a neuroendoscopic procedure, it was noticed that the average ratio of the final to the primary Frontal Horn Index was 0.9. Meanwhile, the same parameter after a shunt implantation was 0.55. Based on the values of the Frontal Horn Indexes, it was observed that the ventricular system in infants after neuroendoscopic procedures was significantly larger than in other age groups (0.7 vs 0.5). After successful neuroendoscopic operations in a group of children suffering from Chiari II malformation, ventricular systems were slightly enlarged. The ratio of the final Frontal Index to the primary Frontal Horn Index was 1.31. In children suffering from chronic hydrocephalus, the average reduction in the size of the ventricular system and the rate of head circumference growth are lower after neuroendoscopic operations than after shunt implantations. Successful neuroendoscopic procedures are characterized by, on average, a higher rate of head circumference growth in infants than in neonates. In addition, the rate of head circumference growth after successful neuroendoscopic procedures could be higher than before the operation, which is clearly visible in children suffering from Chiari II malformation, but it does not mean a constant increase of that parameter during the postoperative period.
Summing up all the mentioned aspects of neuroendoscopic techniques, the neuroendoscopic techniques were the most suitable operative procedures in the treatment of arachnoid cysts in the presented group of patients, providing that the connection between the lumen of the arachnoid cyst and the cerebrospinal fluid cisterns was of good quality.
Purpose The aim of the article is to present the new hybrid technique for ventriculoatrial shunt implantation. M e t h o d s Tw o -a n d -a -h a l f -y e a r -o l d b o y n e e d e d ventriculoatrial shunt implantation due to communicating hydrocephalus and impaired absorptive ability of the peritoneum. Because of a complete occlusion of the right internal jugular vein and critical stenosis of a distal part of the left internal jugular vein, the procedure was performed under fluoroscopy guidance in the catheterisation laboratory equipped with a 3-dimensional single plane angiography machine (Philips Allura-The Netherlands). At the level of critical stenosis of the left jugular vein, it was decided to perform a percutaneous venous balloon angioplasty. This procedure allowed inserting the ventriculoatrial shunt into the right atrium. Results The whole postoperative period was uneventful. Now, the child is free from symptoms of increased intracranial pressure. The boy has been followed for 9 months. In the control MRI examination, the ventricular system did not change as compared with the previous study. Conclusion The disadvantage of the hemodynamic technique is a higher dose of X-ray irradiation in comparison to other techniques. The hybrid technique should be reserved only to very complicated cases.
PurposeThe aim of the article is to present the new extrapedicular percutaneous technique for posttraumatic vertebral column fracture.MethodsA 15-year-old boy needed a surgical Th8 posttraumatic vertebral body (VB) compressive fracture reduction due to insufficient conservative treatment and consistent severe clinical symptoms. After 6 months of external Jevett long-roll brace stabilization, progressive sagittal balance disturbance of thoracic kyphosis was measured and persistent clinical symptoms were observed. It was decided to present a surgical technique method allowing to attempt to reduce VB fracture, rebalance the vertebral column (VC) without any motion limitation, and decrease clinical symptoms. The procedure was performed percutaneously from extrapedicular approach with intravertebral implant (Spine Jack®—Vexim™) and cement (Interface®—Vexim™) under fluoroscopic imaging (Ziehm™ 8000®).ResultsThe whole procedure was uneventful. Now, the child is free from clinical symptoms and the partial reduction of VB fracture was achieved. The patient has been followed for 3 months. In the control CT scans, the VB fracture reduction is stable and no progression of thoracic kyphosis angle is observed. Furthermore since the surgical procedure, the patient is clinical symptom free.ConclusionThe extrapedicular percutaneus technique of VB fracture reduction with intravertebral fixation allowed to partially reduce the VB compressive fracture, rebalance the VC without any motion limitation, avoid external long-roll brace, and eliminate clinical symptoms. The procedure is minimally invasive, fast, and clinically effective. However, the technique should be restricted only to carefully selected clinical cases.
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