Introduction Treatment of hydrocephalus is accomplished primarily through a ventricular-peritoneal shunt (VPS). This study aims to describe the application of retrograde ventricle-sinus shunt (RVSS) in patients with hydrocephalus after surgical treatment of myelomeningocele. Method A prospective, randomized and controlled pilot study. We consecutively enrolled 9 patients with hydrocephalus after surgical repair of myelomeningocele from January 2010 to January 2012. These patients underwent elective RVSS or VPS. Five underwent RVSS and 4 underwent VPS. Patients were followed for one year with quarterly evaluations and application of transcranial Doppler. Results RVSS group showed outcomes similar to those of VPS group. Doppler revealed significant improvement when comparing preoperative to postoperative period. RVSS group had significantly higher cephalic perimeter than VPS group. Neuropsychomotor development, complications and subjective outcomes did not differ between groups. Conclusion RVSS shunt is viable; it is an alternative option for the treatment of hydrocephalus.
In our sample, transcranial Doppler could be used as a diagnostic and follow-up tool to evaluate hemodynamics and hydrodynamics in the preoperative and postoperative phases of RVSS. It was technically feasible in all patients, had close relation with other clinical and image parameters, and was sensitive to identify system malfunction.
Cartas aos editores Glutamatergic excitotoxicity secondary to status epilepticus after crack abuse: a case report Excitotoxicidade glutamatérgica secundária ao uso de crack: relato de caso Dear Editor, Glutamate is a major excitatory neurotransmitter in the central nervous system. Overstimulation of postsynaptic receptors causes excitotoxicity, which underlies neuronal loss 1 resulting in injury in many seemingly unrelated disorders, including ischemia, trauma, hypoglycemia, hypoxia, status epilepticus, Wernicke syndrome, and even neurodegenerative disorders such as Alzheimer's disease, Parkinson's disease, and Huntington's disease. 1,2 In status epilepticus, neuronal seizure activity increases the release of glutamate at presynaptic terminals. Encephalopathy with status epilepticus often involves the hippocampus, other parts of the limbic system, the thalamus, and the cerebellum. 3
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