The use of laparoscopic guidance for abdominal puncture and introduction of ventriculoperitoneal shunt peritoneal catheters using a peritoneal split trocar is proposed. The technique permits location of the catheter in the right parietocolic space or its relocation if trapped within the omentum. Cerebrospinal fluid flow is certified. Since the submission of the paper 6 selected cases have been operated upon without complications.
In a previous paper (Lele, 1962b) it has been shown that by irradiation with a single beam of focused ultrasound it is possible to produce trackless focal alterations of predetermined size at any desired location within a relatively homogeneous and stable medium. This paper will present the results obtained by application of ultrasound, under comparable experimental conditions, to the brain of the cat in a statistical manner and will discuss its potentialities and limitations as an experimental tool. More specifically, it will deal with (1) the relation between ultrasonic dosage and lesion size in different target areas and under controlled experimental conditions, with special reference to the range of deviation that was encountered; and (2) the statistical probability of accurately hitting a pre-determined discrete target in a blind experiment by the stereotaxic method. The neurophysiological effects of ultrasonic irradiation with subthreshold dosages in reference to its potential use for locating targets without inflicting any damage will be dealt with in a subsequent paper. METHODSA single beam of focused ultrasound at the frequency of 2-7 Mc/s subtending a solid angle of 420 in degassed water at 370C as described previously (Lele, 1962a) was used in this investigation. Focal characteristics of the irradiation system were checked at monthly intervals, by determination of energy distribution in the focal plane perpendicular to the main axis of irradiation (see 'lateral scan', Lele, 1962a). Intensity was set to the desired level by means of the radiation pressure gauge ('Sonar Test') before every irradiation and was checked again immediately after the experiment. Recordings of the oscillator cathode current were made after setting the intensity level and during irradiation. The temperature of the irradiation head was maintained at 370 C by immersion into a thermostatically controlled water-bath.
Since the publication by F. Vourc'h in 1963 [Br J Anaesth (1963) 35:118-120] describing the use of a plastic catheter inserted percutaneously for the drainage of lumbar cerebrospinal fluid (CSF) the indications for spinal drainage are numerous, but not very well systematized. The bibliographical review shows few recent papers concerning the techniques, indications, complications and pitfalls. The authors considered it interesting to analyze nine papers, in particular those dedicated to the use of spinal drainage in skull base surgery and in the prevention and/or treatment of CSF fistulas. Two papers describe for the first time pachymeningeal gadolinium enhancement associated with orthostatic headaches, owing to CSF hypotension mimicking an inflammatory or infiltrative disease. The results of the treatment of CSF fistulas are good with a high success rate, avoiding direct surgical repair. The use of a specially designed subarachnoid catheter is clearly superior to the epidural catheter, with good flow of CSF and minimal complications. The main problems are deficient flow and infections. Overdrainage is potentially dangerous, with acute pneumocephalus, brain collapse and neurological deterioration. Infrequent but possible is Chiari II-like syndrome with vocal cord paralysis and life-threatening aspiration, or temporal downward herniation with kinking of the posterior cerebral artery and acute brain infarct. The key to success lies in a rigid protocol, intermittent CSF drainage with a closed circuit, and daily biochemical and microbiological monitoring. Highly qualified medical and nursing staff are essential.
Twenty-eight cases of intracranial arachnoidal cysts diagnosed during the period 1978-1990 are analyzed. All cases were investigated with computed tomography (CT), 5 with magnetic resonance imaging (MRI) and 5 with ultrasonography (US). Seventeen were located in the middle cranial fossa, 3 in the quadrigeminal cistern, 2 were parasagittal, 3 suprasellar and 3 were located in the posterior fossa. Twenty-three of the 28 patients were treated surgically, craniotomy with fenestrations was used in 3 cases. Different varieties of shunts were inserted in 8 cases and in the last 15 patients the only surgical treatment was the insertion of cysto-peritoneal (CP) drainage (without a valve) with excellent results. MRI and/or CT follow-up revealed disappearance of the cyst in 13 out of 22 cases and 7 experienced a marked reduction. In 2 patients the cyst showed little change. There were no cases of infection and no deaths.
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