The Significance of Artificial Cerebrospinal Fluid as Perfusate and Endoneurosurgery

Oka, Kazunari; Yamamoto, Masaaki; Nonaka, Toshiharu; Tomonaga, Masamichi

doi:10.1097/00006123-199604000-00019

Cited by 26 publications

(35 citation statements)

References 7 publications

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“…In the presence of hematoma in the lateral ventricle contralateral to the puncture, septostomy was performed posterior to the anterior septal vein while electrocoagulation was performed using an aspiration tube with the rigid endoscope. The rigid endoscope was then replaced with the flexible endoscope, the ventricle was filled with artificial cerebrospinal fluid, 13) and the foramen of Monro was checked before aspiration of the hematoma in the third ventricle. The hematoma in the third ventricle was aspirated by connecting a 10-ml syringe to the working channel of the flexible endoscope and manually applying negative pressure.…”

Section: Methodsmentioning

confidence: 99%

Comparison of Clinical Outcomes of Intraventricular Hematoma Between Neuroendoscopic Removal and Extraventricular Drainage

Komatsu

Wakuta

et al. 2010

Neurol. Med. Chir.(Tokyo)

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The efficacy of treatment for intraventricular hematoma by neuroendoscopic surgery and extraventricular drainage was compared in 10 patients with intraventricular hematoma and hydrocephalus who underwent neuroendoscopic surgery (endoscopic group), and eight patients with intraventricular hematoma and hydrocephalus treated with extraventricular drainage (EVD group). The outcomes in each group were assessed retrospectively using the Graeb scores on the pre-and postoperative computed tomography (CT), duration of extraventricular drainage, requirement for a shunt operation, and modified Rankin scale score at 12 months. The Graeb scores on the preoperative CT were not significantly different between the two groups, but the duration of catheter placement was significantly shorter (69.3%) in the endoscopic group (2.7 days) than in the EVD group (8.8 days). None of the patients in either group required a shunt procedure for communicating hydrocephalus 12 months after surgery. Neuroendoscopic removal is a safe and effective procedure for intraventricular hematoma. Advantages include rapid removal of hematoma in the ventricular systems and reliable improvement of non-communicating hydrocephalus in the acute phase. The procedure resulted in faster removal of the catheter in the postoperative period and earlier patient ambulation.

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Section: Methodsmentioning

confidence: 99%

Comparison of Clinical Outcomes of Intraventricular Hematoma Between Neuroendoscopic Removal and Extraventricular Drainage

Komatsu

Wakuta

et al. 2010

Neurol. Med. Chir.(Tokyo)

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“…3,5,22 Hyperkalemia, 2 hypokalemia, 6 hypernatremia, 20 and hyponatremia 3,23 have all been reported. Meningeal irritation, headache, and high fever can occur due to an inflammatory response to irrigating fluids 13,17 or to spilled colloid cyst contents causing chemical ventriculitis. 4 Transient ocular divergence and anisocoria can occur from inadvertent stretching of the midbrain and resultant palsies of third or sixth cranial nerves during fenestration of the third ventricle floor.…”

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confidence: 99%

Avoidance and management of perioperative complications of endoscopic third ventriculostomy: the Dhaka experience

Kawsar

Haque

Chowdhury

2015

JNS

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E ndoscopic third ventriculostomy (ETV) is an established therapeutic alternative to conventional shunt surgery for patients with noncommunicating hydrocephalus. 22 Neuroendoscopy has many advantages, including speed, simplicity, avoidance of implants, and avoidance of brain retraction or dissection. However, a variety of perioperative complications have been reported in ETV, attributed mostly to the unique surgical technique, which causes alterations in cerebral flow dynamics and injuries to vital brain areas. Previously reported complication rates range from 5% to 30%, and operative mortality is between 0% and 1%.22 Serious hemodynamic variations, temperature alterations, electrolyte imbalances, and delayed emergence from anesthesia after surgery are some of the complications that may adversely affect outcome. 1Sometimes difficult or unfavorable anatomy may result in procedure abandonment. A thorough understanding of complications resulting from different endoscopic maneuvers can aid complication management and substantially improve patient safety. In this paper we present our experience of operative and immediate postoperative complications that occurred during intraventricular neuroendo scopy at Dhaka Medical College Hospital and other private hospitals in Dhaka, Bangladesh. We also describe some novel but simple maneuvers that can be easily applied intraoperatively to avoid and manage complications. obJect Although endoscopic third ventriculostomy (ETV) is a minimally invasive procedure, serious perioperative complications may occur due to the unique surgical maneuvers involved. In this paper the authors report the complications of elective and emergency ETV and their surgical management in 412 patients from July 2006 to October 2012 at Dhaka Medical College Hospital (a government hospital) and other private hospitals in Dhaka, Bangladesh. The authors attempted some previously undescribed simple maneuvers that may help to overcome the difficulties of managing complications. methods The complication rate was determined by recording intraoperative changes in pulse and blood pressure, bleeding episodes, serum electrolyte abnormalities, CSF leakage, and neurological deterioration in the immediate postoperative period. results Intraoperative complications included hemodynamic alterations in the form of tachycardia, bradycardia, and hypertension. Bleeding was categorized as major in 2 cases and minor in 68 cases. Delayed recovery from anesthesia occurred in 14 cases, CSF leakage from the wound in 11 cases, and electrolyte imbalance in 5 cases. Postoperatively, 2 patients suffered convulsions and 1 had evidence of third cranial nerve injury. Three patients died as a result of complications. coNclusioNs Complications during endoscopy can lead to serious consequences that may sometimes be very difficult to manage. The authors have identified and managed a large number of complications in this series, although the rate of complications is consistent with that in other reported series. These complications should be ke...

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“…After endoneurosurgery for symptomatic aqueductal stenosis, patients who received normal saline as perfusion fluid developed headaches, high fever and neck stiffness, but patients who received artificial CSF experienced only slight fever (Oka et al, 1996). We found that Artcereb is unlikely to induce cellular toxicity, while normal saline and/or lactated Ringer's solution is likely to induce cellular toxicity, based on cell cultures of rat brain cells (Nishimura and Naito, 2008;Nishimura et al, 2010).…”

Section: Introductionmentioning

confidence: 84%

Pharmacological assessment of ARTCEREB irrigation and perfusion solution for cerebrospinal surgery using primary cultures of rat brain cells

et al. 2010

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-ARTCEREB ® irrigation and perfusion solution (Artcereb), an ethical pharmaceutical, is typically applied inside the skull and spinal cavity as artificial fluid. Artcereb is composed of glucose and electrolytes (Na + , K + , Mg 2+ , Ca 2+ , Cl -, HCO 3 -and P) and has a pH of 7.3. An in vitro assessment of the effects of Artcereb on cell culture of rat fetal astrocytes or rat fetal brain cells was performed in comparison with normal saline and lactated Ringer's solutions. Furthermore, the effects of Artcereb on cell culture of rat fetal brain cells were also assessed in comparison with Krebs bicarbonate solution. Cell function after exposure to Artcereb was assessed based on 3 H-thymidine incorporation activity. Cell function after exposure to Artcereb and lactated Ringer's solution in primary cultures of rat fetal astrocytes remained unaffected when compared to that after exposure to normal saline. Cell function after exposure to Artcereb in a primary culture of rat brain cells remained unaffected as compared to that after exposure to normal saline and lactated Ringer's solution. However, function decreased after exposure to a modified Artcereb formulation lacking bicarbonate, thus confirming that the presence of bicarbonate is essential for the Artcereb formulation.

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The Significance of Artificial Cerebrospinal Fluid as Perfusate and Endoneurosurgery

Cited by 26 publications

References 7 publications

Comparison of Clinical Outcomes of Intraventricular Hematoma Between Neuroendoscopic Removal and Extraventricular Drainage

Comparison of Clinical Outcomes of Intraventricular Hematoma Between Neuroendoscopic Removal and Extraventricular Drainage

Avoidance and management of perioperative complications of endoscopic third ventriculostomy: the Dhaka experience

Pharmacological assessment of ARTCEREB irrigation and perfusion solution for cerebrospinal surgery using primary cultures of rat brain cells

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