Journal of neurosurgery
-
Journal of neurosurgery · Jan 2007
Case ReportsTransfemoral vein placement of a ventriculoatrial shunt. Technical note.
Acceptable cavities for the distal portion of a cerebrospinal fluid diversion shunt include the peritoneal, pleural, and atrial cavities. The authors report on a patient in whom placement into the peritoneal cavity failed, the pleural cavity was not an option, and access to the right atrium was not technically possible via standard cannulation techniques into the veins of the neck and shoulder regions. ⋯ Eight months postoperatively, the patient's condition was at baseline and there were no signs of shunt malfunction. This technique may prove useful when other measures have failed.
-
Journal of neurosurgery · Jan 2007
Case ReportsLemierre syndrome complicated by cavernous sinus thrombosis, the development of subdural empyemas, and internal carotid artery narrowing without cerebral infarction. Case report.
Lemierre syndrome is an extremely rare complication of mild-to-moderate pharyngeal infections. The authors present an unusual case of Lemierre syndrome in a 16-year-old boy with cavernous sinus thrombosis and right internal carotid artery narrowing without neurological sequelae, right subdural empyema, and cerebritis in the right temporal and occipital lobes. ⋯ The patient underwent unilateral tonsillectomy, drainage of the peritonsillar abscess, and a myringotomy on the right side. Postoperatively the patient was treated conservatively with antibiotic therapy resulting in an excellent outcome.
-
Journal of neurosurgery · Jan 2007
ReviewPediatric craniopharyngiomas: classification and treatment according to the degree of hypothalamic involvement.
The current treatment of craniopharyngiomas is evolving into one of a multimodal approach in which the aim is disease control and improved preservation of quality of life (QOL). To date, an appropriate classification system with which to individualize treatment is absent. The objectives of this study were to identify preoperative prognostic factors in patients with craniopharyngiomas and to develop a risk-based treatment algorithm. ⋯ For many children with craniopharyngiomas, the cost of resection is hypothalamic dysfunction and a poor QOL. By using a preoperative classification system to grade hypothalamic involvement and stratify treatment, the authors were able to minimize devastating morbidity. This was achieved by identifying subgroups in which complete resection or STR, performed by an experienced craniopharyngioma surgeon and with postoperative radiotherapy when necessary, yielded better overall results than the traditional GTR.