Journal of neurosurgery
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Journal of neurosurgery · Dec 2015
Case ReportsCombined use of diffusion tensor tractography and multifused contrast-enhanced FIESTA for predicting facial and cochlear nerve positions in relation to vestibular schwannoma.
The authors assessed whether the combined use of diffusion tensor tractography (DTT) and contrast-enhanced (CE) fast imaging employing steady-state acquisition (FIESTA) could improve the accuracy of predicting the courses of the facial and cochlear nerves before surgery. ⋯ By using a combination of DTT and multifused CE-FIESTA, the authors were able to increase the number of vestibular schwannoma patients for whom predicted results corresponded with the courses of both the facial and cochlear nerves, a result that has been considered difficult to achieve by use of a single modality only. Although the 3D image including these prediction results helped with comprehension of the 3D operative anatomy, the reliability of prediction remains to be established.
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Journal of neurosurgery · Dec 2015
Observational StudyPredicting success of endoscopic third ventriculostomy: validation of the ETV Success Score in a mixed population of adult and pediatric patients.
Endoscopic third ventriculostomy (ETV) has become the first line of treatment in obstructive hydrocephalus. The Toronto group (Kulkarni et al.) developed the ETV Success Score (ETVSS) to predict the clinical response following ETV based on age, previous shunt, and cause of hydrocephalus in a pediatric population. However, the use of the ETVSS has not been validated for a population comprising adults. The objective of this study was to validate the ETVSS in a "closed-skull" population, including patients 2 years of age and older. ⋯ The ETVSS did not show adequate discrimination but demonstrated excellent calibration in this population of patients 2 years and older. According to decision-curve analyses, the ETVSS is marginally useful in clinical scenarios in which 60% or 70% success rates are the thresholds for preferring ETV to CSF shunt. Previous history of CSF shunt and age were not associated with worse outcomes, whereas posthemorrhagic and postinfectious causes of the hydrocephalus were significantly associated with reduced success rates following ETV.
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Journal of neurosurgery · Dec 2015
Avoidance and management of perioperative complications of endoscopic third ventriculostomy: the Dhaka experience.
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. ⋯ 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 kept in mind perioperatively by both surgeons and anesthesiologists, as prompt detection and action can help minimize the risks associated with neuroendoscopic procedures.