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Neurology in Documentaries
Published in Eelco F. M. Wijdicks, Neurocinema—The Sequel, 2022
Two days before the accident, the documentary shows a night of drinking. Then we see the accident itself, when Kevin attempts a new “cab double cork,” which is a double backflip with a twist. Without bracing himself with his hands, he lands with his face flat on the icy wall. He immediately becomes comatose with a marked orbital hematoma. Witnesses later tell us that he had to be intubated and was “shaking.” Another bystander tells us that his left eye had a “blown pupil.” He is helicoptered out to the neurointensive care unit, where he stays for 26 days. Shown on film is the family receiving notification of the accident—accompanied by a request to grant permission for a ventriculostomy. We get a glimpse of Kevin’s MRI scan, which shows multiple, severe shearing lesions in the hippocampi and lesions peppered throughout the white matter. There is also an extensive intraventricular hemorrhage that likely prompted the ventriculostomy.
Neurosurgery: Supratentorial tumors
Published in Hemanshu Prabhakar, Charu Mahajan, Indu Kapoor, Essentials of Geriatric Neuroanesthesia, 2019
Monica S. Tandon, Kashmiri Doley, Daljit Singh
While most patients are operated on an elective basis, an emergency intervention may be required in those who develop an acute neurological deterioration (22). Patients with an obstructive hydrocephalus may undergo a temporary ventriculostomy or a ventriculoperitoneal (VP) shunt prior to the planned resection, or alternatively, may directly undergo a craniotomy and tumor resection, with the goal of relieving the hydrocephalus.
External ventricular drainage
Published in Hemanshu Prabhakar, Charu Mahajan, Indu Kapoor, Essentials of Anesthesia for Neurotrauma, 2018
The Neurocritical Care Society (NCS) recently published evidence-based guidelines for the management of EVDs to reduce the risk of infections.37 They recommend keeping the EVDs for the minimum time necessary and removing them as soon as the clinical situation allows.37,38 If the patient, however, needs continued monitoring, routine change of catheters is not recommended.39 Only one dose of antimicrobials prior to EVD insertion is sufficient, as the use of prophylactic antibiotics increases the risk of resistant organisms and Clostridium difficile colitis.40,41 Antimicrobial-impregnated catheters may reduce the risk of infection.42–44 Routine CSF sampling should be avoided and CSF analysis should be done only when clinically indicated.45,46 A bundled approach to the insertion and care of the patient with a ventricular drain helps in reduction of ventriculostomy-related infections, which includes aseptic insertion, tunneling of the catheter, use of impregnated catheters, minimal manipulation of the closed system, sterile dressings, and early weaning.47–49
The clinicopathological profile and value of multidisciplinary management of pediatric brain tumors in a low-income setting
Published in Pediatric Hematology and Oncology, 2023
Richard Nyeko, Joyce Balagadde Kambugu, Racheal Angom, Hussein Senyonjo, Solomon Kibudde, Fadhil Geriga, Jaques van Heerden
Only over a quarter (n = 10, 28.5%) of the children underwent surgical resection, of which 6 (17.1%) were gross total resections (GTR) and 4 (11.4%) were subtotal resections (STR). Seven (77.8%) of the children with craniopharyngioma had a cyst decompression procedure. Cerebrospinal fluid (CSF) diversion procedures to relieve intracranial pressure were performed in 15 (42.9%) of the cases, of which seven (20.0%) were ventriculoperitoneal shunts (VPS) and eight (22.9%) were endoscopic third ventriculostomy/external ventricular drain (ETV/EVD). A total of 10 (28.6%) of the children received chemotherapy, 6 (17.1%) received radiotherapy and 7 (20.0%) palliative treatment as part of multimodal therapy. As expected, multimodality treatment was also a common practice as shown in Table 4.
Tetraventricular hydrocephalus with aqueductal flow void: an overlooked entity having consistent improvement following endoscopic third ventriculostomy
Published in British Journal of Neurosurgery, 2023
Sushanta K. Sahoo, Sivashanmugam Dhandapani, Chirag K. Ahuja
Grade 4 included flow voids extending from the third ventricle across the aqueduct through the obex of the fourth ventricle. ETV was performed with a rigid endoscope. Ventriculostomy was performed between the mamillary bodies and infundibular recess with a perforator. A 0.2-ml balloon catheter was used to dilate the stoma.5 During the procedure, ventricular CSF was routinely sent for cytology, biochemistry, culture and sensitivity. All patients were evaluated in the follow-up period for clinical and radiological improvement. MRI was performed at 3 months follow-up period to assess the ventricular size and CSF flow pattern. Improvement of symptoms and nonrequirement of additional procedure for hydrocephalus was considered as successful third ventriculostomy. All similar patients of tetraventricular hydrocephalus without flow voids undergoing ETV were kept as controls.
Long tunnel external ventricular drain: an adjunct in the management of patients with infection associated hydrocephalus
Published in British Journal of Neurosurgery, 2019
Tobin George, Ranjith K. Moorthy, Vedantam Rajshekhar
Predisposing factors for EVD infection include prior craniotomy, synchronous systemic infection, duration for which drain was left in situ, depressed skull fracture, intraventricular haemorrhage, frequent sampling of CSF, and placement of drains outside the operating room as well as administration of prophylactic antibiotics.17,20–24 In one series, number of catheter days and repeated catheter insertion were independent risk factors for ventriculostomy associated infections on multivariate analysis.25 It has been reported that majority of the pathogens in EVD related infections are caused by the contact of the catheter with the skin that is breached during its placement.26Hence these infections occur during manipulation of the EVD drainage system, migration of the skin flora along the tract and lack of proper cleaning and dressing protocols.27,28While antibiotic coated catheters have been associated with reduced rate of colonization of EVD as well as positive CSF cultures5,28,29 the role of prophylactic antibiotics in preventing infection of EVD remains controversial as they may predispose to infection by more resistant organisms.23