An adjustable gravitational valve for initial VP-shunt treatment in hydrocephalic preterm neonates and infants below 1 year of age

Child s Nervous System, Journal Year: 2021, Volume and Issue: 37(11), P. 3497 - 3507

Published: June 21, 2021

Abstract Objective Shunt treatment for hydrocephalus in children should aim sustainable flexibility regard to optional, perspective pressure level adjustment during advancing physical and mental development. Gravitation-assisted shunt valves are designed prevent hydrostatic over-drainage frequently observed the long course of shunt-treated hydrocephalus. We prospectively studied analyzed implication, safety, feasibility an adjustable gravitational unit combined with a fixed differential-pressure (DP) valve neonates infants primary shunted within first 12 months life. Methods Clinical hydrocephalic who received initial VP-shunt insertion early post-natal phase were monitored on basis our digital institutional Hydrocephalus & Registry. All patients equipped DP programmable activated upright body position. Patients minimum follow-up 24 considered further statistical analysis regarding etiology, surgical setting, pre- post-operative ventricular enlargement, head circumference, implication option unit, type number complications, revision-free survival. Results Seventy-eight pediatric at mean age 10 weeks gestationally corrected preterm neonates. was related perinatal IVH (64%), CNS malformation (11%), spina bifida (9%), congenital aqueductal stenosis idiopathic (4%) or post-infectious etiology (3%). Fifty-two (70%) presented history prematurity (gestational 23–36 weeks). Regular carried out period 63 demonstrated that enlargement decreased significantly after applied excessive growth could be counteracted effectively. At least one performed 31% all months, 42% 64% time last clinical since insertion. Pressure adjustments successful cases radiographic signs under- individual various ages entire course. Mean setting position 24.1 cm H 2 O increased 26.4 cmH follow-up. Revision-free shunt-survival rates 79% 70% valve-survival 91% 90%, respectively. Conclusion The combination utilized as first-line regimen feasible safe highly vulnerable subgroup infants. showed frequent increasing over beneficial even very developmental stage limited autonomous mobility. To knowledge this is ever reported long-term investigation age-consistent patient collective system.

Language: Английский

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Neurofluids – Deep Inspiration, Cilia and Preloading of the Astrocytic Network

Published: March 15, 2021

With the advent of real-time MRI, motion and passage cerebrospinal fluid can be visualized without gating exclusion low-frequency waves. This imaging modality gives insights into low-volume, rapidly oscillating cardiac-driven movement as well sustained, high-volume, slowly inspiration-driven movement.Inspiration means a spontaneous or artificial increase in intrathoracic dimensions independent body position. Alterations thoracic diameter enable spinal epidural venous compartments to emptied filled, producing an upward surge inside spine during inspiration; this counterbalances downward pooling blood toward heart.Real-time macroscale vivo observation method, could expand our knowledge neurofluid dynamics, including how astrocytic preloading is adjusted brain buoyancy turgor are maintained different postures zero gravity.Along with these findings, new microscale aquaporin-mediated transfer, its sensing by cilia tuning nitric oxide will reviewed. By incorporating clinical spanning several disciplines, certain disorders—congenital hydrocephalus Chiari malformation, idiopathic intracranial hypertension adult hydrocephalus—are interpreted reviewed according current concepts, from basics interrelated systems their pathology.

Language: Английский

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CSF Upward Motion Is Crucial for ETV Success

Published: Jan. 11, 2022

Purpose: ETV is indicated for treating obstructions of major CSF pathways. The outcome evaluation often yields success rates only +- 70% shunt independency. Hence, compromised absorption seems to occur more than expected. We searched parameters suitable assess the involved dynamics. Material and Methods: This was a prospective study in 58 paediatric patients (7.7 yrs. mean age) between 2000 2020 with aqueductal stenosis (11/58), obstruction aqueduct due tumor growth (22/58),and connatal hydrocephalus (9/58). average follow-up interval 4.7 years. Head circumferences, Evans- fronto-occipital horn ratios before 3 months after were obtained as Delta-indices. Furthermore score (ETVSS), patency pre- postoperatively well stoma assessed by flow void signs on MRI. Evaluation MRI also included shape floor 3rd ventricle whether or not septum pellucidum showed perforation. Four analysed via real-time At least educational status regarding protected unprotected education analyzed. Results:The prevalence bowing 72%, ETVSS 71.0%. In 26 children septal perforations an open prior (19) could be identified. Mean ER FOHR reduced 0.03 0.05 , respectively. Maintained (flow postop MRI) perforation successfully carried out during endoscopic surgery 44 (79%). disproportionate increase head circumference abated 79.4% patients. New insertion occurred 16 (27.5%). Intraoperatively upward detected all cases. Statistical analyses(ANOVA) significant results education, postoperative but stoma. Conclusion: identification through necessary sufficient condition success. our study, ventricular volumes used determine education. Furthermore, enabling driven inspiration crucial successful ETV.

Language: Английский

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Paediatric pineal region cysts: enigma or impaired neurofluid system?

Child s Nervous System, Journal Year: 2023, Volume and Issue: 39(12), P. 3457 - 3466

Published: June 1, 2023

Pineal region cysts (PCs) may affect the tectum and aqueduct cause deep central vein congestion. Beside headaches, PC often causes a broad range of symptoms, leading to prolonged diagnosis therapy. The aims this study are reveal parameters that might explain ambiguity symptoms identify factors in association with respiration-driven neurofluid system.This retrospective included 28 paediatric patients (mean age 11.6 years) who received surgical treatment 18 11.3 were followed conservatively. Symptoms, time diagnosis, cyst size, ventricular indices, head circumference postoperative outcome, analysed. Four investigated for CSF dynamics real-time MRI. mean follow-up was 1.6 years.The most common early onset headaches (92%), blurred vision (42.8%), sleep disturbances (39.3%) vertigo (32.1%). Tectum contact observed 82% patients, MRI examinations revealed imaging flow void signals absent 32.1% patients. maximal diameters 13.7 × 15.6 mm (mean). Together signal, 4 recovered their aqueductal upward flow, which not detectable preoperatively. After surgery main improved.Despite proximity frequently signals, hydrocephalus never detected. Data from depicted reduced preoperative filling compartments, indicating diminished fluid preload, postoperatively.

Language: Английский

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Paediatric Pineal Region Cysts: Enigma or Impaired Glymphatic Neurofluid System?

Published: May 12, 2022

Proposal: Pineal region cysts (PCs) may affect the tectum and aqueduct cause deep central vein congestion endocrine dysfunction. In addition to headaches, PC often causes a broad range of symptoms, leading prolonged diagnosis therapy. The aims this study are reveal parameters that might explain ambiguity symptoms identify factors association with respiration driven neurofluid preload system. Methods: This retrospective included 28 paediatric patients (mean age 11.6 years) who received surgical treatment for pineal 18 11.3 were followed conservatively. Multiple clinical patient characteristics, such as time neuroimaging diagnosis, cyst size, ventricular indices, head circumference postoperative outcome, analysed. Four investigated CSF dynamics real-time MRI. mean follow-up was 1.6 years. Results: most common early onset headaches (92%), blurred vision (42.8%), sleep disturbances (39.3%) vertigo (32.1%). Tectum contact observed in 82% patients, MRI examinations revealed imaging flow void signals absent 32.1% patients. diameters 13.7 mm axial axis 15.6 longitudinal axis. Together signal, 4 recovered their respiration-driven upward flow, which not detectable before OP. After operation 92.1% improved without any mortality or morbidity. Conclusion: Despite proximity frequently aqueductal signals, hydrocephalic enlargement never detected. Data from depicted reduced preoperative filling compartments, indicating diminished fluid preload, postoperatively.

Language: Английский

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