1 / 40

An Overview of Neurosurgery and Spina Bifida

An Overview of Neurosurgery and Spina Bifida. Joseph H Piatt, Jr, MD, FAAP Section of Neurosurgery. Spina Bifida and Neurosurgery. better CSF shunts better CSF shunt surgery removal of CSF shunts avoidance of CSF shunts Chiari malformation type 2 spinal cord complications.

amy
Télécharger la présentation

An Overview of Neurosurgery and Spina Bifida

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. An Overview ofNeurosurgeryandSpina Bifida Joseph H Piatt, Jr, MD, FAAP Section of Neurosurgery

  2. Spina Bifida and Neurosurgery • better CSF shunts • better CSF shunt surgery • removal of CSF shunts • avoidance of CSF shunts • Chiari malformation type 2 • spinal cord complications

  3. CSF shunts • 85 – 90% prevalence among MM pts • shunt failure: acute or insidious • > 1 / 3 fail in first year • 5 – 10% infection rate per operation • 1 – 2% mortality (!) per failure • exacerbation of CM2 / syringomyelia

  4. Better CSF Shunts • the Shunt Design Trial • Bioglide • programmable valves

  5. differential pressure Delta Orbis-Sigma

  6. Better CSF Shunt Surgery • the Endoscopic Shunt Insertion Trial • ultrasound • image guidance • shaveless CSF shunt surgery

  7. * * * * * * * * * * * * * * * * *

  8. Shaveless CSF Shunt Surgery • Horgan MA, Piatt JH Jr. Shaving of the scalp may increase the rate of infection in CSF shunt surgery. Pediatr Neurosurg 1997;26:180-184. • Winston KR. Hair and neurosurgery. Neurosurgery 1992;31:320-329.

  9. Removal of CSF Shunts:Endoscopic 3rd Ventriculostomy • If it ain’t broke, don’t fix it. • E3V for CSF shunt failure • urgent • “elective” for slit ventricle • E3V for CSF shunt infection

  10. Management of Shunt Failure with E3V • Cinalli G. The role of endoscopic third ventriculostomy in the management of shunt malfunction. Neurosurgery 1998;43:1323-7. • Teo C. Management of hydrocephalus by endoscopic third ventriculostomy in patients with myelomeningocele. Pediatr Neurosurg 1996;25:57-63.

  11. Management of Shunt Infection with E3V • Jones R. Third ventriculostomy for shunt infections in children. Neurosurgery 1993;32:855-9. • Fukuhara T. Risk factors for failure of endoscopic third ventriculostomy for obstructive hydrocephalus. Neurosurgery 2000;46:1100-9.

  12. Management of “Slit Ventricle Syndrome” with E3V • Baskin J. Ventricular shunt removal: the ultimate treatment of the slit ventricle syndrome. J Neurosurg 1998;88:478-84. • Reddy, K. Slit ventricle syndrome with aqueduct stenosis: third ventriculostomy as definitive treatment. Neurosurgery 1988;23:756-9.

  13. E3V shunts

  14. Avoidance of CSF Shunts:Antenatal MM Repair • Rationale • Expected benefit – lower extremities • Observations – Chiari • Putative benefit – hydrocephalus • Risks and ethical issues

  15. Avoidance of CSF Shunts:the MRCT • Vanderbilt, CHoP, UCSF • NO repairs outside trial! • Endpoint – CSF shunt insertion • adjudication • Secondary endpoints • “Freezing” of technology

  16. Chiari malformation type 2 • posterior fossa too small • hindbrain developmentally abnormal • medullary dysfunction – infancy • Compression? • medullary dysfunction – later • CSF shunt failue? • syringomyelia

  17. pf

  18. Spinal Complications • syringomyelia / syringobulbia • spinal arachnoid cyst • diastematomyelia • dermoid cyst • tethering

  19. *

  20. Spinal Cord Tethering • progressive neurological deficits • pain • bladder dysfunction • a diagnosis of exclusion • surgical risks and benefits

More Related