Acutely Trapped Ventricle: Clinical Significance and Benefit from Surgical Decompression
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ORIGINAL ARTICLE
Acutely Trapped Ventricle: Clinical Significance and Benefit from Surgical Decompression Gabriel L. Pagani-Este´vez1 • Philippe Couillard1 • Giuseppe Lanzino2 Eelco F. M. Wijdicks1 • Alejandro A. Rabinstein1
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Ó Springer Science+Business Media New York 2015
Abstract Background Focal ventricular obstruction—trapped ventricle—results in cerebrospinal fluid accumulation, mass effect and possible clinical deterioration. There are no systematic studies on the benefit of surgical decompression in adults. Methods We reviewed patients admitted with acutely trapped ventricle on brain imaging to assess their prognosis and the effect of surgical intervention on 30-day mortality. Results Of the 392 patients with trapped ventricle, the most common causes were brain tumor (45 %), intracerebral hemorrhage (ICH) (20 %), and subdural hematoma (SDH) (14 %). Lateral ventricle trapping accounted for 97 % of cases. Two hundred and twenty-one patients (56 %) received a surgical intervention for trapped ventricle or its causes; 126 (83 %) were treated with craniotomy, 26 (17 %) with craniectomy, 30 (14 %) with external ventricular drain (EVD) alone, 23 (10 %) with ventriculoperitoneal shunt alone, and 16 (7 %) with endoscopic fenestration of the septum pellucidum. Surgical intervention was associated with mortality reduction from 95 % (n = 54) to 48 % (n = 11) in the ICH group, from 47 % (n = 27) to 12 % (n = 15) in the tumor group and from 90 % (n = 18) to 20 % (n = 7) in the SDH group (p < 0.001 for all comparisons). Univariate logistic analysis showed that surgical intervention and tumor etiology were associated with decreased mortality while age, ICH & Alejandro A. Rabinstein [email protected] 1
Department of Neurology, Mayo Clinic, 200 1st Street SW, Rochester, MN 55905, USA
2
Department of Neurosurgery, Mayo Clinic, Rochester, MN, USA
etiology, intraventricular hemorrhage, midline shift, and anticoagulation were associated with increased mortality. On multivariate logistic regression, surgical intervention remained associated with decreased mortality (p < 0.0001; OR 0.20, 95 % CI 0.09–0.42). On subgroup analysis of the ICH cohort, surgical intervention was also associated with decreased mortality (p = 0.028). Conclusions Neurosurgical intervention for decompression in patients with trapped ventricle can have a measurable beneficial effect on early mortality. Keywords Hydrocephalus Trapping Ventricular Surgery Ventriculostomy Outcome Mortality
Introduction Trapped ventricle refers to focal or compartmentalized hydrocephalus usually caused by obstruction from a mass lesion. Choroid plexus secretion of cerebrospinal fluid (CSF) into an obstructed ventricle results in focal dilatation, mass effect, and neurologic decline. Trapping has been described at the lateral ventricle due to foramen of Monro obstruction, the temporal horn from trigone obstruction and the fourth ventricle (FV) from obstruction at the foramina of Luschka, Magendie, and the Aqueduct of Sylvius. Acute ventricular trap
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