Sherri A Braksick1,2, Benjamin T Himes3, Kendall Snyder3, Jamie J Van Gompel3, Jennifer E Fugate4, Alejandro A Rabinstein4. 1. Division of Critical Care Neurology, Department of Neurology, Mayo Clinic, Rochester, MN, USA. braksick.sherri@gmail.com. 2. Department of Neurology, University of Kansas, 3901 Rainbow Blvd, Mail Stop 2012, Kansas City, KS, 66160, USA. braksick.sherri@gmail.com. 3. Department of Neurosurgery, Mayo Clinic, Rochester, MN, USA. 4. Division of Critical Care Neurology, Department of Neurology, Mayo Clinic, Rochester, MN, USA.
Abstract
BACKGROUND: Patients with posterior fossa lesions causing obstructive hydrocephalus present a unique clinical challenge, as relief of hydrocephalus can improve symptoms, but the perceived risk of upward herniation must also be weighed against the risk of worsening or continued hydrocephalus and its consequences. The aim of our study was to evaluate for clinically relevant upward herniation following external ventricular drainage (EVD) in patients with obstructive hydrocephalus due to posterior fossa lesions. METHODS: We performed a retrospective review of patients undergoing urgent/emergent EVD placement at our institution between 2007 and 2014, evaluating the radiographic and clinical changes following treatment of obstructive hydrocephalus. RESULTS: Even prior to EVD placement, radiographic upward herniation was present in 22 of 25 (88%) patients. The average Glasgow Coma Scale of patients before and after EVD placement was 10 and 11, respectively. Radiographic worsening of upward herniation occurred in two patients, and upward herniation in general persisted in 21 patients. Clinical worsening occurred in two patients (8%), though in all others the clinical examination remained stable (44%) or improved (48%) following EVD placement. Of the patients who had a worsening clinical exam, other variables likely also contributed to their decline, and cerebrospinal fluid diversion was likely not the main factor that prompted the clinical change. CONCLUSIONS: Radiographic presence of upward herniation was often present prior to EVD placement. Clinically relevant upward herniation was rare, with only two patients worsening after the procedure, in the presence of other clinical confounders that likely contributed as well.
BACKGROUND:Patients with posterior fossa lesions causing obstructive hydrocephalus present a unique clinical challenge, as relief of hydrocephalus can improve symptoms, but the perceived risk of upward herniation must also be weighed against the risk of worsening or continued hydrocephalus and its consequences. The aim of our study was to evaluate for clinically relevant upward herniation following external ventricular drainage (EVD) in patients with obstructive hydrocephalus due to posterior fossa lesions. METHODS: We performed a retrospective review of patients undergoing urgent/emergent EVD placement at our institution between 2007 and 2014, evaluating the radiographic and clinical changes following treatment of obstructive hydrocephalus. RESULTS: Even prior to EVD placement, radiographic upward herniation was present in 22 of 25 (88%) patients. The average Glasgow Coma Scale of patients before and after EVD placement was 10 and 11, respectively. Radiographic worsening of upward herniation occurred in two patients, and upward herniation in general persisted in 21 patients. Clinical worsening occurred in two patients (8%), though in all others the clinical examination remained stable (44%) or improved (48%) following EVD placement. Of the patients who had a worsening clinical exam, other variables likely also contributed to their decline, and cerebrospinal fluid diversion was likely not the main factor that prompted the clinical change. CONCLUSIONS: Radiographic presence of upward herniation was often present prior to EVD placement. Clinically relevant upward herniation was rare, with only two patients worsening after the procedure, in the presence of other clinical confounders that likely contributed as well.
Authors: Cameron M McDougall; Andrew Jack; Jean Raymond; Michel W Bojanowski; Tim E Darsaut Journal: Can J Neurol Sci Date: 2014-01 Impact factor: 2.104
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Authors: Júlia Moscardini-Martelli; Juan Antonio Ponce-Gomez; Victor Alcocer-Barradas; Samuel Romano-Feinholz; Pilar Padilla-Quiroz; Marcela Osuna Zazueta; Luis Alberto Ortega-Porcayo Journal: Surg Neurol Int Date: 2021-07-06