المؤلفون: Thompson, Dominic N. P., Spoor, Jochem, Schotman, Martje, Maestri, Susan, Craven, Claudia L., Desai, Divyesh

المصدر: Child's Nervous System; Jun2021, Vol. 37 Issue 6, p2025-2031, 7p

مصطلحات موضوعية: CONUS, LIPOMA, PROGNOSIS, UROLOGICAL surgery, MORPHOLOGY, SPINA bifida, OVERLAY dentures

مستخلص: Objective: Lumbosacral lipomas (LSL) of the 'dorsal' type have been associated with more favourable outcomes compared with other conus region lipomas. We hypothesised that integrity of the conus on MRI underpins the improved prognosis in this subgroup of LSL patients. Methods: The definition of 'dorsal lipomas' included lipomas with attachment to the conus, but where the conus could be delineated on MRI (Morota type 1) as reported by Morota et al. (J Neurosurg Pediatr 19:428–439, 2017). Additional inclusion criteria included asymptomatic status at presentation, age >3 years at follow-up, and neurological and urological evaluation at presentation and at last follow-up. Lipoma extent and conus level were recorded. Outcome measures were the need for untethering surgery and neuro-urological status at last follow-up. Urological outcomes were defined by continence and efficacy of bladder emptying. Results: Twenty-six children were included (median age 8.7 years). Conus level was low (at or below L2) in 92%. Nine required untethering surgery: 5 prophylactic, 4 because of clinical deterioration. Twenty-five children were continent at last follow-up, one had stress incontinence, and none required catheterisation. One had persisting ankle weakness after surgery requiring orthotic support. Conclusions: In LSL of the conus, visualisation of the conus on MRI is associated with good urological and motor outcomes. The integrity of the conus appears to be a more important prognostic factor than anatomical level. An observational approach to this group of LSL patients does not appear to compromise outcomes. These findings support a selective approach to untethering surgery. [ABSTRACT FROM AUTHOR]

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المؤلفون: Craven, Claudia¹ claudia.craven@gmail.com, Baudracco, Irene¹ irene.baudracco@gmail.com, Zetterberg, Henrik henrik.zetterberg@clinchem.gu.se, Lunn, Michael michael.lunn@uclh.nhs.uk, Chapman, Miles² miles.chapman@uclh.nhs.uk, Lakdawala, Neghat² neghat.lakdawala@uclh.nhs.uk, Watkins, Laurence¹ laurence.watkins@uclh.nhs.uk, Toma, Ahmed¹ ahmed.toma@uclh.nhs.uk

المصدر: Acta Neurochirurgica. Dec2017, Vol. 159 Issue 12, p2293-2300. 8p.

مصطلحات موضوعية: *HYDROCEPHALUS, *BRAIN diseases, *DANDY-Walker syndrome, *CEREBROSPINAL fluid, *NEUROSURGERY, *PROGNOSIS

مستخلص: Background: Idiopathic normal pressure hydrocephalus (INPH) has no reliable biomarker to assist in the selection of patients who could benefit from ventriculo-peritoneal (VP) shunt insertion. The neurodegenerative markers T-tau and Aβ1-42 have been found to successfully differentiate between Alzheimer's disease (AD) and INPH and therefore are candidate biomarkers for prognosis and shunt response in INPH. The aim of this study was to test the predictive value of cerebrospinal fluid (CSF) T-tau and Aβ1-42 for shunt responsiveness. In particular, we pay attention to the subset of INPH patients with raised T-tau, who are often expected to be poor surgical candidates. Methods: Single-centre retrospective analysis of probable INPH patients with CSF samples collected from 2006 to 2016. Index test: CSF levels of T-tau and Aβ1-42. Reference standard: postoperative outcome. ROC analysis assessed the predictive value. Results: A total of 144 CSF samples from INPH patients were analysed. Lumbar T-tau was a good predictor of post-operative mobility (AUROC 0.80). The majority of patients with a co-existing neurodegenerative disease responded well, including those with high T-tau levels. Conclusion: INPH patients tended to exhibit low levels of CSF T-tau, and this can be a good predictor outcome. However levels are highly variable between individuals. Raised T-tau and being shunt-responsive are not mutually exclusive, and such patients ought not necessarily be excluded from having a VP shunt. A combined panel of markers may be a more specific method for aiding selection of patients for VP shunt insertion. This is the most comprehensive presentation of CSF samples from INPH patients to date, thus providing further reference values to the current literature. [ABSTRACT FROM AUTHOR]