nach oben

Child's Nervous System

Erschienen in:

01.08.2003 | Original Paper

In utero surgery for hydrocephalus

verfasst von: Cornelia S. von Koch, Nalin Gupta, Leslie N. Sutton, Peter P. Sun

Erschienen in: Child's Nervous System | Ausgabe 7-8/2003

Einloggen, um Zugang zu erhalten

Abstract

Introduction

Neonatal hydrocephalus is one of the most common congenital anomalies affecting the nervous system.

Discussion

Currently, ultrasonography allows for early detection of fetal ventriculomegaly and presents the family with several treatment options: termination of pregnancy, early delivery and neonatal shunting, and delivery at term followed by shunting. Despite ventricular decompression after birth, the cognitive outcome is variable as prolonged in utero hydrocephalus has a detrimental effect. In the early 1980s, fetal intervention was explored with the intention of improving outcome. However, patient selection was poor. Fetal ventriculomegaly from other conditions was not adequately distinguished from fetal hydrocephalus. In addition, fetal surgical techniques were not advanced. Consequently, the results were poor and a de facto moratorium on fetal shunting was imposed. However, recent improvements in fetal imaging, such as magnetic resonance imaging, and advances in fetal surgical techniques offer the possibility that properly selected fetuses with hydrocephalus can benefit from an in utero intervention.

Amacher AL, Reid WD (1984) Hydrocephalus diagnosed prenatally. Outcome of surgical therapy. Childs Brain 11:119–125PubMed

Amato M, Huppi P, Durig P, Kaiser G, Schneider H (1990) Fetal ventriculomegaly due to isolated brain malformations. Neuropediatrics 21:130–132PubMed

Ammar A, Al-Jama F, Rahman S, Enizi AR, Mauzan Y, Sibai H (1996) Prolonged intrauterine transabdominal ventricular external drainage. A method to decompress dilated fetal ventricles. Minim Invasive Neurosurg 39:1–3PubMed

Arora A, Bannister CM, Russell S, Rimmer S (1998) Outcome and clinical course of prenatally diagnosed cerebral ventriculomegaly. Eur J Pediatr Surg 8 [Suppl 1]:63–64

Babson SG, Benda GI (1976) Growth graphs for the clinical assessment of infants of varying gestational age. J Pediatr 89:815–818

Benacerraf BR, Birnholz JC (1987) The diagnosis of fetal hydrocephalus prior to 22 weeks. J Clin Ultrasound 15:531–536PubMed

Birnholz JC, Frigoletto FD (1981) Antenatal treatment of hydrocephalus. N Engl J Med 304:1021–1023PubMed

Boynton BR, Boynton CA, Merritt TA, Vaucher YE, James HE, Bejar RF (1986) Ventriculoperitoneal shunts in low birth weight infants with intracranial hemorrhage: neurodevelopmental outcome. Neurosurgery 18:141–145PubMed

Braun KP, Vandertop WP, Gooskens RH, Tulleken KA, Nicolay K (2000) NMR spectroscopic evaluation of cerebral metabolism in hydrocephalus: a review. Neurol Res 22:51–64PubMed

10.

Cambria S, Gambardella G, Cardia E, Cambria M (1984) Experimental endo-uterine hydrocephalus in foetal sheep and surgical treatment by ventriculo-amniotic shunt. Acta Neurochir (Wien) 72:235–240

11.

Chervenak FA, Duncan C, Ment LR, Hobbins JC, McClure M, Scott D, Berkowitz RL (1984) Outcome of fetal ventriculomegaly. Lancet 2:179–181PubMed

12.

Chervenak FA, Berkowitz RL, Tortora M, Hobbins JC (1985) The management of fetal hydrocephalus. Am J Obstet Gynecol 151:933–942PubMed

13.

Clewell WH (1985) Intra-uterine shunting procedures. Br J Hosp Med 34:149–153PubMed

14.

Clewell WH, Johnson ML, Meier PR, Newkirk JB, Hendee RW Jr, Bowes WA Jr, Zide SL, Hecht F, Henry G, O'Keeffe D (1981) Placement of ventriculo-amniotic shunt for hydrocephalus in a fetus. N Engl J Med 305:955

15.

Clewell WH, Johnson ML, Meier PR, Newkirk JB, Zide SL, Hendee RW, Bowes WA Jr, Hecht F, O'Keeffe D, Henry GP, Shikes RH (1982) A surgical approach to the treatment of fetal hydrocephalus. N Engl J Med 306:1320–1325PubMed

16.

Cochrane DD, Myles ST, Nimrod C, Still DK, Sugarman RG, Wittmann BK (1985) Intrauterine hydrocephalus and ventriculomegaly: associated anomalies and fetal outcome. Can J Neurol Sci 12:51–59PubMed

17.

Copper RL Goldenber RL, Creasy RK, DuBard MB, Davis RO, Entman SS, Iams JD, Cliver SP (1993) A multicenter study of preterm birth weight and gestational age-specific neonatal mortality. Am J Obstet Gynecol 168:78–84PubMed

18.

Del Bigio M (1993) Neuropathological changes caused by hydrocephalus. Acta Neuropathol (Berl) 85:573–585

19.

Del Bigio MR, Bruni JE (1988) Changes in periventricular vasculature of rabbit brain following induction of hydrocephalus and after shunting. J Neurosurg 69:115–120PubMed

20.

Del Bigio MR, Kanfer JN, Zhang YW (1997) Myelination delay in the cerebral white matter of immature rats with kaolin-induced hydrocephalus is reversible. J Neuropathol Exp Neurol 56:1053–1066PubMed

21.

Del Bigio MR, Bruni JE, Fewer HD (1985) Human neonatal hydrocephalus: an electron microscopic study of the periventricular tissue. J Neurosurg 63:56–64PubMed

22.

Denkhaus H, Winsberg F (1979) Ultrasonic measurement of the fetal ventricular system. Radiology 131:781–787PubMed

23.

Depp R, Sabbagha RE, Brown JT, Tamura RK, Reedy NJ (1983) Fetal surgery for hydrocephalus: successful in utero ventriculoamniotic shunt for Dandy-Walker syndrome. Obstet Gynecol 61:710–714PubMed

24.

Desmond ME, Jacobson AG (1977) Embryonic brain enlargement requires cerebrospinal fluid pressure. Dev Biol 57:188–198PubMed

25.

Dorovini-Zis K, Dolman CL (1977) Gestational development of the brain. Arch Pathol Lab Med 101:192–180

26.

Draper CE, Owen-Lynch PJ, Bannister CM, Miyan J (2001) Proliferation of cerebral cortical cells from the hydrocephalic HTx rat: an in vitro study. Eur J Pediatr Surg 11 [Suppl 1]:S51–S52

27.

Drugan A, Krause B, Canady A, Zador IE, Sacks AJ, Evans MI (1989) The natural history of prenatally diagnosed cerebral ventriculomegaly. JAMA 261:1785–1788CrossRefPubMed

28.

Edwards MS, Harrison MR, Halks-Miller M, Nakayama DK, Berger MS, Glick PL, Chinn DH (1984) Kaolin-induced congenital hydrocephalus in utero in fetal lambs and rhesus monkeys. J Neurosurg 60:115–122PubMed

29.

Elster A (1994) Does MR imaging have any known effects on the developing fetus? Am J Roentgenol 162:1493

30.

Engum SA, Grosfeld JL (1998) Necrotizing enterocolitis. Curr Opin Pediatr 10:123–130PubMed

31.

Escobar GJ, Littenberg B, Petitti DB (1991) Outcome among surviving very low birthweight infants. Arch Dis Child 66:204–211PubMed

32.

Fahmi F, Schmerler S, Hutcheon RG (1994) Hydrocephalus in an infant with trisomy 22. J Med Genet 31:141–144PubMed

33.

Farrell TA, Hertzberg BS, Kliewer MA, Harris L, Paine SS (1994) Fetal lateral ventricles: reassessment of normal values for atrial diameter at US. Radiology 193:409–411PubMed

34.

Filly RA, Goldstein RB (1994) The fetal ventricular atrium: fourth down and 10 mm to go. Radiology 193:315–317PubMed

35.

Filly RA, Goldstein RB, Callen PW (1991) Fetal ventricle: importance in routine obstetric sonography. Radiology 181:1–7

36.

Frigoletto FD Jr, Birnholz JC, Greene MF (1982) Antenatal treatment of hydrocephalus by ventriculoamniotic shunting. JAMA 248:2496–2497CrossRefPubMed

37.

Gardner E, O'Rahilly R, Prolo P (1975) The Dandy-Walker and Arnold-Chiari malformations. Arch Neurol 32:393–407PubMed

38.

Garzetti GG, Rosati P, Angelozzi P, Exacoustos C, Mancuso S (1988) Proposal of an experimental model of fetal hydrocephalus. J Neurosurg Sci 32:93–97PubMed

39.

Girard N, Raybaud C, Poncet M (1995) In vivo MR study of brain maturation in normal fetuses. Am J Neuroradiol 16:407–413PubMed

40.

Giuffre R, Palma L, Fontana M (1986) Infantile nontumoral aqueductal stenosis. J Neurosurg Sci 30:41–46PubMed

41.

Glick PL, Harrison MR, Halks-Miller M, Adzick NS, Nakayama DK, Anderson JH, Nyland TG, Villa R, Edwards MS (1984) Correction of congenital hydrocephalus in utero. II. Efficacy of in utero shunting. J Pediatr Surg 19:870–881PubMed

42.

Glick PL, Harrison MR, Nakayama DK, Edwards MS, Filly RA, Chinn DH, Callen PW, Wilson SL, Golbus MS (1984) Management of ventriculomegaly in the fetus. J Pediatr 105:97–105PubMed

43.

Glinianaia SV, Rankin J (1999) Congenital hydrocephalus: occurrence and outcome. A population-based study in the North of England, 1985–1996. Northern Congenital Abnormality Survey Steering Group. Eur J Pediatr Surg 9 [Suppl 1]:46

44.

Gomez DG, DiBenedetto AT, Pavese AM, Firpo A, Hershan DB, Potts DG (1982) Development of arachnoid villi and granulations in man. Acta Anat (Basel) 111:247–258

45.

Gupta JK, Bryce FC, Lilford RJ (1994) Management of apparently isolated fetal ventriculomegaly. Obstet Gynecol Surv 49:716–721PubMed

46.

Habib Z (1981) Genetics and genetic counselling in neonatal hydrocephalus. Obstet Gynecol Surv 36:529–534PubMed

47.

Hale PM, McAllister JP II, Katz SD, Wright LC, Lovely TJ, Miller DW, Wolfson BJ, Salotto AG, Shroff DV (1992) Improvement of cortical morphology in infantile hydrocephalic animals after ventriculoperitoneal shunt placement. Neurosurg 31:1085–1096

48.

Halliday J, Chow CW, Wallace D, Danks DM (1986) X linked hydrocephalus: a survey of a 20 year period in Victoria, Australia. J Med Genet 23:23–31PubMed

49.

Hanigan WC, Morgan A, Shaaban A, Bradle P (1991) Surgical treatment and long-term neurodevelopmental outcome for infants with idiopathic aqueductal stenosis. Childs Nerv Syst 7:386–390PubMed

50.

Hanlo PW, Gooskens RJ, van Schooneveld M, Tulleken CA, van der Knaap MS, Faber JA, Willemse J (1997) The effect of intracranial pressure on myelination and the relationship with neurodevelopment in infantile hydrocephalus. Dev Med Child Neurol 39:286–291PubMed

51.

Harrison MR, Filly RA, Golbus MS, Berkowitz RL, Callen PW, Canty TH, Catz C, Clewell WH, Depp R, Edwards MS, Fletcher JC, Frigoletti FD, Garrett WJ, Johnson ML, Jonsen A, De Lorimier AA, Liley WA, Mahoney MJ, Manning FD, Meier PR, Michejda M, Makayama DK, Nelson L, Newkirk JB, Pringle K, Rodeck C, Rosen MA, Schulman JD (1982) Fetal treatment 1982. N Engl J Med 307:1651–1652PubMed

52.

Hertzberg BS, Kliewer MA, Bowie JD (1997) Fetal cerebral ventriculomegaly: misidentification of the true medial boundary of the ventricle at US. Radiology 205:813–816PubMed

53.

Hilpert PL, Hall BE, Kurtz AB (1995) The atria of the fetal lateral ventricles: a sonographic study of normal atrial size and choroid plexus volume. Am J Roentgenol 164:731–734

54.

Hirsch JF (1994) Consensus: long-term outcome in hydrocephalus. Childs Nerv Syst 10:64–69PubMed

55.

Hirsch JF, Pierre-Kahn A, Renier D, Sainte-Rose C, Hoppe-Hirsch E (1984) The Dandy-Walker malformation: a review of 40 cases. J Neurosurg 61:515–522PubMed

56.

Hudgins RJ, Edwards MS, Goldstein R, Callen PW, Harrison MR, Filly RA, Golbus MS (1988) Natural history of fetal ventriculomegaly. Pediatrics 82:692–697PubMed

57.

James HE, Bejar R, Merritt A, Gluck L, Coen R, Mannino F (1984) Management of hydrocephalus secondary to intracranial hemorrhage in the high risk newborn. Neurosurgery 14:612–618PubMed

58.

Johnson ML, Dunne MG, Mack RA, Rashbaum CL (1980) Evaluation of fetal intracranial anatomy by static and realtime ultrasound. J Clin Ultrasound 8:311–318PubMed

59.

Jones H (1980) Intercellular pores between ependymal cells lining the roof of the fourth ventricle in mammalian fetuses. Z Kinderchir 37:130–133

60.

Jones HC, Harris NG, Briggs RW, Williams SC (1995) Shunt treatment at two postnatal ages in hydrocephalic H-Tx rats quantified using MR imaging. Exp Neurol 133:144–152CrossRefPubMed

61.

Jouet M (1996) The role of genetics in understanding hydrocephalus and spina bifida. An update. Eur J Pediatr Surg 6:35–36

62.

Kalidasan V, Carroll T, Allcut D, Fitzgerald RJ (1995) The Dandy-Walker syndrome: a 10 year experience of its management and outcome. Eur J Pediatr Surg 5:16–18PubMed

63.

Kirkinen P, Serlo W, Jouppila P, Ryynanen M, Martikainen A (1996) Long-term outcome of fetal hydrocephaly. J Child Neurol 11:189–192PubMed

64.

Levine D, Barnes PD, Sher S, Semelka RC, Li W, McArdle CR, Worawattanakul S, Edelmann RR (1998) Fetal fast MR imaging: reproducibility, technical quality, and conspicuity of anatomy. Radiology 206:549–554PubMed

65.

Levitsky DB, Mack LA, Nyberg DA, Shurtleff DB, Shields LA, Nghiem HV, Cyr DR (1995) Fetal aqueductal stenosis diagnosed sonographically: how grave is the prognosis? Am J Roentgenol 164:725–730

66.

Manning FA, Harrison MR, Rodeck C (1986) Catheter shunts for fetal hydronephrosis and hydrocephalus. Report of the International Fetal Surgery Registry. N Engl J Med 315:336–340PubMed

67.

Mashayekhi F, Bannister CM, Miyan JA (2000) Possible role of CSF in a developmental abnormality associated with early-onset hydrocephalus. Eur J Pediatr Surg 10 [Suppl 1]:S39–S40

68.

Massicotte EM, Buist R, Del Bigio MR (2000) Altered diffusion and perfusion in hydrocephalic rat brain: a magnetic resonance imaging analysis. J Neurosurg 92:442–447PubMed

69.

McAllister JP II, Chovan P (1998) Neonatal hydrocephalus. mechanisms and consequences. Neurosurg Clin N Am 9:73–93PubMed

70.

McClone DG, Naidich TP (1992) Developmental morphology of the subarachnoid space, brain vasculature, and contiguous structures, and the cause of the Chiari II malformation. Am J Neuroradiol 13:463–482PubMed

71.

McDuffie RS Jr (1994) Complete trisomy 9: case report with ultrasound findings. Am J Perinatol 11:80–84PubMed

72.

Michejda M (1989) Neurobehavioral development of in utero treated hydrocephalic monkeys. Z Kinderchir 44 [Suppl 1]:52

73.

Michejda M, Hodgen GD (1981) In utero diagnosis and treatment of non-human primate fetal skeletal anomalies. I. Hydrocephalus. JAMA 246:1093–1097CrossRefPubMed

74.

Michejda M, Patronas N, Di Chiro G, Hodgen GD (1984) Fetal hydrocephalus. II. Amelioration of fetal porencephaly by in utero therapy in nonhuman primates. JAMA 251:2548–2552PubMed

75.

Michejda M, Bayne K, Schneider M, Suomi S (1991) Functional and structural recovery of the brain in in utero treated hydrocephalic monkeys: follow-up of neurobehavioral development. Contrib Gynecol Obstet 18:157–176PubMed

76.

Miyazawa T, Sato K (1991) Learning disability and impairment of synaptogenesis in HTX-rats with arrested shunt-dependent hydrocephalus. Childs Nerv Syst 7:1085–1096

77.

Muller F, O'Rahilly R (1988) The development of the human brain from a closed neural tube at stage 13. Anat Embryol 177:203–224PubMed

78.

Nakayama DK, Harrison MR, Berger MS, Chinn DH, Halks-Miller M, Edwards MS (1983) Correction of congenital hydrocephalus in utero. I. The model: intracisternal kaolin produces hydrocephalus in fetal lambs and rhesus monkeys. J Pediatr Surg 18:331–338PubMed

79.

Nicolaides KH, Berry S, Snijders RJ, Thorpe-Beeston JG, Gosden C (1990) Fetal lateral cerebral ventriculomegaly: associated malformations and chromosomal defects. Fetal Diagn Ther 5:5–14PubMed

80.

Oi S, Ijichi A, Matsumoto S (1989) Immunohistochemical evaluation of neuronal maturation in untreated fetal hydrocephalus. Neurol Med Chir (Tokyo) 29:989–994

81.

Oi S, Matsumoto S, Katayama K, Mochizuki M (1990) Pathophysiology and postnatal outcome of fetal hydrocephalus. Childs Nerv Syst 6:338–345PubMed

82.

Oi S, Yamada H, Sato O, Matsumoto S (1996) Experimental models of congenital hydrocephalus and comparable clinical problems in the fetal and neonatal periods. Childs Nerv Syst 12:292–302PubMed

83.

Oi S, Honda Y, Hidaka M, Sato O, Matsumoto S (1998) Intrauterine high-resolution magnetic resonance imaging in fetal hydrocephalus and prenatal estimation of postnatal outcomes with "perspective classification". J Neurosurg 88:685–694PubMed

84.

Oi SZ, Yamada H, Kimura M, Ehara K, Matsumoto S, Katayama K, Mochizuki M, Uetani Y, Nakamura H (1990) Factors affecting prognosis of intrauterine hydrocephalus diagnosed in the third trimester—computerized data analysis on controversies in fetal surgery. Neurol Med Chir (Tokyo) 30:456–461

85.

O'Rahilly R, Gardner E (1981) Initial development of the human brain. Bibl Anat 19:140–141PubMed

86.

O'Rahilly R, Muller F (1986) The meninges in human development. J Neuropathol Exp Neurol 45:588–608PubMed

87.

Osaka K, Handa H, Matsumoto S, Yasuda M (1980) Development of the cerebrospinal fluid pathway in the normal and abnormal human embryos. Childs Brain 6:26–38PubMed

88.

Patel MD, Filly AL, Hersh DR, Goldstein RB (1994) Isolated mild fetal cerebral ventriculomegaly: clinical course and outcome. Radiology 192:759–764PubMed

89.

Pilu G, De Palma L, Romero R, Bovicelli L, Hobbins JC (1986) The fetal subarachnoid cisterns: an ultrasound study with report of a case of congenital communicating hydrocephalus. J Ultrasound Med 5:365–372PubMed

90.

Pretorius DH, Davis K, Manco-Johnson ML, Manchester D, Meier PR, Clewell WH (1985) Clinical course of fetal hydrocephalus: 40 cases. Am J Roentgenol 144:827–831

91.

Pretorius DH, Drose JA, Manco-Johnson ML (1986) Fetal lateral ventricular ratio determination during the second trimester. J Ultrasound Med 5:121–124PubMed

92.

Quinn TM, Hubbard AM, Adzick NS (1998) Prenatal magnetic resonance imaging enhances fetal diagnosis. J Pediatr Surg 33:553–558PubMed

93.

Raimondi AJ, Soare P (1974) Intellectual development in shunted hydrocephalic children. Am J Dis Child 127:664–671PubMed

94.

Renier D, Sainte-Rose C, Pierre-Kahn A, Hirsch JF (1988) Prenatal hydrocephalus: outcome and prognosis. Childs Nerv Syst 4:213–222PubMed

95.

Revel MP, Pons JC, Lelaidier C, Fournet P, Vial M, Musset D, Labrune M, Frydman R (1993) Magnetic resonance imaging of the fetus: a study of 20 cases performed without curarization. Prenat Diagn 13:775–799PubMed

96.

Reynolds JE, Pernoll ML, Gill WL, Nadell J, Frost A, Mabie W (1985) Fetal hydrocephalus: a case of ventricular-amniotic shunting. South Med J 78:203–204PubMed

97.

Ribeiro MC, Brunoni D (1987) Terminal deletion 1q43 in a newborn with hydrocephalus. Ann Genet 30:126–128PubMed

98.

Robson S, McCormack K, Rankin J (1998) Prenatally detected mild/moderate cerebral ventriculomegaly: associated anomalies and outcome. Northern Congenital Abnormality Survey Steering Group. Eur J Pediatr Surg 8 Suppl 1:70–71

99.

Rosseau GL, McCullough DC, Joseph AL (1992) Current prognosis in fetal ventriculomegaly. J Neurosurg 77:551–555PubMed

100.

Rubin RC, Hochwald GM, Tiell M, Liwnicz BH (1976) Hydrocephalus. II. Cell number and size, and myelin content of the pre-shunted cerebral cortical mantle. Surg Neurol 5:115–118PubMed

101.

Sawaya R, McLaurin RL (1981) Dandy-Walker syndrome: clinical analysis of 23 cases. J Neurosurg 55:89–98PubMed

102.

Schoenwolf GC, Desmond ME (1984) Neural tube occlusion precedes rapid brain enlargement. J Exp Zool 230:405–407PubMed

103.

Serlo W, Kirkinen P, Jouppila P, Herva R (1986) Prognostic signs in fetal hydrocephalus. Childs Nerv Syst 2:93–97PubMed

104.

Siedler DE, Filly RA (1987) Relative growth of the higher fetal brain structures. J Ultrasound Med 6:573–576PubMed

105.

Simon EM, Goldstein RB, Coakley FV, Filly RA, Broderick KC, Musci TJ, Barkovich AJ (2000) Fast MR imaging of fetal CNS anomalies in utero. Am J Neuroradiol 21:1688–1698PubMed

106.

Strain L, Brock DJ, Bonthron DT (1994) Prenatal diagnosis of X-linked hydrocephalus. Prenat Diagn 14:415–416

107.

Twining P, Jaspan T, Zuccollo J (1994) The outcome of fetal ventriculomegaly. Br J Radiol 67:26–31PubMed

108.

Vergani P, Locatelli A, Strobelt N, Cavallone M, Ceruti P, Paterlini G, Ghiini A (1998) Clinical outcome of mild fetal ventriculomegaly. Am J Obstet Gynecol 178:218–222PubMed

109.

Vetsika EK, Bannister CM, Buckle AM, Miyan JA (1999) The effects of CSF blockage in early-onset hydrocephalus on the activity of the germinal epithelium. Eur J Pediatr Surg 9:43–44PubMed

110.

Villani R, Tomei G, Gaini SM, Grimoldi N, Spagnoli D, Bello L (1995) Long-term outcome in aqueductal stenosis. Childs Nerv Syst 11:180–185PubMed

111.

Villani RM, Gaini SM, Giovanelli M, Tomei G, Sganzerla EP, Zavanone M (1986) Treatment of non-neoplastic stenosis of the aqueduct of Sylvius with extrathecal CSF shunts. J Neurosurg Sci 30:55–60PubMed

112.

Vintzileos AM, Campbell WA, Weinbaum PJ, Nochimson DJ (1987) Perinatal management and outcome of fetal ventriculomegaly. Obstet Gynecol 69:5–11PubMed

113.

Walker ME, Lynch-Salamon DA, Milatovich A, Saal HM (1996) Prenatal diagnosis of ring chromosome 6 in a fetus with hydrocephalus. Prenat Diagn 16:857–861CrossRefPubMed

114.

Weller RO, Shulman K (1972) Infantile hydrocephalus: clinical, histological, and ultrastructural study of brain damage. J Neurosurg 36:255–267PubMed

115.

Wilson J (1936) On the nature and mode of origin of the foramen of Magendie. J Anat 71:423–426

Titel: In utero surgery for hydrocephalus
verfasst von: Cornelia S. von Koch
Nalin Gupta
Leslie N. Sutton
Peter P. Sun
Publikationsdatum: 01.08.2003
Verlag: Springer-Verlag
Erschienen in: Child's Nervous System / Ausgabe 7-8/2003
Print ISSN: 0256-7040
Elektronische ISSN: 1433-0350
DOI: https://doi.org/10.1007/s00381-003-0775-4

Neu im Fachgebiet Chirurgie

Wie erfolgreich ist eine Re-Ablation nach Rezidiv?

23.04.2024 Ablationstherapie Nachrichten

Nach der Katheterablation von Vorhofflimmern kommt es bei etwa einem Drittel der Patienten zu Rezidiven, meist binnen eines Jahres. Wie sich spätere Rückfälle auf die Erfolgschancen einer erneuten Ablation auswirken, haben Schweizer Kardiologen erforscht.

Hinter dieser Appendizitis steckte ein Erreger

23.04.2024 Appendizitis Nachrichten

Schmerzen im Unterbauch, aber sonst nicht viel, was auf eine Appendizitis hindeutete: Ein junger Mann hatte Glück, dass trotzdem eine Laparoskopie mit Appendektomie durchgeführt und der Wurmfortsatz histologisch untersucht wurde.

Mehr Schaden als Nutzen durch präoperatives Aussetzen von GLP-1-Agonisten?

23.04.2024 Operationsvorbereitung Nachrichten

Derzeit wird empfohlen, eine Therapie mit GLP-1-Rezeptoragonisten präoperativ zu unterbrechen. Eine neue Studie nährt jedoch Zweifel an der Notwendigkeit der Maßnahme.

Ureterstriktur: Innovative OP-Technik bewährt sich

19.04.2024 EAU 2024 Kongressbericht

Die Ureterstriktur ist eine relativ seltene Komplikation, trotzdem bedarf sie einer differenzierten Versorgung. In komplexen Fällen wird dies durch die roboterassistierte OP-Technik gewährleistet. Erste Resultate ermutigen.

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Aktuelle BDC Leitlinien-Webinare

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

Karpaltunnelsyndrom BDC Leitlinien Webinare

CME: 2 Punkte

Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis

S2e-Leitlinie „Distale Radiusfraktur“

Radiusfraktur BDC Leitlinien Webinare

CME: 2 Punkte

Das Webinar beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske

Dr. med. Benjamin Meyknecht

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

Appendizitis BDC Leitlinien Webinare

CME: 2 Punkte

Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric

Springer Medizin

Abstract

Introduction

Discussion

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 7-8/2003

The etiology of neural tube defects: the role of folic acid

Abortion for fetal CNS malformations: religious aspects

Current status of prenatal management of fetal spina bifida in the world: worldwide cooperative survey on the medico-ethical issue

Fetal MRI: normal gestational landmarks for cerebral biometry, gyration and myelination

Lumbosacral lipomas: in utero diagnosis and prognosis

XXXI Annual Meeting of the International Society for Pediatric Neurosurgery, Monaco, 14-18 September 2003

Update Chirurgie