Eleven patients were discharged home, three to acute rehabilitation, and two patients to assisted living facilities. One patient died 135 days after surgery from complications related to diabetes insipidus. The median clinical followup was 4.35 months. sellekchem Fifteen patients (94%) had relief of their preoperative symptoms. Fourteen patients (88%) had preoperative headaches that improved after surgery. Eight of nine patients who presented with ventriculomegaly and obstructive hydrocephalus had ventricular decompression and restoration of cerebrospinal fluid flow without ventriculoperitoneal shunt (VPS) placement. One patient without hydrocephalus presented with simple partial seizures, which resolved after surgery. 3.2. Extent of Cyst or Tumor Resection All three arachnoid cysts and the pineal cyst were partially resected.
Of the intraventricular tumors, the large colloid cyst, epidermoid tumor including its capsule, immature teratoma, and the benign mixed astroglial cyst were resected in a gross total fashion. The remaining 8 intraventricular tumors were partially resected (Table 2). The pineal parenchymal tumor patient underwent fractionated intensity modulated radiotherapy (IMRT) for treatment of her residual tumor leading to complete resolution of her lesion ten months after treatment. Table 2 Extent of resection. Three patients were taken back to the operating room for a repeat neuroendoscopic approach to further resect their residual intraventricular tumor (one with a SEGA; one with a DNET; and one with a teratoma) and reestablish cerebral spinal fluid flow communication to avoid placement of a VPS.
In all three patients, during the initial procedure, neuroendoscopic resection with the variable aspiration tissue resector was stopped prematurely due to visualization problems after tumor bleeding. The intraventricular hemorrhage noted intraoperatively did not require conversion to an open craniotomy for hematoma evacuation in any of the patients. All three patients remained neurologically stable after their initial neuroendoscopic tumor resection. Placement of an EVD permitted clearing of blood from the ventricles prior to their second procedure. After discharge, no tumor or cyst has demonstrated recurrence or further needs for any surgical management. 3.3.
Restoration of CSF Communication Pathways All patients with intraventricular cysts had restoration of CSF communication pathways with resolution of their obstructive hydrocephalus. No patients with intraventricular Batimastat cysts required placement of a VPS. Restoration of CSF communication pathways was achieved in all tumor patients except for patient 2 who required placement of a VPS for persistent hydrocephalus and treatment of a pseudomeningocele. One patient was taken back to surgery for an endoscopic third ventriculostomy (ETV) and lysis of ventricular adhesions after inability to wean her EVD.
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