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Maroúsi, Greece

Constantini S.,Tel Aviv Medical Center | Sgouros S.,Mitera Childrens Hospital | Kulkarni A.,Hospital for Sick Children
World Neurosurgery

Objectives: The aim of this report is to review current data on the role of neuroendoscopy in infants. Specific emphasis will be given to the International Infant Hydrocephalus Study (IIHS). Previous studies, available information, and future directions are discussed. Methods: The IIHS is a major international endeavor comparing the results of endoscopic third ventriculostomy (ETV) to ventriculoperitoneal shunting in infants younger than 2 years of age. It is a prospective, randomized study, with a "parental preference" option, that recruits infants with aqueductal stenosis without a history of prematurity or other associated brain anomalies. The primary outcome measure is neurocognitive outcome at 5 years of age. In addition to IIHS data, we also looked at results of neuroendoscopy in infants with other indications, such as fourth ventricular outlet obstruction, Dandy Walker syndrome, etc. Results: The IIHS study includes more than 40 centers on all continents. To date, we have recruited more than 150 infants to the study. At this point we can only release limited data, namely that the complication rates are similar between the two arms. More patients are needed to finalize the study, with an endpoint of 250 children. Conclusions: Neuroendoscopy in infants can be performed with reasonable morbidity. The preferred indications in infants are still not totally refined, especially vis-a-vis shunting procedures. More international, multicenter efforts are required to clarify these points. © 2013 Elsevier Inc. All rights reserved. Source

Tsitouras V.,Mitera Childrens Hospital | Sgouros S.,Mitera Childrens Hospital | Sgouros S.,National and Kapodistrian University of Athens
Child's Nervous System

Introduction: Intraventricular/germinal matrix hemorrhage affects 7-30% of premature neonates, 25-80% of whom (depending on the grade of the hemorrhage) will develop hydrocephalus requiring shunting. Predisposing factors are low birth weight and gestational age. Material: There is increasing evidence for the role of TGF-β1 in the pathogenesis of hydrocephalus, but attempts to develop treatment modalities to clear the cerebrospinal fluid (CSF) from blood degradation products have not succeeded so far. Ultrasound is a valuable screening tool for high-risk infants and magnetic resonance imaging is increasingly utilized to differentiate progressive hydrocephalus from ex vacuo ventriculomegaly, evaluate periventricular parenchymal damage, decide on the surgical treatment of hydrocephalus, and follow up these patients in the long term. Treatment of increasing ventriculomegaly and intracranial hypertension in the presence of hemorrhagic CSF can involve a variety of strategies, all with relative drawbacks, aiming to drain the CSF while gaining time for it to clear and the neonate to reach term and become a suitable candidate for shunting. Eventually, patients with progressive ventriculomegaly causing intracranial hypertension, who have reached term and their CSF has cleared from blood products, will need shunting. Conclusion: Cognitive long-term outcome is influenced more by the effect of the initial hemorrhage and other perinatal events and less by hydrocephalus, provided that this has been addressed timely in the early postnatal period. Shunting can have many long-term side effects due to mechanical complications and overdrainage. In particular, patients with posthemorrhagic hydrocephalus are more susceptible to multiloculated hydrocephalus and encysted fourth ventricle, both of which are challenging to treat. © 2011 Springer-Verlag. Source

Charalambides C.,Mitera Childrens Hospital | Sgouros S.,Mitera Childrens Hospital
Pediatric Neurosurgery

Ventriculoperitoneal shunt malfunction is a relatively common problem encountered in shunted hydrocephalic patients and is attributed most frequently to mechanical obstruction of the ventricular catheter. We present the case of a rare cause of mechanical obstruction of the peritoneal catheter due to the spontaneous formation of a knot just underneath the abdominal wound. This occurred 1 year after shunt implantation and is thought to have been caused by a combination of plastic material memory and bowel peristaltic movements. This case brings for discussion the role of radiographic investigation of the shunt system in children who present with suspected shunt obstruction. Radiographic investigation is warranted in children who have unusual shunt arrangements (e.g. Y-connectors and multiple catheters) in order to exclude disconnections or those who develop shunt problems years after implantation, to exclude material fracture in the neck or migration of any kind. In shunt systems which have been implanted for shorter time periods, the need for radiographs is less apparent. Some surgeons proclaim that when clinical circumstances fall outside the realms of obvious possible proximal obstruction, radiographic evaluation of the shunt system should be considered. Copyright © 2013 S. Karger AG, Basel. Source

Papagiannis J.,Mitera Childrens Hospital | Papadopoulou K.,Papageorgiou General Hospital | Rammos S.,Onassis Cardiac Surgery Center | Katritsis D.,Athens Euroclinic
Hellenic Journal of Cardiology

Introduction: Cryoablation is used increasingly for the treatment of atrioventricular nodal reentrant tachycardia (AVNRT). We sought to compare the long-term outcomes of cryoablation (Cryo) vs. radiofrequency (RF) ablation for the treatment of AVNRT in children. Methods: Two groups of consecutive patients were analyzed retrospectively: the RF group, 20 patients (60% males, mean age 13.25 ± 2.59 years), and the Cryo group, 20 patients (55% males, mean age 12.17 ± 3.07 years). Follow up was 52.7 ± 16.5 months for the RF and 32.8 ± 11.9 months for the Cryo group. Results: Acute success rates (100% for RF vs. 90% for Cryo), procedural times (147.75 ± 37.15 min for RF vs. 184.4 ± 75.59 min for Cryo), and fluoroscopy times (10.9 ± 6.46 min for RF vs. 6.41 ± 6.92 min for Cryo) were not statistically significantly different between the two groups. The number of lesions was significantly higher in RF than in Cryo (8.85 ± 6.63 vs. 3.6 ± 1.9, p=0.007). Transient AV block during ablation occurred in 1 patient in each group. No permanent AV block was observed. Recurrence rate was 10% in the RF and 27.7% in the Cryo group (p=0.222) occurring up to 14 months after the procedure. Conclusion: Cryoablation is safe and effective for the treatment of AVNRT in pediatric patients, but there is a tendency for higher recurrence rates compared to radiofrequency ablation. Techniques to reduce recurrence rates after cryoablation are needed. Source

Tzifa A.,Mitera Childrens Hospital | Momenah T.,Prince Salman Heart Center | Al Sahari A.,Prince Salman Heart Center | Al Khalaf K.,Prince Salman Heart Center | And 2 more authors.

Aims: Transcatheter implantation of valved stents (Melody and Edwards valves) for replacement of the pulmonary valve is currently an established procedure. We reviewed our experience on implantation of such valves in the tricuspid valve position. Methods and results: Transcatheter valve implantation in the tricuspid position was attempted in five patients. Four patients had predominantly tricuspid valve regurgitation, two of whom also had tricuspid valve stenosis. All patients had severely symptomatic right heart failure. Patient median age and weight were 12 years and 50 kg (range six-43 years and 13-68 kg, respectively). All patients had a bioprosthetic valve already in place. The mean gradient across the tricuspid valve decreased from 12 to 3 mmHg after the procedure. Median procedure time and fluoroscopy time were 100 and 39 min (range 60-180 and 30-57 min, respectively). The patients' functional class improved from NYHA Class III to II in three and from Class III to I in two patients during a followup period of 15-22 months. Conclusions: Transcatheter replacement of malfunctioning bioprosthetic valves in the tricuspid position using valved stents is an attractive alternative to repeat surgery in hig-hrisk or multioperated patients. Longer follow-up and a larger number of patients are required to establish the long-term benefit of the procedure and freedom from reinterventions. Source

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