Shanti Shankar Praharaj

Endoscopic third ventriculostomy in the management of Chiari I malformation and syringomyelia associated with hydrocephalus

BACKGROUND Chiari malformation with syringomyelia is conventionally managed with foramen magnum decompression and duroplasty. In presence of hydrocephalus, a ventriculoperitoneal shunt insertion has been the initial preferred mode of treatment. METHODS Two patients of Chiari I malformation with syringomyelia who had associated hydrocephalus were initially treated with endoscopic third ventriculostomy (ETV). RESULTS At follow up, both the patients symptomatically improved. Repeat MRI studies revealed collapse of the syrinx cavity and reduction of the Chiari malformation. CONCLUSIONS Chiari malformation and syrinx associated with hydrocephalus may be effectively managed with endoscopic third ventriculostomy.

Hydrocephalus in Paget’s disease

SummaryNeurological manifestations in Paget’s disease are rare. Hydrocephalus is infrequent, its etiology in Paget’s disease being multi-factorial. Surgical and anesthetic procedures may be challenging, requiring special precautions. We describe one such case and discuss these peculiarities. An elderly lady, diagnosed to have Paget’s disease presented with features of recent onset dementia, gait disturbances with urinary incontinence. Hydrocephalus secondary to posterior fossa crowding was present. A ventriculo-peritoneal shunt was inserted. Endotracheal intubation proved to be difficult. Modification of the surgical technique was required to ensure a safe procedure. She improved immediately following CSF diversion. Timely CSF diversion yields good results. Certain precautions during anesthesia and surgery can ensure a safe and uneventful peri-operative period.