Publication year: 2012
Source:World Neurosurgery
J. Humberto Tapia-Pérez, Jaime G. Torres-Corzo, Juan C. Chalita-Williams, Roberto Rodríguez-Della Vecchia, José Juan Sánchez-Rodríguez, Martín Sánchez-Aguilar
Objective In our previous study, we had suggested the usefulness of cerebral endoscopy as a therapeutic option for hydrocephalus due to neurocysticercosis (NCC). Now, we propose a scoring system for the assessment of the inflammatory alterations caused by NCC inside the ventricular cavities and the basal subarachnoid space. Methods We assessed the video recordings of the endoscopic procedures in patients with hydrocephalus due to NCC in a two-phase study. In the first phase (n=10), each patient's assigned score was correlated with the cerebrospinal fluid (CSF) values obtained by lumbar and ventricular puncture. Reproducibility was determined using an intraclass correlation coefficient (ICC). In the second phase (n=30), we tested the prognostic value of our score by comparing it to the patient's Karnofsky performance score (KPS) 3 months after endoscopy. Results The score included 4 main components: ependymal findings, number of involved sites, abnormalities in the subarachnoid space, and other alterations. These values were summed to produce a total score that correlated strongly with both protein and cell counts from ventricular CSF. The ICC of the global score was 0.85. In the second phase, the scores were divided into mild, moderate, and severe categories (6, 15, and 9 patients, respectively). The initial KPS was similar between the groups (p=0.56); however, when measured 3 months later, there were significant differences (p=0.02). The logistic regression analysis of patients with a score in the severe range (OR=0.09, 95% CI, 0.06–0.64) showed a reduced chance for achieving a good outcome (KPS > 90) after 3 months. Conclusions Our scoring system enables an endoscopic classification of the damage caused by NCC in the ventricular and basal subarachnoid space. The score has a biological basis and a good internal reproducibility. Furthermore, the score seems to be useful for determining the short-term prognosis, and patients with high scores would require additional therapeutic measures for improving their outcomes.
Source:World Neurosurgery
J. Humberto Tapia-Pérez, Jaime G. Torres-Corzo, Juan C. Chalita-Williams, Roberto Rodríguez-Della Vecchia, José Juan Sánchez-Rodríguez, Martín Sánchez-Aguilar
Objective In our previous study, we had suggested the usefulness of cerebral endoscopy as a therapeutic option for hydrocephalus due to neurocysticercosis (NCC). Now, we propose a scoring system for the assessment of the inflammatory alterations caused by NCC inside the ventricular cavities and the basal subarachnoid space. Methods We assessed the video recordings of the endoscopic procedures in patients with hydrocephalus due to NCC in a two-phase study. In the first phase (n=10), each patient's assigned score was correlated with the cerebrospinal fluid (CSF) values obtained by lumbar and ventricular puncture. Reproducibility was determined using an intraclass correlation coefficient (ICC). In the second phase (n=30), we tested the prognostic value of our score by comparing it to the patient's Karnofsky performance score (KPS) 3 months after endoscopy. Results The score included 4 main components: ependymal findings, number of involved sites, abnormalities in the subarachnoid space, and other alterations. These values were summed to produce a total score that correlated strongly with both protein and cell counts from ventricular CSF. The ICC of the global score was 0.85. In the second phase, the scores were divided into mild, moderate, and severe categories (6, 15, and 9 patients, respectively). The initial KPS was similar between the groups (p=0.56); however, when measured 3 months later, there were significant differences (p=0.02). The logistic regression analysis of patients with a score in the severe range (OR=0.09, 95% CI, 0.06–0.64) showed a reduced chance for achieving a good outcome (KPS > 90) after 3 months. Conclusions Our scoring system enables an endoscopic classification of the damage caused by NCC in the ventricular and basal subarachnoid space. The score has a biological basis and a good internal reproducibility. Furthermore, the score seems to be useful for determining the short-term prognosis, and patients with high scores would require additional therapeutic measures for improving their outcomes.
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