Cerebrospinal Fluid Formation Research Articles

CSF formation rate—a potential glymphatic flow parameter in hydrocephalus?

BackgroundStudies indicate that brain clearance via the glymphatic system is impaired in idiopathic normal pressure hydrocephalus (INPH). This has been suggested to result from reduced cerebrospinal fluid (CSF) turnover, which could be caused by a reduced CSF formation rate. The aim of this study was to determine the formation rate of CSF in a cohort of patients investigated for INPH and compare this to a historical control cohort.MethodsCSF formation rate was estimated in 135 (75 ± 6 years old, 64/71 men/women) patients undergoing investigation for INPH. A semiautomatic CSF infusion investigation (via lumbar puncture) was performed. CSF formation rate was assessed by downregulating and steadily maintaining CSF pressure at a zero level. During the last 10 min, the required outflow to maintain zero pressure, i.e., CSF formation rate, was continuously measured. The values were compared to those of a historical reference cohort from a study by Ekstedt in 1978.ResultsMean CSF formation rate was 0.45 ± 0.15 ml/min (N = 135), equivalent to 27 ± 9 ml/hour. There was no difference in the mean (p = 0.362) or variance (p = 0.498) of CSF formation rate between the subjects that were diagnosed as INPH (N = 86) and those who were not (N = 43). The CSF formation rate in INPH was statistically higher than in the reference cohort (0.46 ± 0.15 vs. 0.40 ± 0.08 ml/min, p = 0.005), but the small difference was probably not physiologically relevant. There was no correlation between CSF formation rate and baseline CSF pressure (r = 0.136, p = 0.115, N = 135) or age (-0.02, p = 0.803, N = 135).ConclusionsThe average CSF formation rate in INPH was not decreased compared to the healthy reference cohort, which does not support reduced CSF turnover. This emphasizes the need to further investigate the source and routes of the flow in the glymphatic system and the cause of the suggested impaired glymphatic clearance in INPH.

Mathematical model of the dependence between cerebral ventricular size and capillary pressure in laboratory animals

Aim: To adapt a mathematical model describing the interaction between fluid media and brain matter for the purpose of definition of the dependence between brain ventricle size and capillary pressure in laboratory animals of two genotypes, BALB/c and C57BL/6. Material and methods. The study included 4 male mice of each inbred strain C57BL/6 and BALB/c at the age of 12 weeks. The brain and cerebrospinal fluid system images were obtained using an 11.7 T horizontal MR scanner (Bruker, BioSpec 117/16 USR, Germany). An axial section at the level of -0.5 mm from bregma was chosen as the geometry for mathematical modelling. To describe the data obtained, the mathematical model was adapted by selecting a scale factor based on the known values of the cerebrospinal fluid formation rate for humans and mice. Results and discussion. The same qualitative pattern of relationship between capillary pressure and mean ventricular wall displacement was observed for all animals considered. Although the selected genetic strains of BALB/c and C57Bl mice differ significantly in terms of cerebral ventricle size, these differences in animal genotype did not affect the nature of this relationship. Changing the parameters of the fluid media interaction in the area of compression or moderate ventricular dilation almost does not lead to an exit from the physiologically acceptable capillary pressure value. In this case, the size of the ventricles changes significantly. In the area of large ventricular dilation, in contrast, there is little change in ventricular size, and this is accompanied by a dramatic increase in capillary pressure far beyond physiologic limits. Thus, the change in ventricular size is an adaptive process associated with pressure fluctuations caused by changes in intracranial fluid flow. The mere fact that some of the values reach the zone of physiologically unacceptable pressures associated, in fact, with death, provided that there is practically no change in ventricular size indicates that such a situation is rarely realized and is possible in case of violation of intracranial fluid media flows associated with the fact that the increase in ventricular size limits adaptive capabilities. Conclusions. The presented animal model will further increase the understanding of the pattern we have established and allow us to move on to attempts at prediction.

Mechanisms of neurovascular coupling

The brain is characterized by a well-developed vascular network and consumes a significant proportion of cardiac output relative to its mass. Normally, the metabolic needs of the brain significantly depend on the intensity of the functioning of its various departments, which requires constant regulation of the level of local blood flow. On the other hand, the state of systemic hemodynamics can have a significant impact on organ blood flow. Moreover, the importance of accurate and prompt regulation of cerebral blood flow is determined by the lack of energy reserves or substrates for its autonomous production in the nervous tissue and the huge role of the central nervous system in ensuring all physiological processes. In this regard, the organ cerebral blood flow has complex physiological mechanisms of regulation, which are implemented at various levels. At the same time, myogenic reactions are isolated, which occur when the degree of stretching of the smooth muscle cells of the vascular wall changes under the influence of pressure in the lumen of the vessel, as well as under the influence of local humoral effects, including those exerted by metabolites, on vascular tone at the level of the neurovascular unit. This review considers in detail the role of the neurovascular unit in the regulation of cerebral blood flow and the provision of the so-called neurovascular conjugation – a flexible dynamic correspondence between the level of local neuronal activity and the delivery of oxygen and nutrients. The mechanisms and essential importance of neurovascular coupling in the regulation of local cerebral blood flow, which ensures the development of functional hyperemia, as well as the performance several other functions, such as the delivery and removal of metabolites, temperature regulation, and the formation of cerebrospinal fluid, are demonstrated.

Disentangling the impact of cerebrospinal fluid formation and neuronal activity on solute clearance from the brain

BackgroundDespite recent attention, pathways and mechanisms of fluid transposition in the brain are still a matter of intense discussion and driving forces underlying waste clearance in the brain remain elusive. Consensus exists that net solute transport is a prerequisite for efficient clearance. The individual impact of neuronal activity and cerebrospinal fluid (CSF) formation, which both vary with brain state and anesthesia, remain unclear.MethodsTo separate conditions with high and low neuronal activity and high and low CSF formation, different anesthetic regimens in naive rat were established, using Isoflurane (ISO), Medetomidine (MED), acetazolamide or combinations thereof. With dynamic contrast-enhanced MRI, after application of low molecular weight contrast agent (CA) Gadobutrol to cisterna magna, tracer distribution was monitored as surrogate for solute clearance. Simultaneous fiber-based Ca2+-recordings informed about the state of neuronal activity under different anesthetic regimen. T2-weighted MRI and diffusion-weighted MRI (DWI) provided size of subarachnoidal space and aqueductal flow as surrogates for CSF formation. Finally, a pathway and mechanism-independent two-compartment model was introduced to provide a measure of efficiency for solute clearance from the brain.ResultsAnatomical imaging, DWI and Ca2+-recordings confirmed that conditions with distinct levels of neuronal activity and CSF formation were achieved. A sleep-resembling condition, with reduced neuronal activity and enhanced CSF formation was achieved using ISO+MED and an awake-like condition with high neuronal activity using MED alone. CA distribution in the brain correlated with the rate of CSF formation. The cortical brain state had major influence on tracer diffusion. Under conditions with low neuronal activity, higher diffusivity suggested enlargement of extracellular space, facilitating a deeper permeation of solutes into brain parenchyma. Under conditions with high neuronal activity, diffusion of solutes into parenchyma was hindered and clearance along paravascular pathways facilitated. Exclusively based on the measured time signal curves, the two-compartment model provided net exchange ratios, which were significantly larger for the sleep-resembling condition than for the awake-like condition.ConclusionsEfficiency of solute clearance in brain changes with alterations in both state of neuronal activity and CSF formation. Our clearance pathway and mechanism agnostic kinetic model informs about net solute transport, solely based on the measured time signal curves. This rather simplifying approach largely accords with preclinical and clinical findings.

Substituted furan sulfonamides as carbonic anhydrase inhibitors: Synthesis, biological and in silico studies

Carbonic Anhydrases (CAs) are a large family of zinc metalloenzymes that catalyze the reversible hydration of carbon dioxide involved in several of biological processes, such as respiration, calcification, acid-base balance, bone resorption, and the formation of aqueous humor, cerebrospinal fluid, saliva, and gastric acid. They show wide diversity in tissue distribution and in their subcellular localization. Fifteen novel furyl sulfonamides were designed, synthesized and evaluated against four human isoforms: hCA I, hCA II, hCA IV and hCA IX. Compounds appeared to be very active mostly against hCAI (8) and hCA IV (11) isoforms being more potent than reference drug acetazolamide (AAZ). It should be mentioned that four compounds were more active than AAZ against hCA IX isoform, with compound 13d to be selective against hCA I (SI 70), hCA II (SI 13.5) and hCA IV (SI 20). Furthermore, docking was performed for some of these compounds on all isoforms I order to understand the possible interactions with the active site. The most active compounds showed good bioavailability and drug likeness scores.

Multidetector Computed Tomographic Evaluation of Hydrocephalus

Introduction: Hydrocephalus is characterized by imbalance of cerebrospinal fluid formation and absorption. It is manifested as a dilatation of the ventricular system. Computed tomography (CT) is useful in determining the ventricular size and shape as well as the amount of the cerebral cortex present in the evaluation of suspected hydrocephalus. Aim and Objectives: Detection of hydrocephalus and determining the cause of hydrocephalus. Differentiating communicating from noncommunicating (obstructive) hydrocephalus. to assess the severity of the hydrocephalus and seek for any consequences. Materials and Methods: This prospective study included 50 patients referred to the Acharya Vinoba Bhave Rural Hospital, Sawangi (Meghe), Wardha, for 1 year. Patients clinically diagnosed with hydrocephalus were included in the study. Multidetector CT (MDCT) imaging was performed on Siemens 16 Slice MDCT machine. Multiplanar reformation and three-dimensional reconstruction were done wherever necessary. Results: 20% were diagnosed to have meningitis, 10% had Intraparenchymal haemorrhage and Intraventricular extension, 12% had aqueduct stenosis, and 12% had communicating hydrocephalus. In the study, 40% of them had communicating-type hydrocephalus or extraventricular obstructive hydrocephalus and 60% had obstructive hydrocephalus. On the CT scan, it was observed that at the lateral ventricle, dilatation was observed in four regions. Frontal horn dilatation (98%), body dilatation (98%), and 100% dilatation were seen at the temporal horn and occipital horn. Among 100 patients, 14% had cortical thinning and thus were classified as severe hydrocephalus with a poor prognosis, and 20% had periventricular edema. Conclusion: CT is the best means of obtaining images as it is easily available, fast, reliable, and compatible with standard life support devices.

Membrane transporters control cerebrospinal fluid formation independently of conventional osmosis to modulate intracranial pressure

BackgroundDisturbances in the brain fluid balance can lead to life-threatening elevation in the intracranial pressure (ICP), which represents a vast clinical challenge. Nevertheless, the details underlying the molecular mechanisms governing cerebrospinal fluid (CSF) secretion are largely unresolved, thus preventing targeted and efficient pharmaceutical therapy of cerebral pathologies involving elevated ICP.MethodsExperimental rats were employed for in vivo determinations of CSF secretion rates, ICP, blood pressure and ex vivo excised choroid plexus for morphological analysis and quantification of expression and activity of various transport proteins. CSF and blood extractions from rats, pigs, and humans were employed for osmolality determinations and a mathematical model employed to determine a contribution from potential local gradients at the surface of choroid plexus.ResultsWe demonstrate that CSF secretion can occur independently of conventional osmosis and that local osmotic gradients do not suffice to support CSF secretion. Instead, the CSF secretion across the luminal membrane of choroid plexus relies approximately equally on the Na+/K+/2Cl− cotransporter NKCC1, the Na+/HCO3− cotransporter NBCe2, and the Na+/K+-ATPase, but not on the Na+/H+ exchanger NHE1. We demonstrate that pharmacological modulation of CSF secretion directly affects the ICP.ConclusionsCSF secretion appears to not rely on conventional osmosis, but rather occur by a concerted effort of different choroidal transporters, possibly via a molecular mode of water transport inherent in the proteins themselves. Therapeutic modulation of the rate of CSF secretion may be employed as a strategy to modulate ICP. These insights identify new promising therapeutic targets against brain pathologies associated with elevated ICP.

Extracellular Nucleosomes Accelerate Microglial Inflammation via C-Type Lectin Receptor 2D and Toll-Like Receptor 9 in mPFC of Mice With Chronic Stress.

Damage-associated molecular patterns (DAMPs) are the primary promoter of progressive neuroinflammation and are associated with chronic stress-related emotional disorders. The present study investigated the role and mechanism of extracellular nucleosomes and histones, the newly defined DAMPs, in mice with chronic stress. C57BL/6 mice were exposed to chronic unpredictable mild stress (CUMS) and corticosterone drinking, respectively, for 4 weeks. Negative emotional behaviors were comprehensively investigated. Microglial morphology, oxidative stress, and inflammation, as well as C-type lectin receptor 2D (Clec2d) and Toll-like receptor 9 (TLR9) expression in medial prefrontal cortex (mPFC) were assessed with flow cytometer and cell sorting. Specifically, microglial pro-inflammatory activation and inflammation were further investigated with stereotactic injection of recombinant nucleosomes and histones in mPFC and further evaluated with AAV-Clec2d knocking-down, DNase I, and activated protein C (APC) pretreatment. Moreover, the rescue effect by AAV-Clec2d knocking-down was observed in mice with chronic stress. Mice with chronic stress were presented as obviously depressive- and anxiety-like behaviors and accompanied with significant microglial oxidative stress and inflammation, indicating by reactive oxygen species (ROS) production, primed nuclear factor-κB (NF-κB) signaling pathway, activated NACHT, LRR, and PYD domain–containing protein 3 (NLRP3) inflammasome, and upregulated Clec2d and TLR9 in mPFC, together with histones dictation in cerebrospinal fluid and extracellular trap formation. Stereotactic injection of nucleosomes was contributed to promote microglial inflammation rather than histones in mPFC, indicating that the pro-inflammatory role was derived from extracellular histones-bound DNA but not freely histones. AAV-Clec2d knocking-down, DNase I, and APC were all effective to inhibit nucleosome-induced microglial oxidative stress and inflammation. Moreover, AAV-Clec2d knocking-down in mice with chronic stress exhibited reduced microglial inflammation and improved negative emotional behaviors. Our findings reveal a novel mechanism of DAMP-associated inflammation that extracellular nucleosomes accelerate microglial inflammation via Clec2d and TLR9, and then contribute to chronic stress-induced emotional disorders.

THE MORPHOLOGY OF CHOROID PLEXUSES OF RATS’ BRAIN’S VENTRICLES AT THE FIRST YEAR OF THE DEVELOPMENT

Choroid plexuses of brain ventricles play a special role in the functioning of various brain structures and the formation of cerebrospinal fluid. Through the cerebrospinal fluid, biological, immunological, protective functions are realized. Any deficiency in its production in laboratory animals leads to malnutrition of the brain and spinal cord and impaired adaptive behavior. From this point of view, the study of the features of the structural organization of the choroid plexuses of the ventricles of the brain in laboratory animals in the age aspect seems relevant. The objects of the study were 134 white Wistar rats of different ages - 3, 10, 28 days and 5, 8, 12 months of postnatal development. A histological morphometric study of the choroid plexuses of the ventricles of the brain was carried out. To assess the age-related dynamics of the volume of the cerebral ventricles, sections were selected in which their cross-sectional area was maximum, the values ​​of the indicator were determined on digitized microphotographs with a fourfold increase by tracing the boundaries of the ventricles of subsequent calculations in the Image J morphometric computer program. Determination of volumetric fractions of the choroid plexuses in the ventricles of the brain was carried out stereologically on serial sections using an eyepiece grid with 60 equidistant intersection nodes at a magnification of 400 times. The results of the study indicate that after birth, the choroid plexuses of the ventricles of the brain of Wistar rats develop as an integral tissue system, the most intense changes were noted in the lateral ventricles during the first month of life of the animals. The lateral ventricles are characterized by an accelerated growth in size, outstripping the rate of development of the choroid plexuses. According to the calculations, the increase in the volume of the choroid plexus is largely due to the growth of blood vessels and connective tissue. In the III and IV ventricles, a similar trend is traced, but this process is less pronounced. Since the choroid plexuses are a source of cerebrospinal fluid formation, the revealed quantitative patterns indicate the age-related involution of the ventricles of the brain, which possibly leads to a decrease in the functional activity of their choroid plexuses and impaired cerebrospinal fluid dynamics.

Congenital hydrocephalus in a trisomy 9p gained child: a case report

BackgroundHydrocephalus caused by excessive liquor production due to choroid plexus hyperplasia is a rare condition that may necessitate unusual treatment paradigms. It can be seen in trisomy 9p where coexisting congenital heart disease additionally may complicate the therapeutic approach as illustrated in the current case report.Case presentationAt 20 months of age, a Caucasian girl with trisomy 9 and family history of an older brother and twin sister having the same syndrome displayed sign of congenital hydrocephalus due to increasing head circumference. Magnetic resonance imaging revealed enlarged lateral ventricles and a prominent choroid plexus, and the girl was treated with a ventriculoperitoneal shunt, which 2 days later had to be replaced with a ventriculoatrial shunt as cerebrospinal fluid formation greatly exceeded the ability of the patient’s abdominal absorptive capability. At 16 years of age, the patient was diagnosed with cardiomyopathy and diminished ejection fraction. Some months later, she was admitted to the neurosurgical ward showing signs of shunt dysfunction due to a colloid cyst in the third ventricle. Cystic drainage through endoscopic puncture only helped temporarily. Revision of the shunt system showed occlusion of the ventricular drain, and replacement was merely temporary alleviating. Intracerebral pressure was significantly increased at around 30 mmHg, prompting externalization of the drain, and measurements revealed high cerebrospinal fluid production of 60–100 ml liquor per hour. Thus, endoscopic choroid plexus coagulation was performed bilaterally leading to an immediate decrease of daily cerebrospinal fluid formation to 20–30 ml liquor per hour, and these values where stabilized by pharmaceutical treatment with acetazolamide 100 mg/kg/day and furosemide 1 mg/kg/day. Subsequently a ventriculoperitoneal shunt was placed. Follow-up after 1 and 2 months displayed no signs of hydrocephalus or ascites.ConclusionsHigh cerebrospinal fluid volume load and coexisting heart disease in children with trisomy 9p may call for endoscopic choroid plexus coagulation and pharmacological therapy to diminish the daily cerebrospinal fluid production to volumes that allow proper ventriculoperitoneal shunting.

Regulation of Ncbe in the Choroid Plexus of Mice after Hemorrhage‐Induced Hydrocephalus

The choroid plexus (CP) is a small tissue located inside brain ventricles. It is responsible for the production of most of the cerebrospinal fluid (CSF); approximately 500 mL of CSF per day in the adult human [1, 2]. CSF production occurs as a net result of transcellular movement of salt and water, carried out by various cellular transporters.Ncbe is a sodium‐coupled bicarbonate transporter located in the basolateral membrane of the choroid plexus epithelial (CPE) cells. It transports Na+ and HCO3‐ into the cell in exchange for Cl‐. Ncbe is the main sodium loader of the cell and CSF production is probably dependent on this transporter [3].Posthemorrhagic hydrocephalus (PHH) is a pathological state, caused by an accumulation of CSF in the ventricular system following intraventricular hemorrhage. CSF buildup is caused by a disproportion in CSF production and reabsorption. This leads to an expansion of the brain ventricles. Intraventricular hemorrhage (IVH) is known to cause inflammation in the CP, which is coupled to an over‐production of CSF [4‐6].Initially we hypothesized that IVH would stimulate Ncbe in the CPE through increased protein abundance as well as transporter activity. This would lead to increased CSF formation, similar to the response found after treatment with e.g. the cyclic‐AMP agonist forskolin [7]. Our preliminary data, however, suggest that Ncbe abundance is reduced by 24% (n=4, p=0.0329) in mice in the initial stages of PHH and then normalizes.The aim of this study is to investigate which role Ncbe plays in PHH and how Ncbe knock down affects CSF production in both healthy mice and a disease model.An adeno‐associated virus (AAV) shRNA knockdown vector system has been developed to knock down Ncbe gene expression by intracerebroventricular injections. Our preliminary data shows that the CPE cells incorporate the vector when tagged with GFP.We have established an IVH model and recording of CSF secretion rates in mice. Increased CSF formation rate was validated with ventriculo‐cisternal perfusion (data shown in figure). The resulting changes in ventricular volume will be investigated using magnetic resonance imaging (MRI).We propose that Ncbe knock down inhibits CSF production and could potentially target inflammation‐dependent hypersecretion by reducing the availability of the sodium supplying the apical transporters in the CP.

KORELASI HIDROSEFALUS BERDASARKAN PEMERIKSAAN CT SCAN DENGAN KLINIS DI RSUD TIARA KASIH SEJATI PEMATANGSIANTAR

Hydrocephalus is a complex disorder of the formation, flow, and absorption of cerebrospinal fluid (CSF), characterized by increased intracranial pressure, pathological dilatation of the cerebral ventricles, and excessive accumulation of CSF. This study describes the correlation of hydrocephalus degrees in children aged 0-12 with clinical manifestation through a head CT scan to measure the degree of mild, moderate, and severe hydrocephalus using the linear measurement. Research subjects according to age group < 6 years 62.8% and higher in males = 37.2%. Based on clinical manifestations, febrile seizures 48.5%, delayed development 31.3%, and decreased consciousness 20.1%. The average linear measurement values ​ with decreased consciousness were BCI = 0.650, VI = 0.38, FOHR = 0.829, FHR=0.045 and BFI=0.650. The average linear measurement values ​​compared to delayed development FHR, BCI and BFI were 0.500, 0.127, and 0.220, respectively, with the FOHR significance value = 0.109 and the VI significance value = 0.002. Linear measurement values compared to the degree of hydrocephalus with clinical manifestations of febrile convulsions were more in the moderate category, the decrease in consciousness was more in the mild category, while delayed development had more mild categories.

Improve correlation matrix of Discrete Fourier Transformation technique for finding the missing values of MRI images.

Missing values in the k-NN algorithm are a significant research concern, especially in low-grade tumours and CSF fluid, which are commonly identified in MRI scans. Missing values are usually ignored, but when data is mined, they can lead to bias and errors. In addition, the data is not missing at random. This study improves image accuracy, boosts the efficiency of missing k-NN hybrid values, and develops a research technique for detecting CSF fluid deposits in brain areas separated from non-tumor areas. We also offer a new method for detecting low-grade tumours or cerebrospinal fluid (CSF) formation in its early stages. In this study, we combine the hybrid K-Nearest Neighbor algorithm with the Discrete Fourier transform (DFT), as well as Time-Lagged analysis of four-dimensional (4D) MRI images. These dependencies exist in both space and time, but present techniques do not account for both sequential linkages and numerous types of missingness. To address this, we propose the DFLk-NN imputation method, which combines two imputation approaches based on a hybrid k-NN extension and the DFT to capture time-lag correlations both within and across variables. There are several types of missingness are enables the imputation of missing values across the variable even when all the data for a given time point is missing. The proposed method gives high accuracies of MRI datasets and retrieves the missing data in the images.

Drug Utilization Study of Diuretics in Children with Hydrocephalus

Hydrocephalus is a condition characterized by a dynamic imbalance between formation and absorption of cerebrospinal fluid that increases the size of intracranial space of the brain and, in some situations, an extension of the outer space of the brain with or without increased ventricular size. This study aimed to examine the use of diuretics and identify drug therapy problems in hospitalized children with hydrocephalus through the medical record. The study design is observational retrospective with time-limited sampling based on data in medical records at 2010-2013 periods, found 17 of 70 patients using diuretics therapy. There are three categories of diuretic which are used were mannitol (70.6%), acetazolamide (23.5%), and a combination of mannitol and acetazolamide (5.9%). Diuretics can be used for pre-op, post-op, and pre & post-op on all types of hydrocephalus. Still, the specific use of diuretics may be caused by variations in comorbid diagnoses, clinical data, and laboratory data for each patient. Adverse drug reactions are potentially dominant in DTP analysis, and these are 7 of 17 patients. Monitoring of serum electrolytes such as sodium and potassium is needed because it decreases are potential adverse drug reactions of diuretics.

Complications of Ventriculoperitoneal Shunts in Children with Pediatric Hydrocephalus a Local Study at Benha University Hospitals

Ventriculoperitoneal shunting is the main way used for extra-thecal cerebrospinal fluid (CSF) diversion. Despite being the main corner stone of treating different types of hydrocephalus, VP shunts has unfortunately a lot of complications making surgeries to treat these complications much more than initial shunt insertions.Methods:It is a clinical retrospective observational study that was conducted on 221 patients wth congenital hydrocephalus of both genders with age ranging from 0 to 18 yrs old who came with symptoms and signs of shunt complications and were primarily shunted at Benha university hospital between 2016 and 2019. A complete clinical assessment was done, history taking, a final diagnosis was made, and a treatment of individual patients was planned accordingly. Patients were followed up till the end of the study post-operatively. Data was analyzed using the SPSS (version 16.0). VP shunt was inserted for 221 patients. 113 (51.1%) patients had various forms of complications. Obstructive complications accounts for the most common complications as they happened in 48 (42.5%) of complicated patients followed by infective complications as they appeared in 27 (24%) patients.Conclusions: Despite .great revolution in the field of neurosurgery in the past 100 years and sincere efforts from neurosurgeons worldwide , shunt complications still common among shunted patients.Background Hydrocephalus is regarded as an imbalance in the formation and absorption of CSF to a sufficient magnitude producing accumulation of CSF fluid with in ventricular system of the brain leading to an elevation of intracranial pressure. Compensatory adjustments especially in very young subjects may occur that may reduce prevailing CSF pressure to normal range on count of functioning brain tissue [1]. Hydrocephalus is the second most common congenital brain malforma-tion [2].Congenital hydrocephalus is type of hydrocephalus that is present or its underlying cause at birth. majority of cases are attributed to aqueductal stenosis , chiarri malformation , dandy walker malformation ,arachnoid cyst. approximately 55% of all cases of congenital hydrocephalus are due to Primary aqueductal stenosis whereas aqueductal stenosis secondary to neoplasm, infection, or hemorrhage accounts for another 5% [4]. Till now , the standard treatment of hydrocephalus is ventriculoperitoneal shunt. The technique of using the peritoneal cavity for CSF absorption in ventriculoperitoneal shunting (VPS) was developed by Kausch in 1908 [3]. Al- though VPS insertion is the most common neurosurgical Procedure done worldwide, complication rates in Children are high ranging from 10% to 100% [11]. The advent of endoscopic third ventriculostomy has gained popularity due to the high complication and failure rates of ventriculoperitoneal shunt [12]. VP shunts are prone to a lot of complications such as mechanical blockage, shunt infection, shunt migration, and various abdominal complications[13].

Microsurgical Resection of a C1-C2 Dumbbell and Ventral Cervical Schwannoma: 2-Dimensional Operative Video.

Dumbbell schwannoma of the cervical spine is a known entity,1-5 and should be radically resected with the preservation or improvement of neurological function. However, to our knowledge, an operative video of a C1-C2 cervical dumbbell schwannoma with ventral extension and dorsal spinal cord compression has not been reported previously. This tumor resection video performed by the senior author (KIA) includes details of dural opening, and techniques for microsurgical resection and for postoperative closure to avoid cerebrospinal fluid (CSF) leak and pseudomeningocele formation.Fat grafting was performed through a small paraumbilical incision. The patient was prone in MAYFIELD 3-point pin fixation (Integra LifeSciences, Plainsboro Township, New Jersey). Intraoperative neurophysiological electrodes were placed for somatosensory evoked potential (SSEP) and motor evoked potential (MEP) monitoring. Stealth neuronavigation was used to aid in tumor localization. A small suboccipital craniectomy and C1 laminectomy were performed before opening the dura. Using a microsurgical technique, the dura was opened in the form of the letter “Y.” The right-sided dentate ligament was cut to aid in the mobilization of the tumor away from the spinal cord. After dividing the tumor at the dumbbell isthmus, the ventral tumor component was removed, with attention paid to the division of a perforator coming from the vertebral artery. Intraforaminal tumor debulking was performed with a cavitron ultrasonic surgical aspirator (CUSA) and resected.High cervical dumbbell schwannoma should be radically resected while preserving and improving preoperative neurological function. Avoidance of CSF leak and formation of pseudomeningocele should be planned at the beginning, utilizing fascia and fat graft to avoid this feared complication.The patient provided written consent and permission to publish her image.

Cerebrospinal fluid dynamics with its surgical implications

Cerebrospinal fluid (CSF) is largely (70-80%) produced by the choroids plexus of the ventricles and is considered as the plasma ultrafiltrate. While CSF formation, circulation, and composition appear to be physiological and physical, its absorption appears to be mainly physical. The formation, composition, circulation, absorption, and changes in pathological conditions of CSF are discussed briefly in this review article. The CSF pressure dynamics studies provide information about the tightness, elastance, or outflow resistance of the CSF in the CNS. We believe that the present study shall help to provide essential details of CSF physiology which are important to many disciplines including radiology, neurology, and neurosurgery.

Congenital Hydrocephalic Monster in an Indigenous Gir Calf: A Case Report

There are several types of fetal dropsy (fetal ascites, fetal anasarca, fetal hydrocephalus), which have obstetrical importance preventing normal easy delivery of calf. Hydrocephalus is one of the fetal causes of dystocia. It is characterized by an accumulation of fluid which may be in the ventricular system or between the brain and the subarachnoid space. The swelling or enlargement of cranium occurs as a result of an imbalance between formation and drainage of cerebrospinal fluid (Arthur et al., 2001). This congenital dropsical condition is associated with an autosomal recessive gene, whereas some cases are due to BVD-MD or bluetongue virus infection in bovine (Roberts, 1986). Though this dropsical condition is rare in Gir cattle, it is reported in many other species (Dhami et al., 2007; Kumar et al., 2010; Parmar et al., 2018). The present case report depicts an unusual instance of hydrocephalic monster in an indigenous Gir calf, causing dystocia, which was successfully managed by per vaginum.

AQP1 and AQP4 Contribution to Cerebrospinal Fluid Homeostasis.

Aquaporin 1 (AQP1), expressed in epithelial cells of the choroid plexus, and aquaporin 4 (AQP4) present in ependymal cells and glia limitants have been proposed to play a significant role in cerebrospinal fluid (CSF) production and homeostasis. However, the specific contribution of each water channel to these functions remains unknown, being a subject of debate during the last years. Here, we analyzed in detail how AQP1 and AQP4 participate in different aspects of the CSF homeostasis such as the load and drainage of ventricles, and further explored if these proteins play a role in the ventricular compliance. To do that, we carried out records of intraventricular pressure and CSF outflow, and evaluated ventricular volume by magnetic resonance imaging in AQP1−/−, AQP4−/−, double AQP1−/−-AQP4−/− knock out and wild type mice controls. The analysis performed clearly showed that both AQPs have a significant participation in the CSF production, and additionally revealed that the double AQP1-AQP4 mutation alters the CSF drainage and the ventricular compliance. The data reported here indicate a significant extra-choroidal CSF formation mediated by AQP4, supporting the idea of an important and constant CSF production/absorption process, sustained by efflux/influx of water between brain capillaries and interstitial fluid. Moreover, our results suggest the participation of AQPs in structural functions also related with CSF homeostasis such as the distensibility capacity of the ventricular system.

Utilizing real-time contrast medium to detect the fistula of giant spinal arachnoid cyst and treat with minimal invasive surgery

BackgroundSpinal arachnoid cysts are rare and have varied clinical manifestations depending on the affected spinal region and nerve roots. A complete cyst excision with fistula closure is the first choice of treatment. However, it might be difficult to localize the specific position of the fistula because previous images have no enhancements or the fistula is too tiny to be detected.Case presentationThis case is a giant lumbar extradural arachnoid cyst. We administered a lumbar injection with contrast medium into subarachnoid space under digital subtraction angiography (DSA) and disclosed the fistula. Confirming the location of fistula enabled us to perform minimally invasive surgery to ligate the fistula. Surgical intervention for a spinal arachnoid cyst might encounter the problem of the formation of a postoperative cerebrospinal fluid (CSF) fistula. We propose the option of detecting the fistula preoperatively for minimal invasive surgery. Recurrence depends on the long-term follow-up, and more cases are needed to further evaluate our technique.ConclusionsThe real-time contrast medium technique for spinal arachnoid cysts contributes to the complete ligation with minimally invasive surgery.