Common Cause Of Hydrocephalus Research Articles

Evaluation of Shunt-Related Ventriculitis in Infants

Aims: Shunt-related infections are resistant to antibiotics. This study examined patients aged under two years after ventriculitis. It is the first study on ventriculitis developed in a completely closed system (without skin defect infection, or puncture history), evaluating infants only. Method: The study included 13 subjects (four females) with ventriculitis who had undergone surgery for hydrocephalus during the neonatal period and were monitored for shunt infection, evaluating certain parameters. Results: Ventriculitis developed on an average of 2.8 months after surgery. The most common causes of hydrocephalus were spina bifida and intraventricular hemorrhage. Bacteria grown in culture included Staphylococcus epidermidis, Staphylococcus aureus, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Serratia marcescens. Seven (53.8%) patients were treated without complications. Among other patients, three (23.1%) developed multilocular cystic hydrocephalus and three (23.1%) exhibited decreased cerebrospinal fluid production and did not require shunting. Conclusions: Patients receiving intraventricular therapy showed no complications, warranting further studies on early intraventricular therapy. In the presence of gram-negative bacterial growth, cerebrospinal fluid production may decrease and affected patients do not require shunts.

The outcome of surgical management of post-infectious hydrocephalus with multiple intraventricular septations

ObjectivesPost-infection hydrocephalus with multiple intraventricular septations is a complex issue in neurosurgery, with multiple treatment options available. The authors reviewed the results of neuroendoscopic cyst wall fenestration for managing this disease.Materials and MethodsMedical records of 76 patients with post-infection hydrocephalus and multiple intraventricular septations who underwent endoscopic treatment were collected and analyzed.ResultsThe patient group consisted of 40 males (52.6%) and 36 females (47.4%), with a mean age of 22.36 months (range: 4–132 months). Bacterial meningitis was the most common cause of hydrocephalus with multiple intraventricular septations in 37 patients (48.6%), while 24 patients had post-shunt infection (31.6%) that was complicated with multiloculated hydrocephalus. After confirming clearance of CSF infection, all patients underwent ventriculoscopic cyst fenestration and insertion of a ventriculoperitoneal shunt to create a single communicating system drained by one ventricular catheter. Fifty-five patients underwent De novo shunt implantation, while 20 patients required shunt revision. Endoscopy reduced the shunt revision rate from 3.4 per year before fenestration to 0.4 per year after fenestration. During the mean follow-up period of 7.7 months (range: 1–20 months), complications were reported in 13 patients (17.1%), including CSF leakage in eight (10.5%), VPS malfunction in five (6.5%), and two deaths (2.6%).ConclusionThe authors concluded that neuroendoscopic fenestration with the aid of CSF drainage by intraventricular catheter is an effective treatment for managing multiloculated post-infection hydrocephalus with much lower rates of morbidity and mortality than traditional procedures.

Systemic Review: Neurological Deficits following Ventriculoperitoneal Shunt (VPS) Insertion.

A reduction in fluid absorption or an obstruction of normal outflow is a common cause of hydrocephalus. It typically requires medical attention, which frequently entails the placement of a ventriculoperitoneal shunt (VPS) to lower intracranial pressure. We intend to list the few, documented examples of neurological impairments resulting from the installation of a VPS in this systematic study. Two search engines (PubMed and Cochrane) were used to conduct a systematic review from 1975 to December 12, 2021. The following search terms were employed: neurological deficits or neurological injury or palsies or thalamus or tract or longitudinal fasciculus or somatotropy or fasciculus or hearing loss or hemisensory or cortico AND ventriculoperitoneal shunt or VPS AND hydrocephalus. The inclusion criteria included VPS, neurological deficits, and human participants. The exclusion criteria included ventriculoarterial shunt, lumboperitoneal shunt, nonhuman subjects, and infection. Twenty trials in total, including a total of 25 patients, were included. There were 17 case report studies. A total of 35/785 patients (4.46%) experienced neurological impairments. In 9/25 (36%) of shunt cases had one of the three recognized causes: trapped fourth ventricle, dandy walker, or syringomyelia. Most of the patients developed VI, VII nerve palsies 11/25 (44%) followed by weakness, cerebellar symptoms, and VI nerve palsy. The brainstem was seen to be the most often injured structure (15/25; 60%), followed by deep brain structures (thalamus, basal ganglia, and white matter tracts; 20%). Even though ventriculoperitoneal shunting is a routine and straightforward treatment, issues can still arise. Although rare, there have been reports of cranial nerve impairments, therefore care should be taken.

Ventriculoperitoneal Shunt Surgery for Hydrocephalus: One of the Common Neurosurgical Procedures and Its Related Problems.

Objective This study was conducted to assess the outcome in patients with hydrocephalus who underwent ventriculoperitoneal (VP) shunt surgery. Methods This retrospective study was conducted at the neurosurgery department of a tertiary care hospital. The time frame was three years and five months from January 2017 to May 2020 with a follow-up of six months. Results This study included 1030 patients, out of whom 64.2% were male and 35.8% were female. While the majority of the patients were more than 11 years of age (466), age did not have any significant impact on the outcome of the ventriculoperitoneal shunt surgery. The most common cause of hydrocephalus was congenital (47.6%). A good outcome was seen in 63.4%, mortality was 10.6%, and complications were identified for 25.8%. The underlying pathology had a significant impact on the outcome in our study (p-value < 0.05) where the congenital cause of hydrocephalus showed a better outcome than any other cause. Conclusion Ventriculoperitoneal shunt is a good way to manage hydrocephalus, but there is always a high risk of complications.

Endoscopic third ventriculostomy

Introduction. Endoscopic third ventriculostomy (ETV) is the treatment of choice in obstructive hydrocephalus. It has become the main standard choice in management since 1962. However, there is scant data regarding the complications from clinical or multi-centre trials. This study highlights the specific complications and prevention methods related to ETV in Neurosurgical Teaching Hospital, Baghdad, Iraq. Methods. It is a prospective case series study conducted on cases in the Neurosurgical Teaching Hospital in Baghdad, Iraq, from January 2014- October 2019. We selected ninety patients. The sample selection was convenient as any patients admitted in the study period who met the selection criteria were included. All included patients underwent a Computerized Tomography scan or Magnetic Resonance Imaging in the periprocedural management. Results. Ninety cases have 59 (65.5%) females and 31 (34.5%) males. The most common cause of hydrocephalus is congenital causes (51 cases (56.6%), especially within the first decade of life. Aqueduct stenosis is the leading cause in 37 cases (72%). ETV complications were found in 32 cases (35.5%). The most common cause of complications is congenital cases of 14 (15%). Intraoperative complications include bleeding (mild, moderate, and severe) in 18 cases (20%). Mild bleeding constitutes 15 cases (16.6%) of all complicated cases. Conclusion. ETV is a standard procedure in the management of obstructive hydrocephalus. The complication rate is found in around one-third of the cases in our study. Surgeons’ selection of indicated patients and better surgical experience decrease the failure rate of ETV and complications.

A Prospective Study On Ventriculoperitoneal Shunt Surgery Complications In Tertiary Care Hospital

Background and Aim: Hydrocephalus is defined as enlargement in ventricles size due to the increase in cerebrospinal fluid volume. Impaired cerebrospinal fluids in terms of absorption and pathways obstruction or subarachnoid spaces are the different causes for hydrocephalus. Ventriculoperitoneal shunt is the most prevalent performed treatment modality on elective or emergency basis for hydrocephalus in neurosurgery. However, this treatment modality is apprehended due to its various complications. There is paucity of data regarding ventriculoperitoneal shunt surgery complications. The present study aimed to evaluate the ventriculoperitoneal shunt complications in a tertiary care hospital.&#x0D; Methodology: This prospective study was conducted on 96 hydrocephalus patients who underwent ventriculoperitoneal shunt in the Department of Neurosurgery, Lady Reading Hospital, Peshawar from January 2020 to December 2021. Hospital research and ethical committee approved the study protocol and written informed consent was obtained from each patient. Hydrocephalus patients of either gender without age discrimination who underwent first ventriculoperitoneal shunts were enrolled. Patients who underwent external ventricular drain, lumboperitoneal shunts, shunts revision, and ventriculoatrial shunts were excluded. Detailed history, clinical inspections, and full investigations such as cerebrospinal fluid, C-reactive protein (CRP), X-rays examinations, full blood count (FBC), brain CT scans and abdomen pelvis ultrasound has been carried out in all eligible patients. Post-surgery routine follow-up was scheduled one and six months after discharge. SPSS version 25 was used for data analysis.&#x0D; Results: Of the total 96 hydrocephalus patients, there were 63 (66%) male and 33 (34%) females. Patient’s age-wise distribution was as follows: Age&lt; 1 year 36 (37.5%), 1-10 years 28 (29.2%), 11-20 years 22 (22.9%), 21-30 years 7 (7.3%), and 31-40 years 3 (3.1%). The incidence of ventriculoperitoneal shunt surgery complications such as shunt blockage, infection, shunt erosion, and extrusion was 44 (45.8%), 34 (35.4%), 16 (16.7%), and 9 (9.4%) respectively. The mortality rate was 3.1% due to the complications of ventriculoperitoneal shunt surgery. Brain tumors was the most prevalent cause of hydrocephalus in 37 (38.5%) followed by Post-meningitis 21 (21.9%), encephaloceles 11 (11.5%), Cerebellar hematoma 10 (10.4%), Intraventricular hemorrhage 6 (6.3%), Aqueduct stenosis 4 (4.2%), Neurocysticercosis 2 (2.1%) and others 2 (2.1%). &#x0D; Conclusion: Our study concluded that the most prevalent ventriculoperitoneal shunt surgery complications were shunt blockage and shunt infection. Brain tumors were the common cause of hydrocephalus followed by post-meningitis and encephaloceles. Shunt upper end is more susceptible to complications than the lower end. The overall mortality rate was 3.1%. These complications might leads to server clinical issues that results patient’s death.

Correlation of fetal ventricular size and need for postnatal cerebrospinal fluid diversion surgery in open spina bifida.

Open spina bifida is a common cause of hydrocephalus in the postnatal period. In-utero closure of the fetal spinal defect decreases the need for postnatal cerebrospinal fluid (CSF) diversion surgery. Good prenatal predictors of the need for postnatal CSF diversion surgery are currently lacking. In this study, we aimed to assess the association of fetal ventriculomegaly and its progression over the course of pregnancy with the rate of postnatal hydrocephalus requiring intervention. In this retrospective study, fetuses with a prenatal diagnosis of open spina bifida were assessed longitudinally. Ventricular diameter, as well as other potential predictors of the need for postnatal CSF diversion surgery, were compared between fetuses undergoing prenatal closure and those undergoing postnatal repair. The diameter of the lateral ventricle increased significantly throughout gestation in both groups, but there was no difference in maximum ventricular diameter at first or last assessment between fetuses undergoing prenatal closure and those undergoing postnatal repair. There was no significant difference in the rate of progression of ventriculomegaly between the two groups, with a mean progression rate of 0.83 ± 0.5 mm/week in the prenatal-repair group and 0.6 ± 0.6 mm/week in the postnatal-repair group (P = 0.098). Fetal repair of open spina bifida was associated with a lower rate of postnatal CSF diversion surgery (P < 0.001). In all subjects, regardless of whether they had prenatal or postnatal surgery, the severity of ventriculomegaly at first and last assessments was associated independently with the need for postnatal CSF diversion surgery (P = 0.005 and P = 0.001, respectively), with a greater need for surgery in fetuses with larger ventricular size, even after controlling for gestational age at assessment. In fetuses with open spina bifida, fetal ventricular size increases regardless of whether spina bifida closure is performed prenatally or postnatally, but the need for CSF diversion surgery is significantly lower in those undergoing prenatal repair. Ventriculomegaly is associated independently with the need for postnatal CSF diversion in fetuses with open spina bifida, irrespective of timing of closure. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.

Proposal for a normal pressure hydrocephalus syndrome center of excellence

Normal pressure hydrocephalus syndrome, characterized by ventriculomegaly and the classic triad of symmetric gait disturbance, cognitive decline, and urinary incontinence, is the most common cause of hydrocephalus in the adult population and a significant cause of reversible dementia among older adults. The only effective treatment for this syndrome, to date, is a cerebrospinal fluid shunting procedure, commonly a ventriculoperitoneal, ventriculoatrial, or lumboperitoneal shunt. The shunting success rate ranges between 73 and 96%. Hence, early identification, proper diagnosis, and treatment are paramount.We designed a protocol-based program supported on the best available evidence for an integral approach of patients with normal pressure hydrocephalus syndrome. The protocol consists of a series of patient-centered tests and interventions performed on adults with clinical suspicion, leading to optimized and sustainable outcomes for patients living with this condition.The program obtained the recognition of the Joint Commission International as an accredited center of excellence. The objectives of our center are increasing awareness and knowledge of normal pressure hydrocephalus syndrome within the community, delivering optimized interdisciplinary care, mitigating risks, improving quality of life to patients and their families, and ultimately saving from oblivion a significant number of patients who would be otherwise condemned.

Congenital hydrocephalus in a Maine Coon foetus detected using ultrasound during pregnancy

A congenital defect that blocks the cerebrospinal fluid outflow is the most common cause of hydrocephalus in young cats. It usually manifests itself within a few weeks of birth. Diagnostic imaging is essential. Therefore, it was decided to report on, for the first time, a clinical case of congenital hydrocephalus in a Maine Coon foetus detected using ultrasound during pregnancy. A difference between the size of the skull bones in the Maine Coon foetuses was recognised during a routine pregnancy ultrasound. Analysis of the sonogram of the bones and brain structures of the diagnosed foetus revealed that the features were highly suggestive of a hydrocephalus. Five clinically healthy kittens and one with hydrocephalus were delivered without complications. The necropsy of the malformed foetus was consistent with the ultrasonographic findings. Bacteriological and virological tests were performed and all were negative which suggest a congenital background of the malformation. This is the first reported case of an intrauterine ultrasound diagnosis of congenital hydrocephalus in a Maine Coon of multiple gestation. The ultrasound control along with the foetometry seem to be useful tools to recognise certain pathologies of pregnancy in cats, including congenital malformations of various origins, which is of significant diagnostic and prognostic importance.

The association of brain tumor and hydrocephalus in the patient managed with craniotomy and ventriculoperitoneal shunt – The single-centre study

OBJECTIVE: To determine frequency of hydrocephalus in brain tumor perioperative and and need of perment VP shunt .&#x0D; METHOD &amp; MATERIAL: This was descriptive study, the ethical approval was taken from the hospital, study duration from 24-June-2014 to 30-september-2020 at JPMC, Karachi. Inclusion criteria were patient with brain tumor associated with hydrocephalus or postoperatively developed hydrocephalus within 3months of surgery and exclusion criteria were they had shunted previously due to some other reason, history of operation of brain tumor previously, history of trauma.&#x0D; RESULTS: We operated 156 cases of brain tumor concomitant with hydrocephalus, these included pre-operative and post-surgery development of hydrocephalus, out of that 65 (41.6%) were adult and 91 (58.33%) were children, who had hydrocephalus due to brain tumor. 90 (57.6%) were male and 66(42.3%) were female. The mean age for an adult was 34.2±8years and 8.1±4years was for a pediatric population of the patient. Patients who had preoperative hydrocephalus were 34 (21.7%) adults and 55(35.25%) pediatric and post-operative development of hydrocephalus was 28 (17.9%) in adults and 41 (26.28%) pediatric patients,&#x0D; CONCLUSION: The common brain tumor associate with hydrocephalus in children was craniopharyngioma and in adults it was CP angle tumor. Among 6026 cases of brain surgeries 2.6% required vp shunt dependency. Considering common cause of hydrocephalus in brain tumors, perioperative decision-making plays a pivotal role in the management of tumour-associated hydrocephalus.&#x0D; &#x0D; &#x0D;

A Retrospective Study on Ventriculoperitoneal Shunt Complications in a Tertiary Care Centre

Abstract Background Ventriculoperitoneal shunt (VPS) is a common technique employed to treat the second most common congenital brain malformation, “hydrocephalus.” Postshunt insertion, the consequent complications and factors contributing to shunt malfunction are much fought occurrences. The current study was planned to assess the effectiveness of the procedure, analyze the complications of VP shunt, and recognize the factors influencing shunt malfunction. Materials and Methods The present study was a retrospective observational study, which was conducted at the Department of Neurosurgery, PGIMER RML Hospital, New Delhi, from August 2016 to July 2018. Patients with hydrocephalus requiring shunt intervention were included in the study. A Chhabra “slit n spring” hydrocephalus shunt system was inserted in all patients. All patients with VP shunts were followed to assess for any postshunt complications. Results Out of 541 patients for whom VP shunt was inserted over a period of 2 years, 126 (23.3%) patients developed complications. The most common cause of hydrocephalus for which VP shunt was done was tubercular meningitis (39.3%, n = 63), followed by ventriculitis (12.38%, n = 20), congenital hydrocephalus (8.87%, n = 14) and aqueductal stenosis (5.54%, n = 03). The most common complication in our study was obstruction of proximal end of the catheter by debris, which was noted in 50 patients (39.68%). The second most common complication was poor peritoneal absorption or obstruction of lower end (21.43%, n = 27 cases). Abscess along the shunt was seen in 21 patients (16.67%). Complications were mostly documented in cases with hydrocephalus due to tubercular meningitis (TBM) (39.3%, 63 patients) and ventriculitis (12.38%, 20 patients). Other complications were hyperemia with superficial ulceration or complete exposure of skin overlying the tube (11.9%, n = 15), overdrainage of the ventricles leading to chronic subdural hematoma (n = 14, 11.11%), and infection around the distal catheter (4.76%, n = 6). Conclusion VPS procedure led to a complication in several patients, with the most common being obstruction of proximal catheter and poor peritoneal absorption or obstruction of lower end followed by abscess and infection.

Ventriculoperitoneal Shunt Complication in Pediatric Hydrocephalus: Risk Factor Analysis from a Single Institution in Nepal.

Objective:Ventriculoperitoneal (VP) shunt surgery is one of the commonly performed neurosurgical procedures. Complications due to shunt failure are associated with high morbidity and mortality. We report an analysis of risk factors for shunt failure in pediatric patients from a single institution in Nepal.Materials and Methods:A retrospective analytical study with prospective data was designed. All children younger than 15 years, with first time VP shunting, at a tertiary government hospital in Kathmandu during 2014-2017 were followed up. Association of independent variables with the primary outcome variable (complication of VP shunt) was analyzed using Chi-square test. Bivariate logistic regression was performed to identify unadjusted odds ratio (OR) with 95% confidence interval (CI). Multivariate logistic regression model was designed to calculate adjusted OR with 95% CI.Results:Of 120 patients, more than half (55.8%) of the patients were male. Mean age was 62.97 months. Maximum duration of follow-up was 30 months. Most common cause of hydrocephalus was congenital aqueductal stenosis (40.8%) followed by tumors (29.2%). Overall shunt complication was found in 26.7% (95% CI 19.0%–35.5%). Shunt infection was seen in 5% while malfunction without infection was found in 21.7%. Bivariate logistic regression showed duration of surgery more than 1 h (OR 2.67, 95% CI 1.11–6.42, P = 0.028) compared to 1 h or less, experienced surgeon (OR 0.37, 95% CI 0.16–0.89, P = 0.026) compared to residents, and emergency surgery (OR 3.97, 95% CI 1.69–9.29, P = 0.001) compared to elective surgery as significant risk factors, while emergency surgery was the only significant variable for shunt failure on multivariate regression analysis (OR 3.3, 95% CI 1.16–9.35, P = 0.025).Conclusion:Longer duration of surgery, less experience of the surgeon, and the priority of the case (emergency) were independent risk factors for shunt complications.

Neonatal hydrocephalus leads to white matter neuroinflammation and injury in the corpus callosum of Ccdc39 hydrocephalic mice.

The authors sought to determine if hydrocephalus caused a proinflammatory state within white matter as is seen in many other forms of neonatal brain injury. Common causes of hydrocephalus (such as trauma, infection, and hemorrhage) are inflammatory insults themselves and therefore confound understanding of how hydrocephalus itself affects neuroinflammation. Recently, a novel animal model of hydrocephalus due to a genetic mutation in the Ccdc39 gene has been developed in mice. In this model, ciliary dysfunction leads to early-onset ventriculomegaly, astrogliosis, and reduced myelination. Because this model of hydrocephalus is not caused by an antecedent proinflammatory insult, it was utilized to study the effect of hydrocephalus on inflammation within the white matter of the corpus callosum. A Meso Scale Discovery assay was used to measure levels of proinflammatory cytokines in whole brain from animals with and without hydrocephalus. Immunohistochemistry was used to measure macrophage activation and NG2 expression within the white matter of the corpus callosum in animals with and without hydrocephalus. In this model of hydrocephalus, levels of cytokines throughout the brain revealed a more robust increase in classic proinflammatory cytokines (interleukin [IL]-1β, CXCL1) than in immunomodulatory cytokines (IL-10). Increased numbers of macrophages were found within the corpus callosum. These macrophages were polarized toward a proinflammatory phenotype as assessed by higher levels of CD86, a marker of proinflammatory macrophages, compared to CD206, a marker for antiinflammatory macrophages. There was extensive structural damage to the corpus callosum of animals with hydrocephalus, and an increase in NG2-positive cells. Hydrocephalus without an antecedent proinflammatory insult induces inflammation and tissue injury in white matter. Future studies with this model will be useful to better understand the effects of hydrocephalus on neuroinflammation and progenitor cell development. Antiinflammatory therapy for diseases that cause hydrocephalus may be a powerful strategy to reduce tissue damage.

CAUSES OF HYDROCEPHALUS AND COMPLICATIONS OF VP SHUNT IN PEDIATRIC POPULATION

ABSTARCT Background: Ventriculoperitoneal (VP) shunt is a common procedure for treatment of hydrocephalus. The objectives of the study were to determine the causes of hydrocephalus and complications of VP shunt in our pediatric population. Materials &amp; Methods: This descriptive, cross-sectional study was conducted in the Department of Neurosurgery, Gomal Medical College, D.I.Khan, Pakistan from January 2018 to January 2019. The sample size was 97 selected through consecutive, non-probability sampling technique using online sample size calculator, the Raosoft. The inclusion criteria were all pediatric patients with hydrocephalus. All those post-operative patient operated for other pathologies of brain and spine without VP shunt were excluded from the study. CT or MRI of brain with and without contrast were done. Post operatively all the patients were followed up till 6 months and any complication which occurred were documented. Demographic variable were sex and age in years. Research variables were causes of hydrocephalus and post-operative complications of VP shunt. All variables except age in years being categorical were analyzed through frequency and percentages. Age was calculated by mean and SD using SPSS version 20. Results: Out of 97 patients, boys were 59(60.82%) and girls were 38(39.17%). The mean age of the sample was 4.5 ±5 ranging from 5 months to 13 years. The most common cause was aqueductal stenosis having 58(59.7 %), myelo-meningocele were 17(17.7%), post meningitis were 12(12.3%) and remaining 10(10.3%) were associated with brain tumors. Out of 21 patients 12(57.2%) developed shunt obstruction, 5(23.8%) shunt infection, 2(9.5%) developed post-operative seizures, 2(9.5%) had exteriorization of lower end of shunt through abdominal incision. Conclusion: The most common cause of hydrocephalus is acqueductal stenosis. The most common complication of VP shunt is shunt obstruction in pediatric population, having pre-school boys as modal group.

Endoscopic Third Ventriculostomy in Children with Failed Ventriculoperitoneal Shunt.

Context:Endoscopic third ventriculostomy (ETV) is an accepted procedure for the treatment of obstructive hydrocephalus. The role of endoscopic treatment in the management of shunt malfunction was not extensively evaluated. The aim of this study is to evaluate the success rate of ETV in pediatric patients formerly treated by ventriculoperitoneal (V-P) shunt implantation.Materials and Methods:Thirty-three patients with their first shunt failure and obstructive hydrocephalus in brain imaging between 2008 and 2014 were enrolled in this study.Results:The most common causes of hydrocephalus in these patients were aqueductal stenosis and myelomeningocele with or without associated shunt infection. Of these 33 cases, 20 ETV procedures were successful, and 13 cases needed shunt revision after ETV failure. There was no serious complication during ETV procedures. The follow-up period of patients with successful ETV was 6–50 months (mean 18 months). The time interval between ETV and new shunting subsequent to ETV failure was 24.4 days (10–95).Conclusions:ETV can be considered as an alternative treatment paradigm in patients with previous shunt or new shunt failure with an acceptable success rate of 6o%, although long-term follow-up is needed for these patients.

Unruptured brain arteriovenous malformations and hydrocephalus: Case series and review of the literature

ObjectiveHydrocephalus is an uncommon presentation of unruptured brain arteriovenous malformations (AVMs). The goal of this case series and literature review is to present possible pathological mechanisms, management strategies and outcomes in patients with hydrocephalus due to unruptured AVMs. MethodsThree consecutive patients with hydrocephalus caused by unruptured AVMs as well as all cases previously reported in the literature were retrospectively reviewed to determine clinical symptoms, AVM location, nidus size, venous drainage, mechanism of hydrocephalus, level/cause of obstruction, and degree of hydrocephalus. Management of hydrocephalus, AVM treatment, and follow-up length were evaluated. ResultsOf 350 patients unruptured AVMs, 3 presented with hydrocephalus (0.8%). In the literature review we found an additional 22 patients for a total of 25 cases. Eighteen patients had mechanical obstruction by the draining vein or the AVM nidus, usually at the level of the aqueduct (52%). Impaired cerebrospinal fluid resorption secondary to venous congestion led to hydrocephalus in 7 patients. Ten patients were treated for both the AVM and hydrocephalus, 13 patients underwent treatment of either hydrocephalus, or the AVM alone. Treatment of hydrocephalus, with or without associated treatment of the brain AVM, resulted in improvement of symptoms in 92% of patients. No rupture of the AVM was reported at follow-up. ConclusionsThe most common cause of hydrocephalus in unruptured brain AVMs is mechanical obstruction by the draining vein if it is located in a strategic position. Treatment of hydrocephalus alone or with associated treatment of the AVM is safe and effective.

Ventriculosubgaleal shunt in children with hydrocephalus

Objective: To determine the rate of conversion to ventriculoperitoneal (VP) shunt in children treated with ventriculosubgaleal (VSG) shunt for hydrocephalus of infective and noninfective etiology. Materials and Methods: A prospective, observational study was conducted at the department of neurosurgery in a tertiary care medical institute in children who underwent VSG shunt for congenital and acquired hydrocephalus of infective and noninfective etiology. Primary outcome measure was rate of conversion to VP shunt. Results: In total 58 children, 65.5% were aged 5 days to 12 months and 67.2% were male. Meningitis (70.7%) was the most common cause of hydrocephalus, followed by hemorrhage (20.7%) and congenital causes (8.6%). The rate of conversion to VP shunt was 58.6%. Moreover, 25.9% of the children had spontaneous resolution of hydrocephalus with no further requirement of shunt, whereas 15.5% required endoscopic third ventriculostomy. Shunt revision was required in 6.9% of the children and shunt malfunction rate was 5.2%. Other complications such as cerebrospinal fluid (CSF) leak (3.4%), wound infection (1.7%), and shunt tip migration (1.7%) were uncommon. Conclusion: VSG shunt is a simple and effective treatment for temporary diversion of CSF for infective and noninfective hydrocephalus in children who are not ideal for a permanent method of CSF diversion even in the presence of active meningitis and shunt infection. In experienced hands and in selected cases, VSG shunt alone can help resolve the hydrocephalus.

Neonatal Hydrocephalus

Hydrocephalus is one of the most common congenital abnormalities affecting the nervous system, occurring in 0.3 to 2.5 per 1,000 live births. It results from obstruction of cerebrospinal fluid (CSF) pathways by a diverse range of developmental, genetic, and acquired abnormalities and can have negative consequences on the neurodevelopmental outcome of affected neonates. Historically, hydrocephalus was diagnosed after birth and managed with a shunt procedure; however, with the advent of advanced antenatal imaging techniques, it may now be detected and treated before delivery in some individuals. Moreover, surgical options for the treatment of hydrocephalus have increased over the past few decades, and temporary CSF diversion may prevent the need for permanent shunt placement. Posthemorrhagic hydrocephalus is the most common cause of hydrocephalus in the preterm newborn, but the timing of surgical intervention for this condition remains controversial. Recent evidence suggests that earlier, rather than later, intervention may have some benefits, but more data are needed to adequately inform clinical practice. Regardless of etiology or timing of diagnosis, a thorough understanding of the natural history of hydrocephalus and the range of treatment options available is needed for parental counseling, prognostication, and appropriate surgical management.

An experience with ventriculoperitoneal shunting at keen's point for hydrocephalus.

Objective:This study was conducted to assess outcomes in patients with hydrocephalus who underwent ventriculoperitoneal shunting at Keen’s point.Methods:This retrospective study was conducted in Combined Military Hospital (CMH) Peshawar. Time frame was four years from January 2011 to January 2015. The presenting complaints, clinical findings, investigations, treatment plans and surgical outcomes were noted. Ventriculo-Peritoneal (VP) shunting was done at Keen’s point. The presence of shunt complications in the first week post-surgery was noted and at a three-month follow up in the outpatient department. General condition of the patient, shunt complications, presence of seizure and worsening of vision were noted.Results:Study included 143 patients, out of whom 46 were females and 95 were male patients. Most common causes of hydrocephalus were congenital (79). Majority of adults had hydrocephalus due to central nervous system tumors while congenital hydrocephalus in children was most frequently due to aqueductal stenosis. Good clinical improvement was seen in 114 patients after shunt placement, satisfactory in 20 patients, 7 patients died while we observed no change in two patients.Conclusion:Our experience with VP shunting at Keen’s point resulted in excellent outcomes. It can be used for the management of hydrocephalus both in pediatric as well as adult population.

Visual outcome after endoscopic third ventriculostomy for hydrocephalus

Hydrocephalus-related symptoms are mostly improved after successful endoscopic third ventriculostomy (ETV). However, visual symptoms can be different. This study was focused on visual symptoms. We analyzed the magnetic resonance images (MRI) of the orbit and visual outcomes. From August 2006 to November 2016, 50 patients with hydrocephalus underwent ETV. The male-to-female ratio was 33:17, and the median age was 61years (range, 5-74years). There were 18 pediatric and 32 adult patients. Abnormal orbital MRI findings included prominent subarachnoid space around the optic nerves and vertical tortuosity of the optic nerves. We retrospectively analyzed clinical symptoms, causes of hydrocephalus, ETV success score (ETVSS), ETV success rate, ETV complications, orbital MRI findings, and visual impairment score (VIS). The median duration of follow-up was 59months (range, 3-113months). The most common symptoms were headache, vomiting, and gait disturbance. Visual symptoms were found in 6 patients (12%). The most common causes of hydrocephalus were posterior fossa tumor in 13 patients, pineal tumor in 12, aqueductal stenosis in 8, thalamic malignant glioma in 7, and tectal glioma in 4. ETVSS was 70 in 3 patients, 80 in 34 patients, and 90 in 13 patients. ETV success rate was 80%. ETVSS 70 showed the trend in short-term survival compared to ETVSS 90 and 80. ETV complications included epidural hematoma requiring operation in one patient, transient hemiparesis in two patients, and infection in two patients. Preoperative abnormal orbital MRI findings were found in 18 patients and postoperative findings in 7 patients. Four of six patients with visual symptoms had abnormal MR findings. Three patients did not show VIS improvement, including two with severe visual symptoms. Patients with severe visual impairment were found to have bad outcomes. The visual symptoms related with increased intracranial pressure should be carefully monitored and controlled to improve outcomes.