Communicative Hydrocephalus Research Articles

An MR Imaging Study of Communicating Hydrocephalus After Gamma Knife Radiosurgery for Vestibular Schwannoma

Patients with vestibular schwannoma (VS) face a 3.7-23.7% risk developing hydrocephalus. Small-sized VS are associated with communicating or non-communicating hydrocephalus. Hydrocephalus in VS patients can persist or worsen post-tumor removal. Gamma knife radiosurgery is effective, especially in younger patients with functional hearing. Although the causal relationship between gamma knife radiosurgery and hydrocephalus isn't firmly established, this case reports a possible association between developing hydrocephalus and Vestibular schwannoma. Elevated CSF protein suggests communicating hydrocephalus due to tumor necrosis. The rarity of hydrocephalus post-gamma knife surgery likely relates to tumor variations rather than procedural nuances. Gamma Knife radiosurgery for vestibular schwannomas can lead to communicative hydrocephalus. MR imaging, including pre- and post-treatment scans, along with MR CSF cine-flow studies, highlights the link between gamma knife involvement and hydrocephalus development. Despite the rarity, this negative outcome underscores the need for careful consideration and investigation of risk factors associated with hydrocephalus post-radiosurgery. A middle aged man with vestibular schwannoma was investigated in this case. Patient was procedure through gamma knife radiosurgery for vestibular schwannoma. Patient was passed through MR scans before the radio surgical procedure and 9 months past surgical procedure. Nine months later, severe ventriculomegaly was observed, revealing central necrosis in the tumor. Lumbar puncture indicated abnormal CSF characteristics without evidence of infection. Despite a failed endoscopic third ventriculostomy, MR imaging cine-flow studies confirmed free CSF flow, emphasizing the complexity of managing hydrocephalus post-gamma knife radiosurgery for vestibular schwannomas. VS typically occurs in older individuals, this case's younger age and optimal tumor size for gamma knife treatment add complexity. Faster-growing and larger tumors are more prone to post-treatment necrosis and hydrocephalus, necessitating careful management. MR cine-flow aids in hydrocephalus differentiation.

A ruptured blister aneurysm of the A1 segment of the anterior cerebral artery with communicating hydrocephalus: a case report with histo-pathological and genetic predisposition

Background: Cerebral arteries experience aneurysms more commonly than systemic arteries. This case report discusses a blister aneurysm that affected the anterior cerebral artery's A1 segment. The histological and genetic background is related to the aneurysm's unique presentation. Case description: The blister aneurysm ruptured, leading to interventricular and basal subarachnoid hemorrhage. A right sided fronto-temporo-parietal decompressive craniotomy was performed to explore it, along which clipping operation was performed. A communicative hydrocephalus develops after the craniectomy for which a right parietal VP shunt was conducted that underwent malfunction. The patient succumbed due to septic shock after 4 months of VP shunt revision surgery. Discussion: Different forms of cerebral aneurysms were analyzed, with regards to their histo-pathological characteristics and underlying anatomical basis of their formation. Finally, the genetic propensity of all the aneurysm was explained. There was an interventricular and basal subarachnoid hemorrhage because of the blister aneurysm's rupture. To explore it, a fronto-temporo-parietal decompressive craniotomy on the right side was done, along with a clipping operation. After the craniectomy, a right parietal VP shunt was performed, however it malfunctioned, leading to a communicative hydrocephalus. After undergoing VP shunt revision surgery for 4 months, the patient passed away from septic shock. Conclusions: The common types of cerebral aneurysms (saccular, fusiform, mycotic and blister) and the anatomical basis of their occurrence are reviewed in-depth in the histopathological and genetic literature.

CT Image under Improved Fuzzy C-Means Clustering Algorithm for Evaluation of the Relationship between Cerebrospinal Fluid Change and Communicating Hydrocephalus after Decompressive Craniectomy in Patients with Traumatic Brain Injury

This study was aimed to realize the automatic segmentation of communicating hydrocephalus lesions in brain CT after decompressive craniotomy (DC) in patients with traumatic brain injury (TBI) and discover correlation between cerebrospinal fluid changes and communicating hydrocephalus. Based on the traditional fuzzy C-means (FCM) algorithm, a new segmentation method filter-based FCM (FBFCM) algorithm was proposed. With 56 TBI patients as the research objects, the hydrocephalus lesions in CT images of patients after DC were segmented. The segmentation success rate (SSR), the segmentation coefficient Epc, the segmentation entropy Epe, and the number of iterations were indicators reflecting segmentation performance of FBFCM. The region of interest (ROI) on the segmented image was used to study the patient’s cerebral aqueduct, foramen magnum, and C2 level of the cerebrospinal fluid velocity and flow, to analyze the characteristics of the occurrence of communicative hydrocephalus. It was indicated that average Epc of FBFCM algorithm was 0.9321 ± 0.0144, Epe was 0.1126 ± 0.0081, the average number of iterations was 14.42 ± 3.79, and the segmentation success rate was 96%. Moreover, the above four indicators had statistically considerable differences compared with those of the FCM algorithm and the hard clustering algorithm (HCM) ( P < 0.05). Analysis of the cerebrospinal fluid flow rate in patients with communicative hydrocephalus found that the cerebrospinal fluid flow rate at the midbrain aqueduct of the patient increased greatly. The net flow was 0.000 ± 0.004 mL/s in the aqueduct of the midbrain, 0.001 ± 0.006 mL/s in the foramen magnum, and 0.002 ± 0.004 mL/s in the C2 layer. In summary, the FBFCM algorithm is effective in the segmentation and processing of CT images, which can further improve the effect of this diagnosis. After examination, it is concluded that the cranial cerebrospinal fluid flow rate and flow of TBI patients are improved after DC treatment, so that the patient’s condition can be effectively relieved. It has promotion value with clinical application.

Survival status and predictors of mortality among children who underwent ventriculoperitoneal shunt surgery at public hospitals in Addis Ababa, Ethiopia

Background: Despite the increase in ventriculoperitoneal shunt surgeries performed for children with hydrocephalus, the potential complications and survival of patients after the procedure remains the major challenge for both clinical and public health aspects. This study intends to assess the survival status and scrutinize the predictive factors of mortality among children after a ventriculoperitoneal shunt. Methods: A retrospective cohort study was employed by reviewing charts of 337 systematically selected children who have undergone a ventriculoperitoneal shunt from 2016 to 2018 in Addis Ababa. The extraction tool was used for data collection, Epi-data version 4.4.2 for data entry, and Stata version-14 for cleaning and analysis. Kaplan-Meier curve, log-rank test, and life table were used to describe the data. Cox proportional hazard regression model was used for analysis. Any variable at p < 0.25 in the bi-variable analysis was fitted to multivariate analysis, and significance was declared at p ≤ 0.05. Then, AHR with 95% CI was used to report the association and test the statistical significance. Finally, texts and tables were used to present the results. Results and Conclusion: The incidence rate of mortality was 58.4 per 1000 child-months of observation with a median survival time of 12 months (95%CI: 9.04–14.96). Communicative hydrocephalus (AHR: 1.99, 95% CI: 1.18–3.36), post-traumatic brain injury (AHR: 7.43, 95% CI: 3.21–16.88), emergency surgery (AHR: 1.86, 95% CI: 1.17–3.13) as well as revised shunt procedure (AHR: 8.01, 95% CI: 6.12–13.43) were independent predictors of death. Besides, sunset eye (ARH: 2.01; 95% CI: 1.17–3.47), rapidly increased head size (ARH: 2.05, 95% CI: 1.14–3.37), prolonged antibiotics treatment (AHR: 2.46, 95% CI: 1.82–7.37), and gram-negative infections (AHR: 1.95, 95% CI: 1.60–12.64) were also significantly associated. Hence, health professionals ought to give special attention to patients with identified predictors.

Shunt exposure as a ventriculoperitoneal shunt complication: A case series

IntroductionShunting is a technique in neurosurgery for treating hydrocephalus. Shunting is an effective choice for both cases of obstructive or communicative hydrocephalus. However, in some rare cases, complications, such as exposed shunt, can occur. In this case series, the author discusses 6 cases of hydrocephalus patients with exposed shunts. The risk factors, diagnosis, and management of exposed VP shunt will be discussed further in this case series report. MethodsThis study was an analysis of all cases treated in a period of 1 year from January to December 2018 with an inclusion criterion of history of exposed shunt of any age group. This study is a single-centre retrospective report of the clinical presentation and radiology examination before and after treatment. Clinical and radiology evaluation were performed in immediate post procedural period. A detailed clinical examination was performed to look for exposed shunt complication. ResultsIn this series of studies 6 patients with hydrocephalus who had shunts were reported. All patients were pediatric patients. Six patients had exposed shunt on the scalp or abdomen. Radiological examinations including CT scan, chest X-ray or babygram were performed to evaluate the location of the shunt. The data reported was from January to December 2018 and there were 301 VP shunt installment cases. Management included surgical revisions and treatments to prevent further complications. ConclusionShunting is still a routine therapy in the field of neurosurgery, although other modalities such as endoscopic third ventriculostomy (ETV) have started to be performed more frequently. Complications such as exposed shunt are rare in the treatment of pediatrics with hydrocephalus. We presented that exposed shunt is a rare complication (2.3% incidence rate) which might be caused by certain risk factors, such as age of patient when the shunting was performed, and nutritional status. Early diagnosis and treatment are important to prevent further complications, especially infections. Subpericranial technique for shunt tunneling might be useful in preventing exposure of shunts with associated morbidity factors.

Hydrocephalus in primary intradural spinal cord tumors: a systematic review of the literature in the pediatric population.

Hydrocephalus in children with primary intradural spinal cord tumors is exceedingly rare. Herewith, we performed a systematic literature review to address epidemiology, suggested pathophysiological mechanisms, prognostic factors, and treatment of such cases. We performed a systematic review with the best available evidence on cases of pediatric primary intradural tumors of the spinal cord presented with hydrocephalus. The patients were subjected to quantitative analysis on a basis of epidemiological features (age, sex, tumor type and location, clinical presentation, survival, dissemination). The possible pathophysiological theories are discussed in detail. Forty-four studies with a total of 121 patients were included in the study. Astrocytomas were the most frequent tumor (64.5%) type, while most tumors were located in cervical (31.4%) or cervicothoracic region (25.6%). About half of the cases concerned children under 6years of age. The block of subarachnoid CSF (cerebrospinal fluid) pathways from disseminated tumor cells and the neoplastic inflammation caused by tumor elements advocated to be the major pathogenetic mechanisms. Surgical excision of the tumor and hydrocephalus treatment is usually performed. Primary intradural spinal cord tumors should be considered in children with communicative hydrocephalus of unknown etiology. Onset of hydrocephalus after tumor removal is related to higher mortality.

Do the clinicoradiological outcomes of endoscopic fenestration for intracranial cysts count on age? An institutional experience.

The clinicoradiological outcome of endoscopic fenestration of intracranial cysts and predictors of an unfavorable outcome, including age, are under reported in the neurosurgical literature. In this cohort, our experience in the endoscopic fenestration of intracranial cysts is reviewed. Thirty consecutive patients treated with endoscopic fenestration for intracranial cysts were identified and analyzed. The study population in our series was followed clinically and radiographically. In this series, the overall resolution of clinical symptoms such as headache, seizures, and neurological deficits was 83%, P= 0.0001. The percentage of clinical resolution after endoscopic intervention was significantly higher (85% vs. 76%, P= 0.001) in arachnoid cysts compared to other cyst types. The reduction of arachnoid cyst size was significantly higher in adults with obstructive hydrocephalus compared to the children group (P = 0.037). In addition, requirement of a cystoperitoneal shunt placement (P = 0.0001) and its subsequent revision (P = 0.0001) was significantly lower in adults compared to children. Adults (P = 0.041), presence of an arachnoid cyst (P = 0.026), female gender (P = 0.016), and presence of communicative hydrocephalus (P = 0.015) were significant predictors for improvement in the symptoms of intracranial pressure. Lastly, adults (P = 0.028), presence of arachnoid cyst (P = 0.046), and presence of communicative hydrocephalus (P = 0.012) were significant positive predictors for shunt revision. This study revealed that endoscopic fenestration is an effective neurosurgical procedure for the management of intracranial cysts both in adults and children. Moreover, endoscopic fenestration is more beneficial in adults and patients with an arachnoid cyst compared to that in children and other cyst types, respectively.

Endoscopic third ventriculostomy in the treatment of idiopathic normal pressure hydrocephalus: a review study.

Idiopathic normal pressure hydrocephalus is a hydrodynamic disorder whose etiology remains unclear. The diagnosis is mainly clinical and the traditional treatment is cerebrospinal fluid shunt diversion. With the introduction of modern management strategies, endoscopic third ventriculostomy has become a viable alternative to shunting and constitutes a well-established method of treatment for obstructive hydrocephalus. The new hydrodynamic concept of hydrocephalus suggests that endoscopic third ventriculostomy (ETV) may be an effective treatment for communicative hydrocephalus. In our current review, the authors focus on the up-to-date knowledge regarding the consideration of endoscopic third ventriculostomy as a safe surgical option in the management of idiopathic normal pressure hydrocephalus.

Hydrocephalus associated with vestibular schwannomas: perioperative changes in cerebrospinal fluid

Cerebrospinal fluid (CSF) protein levels are known to increase in patients with vestibular schwannomas (VS) with concomitant hydrocephalus, however the only information available on perioperative changes in CSF in these patients comes from case reports. Here, we investigated the relation between CSF protein and hydrocephalus in a large series of patients undergoing resection of VS. We classified 376 patients undergoing resection for VS at our institute into two groups, namely VS and no hydrocephalus (control, n = 319) and VS with concomitant hydrocephalus (n = 57), and compared clinical parameters. Among the 57 patients diagnosed with hydrocephalus, hydrocephalus status was examined by lumbar puncture in 20 patients with communicative hydrocephalus, and pre- and postoperative scores in CSF properties were compared. Patients in the hydrocephalus group were significantly older than those in the control group (mean, 55.8 vs. 43.8 years), and had a longer disease duration (median, 76 vs. 12 months), larger tumors (median, 15.6 vs. 5.5 ml), and a higher protein concentration in CSF (median, 147.3 vs. 65.1 mg/dl). Perioperative CSF samples of hydrocephalus patients showed a significantly decrease in cerebrospinal pressure after tumor removal (median, -75mmH2O), followed by a decrease in CSF protein (median, -74.5 mg/dl). No patients required the placement of a shunt. Extended disease duration and elevated CSF protein secondary to the presence of a tumor contribute to the occurrence of hydrocephalus. Primary maximal tumor removal for VS with coexisting hydrocephalus avoids an unnecessary shunt.

Phenotypic Characteristics of Hydrocephalus in Stillborn Friesian Foals

Hydrocephalus is uncommon in horses. However, in recent years, it has become clear that the prevalence of hydrocephalus is greater in Friesian horses than in other breeds probably due to their limited gene pool. Before identification of candidate genes that predispose to the development of hydrocephalus in Friesian horses can be pursued, an in-depth, phenotypic, pathological description of the condition in Friesians would be of great benefit. Our study aimed to characterize the morphology of hydrocephalus in Friesian horses, to support further investigation of the genetic background of this condition. Four stillborn Friesian foals with hydrocephalus were examined macroscopically and microscopically and compared with 2 normal stillborn Friesian foals without hydrocephalus. In all clinical cases, tetraventricular and venous dilatations were observed, together with malformation of the petrosal bone and, as a result, narrowing of the jugular foramen. These observations suggest a communicative hydrocephalus with a diminished absorption of cerebrospinal fluid into the systemic circulation at the venous sinuses due to a distorted, nonfunctional jugular foramen. This type of hydrocephalus is also recognized in humans and dogs and has been linked genetically to chondrodysplasia; this has already been recognized in dwarfism, which is another monogenetic defect in Friesian horses.

Imatinib and Pregnancy.

Animal studies with imatinib have shown it to be teratogenic, embryotoxic and to result in increased rates of post-implantation loss. As a consequence there are justifiable physician/patient concerns regarding the safety of tyrosine kinase inhibitors during pregnancy. We can now report on 180 mothers (the majority with chronic myeloid leukemia but some treated for other indications) exposed to the drug during pregnancy. Timing of exposure to imatinib by trimester is available for 146 (81%). 71% of these were exposed in the 1st trimester (includes 4 exposed in both 1st and 2nd trimesters), 38 (26%) were exposed in all trimesters and 4 only after the 1st trimester. Outcome data are known for 125/180 (69%). 63 pregnancies resulted in the birth of normal live infants (50% of those with known outcome (KO), 35% of all pregnancies). 35 women (28% of KO or 19.5% of all pregnancies) underwent elective terminations, 3 following identification of fetal defects. The remainder either had no defects or were of unknown status. There were 12 pregnancies with fetal abnormalities (9.6% KO), resulting in 8 live and 1 still birth. 18 pregnancies (14.4% KO) ended in spontaneous abortion. Although within expected limits for the general population (spontaneous abortion rates of 10–15%) these data may be skewed by absent data from 55 cases. In 51 patients whose pregnancies were reported after a known outcome (as opposed to reporting at the time of confirmation of pregnancy) 11 (22%) resulted in spontaneous abortion- a higher rate than expected in the general population which may suggest an abortifacient effect. Abnormalities included one infant with premature closure of the skull sutures (craniosynostosis), one with hypoplastic lungs, exomphalos, left duplex kidney, right absent kidney, hemivertebrae and a right shoulder anomaly, another child with exomphalos, right renal agenesis and hemivertebrae and a fourth with a small exomphalos and scoliosis. These 4 cases are pertinent as in animal models imatinib causes similar bony defects including exencephaly, encephaloceles and deformities of the skull bones. Other severe defects included a child with communicative hydrocephalus, cerebellar hypoplasia, atrial septal defect, over-riding aorta, ascites and pericardial effusion - this infant was born live but later died. A baby with a meningocoele was still born. The remaining cases include cleft palate and polydactyly, 2 cases of hypospadias, 1 case of pyloric stenosis, 1 abnormal ultrasound with raised AFP and 1 case of warfarin embryopathy. Despite this information, balancing the risk to the foetus of continuing imatinib vs. the risk to the mother of stopping it remains difficult. In a recent report of 10 women who interrupted treatment with imatinib due to pregnancy, 6 had an increase in Ph positive metaphases. At a median of 18 months since restarting imatinib only 3/10 have achieved a complete cytogenetic response. Given the above findings the current recommendation to avoid imatinib during pregnancy remains unchanged. In cases of accidental or desired pregnancy, risk/benefit evaluations must be carried out on an individual basis with careful counselling of both parents. As experience with imatinib continues to grow, further information will become available which should clarify the situation. To facilitate this a global pregnancy registry will be established in the near future.

172 Transforming Growth Factor Beta 1 and Procollagen 1 N- Propeptide in the CSF of Neonates with Spina Bifida Aperta Developing Hydrocephalus

Background: The pathogenesis of hydrocephalus in human neonates with spina bifida aperta (SBA) is incompletely understood. Cerebrospinal fluid (CSF) outflow obstruction or arachnoideal resorption deficit may play an important role in the development of ventriculomegaly. In animal model, overexpression of transforming growth factor beta 1 (TGF beta 1) or increased local collagen turnover in the CSF lead to tissue proliferation and CSF malabsorption.Objective: To determine the relative contribution of CSF malabsorption and CSF obstruction in the development of hydrocephalus in SBA neonates.Patients / Methods: The CSF concentration of the aminoterminal propeptide of type 1 collagen (PINP; immunoassay, Roche Diagnostics) and TGF beta 1 (ELISA, DPC Biermann) were assessed in 3 groups of neonates with congenital hydrocephalus. Group1: SBA (n=10); group 2: neonatal aqueduct stenosis (obstructive hydrocephalus (n=4)); group 3: fetal intracerbral hemorrhage (communicative hydrocephalus (n=4)). Interleukin-6 concentrations in the CSF (IL-6; ELISA, DPC Biermann) were determined in all samples to estimate the proinflammatory state.Results: PINP concentrations in the CSF of group 1 (median: 180.5 ng/ml, range 90–809) were significantly lower when compared with group 3 (median: 1074, range 978-1194; p=0.002). No significant differences in PINP values were found between group 1/group 2 or group 2/group3. TGF beta 1 concentrations were found significantly lower in group 1 (median 103.5, range 78–675 pg/ml) compared with group 3 (median 277 pg/ml, range 129–414; p= 0.03). No significant differences in TGF beta 1 concentrations were found between group 1 vs. group 2 or group 2 vs. group 3. Median IL-6 CSF concentrations were found to be low in all patient groups.Conclusions: Present data on CSF biomarkers strongly indicate that CSF obstruction contributes more to the development of hydrocephalus in SBA neonates than CSF malabsorption.

Incidence, CT findings and rehabilitation outcome of patients with communicative hydrocephalus following severe head injury.

Communicative hydrocephalus (CH) is considered as one of the late sequelae of severe craniocerebral injury. However, as most of the series of patients with CH described in the literature deal with the results of various shunting procedures, the incidence of post-traumatic communicative hydrocephalus is not documented. We have found that almost 3.9% of 335 severe craniocerebral-injured patients develop communicative hydrocephalus. These patients were unconscious for various periods of time, therefore the triad described by Hakim and Adams cannot by itself lead the clinician to suspect possible development of communicative hydrocephalus. It is suggested that in prolonged coma, or in the presence of arrest in clinical progress in conscious craniocerebral-injured patients, communicative hydrocephalus should be suspected.