Course Of Hydrocephalus Research Articles

Features of the course of hydrocephalus in children after removal of a tumor of the posterior cranial fossa in the near and long term

The article presents the results of a study of the dynamics of the development of persistent hydrocephalus in children after surgical removal of a tumor of the posterior cranial fossa in the early and late postoperative period. The analysis of the incidence of neuropsychological syndromes: cerebellar cognitive-affective syndrome and cerebellar mutism syndrome in children of this group was carried out. Retrospective analysis included 30 patients under 18 years of age with a diagnosis tumor of the posterior cranial fossa complicated by occlusive hydrocephalus. All patients were operated on in the conditions of the Department of Neurosurgery for Children No. 7 of the Almazov National Medical Research Centre. As a result of the study, the risk groups for maintaining hydrocephalus after removal of the tumor of the posterior cranial fossa were determined, and the frequency of occurrence of neuropsychological syndromes in the postoperative period was determined.

Clinical and etiological features of hydrocephalus in infants

Aim. To analyze the causes and clinical course of hydrocephalus in infants and its association with various etiological factors.Materials and Methods. The study involved a retrospective analysis of data from 47 infants who were hospitalized in the Pediatric Neurosurgery Department of the Republican Scientific Center of Neurosurgery named after Shifobakhsh between the years 2020 and 2022. The patients were evaluated using a comprehensive range of diagnostic techniques, including CT, MRI, neuro-ophthalmoscopy, and neurosonography.Results. Among the infants with hydrocephalus, infectious-inflammatory CNS diseases were identified as the primary cause in 23 cases (48.9%), cranial-brain trauma in 12 cases (25.6%), brain tumor processes in 7 cases (14.9%), and congenital factors in 5 cases (10.6%). All 47 (100%) patients presented with generalized cerebral symptoms and exhibited signs of hypertensive-hydrocephalic syndrome.Conclusion. Our findings demonstrate that hydrocephalus in infants most commonly develops following the occurrence of infectious-inflammatory CNS diseases, while congenital causes are relatively less prevalent. The investigation of the clinical features and etiology of hydrocephalus enables the selection of appropriate diagnostic strategies and optimal surgical treatment methods.

Erratum - Effect of Albendazole Treatment in an Experimental Model of Neurocysticercosis-Induced Hydrocephalus

Hydrocephalus is a major concern in neurocysticercosis (NCC), and its management is more challenging than that of hydrocephalus caused by other etiologies. Even though albendazole is a well-established drug for the treatment of NCC, the death of the parasites may worsen the clinical symptoms and eventually, deteriorate the course of hydrocephalus. The aim of this study was to analyze the effects of treatment with albendazole on the course of hydrocephalus as well as on animal behavior in a rat model of NCC-induced hydrocephalus in order to verify whether the course of hydrocephalus and the animal behavior were changed. Ventricle volumes before and after treatment showed a slight but non-statistically significant difference (168.11 mm 3 versus 184.98 mm 3 , p = 0.45). The distribution and location of the cysts were unaffected. In addition, the behavioral patterns before and after the treatment were not significantly different, as assessed by the open field test. On histologic assessment, mononuclear leukocyte infiltration was present in diverse sites, such as the perivascular and peri-ependymal regions, choroid plexus, and meningeal membranes. A positive correlation was found between the degree of ventricle enlargement and tissue damage. Further studies with long-term comparisons are required.

Effect of Albendazole Treatment in an Experimental Model of Neurocysticercosis-Induced Hydrocephalus

AbstractHydrocephalus is a major concern in neurocysticercosis (NCC), and its management is more challenging than that of hydrocephalus caused by other etiologies. Even though albendazole is a well-established drug for the treatment of NCC, the death of the parasites may worsen the clinical symptoms and eventually, deteriorate the course of hydrocephalus. The aim of this study was to analyze the effects of treatment with albendazole on the course of hydrocephalus as well as on animal behavior in a rat model of NCC-induced hydrocephalus in order to verify whether the course of hydrocephalus and the animal behavior were changed. Ventricle volumes before and after treatment showed a slight but non-statistically significant difference (168.11 mm3 versus 184.98 mm3, p = 0.45). The distribution and location of the cysts were unaffected. In addition, the behavioral patterns before and after the treatment were not significantly different, as assessed by the open field test. On histologic assessment, mononuclear leukocyte infiltration was present in diverse sites, such as the perivascular and peri-ependymal regions, choroid plexus, and meningeal membranes. A positive correlation was found between the degree of ventricle enlargement and tissue damage. Further studies with long-term comparisons are required.

Intramedullary spinal cord tumors and hydrocephalus: an analysis of the results of surgical treatment in 541 patients

The study purpose was to explore, based on large clinical material, the occurrence of hydrocephalus combined with intramedullary tumors, possible pathogenetic mechanisms of its development, effect of tumor resection on the course of hydrocephalus, and need and timing of shunting surgery. We present and analyze the data of the largest individual series of patients of all age groups operated on for IMTs of the spinal cord: 541 patients; 586 operations; age from 2 months to 72 years. Our findings confirm a potential pathogenetic relationship between IMT and HC. The overall occurrence rate of HC in IMT patients was 6.3%. In patients with benign tumors (WHO Grade 1-2; 449 patients), HC developed in 25 (5.6%) cases; in patients with malignant tumors (WHO Grade 3-4; 84 patients), HC developed in 7 (8.3%) cases. A statistically significant prevalence of cervico-medullary tumors was found in HC patients: 19 (59.4%) cases. According to our data, dissemination of the tumor process is a potential factor of HC development.

Etiology and Clinical Course of Hydrocephalus

This article discusses the incidence, various causes, and different clinical presentations in children and adults with hydrocephalus.

Glucose metabolism and protective biochemical mechanisms in a rat brain affected by kaolin-induced hydrocephalus.

To clarify glucose metabolism in a hydrocephalic rat brain, substances related to glycolytic metabolism were biochemically measured. Kaolin-induced hydrocephalic rats were sacrificed and lactate dehydrogenase (LDH), LDH isozyme, lactate, adenosine triphosphate (ATP), and isocitrate dehydrogenase (ICDH) were measured in the following regions: cortex, thalamus, midbrain, hippocampus, cerebellum, and pons with medulla. During the development of hydrocephalus, lactate and LDH increased in most regions, the LDH M-subunit increased in the cortex, and ICDH decreased in most regions. However, ATP levels did not change. The increases in lactate, LDH and M-subunit suggested an anaerobic environment in the cell leading to activation of the anaerobic glycolysis. The decrease in ICDH represented a diminution of the tricarboxylic acid cycle. Through these alterations, the ATP level can be kept constant during the course of hydrocephalus, allowing the brain to create a better biochemical milieu.

The efficacy of shunting the hydrocephalic edema.

The efficacy of shunting the hydrocephalic edema was evaluated by means of transmission electromicroscopical observation (TEM) comparing ultrastructural alterations seen in either valid or invalid shunted feline hydrocephalus. Owning to shunt placement, deteriorated clinical symptoms recovered and one of the observed morphological alterations such as gliosis developed chronologically after the initiation of hydrocephalus. On the other hand, so called hydrocephalic edema observed in the region of periependymal tissue after shunt placement was improved not only in both valid and invalid shunted but also even in sham group however the extent of these alterations were different from each other. Among such observation, a distinct chronological linkage between the morphological alterations and clinical outcome was not noted. Our conclusions in present study were 1) shunt implantation results in the promotion of gliosis in the region of periventricular tissue in spite of the expected efficacy of shunt, 2) recovery of hydrocephalic edema was influenced not only by effective shunt implantation but also by the processes in chronological tissue reconstructions occurred in the natural course of hydrocephalus, and 3) early treatment of periventricular edema in hydrocephalus through shunting corrects the ill-fated neuro axis environments and reforming the intracranial conditions such as normalizing ICP and relieving hemodynamic distress seems to be more important than morphological recovery in treating hydrocephalus.

Tuberculous Meningitis

Tuberculous meningitis is an uncommon but potentially devastating form of tuberculosis. Current antituberculous drugs are highly effective when treatment is initiated early, before the onset of altered mentation or focal neurologic deficits. Because the clinical outcome depends greatly on the stage at which therapy is initiated, early recognition is of paramount importance. Patients with the meningoencephalitis syndrome and CSF findings of low glucose levels, elevated protein levels, and pleocytosis should be treated immediately if there is evidence of TB elsewhere in the body, or if prompt evaluation fails to establish an alternative diagnosis. Examination of CSF is the best diagnostic approach; with sufficient diligence, serial AFB smears and cultures will usually yield positive results, even days after therapy has been started. The CT scan is an important and highly effective tool for the diagnosis and management of patients with TBM. In a patient with compatible clinical features, the combination of basilar meningeal enhancement and any degree of hydrocephalus is strongly suggestive of the diagnosis of TBM. Serial evaluation by CT scanning is useful for following the course of hydrocephalus and tuberculoma, particularly in reference to the need for, or response to, adjunctive therapy with corticosteroids and surgery. The decision to administer corticosteroids should be based on careful correlation of the clinical and radiographic features of the case. Surgical shunting should be considered early in the patient with hydrocephalus and symptoms of raised intracranial pressure. Tuberculomas are best treated medically, often in conjunction with corticosteroids where cerebral edema is believed to contribute to neurologic decline. The recommended chemotherapy regimen is isoniazid and rifampin in all patients, together with pyrazinamide for the first 2 months.

Brainstem auditory evoked potential abnormalities in myelomeningocoele in the older child.

Brainstem auditory evoked potentials and clinical findings were examined in 18 children over the age of 5 years who were born with myelomeningocoele which was closed at birth, and whose hydrocephalus was managed by long term shunting in most of them. The potentials were compared with age and sex matched normal subjects and with four patients with hydrocephalus only. All but one had an abnormal brainstem auditory evoked potential with 72% showing a delay in the II-V and I-V interpeak latencies of more than three standard deviations. It is proposed that the abnormalities are a reflection of brainstem dysgenesis which is part of an associated Arnold-Chiari malformation, though the malformation was clinically asymptomatic in all. The usefulness of the brainstem auditory evoked potential for assessing the course of hydrocephalus and for predicting symptomatic Arnold-Chiari malformation is questioned.

"Nautral" canine model of infantile hydrocephalus.

A review of the current knowledge about a variety of aspects of infantile hydrocephalus suggests that one cause of this problem is subarachnoid blood from birth trauma interacting with an anatomically immature cerebrospinal fluid-absorbing system. To test this hypothesis and to create a model that could be used to devise various methods of prophylaxis and therapy, we injected autologous blood into the cisterna magna of puppies, followed the size of their ventricles with serial computerized tomographic (CT) scans, and evaluated the scanning electron microscopic (SEM) appearance of the ventricular walls and subarachnoid space. By injecting blood until the dogs were just at the point of apnea, we obtained a 46% incidence of hydrocephalus with a 13% mortality rate. The amount of blood accepted was variable. The size of the ventricles was followed with CT scans; the time course of hydrocephalus was variable, and in some cases it resolved. SEM revealed significant regional, free cell aggregation and calcification, especially over the base of the brain, which was most marked in the animals that developed hydrocephalus. This suggests a more marked reaction or a lesser ability to clear the subarachnoid blood in those animals, although the reason for this is not clear. Possible uses for this model are suggested.

Tuberculous Meningitis.

Tuberculous meningitis is an uncommon but potentially devastating form of tuberculosis. Current antituberculous drugs are highly effective when treatment is initiated early, before the onset of altered mentation or focal neurologic deficits. Because the clinical outcome depends greatly on the stage at which therapy is initiated, early recognition is of paramount importance. Patients with the meningoencephalitis syndrome and CSF findings of low glucose levels, elevated protein levels, and pleocytosis should be treated immediately if there is evidence of TB elsewhere in the body, or if prompt evaluation fails to establish an alternative diagnosis. Examination of CSF is the best diagnostic approach; with sufficient diligence, serial AFB smears and cultures will usually yield positive results, even days after therapy has been started. The CT scan is an important and highly effective tool for the diagnosis and management of patients with TBM. In a patient with compatible clinical features, the combination of basilar meningeal enhancement and any degree of hydrocephalus is strongly suggestive of the diagnosis of TBM. Serial evaluation by CT scanning is useful for following the course of hydrocephalus and tuberculoma, particularly in reference to the need for, or response to, adjunctive therapy with corticosteroids and surgery. The decision to administer corticosteroids should be based on careful correlation of the clinical and radiographic features of the case. Surgical shunting should be considered early in the patient with hydrocephalus and symptoms of raised intracranial pressure. Tuberculomas are best treated medically, often in conjunction with corticosteroids where cerebral edema is believed to contribute to neurologic decline. The recommended chemotherapy regimen is isoniazid and rifampin in all patients, together with pyrazinamide for the first 2 months.

Early infantile hydrocephalus assessed by the posterior fossa ratio method.

The spontaneous course of hydrocephalus developing in three untreated myelomeningocele patients was followed for several weeks. The size of the posterior cranial fossa was estimated against the increase of the calvarium and expressed objectively in mathematical terms as well as diagrammatically. By this method hydrocephalus imminence could very early be shown.

Ventriculo-direct atrial shunts through a medial sternotomy using a special holter catheter

In the course of hydrocephalus treated by ventriculoatrial shunt revision operations are often necessary mostly for elongation of the catheter. After several revisions it may became difficult or even impossible to introduce the catheter into the auricle through the jugular vein. The authors report on 19 direct cardiac implantations using a medial sternotomy. Operative technique, complications and results are described. This approach proved to be very safe and useful and seems to be superior to the thoracotomy already recommended by other neurosurgical teams. But it is not recommended for children under the age of 3 years.