Hydrocephalus Fluid Research Articles

Percutaneous Minimally Invasive Fetoscopic Surgery: Ramah Ibu dan Janin

Spina bifida is a neural tube defect in which incomplete closing of the spine membrane that occurs in the lumbar and sacral. The defect of spina bifida can be motoric defect or sensoric defect. Clinical manifestation of spina bifida can be appear as limb anaesthesia, total paralysis, incontinensia urine and alvi that can cause recurrent uronary tract infection, renal insufficiency, and nephropathy reflux. Spina bifida can cause hindbrain herniation and hydrocephalus. Diagnosis of spina bifida can use 2D ultrasonography, 3D ultrasonography, and MRI. Procedure surgery of spina bifida can be done with postnatal surgery, prenatal surgery, or percutaneous minimally invasive fetoscopic surgery. Percutaneous minimally invasive fetoscopic surgery is a procedure to close the defect of fetus while intrauterine using minimal access with three or four trocar and using partial amniotic carbon dioxide insufflation (PACI) without laparotomy or hysterectomy. The adventage of percutaneous minimally invasive fetoscopic surgery compare with postnatal surgery and prenatal surgery is improve baby’s motoric function, decrease risk of ventriculoperitoneal (VP) shunt, decrease hindbrain herniation, decrease fluid in hydrocephalus, decrease risk of preterm birth, decrease risk of spontaneous membrane rupture, oligohydramnione, uterine dehiscence, uterine rupture, less pain in two days, and mother can go home from the hospital in a weeks.
 Keywords: Spina bifida, percutaneous minimally invasive fetoscopic surgery, partial amniotic carbon dioxide insufflation (PACI)

The Neuroepithelium Disruption Could Generate Autoantibodies against AQP4 and Cause Neuromyelitis Optica and Hydrocephalus.

Neuromyelitis optica is an inflammatory disease characterized by neuritis and myelitis of the optic nerve. Its physiopathology is connected with the aquaporin-4 water channel, since antibodies against aquaporin-4 have been found in the cerebrospinal fluid and blood of neuromyelitis optica patients. The seropositivity for aquaporin-4 antibodies is used for the diagnosis of neuromyelitis optica or neuromyelitis optica spectrum disease. On the other hand, aquaporin-4 is expressed in astrocyte feet in the brain-blood barrier and subventricular zones of the brain ventricles. Aquaporin-4 expression is high in cerebrospinal fluid in hydrocephalus. Furthermore, neuroepithelial denudation precedes noncommunicating hydrocephalus and this neuroepithelial disruption could allow aquaporin-4 to reach anomalous brain areas where it is unrecognized and induce the generation of aquaporin-4 antibodies which could cause the neuromyelitis optica and certain types of hydrocephalus.

1500 Years of Hydrocephalus Treatment—How Little It Has Changed

ydrocephalus is an ancient disease from both an archeological perspective and written history. In H reviewing our surgical treatment of hydrocephalus, where there has been at least some modicum of surgical success, we can only go back 100 years to the end of the 19th century. An early invasive treatment (albeit temporary) was introduced by Heinrich I. Quincke (1842e1922) in which he introduced the spinal puncture and serial spinal taps for removal of spinal fluid (4). The spinal tap was introduced in the 1890s both for diagnostic examination of the spinal fluid and also for removal of spinal fluid in hydrocephalus. Other inventive individuals attempted cerebrospinal fluid (CSF) drainage/diversion by putting in tubes through the vertebral body and draining the fluid into the peritoneum. Neurosurgeons really did not have any successful forms of surgical treatment for hydrocephalus until the 1950s, when some inventive people such as John W. Holter, Robert H. Pudenz, Frank E. Nulsen, and Eugene B. Spitz, among others, came up with CSF diversion systems allowing the CSF to be diverted from the cerebral ventricles to the heart or abdomen using a recently introduced tubing material made of silicone. To put this all into perspective, the generation practicing neurosurgery now has in 1 generation been able to come up with some reasonably good surgical solutions for the surgical treatment of hydrocephalus.

Nerve growth factor level in the cerebrospinal fluid in hydrocephalus

Nerve growth factor level in the cerebrospinal fluid in hydrocephalus

Influence of the rate of ventricular enlargement on the white matter water content in progressive feline hydrocephalus.

The effectiveness of transependymal absorption of cerebrospinal fluid in hydrocephalus was studied by correlating the measured water content of feline hydrocephalic white matter with the rate of enlargement of the ventricles. Two groups of cats were subjected to opening of either the calvaria or the calvaria and dura before the intracisternal injection of kaolin to obtain two profiles of ventricular enlargement. The water content 1, 2, and 3 mm from the lateral ventricles was measured in each group using the dry/wet weight and microgravimetric techniques after sacrificing the animals in each group at 2, 3, or 6 weeks after inducing hydrocephalus. In the animals with both calvarial and dural opening, the ventricles enlarged rapidly in the first 2 to 3 weeks and then continued to increase but at a slower rate. Concomitant with this early increase of ventricular size was a progressive increase in white matter water content both adjacent to and remote from the ventricles, which continued through 6 weeks. When only the calvaria was opened, ventricular size increased gradually, but continued to increase at a constant rate throughout the 6 weeks. Water content adjacent to the ventricle did not increase until the 3rd week, with little spread to adjacent areas by the 6th week. The central canals of the spinal cord were enlarged in both groups at all sampling levels. Neither increased periventricular water nor dilatation of the central canal was associated with stabilization of ventricular size in these studies. The authors conclude that these pathways are not sufficient to arrest the hydrocephalic process in these models.

Epidural and subdural haematomas as a complication of internal drainage of cerebrospinal fluid in hydrocephalus.

After mentioning the most important indications for the implantation of atrio-ventricular systems in increased intracranial pressure, the importance of epidural and/or subdural bleeding as one of the main postoperative complications is pointed out. In the literature, known to us, there are reports of 9 epidural and 25 subdural haematomas. Four more personal cases are reported. The cause of the bleeding is collapse of the cortex which leads to rupture of cortical veins or epidural vessels. Especially at risk are adult patients with high intracranial pressure or atrophy of the cortex in long standing hydrocephalus. Epidural haematoma always develops in the first few hours after the operation, whereas subdural haematomas may develop either in the first days or even after weeks and months. The incidence of this complication in our adult patients is 5.6%. Some possibilities for the prophylaxis of intracranial bleeding are mentioned.

Transventricular absorption and isotope ventriculography.

A simulation of isotope ventriculography with the use of iodinated I 131 serum albumin in a glass ventricular model is used for comparison with conventional air ventriculography. The poor resolution of the rectilinear scanning method does not allow good definition of the true ventricular outline. The geometry of a rectilinear scanning system precludes direct comparisons between scans and air ventriculography. The interpretation of isotope ventriculograms as providing evidence for the transventricular absorption of protein and of cerebrospinal fluid in hydrocephalus is invalid.

Peritoneal atrial shunt for intractable ascites.

MECHANICAL means have in the past been tested to drain peritoneal fluid into the venous system^1,2but none has been successful due mainly to a propensity for clotting. The analogous problem of draining cerebrospinal fluid in hydrocephalus has been assisted by insertion of a manually compressable subcutaneous pump in the line which helps to keep the system patent.^3,4Smith reported using such a device for drainage of ascitic fluid in one patient.⁵This is a report of the development of a peritoneal-right atrial shunt fitted with a plastic clearing pump that has been used in eight patients. <h3>Description of Device</h3> The shunt has three elements: the intraperitoneal collecting sump, the connecting tubes containing the one-way valves, and the flushing pump. Each has undergone progressive modification during this clinical experience.^6,7The shunt now used is illustrated (Fig 1). <h3>Sump.</h3> —The intraperitoneal collecting device consists of a double

AMOUNT OF CEREBROSPINAL FLUID IN HYDROCEPHALUS

It is difficult to measure the progress of hydrocephalus. The method of estimating changes in the amount of cerebrospinal fluid by the effect produced on the size of the head is unsatisfactory, the variations in circumference showing only relatively gross changes and not giving any definite idea of the actual amount of fluid present in the cranium. The thickness of the brain tissue in the region of the parietal lobes can be gaged roughly by noting the distance it is necessary to insert a needle before the ventricles are entered, but this procedure again furnishes no information on which to base an estimate of the actual amount of fluid in the ventricles and subarachnoid space. A knowledge of the quantity of cerebrospinal fluid in hydrocephalus would certainly be advantageous. It could be used as an index of the progress of the disease, and a variation in the amount would probably