Hydrocephalus Patients Research Articles

Differential proteomic profile of lumbar and ventricular cerebrospinal fluid

BackgroundPathological cerebral conditions may manifest in altered composition of the cerebrospinal fluid (CSF). Although diagnostic CSF analysis seeks to establish pathological disturbances in the brain proper, CSF is generally sampled from the lumbar compartment for reasons of technical ease and ethical considerations. We here aimed to compare the molecular composition of CSF obtained from the ventricular versus the lumbar CSF compartments to establish a relevance for employing lumbar CSF as a proxy for the CSF bathing the brain tissue.MethodsCSF was collected from 46 patients with idiopathic normal pressure hydrocephalus (iNPH) patients during their diagnostic workup (lumbar samples) and in connection with their subsequent CSF diversion shunt surgery (ventricular samples). The mass-spectrometry-based proteomic profile was determined in these samples and in addition, selected biomarkers were quantified with ELISA (S100B, neurofilament light (NfL), amyloid-β (Aβ40, Aβ42), and total tau (T-tau) and phosphorylated tau (P-tau) forms). The latter analysis was extended to include paired porcine samples obtained from the lumbar compartment and the cerebromedullary cistern closely related to the ventricles.ResultsIn total 1231 proteins were detected in the human CSF. Of these, 216 distributed equally in the two CSF compartments, whereas 22 were preferentially (or solely) present in the ventricular CSF and four in the lumbar CSF. The selected biomarkers of neurodegeneration and Alzheimer’s disease displayed differential distribution, some with higher (S100B, T-tau, and P-tau) and some with lower (NfL, Aβ40, Aβ42) levels in the ventricular compartment. In the porcine samples, all biomarkers were most abundant in the lumbar CSF.ConclusionsThe overall proteomic profile differs between the ventricular and the lumbar CSF compartments, and so does the distribution of clinically employed biomarkers. However, for a range of CSF proteins and biomarkers, one can reliably employ lumbar CSF as a proxy for ventricular CSF if or a lumbar/cranial index for the particular molecule has been established. It is therefore important to verify the compartmental preference of the proteins or biomarkers of interest prior to extrapolating from lumbar CSF to that of the ventricular fluid bordering the brain.

Enhanced brain parcellation via abnormality inpainting for neuroimage-based consciousness evaluation of hydrocephalus patients by lumbar drainage

Brain network analysis based on structural and functional magnetic resonance imaging (MRI) is considered as an effective method for consciousness evaluation of hydrocephalus patients, which can also be applied to facilitate the ameliorative effect of lumbar cerebrospinal fluid drainage (LCFD). Automatic brain parcellation is a prerequisite for brain network construction. However, hydrocephalus images usually have large deformations and lesion erosions, which becomes challenging for ensuring effective brain parcellation works. In this paper, we develop a novel and robust method for segmenting brain regions of hydrocephalus images. Our main contribution is to design an innovative inpainting method that can amend the large deformations and lesion erosions in hydrocephalus images, and synthesize the normal brain version without injury. The synthesized images can effectively support brain parcellation tasks and lay the foundation for the subsequent brain network construction work. Specifically, the novelty of the inpainting method is that it can utilize the symmetric properties of the brain structure to ensure the quality of the synthesized results. Experiments show that the proposed brain abnormality inpainting method can effectively aid the brain network construction, and improve the CRS-R score estimation which represents the patient’s consciousness states. Furthermore, the brain network analysis based on our enhanced brain parcellation method has demonstrated potential imaging biomarkers for better interpreting and understanding the recovery of consciousness in patients with secondary hydrocephalus.

Pituitary enlargement in patients with cerebrospinal fluid drainage due to ventricular shunt insertion: know the condition and do not mistake for adenoma

ObjectiveChildhood hydrocephalus patients treated by ventriculo-peritoneal (v.-p.) shunting are sometimes referred years after this therapy for evaluation of suspicious pituitary enlargement. Since pituitary size has been shown to depend on cerebrospinal fluid (CSF) pressure, we assume this phenomenon to be caused by shunt overdrainage. Therefore, we studied pituitary size and morphology in shunted hydrocephalus patients with radiological signs of high CSF drainage.Patients and methodsRetrospective study of pituitary size and morphology in 15 shunted patients with non-tumoral hydrocephalus and 7 shunted hydrocephalus patients due to childhood brain tumor compared to a population mean. In five brain tumor patients also pre- and postsurgical comparisons were performed.ResultsPituitary mid-sagittal size and pituitary volume were significantly higher in both hydrocephalus groups, compared to the population mean (midsagittal size t = 5.91; p < 0.001; pituitary volume, t = 3.03; p = 0.006). In patients available for pre- and postoperative comparison, there was also a significant increase in pituitary size and volume postoperatively (mean preoperative midsagittal height 2.54 ± 1.0 mm vs. 6.6 ± 0.7 mm post-surgery; mean pre-operative pituitary volume 120.5 ± 69.2 mm3 vs. 368.9 ± 57.9 mm3 post-surgery).ConclusionOur results confirmed a significant increase in pituitary size and volume, mimicking pituitary pathology, after v.-p. shunt insertion. This phenomenon can be explained by the Monro–Kellie doctrine, stating that intracranial depletion of CSF—as caused by v.p. shunting—leads to compensatory intracranial hyperemia, especially in the venous system, with the consequence of engorged venous sinuses, most likely responsible for enlargement of the pituitary gland.

Multi Loculated Hydrocephalus and Simple Hydrocephalus: Comparison of Outcomes in a Paediatric Population

Background: Management for simple hydrocephalus in low/middle income countries include insertion of a ventriculoperitoneal shunt (VPS) or performance of an endoscopic third ventriculostomy (ETV).&#x0D; Objective: This present study was carried out to compare presenting features, surgical management and outcomes for patients with simple and loculated hydrocephalus.&#x0D; Methodology: This case-control study was performed in the Department of Paediatric Neurosurgery at National Institute of Neurosciences and Hospital, Dhaka, Bangladesh from July 2017 to June 2019. The patients with loculated hydrocephalus were included in the analysis and comparison made to case matched simple hydrocephalus controls. Presenting features, operative details, and outcomes measured by the Glasgow Outcome Scale- Paediatric (GOS) were recorded over a follow up period of one year.&#x0D; Results: A total number of 17 patients with loculated hydrocephalus were recruited for this study. Loculated patients underwent ETV (n=3), VPS (n=7), aqueductoplasty (n=1) and no procedure (n=6). Simple hydrocephalus patients underwent ETV (n=4), VPS (n=7), no procedure (n=2). Patients undergoing intraoperative irrigation had a mean GOS of 3 compared to a GOS of 6 in non-irrigated patients (p=0.0434). Mortality occurred in 9 patients (5 loculated HCP and 4 simple HCP). Mortality was seen to be higher in male patients (p&lt;0.0001) and those with congenital aetiologies (p&lt;0.0001).&#x0D; Conclusion: There is no statistically significant difference in mortality or GOS at follow up between the 2 groups.&#x0D; Journal of National Institute of Neurosciences Bangladesh, July 2022;8(2):112-120

The effect of shunt removal on the quality of life in patients with congenital hydrocephalus.

Although there have been reports investigating the quality of life of patients who underwent ventriculoperitoneal shunting or endoscopic third ventriculostomy (ETV) for congenital hydrocephalus, there have been no studies of the quality of life of patients after ventriculoperitoneal shunt (VPS) removal. In the present study, a survey of pediatric and congenital hydrocephalus patients was conducted to compare the quality of life of patients with a remaining VPS with that of patients who had the shunt removed. Between February 2020 and November 2021, an outpatient survey was administered to patients 8years of age and older who had undergone VPS due to a diagnosis of congenital hydrocephalus. The Hydrocephalus Outcome Questionnaire (HOQ) was used to assess the quality of life for this study. The HOQ scores (overall health score, physical health score, cognitive health score, and social-emotional health score) were compared among three groups: a VPS-remaining group, VPS-removed with endoscopic third ventriculostomy (ETV) group, and VPS-removed without ETV group. The total number of patients who underwent VPS for hydrocephalus was 71, with 47 in the VPS-remaining group, 14 in the shunt-removed with ETV group, and 10 in the shunt-removed without ETV group. The HOQ overall health score was 0.68 for the VPS-remaining group, 0.74 for the shunt-removed with ETV group, and 0.74 for the shunt-removed without ETV. There were no significant differences between the VPS-remaining group and the VPS-removed with or without ETV groups (p = 0.3255, 0.4178, respectively). There was no significant difference in the quality of life between patients with a remaining VPS and those who had their VPS removed with or without ETV.

Perioperative external ventricular drainage vs. no-EVD strategy in pediatric posterior fossa tumors—pilot study results

IntroductionPediatric brain tumors of the posterior fossa often present with occlusive hydrocephalus. Endoscopic third ventriculostomy (ETV) or ventriculoperitoneal shunting (VPS) has been established for definite hydrocephalus treatment. The aim of the study was to analyze the impact and safety of perioperative temporary external ventricular CSF drainage (EVD) placement on postoperative hydrocephalus outcome compared to a no-EVD strategy.Patients and methodsIn a prospective database, 36 posterior fossa tumor patients of 2–18 years were included with a follow-up of 1 year. Fifty-eight percent presented with preoperative hydrocephalus. Patients were assigned to non-hydrocephalus group: group I (n = 15) and to preoperative hydrocephalus, group IIa with EVD placement (n = 9), and group IIb without EVD (n = 12).ResultsMedian age of patients was 8.1 years (range 3.17 to 16.58 years). One-third of 21 hydrocephalus patients required ETV or VPS (n = 7). Occurrence of de novo hydrocephalus in group I after surgery was not observed in our cohort. Age and histology were no confounding factor for EVD placement between group IIa and IIb (p = 0.34). The use of EVD did not result in better control of hydrocephalus compared to no-EVD patients considering pre- and postoperative MRI ventricular indices (p = 0.4). Perioperative placement of an EVD resulted in a threefold risk for subsequent VPS or ETV (group IIa 55.5% vs group IIb 16.6%): relative risk for EVD patients compared to no-EVD patients with hydrocephalus was 3.3 (CI = 1.06–13.43, p = 0.09).ConclusionPerioperative EVD placement appears to harbor a threefold relative risk of requiring subsequent permanent CSF diversion in children above 2 years. EVD was not more effective to control ventricular enlargement compared to tumor removal alone. The no-EVD strategy was safe and did not result in postoperative complications. Thus, to evaluate potential adverse effects on hydrocephalus outcome by EVD placement, a prospective study is warranted to falsify the results.

The application of integrated MRI CSF flowmetry in the diagnosis and treatment of CSF dynamic changes in hydrocephalus patients: a systematic review

Background: CSF has contributed to the growth of brain development during the time of evolution and later protects against external trauma. Idiopathic normal pressure hydrocephalus (iNPH) is known as an aberration of intracranial hydrodynamics resulting in the accumulation of CSF endo-ventricular. The use of phase-contrast (PC) MRI is proven effective in assessing the communication of arachnoid cyst and subarachnoid CSF spaces. The CSF flow MRI has been found to show efficacy in differentiation between the communicating and non-communicating hydrocephalus for localizing obstruction levels in obstructive hydrocephalus and later providing important information concerning the preoperative evaluation of NPH, along with the differential diagnosis and the prediction of the related advantages from surgery and post-operative follow-up. Hence, the present study aimed for analyzing the role of MRI CSF flowmetry in the evaluation of patients with suspected hydrocephalus. Method: The role of MRI CSF flowmetry in the evaluation of patients with suspected hydrocephalus was undertaken by conducting a systematic literature review. The current review was reported as required reporting features for systematic reviews and meta-analysis statements (PRISMA). The systematic literature review included a total of 22 studies that analyzed the various applications of MRI CSF flowmetry in the medical field, mainly focusing on the use of MRI CSF flowmetry in the evaluation of patients with suspected hydrocephalus. Results: The result mainly included the identification of the CSF flow by integrating the PC MRI technique and the aqueduct-CSF flow rate was detected accurately showing as statistically significant in diagnosis of NPH. Evaluating the peak velocities and aqueductal stroke volume (ASV) showed a significant increase among hydrocephalus patients. Conclusion: The condition of hydrocephalus makes the ventricular size increase and eventually puts pressure on the brain due to excess accumulation of fluid while blocking the CSF flow after it exits ventricles. Currently, many imaging techniques are available for the detection of hydrocephalus that study the CSF flow dynamics and its related parameters. Among them, the MRI technique is the most reliable, rapid, and most importantly, a non-invasive method for the quantitative measurement of CSF flow rate and intracranial pulsations. Keywords: Intracranial pressure, Magnetic resonance imaging (MRI), MRI CSF Flowmetry, Neurological disorder, CSF dynamics

Practical Application of Deep Learning in Neurosurgery: Identifying CSF Shunt Systems in Hydrocephalus Patients

Practical Application of Deep Learning in Neurosurgery: Identifying CSF Shunt Systems in Hydrocephalus Patients

Intraventricular Hemorrhage and Related Hydrocephalus Patients Demographics in a University Hospital NICU: Single-Center Data.

To analyze the demographic and clinical data of preterm or low birth weight newborns with periventricular hemorrhage. This retrospective study analyzed patients admitted to the neonatal intensive care unit of a Bahcesehir University School of Medicine-Affiliated Hospital due to preterm birth or low birth weight between June 1, 2012, and April 30, 2021. Categorical values were evaluated by Pearson chi-square or Fisher's exact test. The Mann-Whitney U test compared continuous values between the groups. Logistic regression was used to evaluate the factors that affected permanent cerebrospinal fluid (CSF) diversion. The study finally evaluated 180 newborns. Ninety-one newborns (50.5%) had grade I, 18 (10%) had grade II, 22 (12.2%) had grade III, and 49 (27.2%) had grade IV hemorrhage. One hundred and forty-nine patients (82.8%) were delivered by cesarean section, and 31 (17.2%) were delivered vaginally. All patients with low-grade hemorrhage who needed temporary CSF diversion eventually required permanent CSF diversion. For high-grade hemorrhage, 15 (grade III, 1; grade IV, 14) of 51 (29.4%) patients with ventricular access device (VAD) insertion required permanent CSF diversion. Fifteen (grade III, 6; grade IV, 9) of these 51 (29.4%) patients did not need permanent CSF diversion; thus, their VADs were removed. The permanent CSF diversion rate was significantly higher in the high-grade hemorrhage group, which had significantly lower weight and gestational age at birth. Moreover, only weight at VAD insertion had minimal effect on the need for permanent CSF diversion.

Case Report: Optical Coherence Tomography, as a Non-Invasive Approach to Evaluate Intracranial Pressure in Normal Pressure Hydrocephalus Patients, as with their Treatment Follow-ups and VP Shunts Reprogramming Procedures

Case Report: Optical Coherence Tomography, as a Non-Invasive Approach to Evaluate Intracranial Pressure in Normal Pressure Hydrocephalus Patients, as with their Treatment Follow-ups and VP Shunts Reprogramming Procedures

The genetic background of hydrocephalus in a population-based cohort: implication of ciliary involvement.

Hydrocephalus is one of the most common congenital disorders of the central nervous system and often displays psychiatric co-morbidities, in particular autism spectrum disorder. The disease mechanisms behind hydrocephalus are complex and not well understood, but some association with dysfunctional cilia in the brain ventricles and subarachnoid space has been indicated. A better understanding of the genetic aetiology of hydrocephalus, including the role of ciliopathies, may bring insights into a potentially shared genetic aetiology. In this population-based case-cohort study, we, for the first time, investigated variants of postulated hydrocephalus candidate genes. Using these data, we aimed to investigate potential involvement of the ciliome in hydrocephalus and describe genotype-phenotype associations with an autism spectrum disorder. One-hundred and twenty-one hydrocephalus candidate genes were screened in a whole-exome-sequenced sub-cohort of the Lundbeck Foundation Initiative for Integrative Psychiatric Research study, comprising 72 hydrocephalus patients and 4181 background population controls. Candidate genes containing high-impact variants of interest were systematically evaluated for their involvement in ciliary function and an autism spectrum disorder. The median age at diagnosis for the hydrocephalus patients was 0 years (range 0-27 years), the median age at analysis was 22 years (11-35 years), and 70.5% were males. The median age for controls was 18 years (range 11-26 years) and 53.3% were males. Fifty-two putative hydrocephalus-associated variants in 34 genes were identified in 42 patients (58.3%). In hydrocephalus cases, we found increased, but not significant, enrichment of high-impact protein altering variants (odds ratio 1.51, 95% confidence interval 0.92-2.51, P = 0.096), which was driven by a significant enrichment of rare protein truncating variants (odds ratio 2.71, 95% confidence interval 1.17-5.58, P = 0.011). Fourteen of the genes with high-impact variants are part of the ciliome, whereas another six genes affect cilia-dependent processes during neurogenesis. Furthermore, 15 of the 34 genes with high-impact variants and three of eight genes with protein truncating variants were associated with an autism spectrum disorder. Because symptoms of other diseases may be neglected or masked by the hydrocephalus-associated symptoms, we suggest that patients with congenital hydrocephalus undergo clinical genetic assessment with respect to ciliopathies and an autism spectrum disorder. Our results point to the significance of hydrocephalus as a ciliary disease in some cases. Future studies in brain ciliopathies may not only reveal new insights into hydrocephalus but also, brain disease in the broadest sense, given the essential role of cilia in neurodevelopment.

Medico-socio-economic perspective of congenital hydrocephalus patients treatment in dr. Soetomo Academic General hospital, Surabaya, Indonesia

Background: Hydrocephalus is a brain disease that requires prompt treatment. The outcome of hydrocephalus is dependent on early detection and treatment. This study was conducted to analyze the medico-socio-economic perspective on the delayed treatment of hydrocephalus patients, which aimed to advance the practice of neurosurgery in the socio-neurosurgery field, including both preventive and therapeutic aspects. Method: This was an observational analysis study. The study subjects were all patients with congenital hydrocephalus treated in dr. Soetomo Academic General Hospital between January 2017 and December 2019. The study was carried out on January 2017 to December 2019 at the Inpatient Surgery ward, dr Soetomo Academic General Hospital, neurosurgery outpatient unit, and home visits. Research data consists of both primary and medical record data. Data on patient characteristics were obtained through direct interviews with the sample using prepared questionnaires, medical record data, and radiological data of both patients examined at dr. Soetomo Academic General Hospital and other health services. Bivariate correlation analysis was performed to assess the effect of each risk factor on the incidence of delay in treatment, and multivariate logistic regression analysis was performed to assess the magnitude of the effect of risk factors. Result: The number of cases was 101 subjects. A total of 101 patients included as research samples were congenital hydrocephalus patients who received the first treatment at dr. Soetomo Academic General Hospital from January 2017 to December 2019. Up to 50 individuals (49.5%) were delayed in treatment. The data analysis with Chi-square did not reveal a statistically significant correlation between delay in treatment and level of parent's education (p=0.0951), delay in treatment and economic status ((p=0.4955). Delays in the treatment of congenital hydrocephalus were statistically significant and correlated with Posyandu's role (p=0.0012), health insurance ownership (p=0.0001), family support (p=0.0130), and professional medical decisions (p=0.0001). Health insurance ownership has the smallest p-value (0.000) and largest wald (16.545) in the multivariate logistic regression analysis calculation using the enter method. The insurance ownership variable has the most significant and largest partial influence on the delay in treating congenital hydrocephalus. Conclusion: There were 101 patients included, and up to 50 individuals (49.5%) were delayed in treatment. Parents' education level and socioeconomic status were not associated with delayed treatment of congenital hydrocephalus. Delays in managing congenital hydrocephalus were influenced by Posyandu's role, health insurance ownership, family support, and professional medical decisions.

Epidemiology of hydrocephalus in Brazil

ObjectiveDescribe the epidemiological profile and social-economic burden that hydrocephalus patients represent to the national public health system, using data available at the online database of the Brazilian Health Ministry (DataSUS). MethodsThis is a populational study based on descriptive statistics of all clinical and surgical appointments included in the DataSUS database. Data included herein were collected between 2015 and 2021 and subdivided into three main groups, related to hydrocephalus incidence and mortality, hospitalizations, and financial costs. ResultsIn the study period, 3993 new cases of congenital hydrocephalus were diagnosed, with 6051 deaths overall. The mortality rate in the country was 1.5/100000 live births and the prevalence was 0.374/100000 inhabitants. The number of hospitalizations resulting from treatment procedures and complications of hydrocephalus was 137,880 and there was a reduction of up to 27.2% during the SARS-CoV-2 pandemics concerning previous years. Total costs for hydrocephalus management in the country amounted to 140,610,585.51 dollars. ConclusionsHydrocephalus has a significant impact on public health budgets and pediatric mortality rates; however, it is probably underestimated, due to the paucity of demographic data and epidemiological studies in Latin America and, specifically, in Brazil. The dataSUS also has several limitations in accessing certain data related to hydrocephalus, making it difficult to have a more assertive understanding of the disease in Brazil. The results of this study provide important guidance for future research projects in clinical and experimental hydrocephalus and also the creation of public policies for better governance and care of hydrocephalus patients.

Concordance of CSF AD biomarkers between intraventricular and lumbar CSF in iNPH

AbstractBackgroundThe core Alzheimer’s Disease cerebrospinal fluid (CSF) biomarkers, amyloid β 1‐42 (Aβ42), total tau (T‐tau) and phosphorylated tau 181 (P‐tau181), have presented added value for differential diagnostics in the field of neurodegenerative diseases. Moreover, the concentration gradient of these biomarkers between intraventricular (V‐CSF) and lumbar region CSF (L‐CSF) has been partly established for idiopathic normal pressure hydrocephalus (iNPH) patients. In this study, we aim to provide conversion factors between V‐CSF and L‐CSF.MethodAltogether 138 patients were diagnosed for possible iNPH and received ventriculoperitoneal shunt. Lumbar CSF samples were obtained 3‐months prior shunt surgery. Additional intraoperative interventricular CSF samples were obtained from 97 patients. Furthermore, follow‐up samples of 41 patients were obtained 0‐, 3‐, 6‐ and 18‐months (0M, 3M, 6M, 18M) postoperatively by shunt valve and lumbar punctures. Aβ42, T‐tau and P‐tau181 CSF concentrations of samples collected were analyzed using Elecsys (Cohort of 97 patients) and Innotest (Cohort of 41 patients) assays.ResultPreoperative L‐CSF Aβ42, T‐tau and P‐tau181 associated to intraoperative V‐CSF (Sprearman ρ=0.54 Aβ42, r=0.34 T‐tau, r=0.55 P‐tau, all p&lt;0.001). Strong associations were seen between postoperative L‐ and V‐CSF for all biomarkers in the every follow‐up sampling point (Spearman ρ Aβ42: 0M=.77, 3M=.88, 6M=.83, 18M=.84) (T‐tau: 0M=.92, 3M=.91, 6M=.92, 18M=.94) (P‐tau181: 0M=.96, 3M=.95, 6M=.94, 18M=.94) (all p&lt;0.0001). Regression equations were determined for intraoperative V‐CSF and preoperative L‐CSF (Aβ42: V‐CSF=185+0.34*L‐CSF, T‐tau: Ln(V‐CSF)=3.11+0.49*Ln(L‐CSF) and P‐tau181: V‐CSF=8.2+0.51*L‐CSF, all p&lt;0.01), and for postoperative V‐CSF and L‐CSF (Aβ42: V‐CSF=86.7+0.75*L‐CSF, T‐tau: V‐CSF=86.9+0.62*L‐CSF and P‐tau181: V‐CSF=1.9+0.75*L‐CSF all p&lt;0.0001).ConclusionThe Aβ42, T‐tau and P‐tau181 showed linear dependency between ventricular and lumbar CSF for preoperative L‐CSF and intraoperative V‐CSF as well as for postoperatively collected L‐CSF and V‐CSF. The regression equations based on these findings provide a novel tool to use V‐CSF for diagnostics and prognostics entities that rely on the lumbar CSF concentrations.

A pilot study assessing sphingolipids and glycolipids dysmetabolism in idiopathic normal pressure hydrocephalus

Idiopathic normal pressure hydrocephalus usually exhibits triad of symptoms including gait disturbance, urinary incontinence, and dementia with ventriculomegaly. Currently, its pathogenesis remains to be fully elucidated.To provide a better understanding of this order, we examined whether dysmetabolism of sphingolipids as major lipid components in the brain present in cerebrospinal fluid (CSF) of the patients. Here, we measured various sphingolipidsincluding ceramide and sphingomyelin and glycolipids by electrospray ionization-tandem mass spectrometry in the cerebrospinal fluid of 19 consecutive idiopathic normal pressure hydrocephalus patients, 49 Parkinson's disease patients, and 17 neurologically normal controls.The data showed that there was a significant and specific reduction of all galactosylceramide subspecies levels in idiopathic normal pressure hydrocephalus patients compared with other groups, whereas ceramide and sphingomyelin levels as well as other neutral glycolipids such as glucosylceramide and lactosylceramide were similar in both disease states. Multiple regression analysis of sex and age did not show any correlation with galactosylceramide levels. We also examined whether MMSE scores are correlated with sphingolipid levels in iNPH patients. A specific subspecies of sphingomyelin (d18:1/18:0) only exhibited a statistically significant negative correlation (p = 0.0473, R = −0.4604) with MMSE scores but no other sphingolipids in iNPH patients. These data strongly suggest that myelin-rich galactosylceramide metabolism is severely impaired in idiopathic normal pressure hydrocephalus patients and might serve as the basis of biomarker for this disorder.

First Experience With Postoperative Transcranial Ultrasound Through Sonolucent Burr Hole Covers in Adult Hydrocephalus Patients.

Managing patients with hydrocephalus and cerebrospinal fluid (CSF) disorders requires repeated head imaging. In adults, it is typically computed tomography (CT) or less commonly magnetic resonance imaging (MRI). However, CT poses cumulative radiation risks and MRI is costly. Ultrasound is a radiation-free, relatively inexpensive, and optionally point-of-care alternative, but is prohibited by very limited windows through an intact skull. To describe our initial experience with transcutaneous transcranial ultrasound through sonolucent burr hole covers in postoperative hydrocephalus and CSF disorder patients. Using cohort study design, infection and revision rates were compared between patients who underwent sonolucent burr hole cover placement during new ventriculoperitoneal shunt placement and endoscopic third ventriculostomy over the 1-year study time period and controls from the period 1 year before. Postoperatively, trans-burr hole ultrasound was performed in the clinic, at bedside inpatient, and in the radiology suite to assess ventricular anatomy. Thirty-seven patients with sonolucent burr hole cover were compared with 57 historical control patients. There was no statistically significant difference in infection rates between the sonolucent burr hole cover group (1/37, 2.7%) and the control group (0/57, P = .394). Revision rates were 13.5% vs 15.8% (P = 1.000), but no revisions were related to the burr hole or cranial hardware. Trans-burr hole ultrasound is feasible for gross evaluation of ventricular caliber postoperatively in patients with sonolucent burr hole covers. There was no increase in infection rate or revision rate. This imaging technique may serve as an alternative to CT and MRI in the management of select patients with hydrocephalus and CSF disorders.

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.

Long-term recovery behavior of brain tissue in hydrocephalus patients after shunting

The unpredictable complexities in hydrocephalus shunt outcomes may be related to the recovery behavior of brain tissue after shunting. The simulated cerebrospinal fluid (CSF) velocity and intracranial pressure (ICP) over 15 months after shunting were validated by experimental data. The mean strain and creep of the brain had notable changes after shunting and their trends were monotonic. The highest stiffness of the hydrocephalic brain was in the first consolidation phase (between pre-shunting to 1 month after shunting). The viscous component overcame and damped the input load in the third consolidation phase (after the fifteenth month) and changes in brain volume were stopped. The long-intracranial elastance (long-IE) changed oscillatory after shunting and there was not a linear relationship between long-IE and ICP. We showed the long-term effect of the viscous component on brain recovery behavior of hydrocephalic brain. The results shed light on the brain recovery mechanism after shunting and the mechanisms for shunt failure.

Quantification of pathological gait parameter thresholds of idiopathic normal pressure hydrocephalus patients in clinical gait analysis

The aim of the study was to distinguish the hypokinetic gait disorder in idiopathic normal pressure hydrocephalus (NPH) patients from the gait decline in the elderly population by quantifying pathological gait parameter thresholds utilizing a multiple condition gait assessment. 55 NPH patients and 55 age-matched healthy subjects underwent a standardized gait assessment with eight gait conditions. Spatiotemporal gait parameters were assessed through a pressure-sensitive carpet. Statistical analysis consisted of a binary logistic regression (BLR) model, logistic curve-fit evaluated by a Chi-square goodness-of-fit-test, receiver operating characteristic models with area under the curves (AUC), and inverse BLR. Most discriminative gait parameter thresholds were observed in pace, gait cycle, and support gait domains. The most distinct gait conditions were preferred walking speed and semantic dual task. During preferred walking speed, the most significant gait parameter thresholds were stride length ≤ 1.02 m (sensitivity 0.93/specificity 0.91/AUC 0.96), gait velocity ≤ 0.83 m/s (0.80/0.91/0.93), double support phase ≥ 27.0% (0.96/0.76/0.91), and stride length coefficient of variation ≥ 3.4% (0.93/0.72/0.90). In conclusion, the hypokinetic gait disorder in NPH can be quantitatively differentiated from gait patterns of the elderly population. In future studies, this approach may be useful to differentiate clinical entities with similar gait disorders utilizing instrumented gait analysis procedures.

A mathematical framework for the dynamic interaction of pulsatile blood, brain, and cerebrospinal fluid

BackgroundShedding light on less-known aspects of intracranial fluid dynamics may be helpful to understand the hydrocephalus mechanism. The present study suggests a mathematical framework based on in vivo inputs to compare the dynamic interaction of pulsatile blood, brain, and cerebrospinal fluid (CSF) between the healthy subject and the hydrocephalus patient. MethodThe input data for the mathematical formulations was pulsatile blood velocity, which was measured using cine PC-MRI. Tube law was used to transfer the created deformation by blood pulsation in the vessel circumference to the brain domain. The pulsatile deformation of brain tissue with respect to time was calculated and considered to be inlet velocity in the CSF domain. The governing equations in all three domains were continuity, Navier-Stokes, and concentration. We used Darcy law with defined permeability and diffusivity values to define the material properties in the brain. ResultsWe validated the preciseness of the CSF velocity and pressure through the mathematical formulations with cine PC-MRI velocity, experimental ICP, and FSI simulated velocity and pressure. We used the analysis of dimensionless numbers including Reynolds, Womersley, Hartmann, and Peclet to evaluate the characteristics of the intracranial fluid flow. In the mid-systole phase of a cardiac cycle, CSF velocity had the maximum value and CSF pressure had the minimum value. The maximum and amplitude of CSF pressure, as well as CSF stroke volume, were calculated and compared between the healthy subject and the hydrocephalus patient. ConclusionThe present in vivo-based mathematical framework has the potential to gain insight into the less-known points in the physiological function of intracranial fluid dynamics and the hydrocephalus mechanism.