Internal Hydrocephalus Research Articles

Pathomorphology of hydrocephalus associated with anomalies of development of the cerebral aqueduct

Aim. The aim of the study was to reveal structural peculiarities of the ventricular germinal zone and of the neocortex in newborns of 22-40 weeks gestation with congenital hydrocephalus associated with anomalies in development of the cerebral aqueduct.
 Materials and Methods. The main group was the brain of newborns aged 22-40 weeks of gestation with hydrocephalus, formed with the underlying developmental anomalies of the cerebral aqueduct (n=10); comparison group (n=30) was the brain of newborns without visible pathology of the CNS with the width of the lumen of lateral ventricles not exceeding 0.5 cm. A complex pathomorphological study of the ventricular germinal zone and the neocortex in the projection of field No. 6 (cortical representation of the motor analyzer) was carried out.
 Results. Hydrocephalus associated with anomalies of development of the cerebral aqueduct is characterized by disorders in formation of sulci and gyri (micropolygyria, asymmetry and breakage of the gyrification sequence), by absence of signs of remodeling of the ventricular germinal zone and by retardation of differentiation of III-VI cytoarchitectonic layers of the neocortex, with the underlying increased expression of S-100 glial protein in glioblasts of white matter, decreased expression of vimentin in vessels of periventricular region, negative expression of metalloproteinases-9 in glioblasts, of reelin in Cajal-Retzius neurons, of desmin in periventricular vessels.
 Conclusion. Structural peculiarities of the ventricular germinal zone and the neocortex in newborns of 22-40 weeks of gestation with hydrocephalus, associated with anomalies in development of the cerebral aqueduct, should be considered as morphological diagnostic criteria for differentiation of the given pathology with internal hydrocephalus of a different etiology.

Extensive Spinal Adhesive Arachnoiditis After Extradural Spinal Infection–Spinal Dura Mater Is No Barrier to Inflammation

Spinal adhesive arachnoiditis (SAA) is an inflammatory process of the meninges. Cystic changes and cicatrization may lead to neurologic deficits and immobilization. Therapy is difficult and often unsatisfactory. We describe 8 cases of extensive SAA after extradural spinal infection. A total of 238 patients with epidural abscess or osteomyelitis were treated at our institution between 2011 and 2018. We identified 8 patients who developed extensive SAA on follow-up. Different forms of the disease, radiologic changes, and potential treatment options are described. Eight patients developed extensive SAA after either spontaneous epidural infection in 4 cases (50%) or after surgery or steroid injection (50%). Initial treatment for epidural infection was surgery without dural injury in 87.5%. One patient was treated conservatively. SAA was diagnosed 1 month to 8 years after the initial infection, not only in the index region but throughout the whole spine, with varying clinical symptoms. Treatment options such as corticosteroids (n= 4), thecaloscopy (n= 1), syringe-subarachnoid shunting (n= 1), and focal or multilevel arachnolysis (n= 5) were applied. In 2 patients (25%), a rare complication of internal malabsorptive hydrocephalus had to be treated. Patients showed diverse outcomes at last follow-up (mean, 37 months). The prognosis for extensive SAA is poor. Surgical interventions may improve radiologic findings and clinical presentation at least temporarily. Even extradural infection can lead to severe SAA. Early surgery with local reduction of the epidural infection might reduce the risk of inflammation passing the dural sac and causing SAA.

Endoscopic biopsy of intra- and paraventricular brain tumors.

IntroductionSelection of the optimal treatment method of intra- and paraventricular tumors often requires histopathological verification that can be obtained by endoscopic biopsy.AimTo discuss the usefulness of the method in their own experience.Material and methodsThe results of 32 biopsies carried out during a 15-year period were reviewed retrospectively. All tumors were located supratentorially, 25 of them were intraventricular and 7 paraventricular. In 18 patients the tumor was accompanied by internal hydrocephalus. If the ventricular system was narrow, the biopsy was supported by a neuronavigation system. A rigid neuroendoscope was used. The obtained material was subjected to intraoperative and final histopathological examination.ResultsViable diagnostic material was obtained from all patients. In 11 patients with tumor of the posterior portion of the third ventricle, cerebrospinal fluid was collected additionally for diagnostic tests. In 9 patients with obstructive hydrocephalus concomitant third ventriculostomy was performed. In 4 patients with tumor of the interventricular foramen, the tumor mass was reduced and in 2 cases septostomy was performed. In 3 (9.4%) cases the histopathological diagnosis was descriptive and did not explain the nature of the lesion. Four biopsies resulted in persistent bleeding, in 3 patients transient memory impairments were observed, and in 1 patient an epileptic seizure occurred. Five patients needed ventriculoperitoneal shunt placement.ConclusionsEndoscopic biopsy is a safe method to verify the histopathological nature of intra- and paraventricular lesions. It enables sampling of cerebrospinal fluid, reduction of tumor size, and in cases of coexisting obstructive hydrocephalus also third ventriculostomy or septostomy.

Klinische presentatie en diagnose met behulp van MRI van unilaterale hydrocefalus en een vermoeden van periventriculaire encefalitis bij een jonge hond

Een vier maanden oude Engelse buldog werd aangeboden met klachten van acute faciale spiertrekkingen, scheve kopstand en een abnormaal bewustzijn. Het neurologisch onderzoek was indicatief voor een multifocale hersenaandoening. Het hematologisch en biochemisch onderzoek was normaal. Magnetische resonantie van de hersenen onthulde een uitgesproken vergroting van de linker laterale ventrikel, met bijkomend een vergroting van het calvarium op dit niveau. Er waren ook periventriculaire letsels op T2W- en FLAIR-beelden zichtbaar met een matige contrastopname. Analyse van het cerebrospinale vocht toonde matig gemengde, mononucleaire pleiocytose en het testen op infectieziekten kwam negatief terug. De meest waarschijnlijke diagnose was unilaterale interne hydrocefalus veroorzaakt door periventriculaire encefalitis. Ondanks de slechte prognose werd de patiënt succesvol behandeld met prednisolone en fenobarbital. Dit is de eerste beschrijving van unilaterale hydrocefalus met vermoedelijke periventriculaire encefalitis bij een hond gediagnosticeerd met behulp van MRI.

The Relationship between Brachycephalic Head Features in Modern Persian Cats and Dysmorphologies of the Skull and Internal Hydrocephalus.

BackgroundCat breeders observed a frequent occurrence of internal hydrocephalus in Persian cats with extreme brachycephalic head morphology.ObjectiveTo investigate a possible relationship among the grade of brachycephaly, ventricular dilatation, and skull dysmorphologies in Persian cats.Animals92 Persian‐, 10 Domestic shorthair cats.MethodsThe grade of brachycephaly was determined on skull models based on CT datasets. Cranial measurements were examined with regard to a possible correlation with relative ventricular volume, and cranial capacity. Persians with high (peke‐face Persians) and lower grades of brachycephaly (doll‐face Persians) were investigated for the presence of skull dysmorphologies.ResultsThe mean cranial index of the peke‐face Persians (0.97 ± 0.14) was significantly higher than the mean cranial index of doll‐face Persians (0.66 ± 0.04; P < 0.001). Peke‐face Persians had a lower relative nasal bone length (0.15 ± 0.04) compared to doll‐face (0.29 ± 0.08; P < 0.001). The endocranial volume was significantly lower in doll‐face than peke‐face Persians (89.6 ± 1.27% versus 91.76 ± 2.07%; P < 0.001). The cranial index was significantly correlated with this variable (Spearman's r: 0.7; P < 0.0001). Mean ventricle: Brain ratio of the peke‐face group (0.159 ± 0.14) was significantly higher compared to doll‐face Persians (0.015 ± 0.01; P < 0.001).Conclusion and Clinical RelevanceHigh grades of brachycephaly are also associated with malformations of the calvarial and facial bones as well as dental malformations. As these dysmorphologies can affect animal welfare, the selection for extreme forms of brachycephaly in Persian cats should be reconsidered.

VENTRICULO-SINUS TRANSVERSAL SHUNT IN THE TREATMENT OF DECOMPENSATED HYDROCEPHALUS IN CHILDREN (THE RESULTS OF CLINICAL TESTING OF THE METHOD)

The analysis of the results of the implantation of a shunt system between the lateral ventricle and the transverse sinus in hydrocephalus in children, the treatment of which the use of other CSF-shunting operations proved ineffective or impractical. Materials and methods . 50 patients aged from 2 months to 17 years, with decompensated internal hydrocephalus was performed anastomosis between the lateral ventricle and the transverse sinus, through the implantation of the valve low-pressure system or a programmable system with low values of the valve settings. The result of operations is determined by evaluating the dynamics of quantitative clinical and manifestations of hydrocephaly and hypertensive syndrome. Results. In all cases, it was a severe ventriculomegaly and hypertensive syndrome. In all cases, the use of ventriculoatriostomy and ventriculoperitoneostomy proved ineffective or impractical. As a result of the treatment, stabilization of the patients, and the manifestations of decompensated hydrocephalus regression was achieved in 38 of 50 children (76%). In the remaining 12 patients on the background of a functioning shunt preserved manifestations of hydrocephalus, a condition seen as hypodraige. According to our data, hypоdraige manifestations were more common in cases where the venous pressure was high and equal to us certain values liquor pressure in the patient. Conclusion. Ventriculo-sinus transversal shunt may be the method of choice for the treatment of decompensated hydrocephalus in cases where the application of classical operations is not advisable. We consider it appropriate intraoperative assessment of venous pressure in the sinus, as well as the correlation with intraventricular pressure.

Parameters of internal hydrocephalus in different types of multiple sclerosis

Internal hydrocephalus symmetrically increases with progression of multiple sclerosis. Statistically significant differences (р0,01) in terms of height and width of lateral ventricles were observed between patient groups with remitting and progressive types of disease. This method can be used to predict the course of disease.

Increased CSF aquaporin-4, and interleukin-6 levels in dogs with idiopathic communicating internal hydrocephalus and a decrease after ventriculo-peritoneal shunting.

BackgroundStudies in animal models, in which internal hydrocephalus has been induced by obstructing the cerebrospinal fluid pathways, have documented an up-regulation of the concentrations of aquaporin-4 (AQP4) in the brain. In this study, the concentrations of aquaporin-1 (AQP1), AQP1, AQP4 and interleukin-6 (IL-6) were determined in the CSF of dogs with idiopathic communicating hydrocephalus before and after the reduction of intraventricular volume following ventriculo-peritoneal shunt (VP-shunt) treatment.ResultsThe concentrations of AQP4 and IL-6 were increased in the cerebrospinal fluid of dogs with hydrocephalus compared to controls. Both parameters significantly decreased after surgical treatment, accompanied by decrease of ventricular size and the clinical recovery of the dogs. AQP1 was not detectable in CSF.ConclusionsBrain AQP4 up-regulation might be a compensatory response in dogs with hydrocephalus. Future determination of AQP4 at the mRNA and protein level in brain tissue is warranted to substantiate this hypothesis.

Leukoencephalopathy with Vanishing White Matter (VWM) Presenting with Early Myoclonic Encephalopathy (EME) and Rapid Progressive Internal Hydrocephalus

Leukoencephalopathy with Vanishing White Matter (VWM) Presenting with Early Myoclonic Encephalopathy (EME) and Rapid Progressive Internal Hydrocephalus

Slit ventricle syndrome and subdural haemorrhage due to suspected overshunting in a dog with hydrocephalus internus

A 1.5-year-old Chihuahua was presented with clinical signs consistent with multifocal localisation. MRI revealed hydrocephalus internus. Following placement of a ventriculoperitoneal (VP) shunt with a low-pressure valve, improvement was noted....

Internal hydrocephalus caused by Coenurus cerebralis in a ewe

Objective: Coenurosis is a parasitic disease that particularly affects sheep and goats. The disease is caused by Coenurus cerebralis which is the larval stage of Taenia multiceps . The objective of this study was to investigate the clinical and the pathological lesions caused by C. cerebralis in a ewe. Materials and methods: Two-and-a-half year-old female ewe showing neurological signs was presented to the Veterinary Teaching Hospital, Assiut University, Egypt. Postmortem and histopathological examinations were done to investigate the pathological lessions caused by C. cerebralis . Results: Postmortem examination of the brain revealed Coenurus cyst measuring 5×3 cm associated with dilated lateral ventricle. Histopathological examination revealed extensive areas of liquefactive necrosis in the cerebrum. The necrotic area was infiltrated with lymphocytes, microglia cells and eosinophils. Internal hydrocephalus and atrophy of the ependymal cells of both lateral ventricle and choroid plexus were also seen. Conclusion: It was concluded that coenurosis might be associated with internal hydrocephalus along with some clinical and pathological findings. http://doi.org/10.5455/javar.2016.c138

Specific features of reelin expression in the brain of fetuses and newborns with internal hydrocephalus

to study reelin expression in the neocortex of fetuses and newborns with internal hydrocephalus (HC) and to reveal its features in relation to the etiology of HC. The brains of fetuses and newborn at 22-40 weeks' gestation with internal HC associated with Sylvian aqueduct malformation (n=9), post-inflammatory (n=4) and post-hemorrhagic (n=5) HC were examined. In a comparison group, the fragments of brain tissue with a slit-like lumen of the lateral ventricles were no more than 0.5 cm (n=20). A standard immunohistochemical method was used to reveal reelin expression in the neocortex of the anterior third of the precentral gyrus. HC associated with Sylvian aqueduct malformation is characterized by a negative reelin immunoexpression. In postinflammatory HC, the expression of reelin decreases significantly (p=0.025) with respect to the conditional norm and, in posthemorrhagic HC it is comparable with that in the comparison group. The features of reelin expression in the brain of fetuses and newborns at 22-40 weeks' gestation with internal HC should be considered as morphological differential and diagnostic criteria for the disease in relation to its etiology.

A fetopathological and clinical study of the Dandy-Walker malformation and a literature review

Abstract Aim: The Dandy-Walker malformation is a rare abnormality of the central nervous system pertaining to the group of cystic malformations. The frequency of occurrence of the malformation ranges from 1:800 to 35,000 live births. The aim of this study is to investigate the Dandy-Walker malformation in two cases – one by autopsy after abortion due to medical indications during the 25th gestational week at The Clinic of Embryo and Fetopathology, Center for Maternity and Neonatology, Tunis, Tunisia, and another case of a 1-year-old infant diagnosed with an acute internal hydrocephalus at The Clinic of Neurosurgery, Medical University Plovdiv, Bulgaria, and to compare the results with those in the literature. Results: Both cases are of an isolated Dandy-Walker malformation without any associated abnormalities of the central nervous system and other organs and systems. After the placement of a ventriculoperitoneal shunt in the second case, the child’s condition was greatly improved. Conclusion: The question arises whether the prenatal diagnosis of an isolated Dandy-Walker malformation is an indication for pregnancy termination, and who and after what examinations has the right to make this decision, given the favorable outcome after surgical treatment.

Effect of acetazolamide and subsequent ventriculo-peritoneal shunting on clinical signs and ventricular volumes in dogs with internal hydrocephalus

BackgroundAcetazolamide is recommended for the reduction of cerebrospinal fluid production in canine internal hydrocephalus. The efficacy of the drug in terms of alleviation of the clinical symptoms and the restoration of normal ventricular volume has not been documented. We hypothesize that acetazolamide inadequately improve clinical signs and has no effect on the ventricular volume. Six dogs with internal hydrocephalus underwent neurological examination and were examined by magnetic resonance imaging, on the day of the diagnosis, after treatment with acetazolamide directly before surgery, and 6 weeks after implantation of a vetriculo-peritoneal shunt due to lack of improvement after medical therapy with 10 mg/kg acetazolamide three times daily (TID). The ventricular volume in relation to the total brain volume was determined on each occasion. The changes in relative ventricular volume and of the neurological status were assessed and compared.ResultsMcNemar’s test revealed no significant differences in clinical symptoms before and after medical treatment (P > 0.05). However, clinical symptoms changed significantly after surgical treatment (P = 0.001). The ventricle-brain ratio was not significantly changed after therapy with acetazolamide (P > 0.05); however, after subsequent shunt implantation, it was significantly reduced (P = 0.001).ConclusionAcetazolamide (10 mg/kg TID) showed no effects on clinical signs or ventricular volume in dogs with internal hydrocephalus. After subsequent ventriculo-peritoneal shunting, the dogs had a significantly reduced cerebral ventricular volume and five out of six dogs had no abnormal findings in neurological examination.

Magnetic resonance imaging signs of high intraventricular pressure--comparison of findings in dogs with clinically relevant internal hydrocephalus and asymptomatic dogs with ventriculomegaly.

BackgroundMagnetic resonance imaging (MRI) findings of canine brains with enlarged ventricles in asymptomatic dogs were compared to those in dogs with clinically relevant internal hydrocephalus, in order to determine the imaging findings indicative of a relevant increase in intraventricular pressure. Discrimination between clinically relevant hydrocephalus and ventriculomegaly based on MRI findings has not been established yet and is anything but trivial because of the wide variation in ventricular size in different dog breeds and individuals. The MRI scans of the brains of 67 dogs of various breeds, skull conformation and weight were reviewed retrospectively. Based on clinical and imaging findings, the dogs were divided into three groups: a normal group (n = 20), a group with clinically silent ventriculomegaly (n = 25) and a group with severe clinically relevant internal hydrocephalus (n = 22). In addition to the ventricle/brain-index, a number of potential subjective signs of increased intraventricular pressure were recorded and compared between the groups.ResultsThe ventricle/brain-index was significantly higher in dogs with relevant hydrocephalus (p < 0.001) and a threshold value of 0.6 was specified as a discriminator between internal hydrocephalus and ventriculomegaly. Other MR imaging findings associated with clinically relevant hydrocephalus were an elevation of the corpus callosum (p < 0.01), dorsoventral flattening of the interthalamic adhesion (p < 0.0001), periventricular edema (p < 0.0001), dilation of the olfactory recesses (p < 0.0001), thinning of the cortical sulci (p < 0.0001) and/or the subarachnoid space (p < 0.0027) and disruption of the internal capsule adjacent to the caudate nucleus (p < 0.0001).ConclusionA combination of the abovementioned criteria may support a diagnosis of hydrocephalus that requires treatment.Electronic supplementary materialThe online version of this article (doi:10.1186/s12917-015-0479-5) contains supplementary material, which is available to authorized users.

Inverted formin 2‐related Charcot‐Marie‐Tooth disease: extension of the mutational spectrum and pathological findings in Schwann cells and axons

Mutations in the gene encoding inverted formin FH2 and WH2 domain-containing protein (INF2), a Cdc42 effector involved in the regulation of actin dynamics, cause focal segmental glomerulosclerosis (FSGS) and intermediate Charcot-Marie-Tooth neuropathy combined with FSGS (FSGS-CMT). Here, we report on six patients from four families with sensorimotor polyneuropathy and FSGS. Nerve conduction velocities were moderately slowed, and amplitudes of sensory and motor potentials were decreased. One patient had internal hydrocephalus and was intellectually disabled. Molecular genetic testing revealed two known and two novel missense mutations in the second and fourth exons of the INF2 gene. Investigations of one nerve biopsy confirmed the diagnosis of intermediate-type CMT and revealed occasional abnormal in- and outfoldings of myelin sheaths and expansions of the endoplasmic reticulum in axons and Schwann cells. While earlier reports suggested that mutations causing FSGS-CMT are restricted to exons 2 and 3 of the INF2 gene, we found one CMT-FSGS causing mutation (p.Glu184Lys) in exon 4 extending the critical region of INF2 for rapid CMT-FSGS molecular genetic diagnosis. Study of a nerve biopsy showed abnormalities that might be related to the known role of the INF2-binding partner CDC42 in myelination.

Koala retrovirus related diseases in European zoo-based koalas (Phascolarctos cinereus)

European zoos have housed koalas (Phascolarctos cinereus) for almost 25 years. From the time the first individual arrived on the old continent to the present population of 30 (15.15) animals, medical knowledge has improved significantly. During this time, 57 koala deaths have been recorded. With the discovery of the koala endogenous retrovirus (KoRV), the question remains whether it is involved in the various diseases found in captive population and specifically whether it was involved in the 57 deaths. This question is unfortunately difficult to answer as no real time tests were performed before and during the course of the diseases. A study of the detailed information of these records shows that almost half of them concern very young animals probably mainly because of joeys falling from the pouch and maternal neglect. A few deaths have no recorded information or are clearly not related to any infectious cause. 44% are due to neoplastic and opportunistic or non-opportunistic bacterial infectious process. While KoRV is thought to cause immunosuppression and tumour induction (mainly lymphomas), the link between disease and the virus has not been clearly established. Mulot, Baptiste. 2014. Koala retrovirus related diseases in European zoo-based koalas (Phascolarctos cinereus). In The Koala and its Retroviruses: Implications for Sustainability and Survival, ed. Geoffrey W. Pye, Rebecca N. Johnson and Alex D. Greenwood. Technical Reports of the Australian Museum, Online 24: 51–54. The San Diego Zoo loaned the first koalas to European zoos in 1989 (Hamlin Andrus, 2011) to the London zoo. The first breeding pair arrived in 1991 at the Jardim Zoologico de Lisbon, Portugal. Twenty-five years later, seven institutions house 30 animals (15.15) (Hamlin Andrus, 2011). Over the past 25 years, our knowledge in husbandry and care of this unique species has greatly improved. One of the major recent discoveries was the presence of an active endogenous retrovirus in the genome of a large portion of wild koalas and most (if not all) captive koalas (Canfield et al., 1988; Hanger et al., 2000; Tarlinton et al., 2005). This retrovirus is thought to be responsible for an innate immunosuppression and neoplastic induction, especially, but not only, lymphoma (Tarlinton et al., 2005). This detailed retrospective study of koala deaths that have occurred in the European captive population aims to look for a possible association with the presence of the retrovirus. In 25 years, 57 deaths have been recorded in the European population (a list of every death with details can be found in Table 1). While every adult death has been examined in detail, some joey deaths, mainly during the first days of life, are missing, depending on the keepers observations. Among these 57 deaths, 4% (2) have no record. 5% (3) are clearly not related to the retrovirus: one case of bladder stone with death occurring post surgery, one case of head trauma with hydrocephalus internus associated, and one case of ileum and colon torsion. Deaths of joeys accounted for 47% (27) of all deaths. Most of these cases have no details, but we can assume most of them are related to joey falling from the pouch or maternal neglect (absence of pouch cleaning, joey rejected, etc.). A few cases have bacterial culture recorded and the results are listed among the other bacterial results (Table 2).

Pituitary Null Cell Adenoma in a Domestic Llama (Lama glama)

Pituitary gland neoplasia has been reported rarely in camelids. A 12-year-old neutered male llama (Lama glama) presented with lethargy, inappetence and neurological signs. On physical examination, the llama was mentally dull and exhibited compulsive pacing and circling to the left. Complete blood count and serum biochemistry revealed haemoconcentration, mild hypophosphataemia, hyperglycaemia, hypercreatininaemia and hyperalbuminaemia. Humane destruction was elected due to rapid clinical deterioration and poor prognosis. Post-mortem examination revealed a pituitary macroadenoma and bilateral internal hydrocephalus. Microscopically, the pituitary tumour was composed of neoplastic chromophobic pituitary cells. Ultrastructural studies revealed similar neoplastic cells to those previously described in human null cell adenomas. Immunohistochemically, the neoplastic cells were strongly immunoreactive for neuroendocrine markers (synaptophysin and chromogranin A), but did not exhibit immunoreactivity for epithelial, mesenchymal, neuronal and all major pituitary hormone markers (adrenocorticotropic hormone, follicle stimulating hormone, growth hormone, luteinizing hormone, melanocyte-stimulating hormone, prolactin and thyroid stimulating hormone), consistent with the diagnosis of a pituitary null cell adenoma. This is the first report of pituitary neoplasia in a llama.

Wpływ sewofluranu na mózgowe ciśnienie perfuzyjne u chorych z wodogłowiem wewnętrznym

Due to its confirmed neuroprotective properties, sevoflurane is one of a few anaesthetics used for neuroanaesthesia. Its effects on the cerebral and systemic circulations may be of particular importance in patientswith intracranial pathology. This study aimed to evaluate the effect of sevoflurane at concentrations lower than 1 MAC on cerebral perfusion pressure (CPP) in patients with internal hydrocephalus. The study was conducted on14 patients with internal hydrocephalus, who underwent ventriculo-peritoneal shunt implantation. After inserting the catheter into the lateral cerebral ventricle, sevoflurane, at 1.1 and 2.2 vol%, was initiated at two successive 15-minute intervals. The intracranial pressure (ICP) was continuously measured; special attention was focused on the values prior to and at the end of each observation period. The following parameters were monitored: mean arterial pressure (MAP), CPP, heart rate, end-tidal CO₂ concentration, core body temperature, and the inspiratory and end-expiratory concentrations of sevoflurane. The HR and MAP decreased during successive observation intervals compared to baseline values. Likewise, the CPP decreased from 75.6 ± 2.8 mm Hg to 72.2 ± 2.6 mm Hg to 70.2 ± 0.8 mm Hg. The baseline value for ICP was 16.3 ± 0.6 mm Hg and increased to 17.7 ± 0.8 and 18.9 ± 0.5 mm Hg during the next observation periods. Sevoflurane administered ata concentration below 1MAC to patients with internal hydrocephalus increases the ICP and decreases the MAP, which leads to adecrease in CPP. The CPP decrease is more dependent on depressing the systemic circulatory system than an increased ICP.

Outcome of ventriculoperitoneal shunt implantation for treatment of congenital internal hydrocephalus in dogs and cats: 36 cases (2001–2009)

To examine outcome data for cats and dogs with congenital internal hydrocephalus following treatment via ventriculoperitoneal shunting to determine treatment-associated changes in neurologic signs, the nature and incidence of postoperative complications, and survival time. Retrospective multicenter case series. 30 dogs and 6 cats with congenital internal hydrocephalus (confirmed via CT or MRI). Medical records for dogs and cats with internal hydrocephalus that underwent unilateral ventriculoperitoneal shunt implantation from 2001 through 2009 were evaluated. Data collected included the nature and incidence of postoperative complications, change in clinical signs following surgery, and survival time. To compare pre- and postoperative signs, 2-way frequency tables were analyzed with a 1-sided exact McNemar test. 8 of 36 (22%) animals developed postoperative complications, including shunt malfunction, shunt infection, and seizure events. Three dogs underwent shunt revision surgery. Thirteen (36%) animals died as a result of hydrocephalus-related complications or were euthanized. Following shunt implantation, clinical signs resolved in 7 dogs and 2 cats; overall, 26 (72%) animals had an improvement of clinical signs. After 18 months, 20 animals were alive, and the longest follow-up period was 9.5 years. Most deaths and complications occurred in the first 3 months after shunt placement. Results indicated that ventriculoperitoneal shunt implantation is a viable option for treatment of dogs or cats with congenital hydrocephalus. Because complications are most likely to develop in the first 3 months after surgery, repeated neurologic and imaging evaluations are warranted during this period.