Noncommunicating Hydrocephalus Research Articles

A case of a pineal parenchymal tumor of intermediate differentiation with bifocal lesions differentiated by negative placental alkaline phosphatase in the spinal fluid.

Placental alkaline phosphatase (PLAP) in the spinal fluid is helpful for the diagnosis of intracranial germinomas. Bifocal lesions involving the pineal and pituitary regions have also been reported as characteristic findings of intracranial germinomas. We present a rare case of a 15-year-old boy with a pineal parenchymal tumor of intermediate differentiation (PPTID) with bifocal lesions negative for PLAP. Magnetic resonance imaging of the brain revealed bifocal mass lesions in the pineal and suprasellar regions and non-communicating hydrocephalus. We initially suspected a germinoma based on imaging findings, but all tumor markers, including PLAP, in the spinal fluid were negative. Based on these results, germinoma was considered less likely, and an endoscopic third ventriculostomy and endoscopic tumor biopsy were performed for diagnosis. The histopathological diagnosis was PPTID, corresponding to World Health Organization grade 3, in both pineal and suprasellar specimens. A craniotomy for tumor removal was performed, resulting in total resection. PLAP is known to have high sensitivity and extremely high negative predictive value for germinomas. Although bifocal lesions highly suggest germ cell tumors, there are exceptions, as in the present case. This case suggests that PLAP measurements are useful for differentiation, leading to appropriate treatment strategies.

Case report: Rare case Pandoraea ssp causing bacteremia associated with CRBSI in patients with hydrocephalus post intraventricular hemorrhage drain revision at Prof. Ngoerah Hospital, Denpasar, Bali

Introduction: Pandoraea species is a multidrug-resistant, gram-negative bacillus usually isolated from patients with cystic fibrosis (CF) and also commonly found in water and soil. Bloodstream infection with Pandoraea ssp in non-CF patients is uncommon. We report the first case of post-revision VP shunt hydrocephalus with bacteremia and associated CRBSI caused by Pandoraea ssp. Case description: A 50-year-old Balinese man with underlying disease of sepsis by Pandoraea ssp. after several histories of surgery, a patient with non-communicating hydrocephalus and intraventricular hemorrhage after endoscopic Intra Ventricular Hemorrhage evacuation and revision of the proximal shunt. The patient complained of being unconscious for 2 days, slurred speech, weakness in half of the body, vomiting once, seizures, and a fever. The CVC device was installed for 20 days, and he had a fluctuating fever during the hospitalization. Ceftriaxone and levofloxacin were given intravenously for empiric treatment. Pandoraea ssp. were isolated from both his blood samples and exit site; once the pathogen and drug sensitivity were confirmed, levofloxacin was planned for definitive treatment. One month after the patient was admitted, his condition worsened and he was pronounced dead. Discussion: Pandoraea ssp. had been reported in this patient with multiple organ dysfunction as a complicating factor. In our case, the potential source of this bacteria was considered to be contamination from the environment. This infection is considered CRBSI during hospitalization. This bacteria is multi-drug-resistant, which makes treatment of Pandoraea infections complicated. Conclusion: The finding case will be beneficial to clinicians because it provides additional information about the lesser-known Pandoraea species.

Suprasellar Immature Teratoma in A 20-year-old Male: A Case Report

Background: Immature teratomas are very rare in adults, especially in the suprasellar area, but they should be considered in the differential diagnosis, particularly when dealing with tumors located in the midline structure. Case presentation: In this study, we present a rare case of an immature teratoma in the suprasellar region of a 20-year-old male. A contrast-enhanced brain MRI revealed a multilocular cystic mass in the suprasellar area, accompanied by non-communicating hydrocephalus. To alleviate intracranial pressure, a shunting procedure was performed to redirect the cerebrospinal fluid. Moreover, tumor resection was carried out using an interhemispheric transcallosal approach. Conclusion: Histopathological examinations unveiled the presence of all three germ layers, followed by immature tissue, consistent with the features of an immature teratoma.

Cortical Laminar Necrosis After Severe Hydrocephalus: Case Report and Review of the Literature

Objectives We present a case of cortical laminar necrosis after severe hydrocephalus to highlight considerations for multimodal cerebral autoregulation monitoring to determine mean arterial pressure (MAP) thresholds during neurological emergencies, as well as postoperative head imaging for patients with ventriculoperitoneal shunts (VPS). Methods A 40-year-old woman with a history of Chiari II malformation and non-communicating hydrocephalus with VPS presented in septic shock from a sacral wound. One week after colostomy for fecal diversion, the patient became comatose and had progressive slowing to full suppression on electroencephalogram (EEG). Results CT imaging revealed hydrocephalus, most likely due to VPS distal obstruction from intraperitoneal surgery. Despite neurosurgical and neurocritical care management, MRI confirmed diffuse cortical hypoxic ischemic injury. Discussion The Neurocritical Care Society’s Emergency Neurological Life Support (ENLS) protocol for neurological emergencies focuses on managing increased intracranial pressure (ICP) but does not set MAP goals. As ICP may be very high during brain herniation, our case demonstrates that higher MAP may be required to maintain adequate circulation. To determine the optimal MAP target, bedside multimodality monitoring, including ICP monitors, transcranial doppler, and near infrared spectroscopy, can help establish individualized cerebral autoregulation guided thresholds. Outside of a neurological intensive care unit, EEG can monitor cerebral blood flow and indicate windows for intervention before exam or imaging changes. Additionally, our case demonstrates how a post-operative surveillance CT head should be considered for patients with VPS.

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

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

Which Theory of Cerebrospinal Fluid Production and Absorption Do Neurosurgeons Teach to Medical Students? Survey from Medical Universities in Japan, 2022.

Several new studies have been conducted on cerebrospinal fluid (CSF) dynamics. Our educational guidelines, the Model Core Curriculum for Medical University, recommend access to the best current information. However, we do not know whether or when to introduce changes to this concept.We surveyed which theory of CSF dynamics taught to students by neurosurgeons. The old theory is the bulk flow theory, and the new theory explains that CSF is produced from the choroid plexus and capillaries; CSF then pulsates and drains into the venous and lymphatic systems through newly discovered pathways.Old and new theories were taught to 64.8% and 27.0% of students, respectively. The reason for teaching the old theory was to help them understand the pathogenesis of noncommunicating hydrocephalus (77.1%), whereas the reason for teaching the new theory was to teach the latest knowledge (40.0%). Physicians who wished to teach the new theory in the near future accounted for 47.3%, which was higher than those who would teach the new theory in 2022 (27.0%), and those who still wished to teach the old theory in the near future accounted for 43.2%.An education policy on CSF dynamics will be established when we interpret ventricular enlargement and its improvement by third ventriculostomy in noncommunicating hydrocephalus based on the new theory. The distributed answers in the survey shared that it is difficult to teach about CSF dynamics and provided an opportunity to discuss these issues.

Intracranial Ewing sarcoma with obstructive hydrocephalus in pediatric patient: a rare case report

Link of Video Abstract: https://youtu.be/b4jB7Jos8tw   Background: Ewing’s sarcoma is the second most common primary bone tumor presenting in childhood and adolescence. Ewing's sarcoma of the skull bones is an unusual occurrence (6 to 9% of all Ewing’s. sarcoma cases). Here, we present a rare case of Ewing's sarcoma involving the central nervous system (CNS) in a 13-month-old child and share our experience with its management. Case Presentation: We report a case of a 13-month-old girl with a chief complaint of gradually progressive head size. There is a history of seizures once a week before admission. The head CT scan with contrast administration revealed non-communicating hydrocephalus with bone defect in the occipital region and an intraaxial tumor of the posterior fossa due to Ewing’s sarcoma. Conclusion: Primary cranial Ewing's sarcoma of the cranium is a rare occurrence; its extension to intraparenchymal is even rare. This diagnosis can be considered in the differential diagnosis in children with a tumor involving the skull with destruction of the bone.

Endoscopic third ventriculostomy versus ventriculoperitoneal shunt in patients of hydrocephalus in eastern India: A prospective observational study

Background: Hydrocephalus is a disorder of cerebrospinal fluid (CSF) physiology, resulting in an abnormal enlargement of the ventricles due to excessive accumulation of CSF. Although neurosurgical treatment has evolved over time with ventriculoperitoneal shunt (VPS) as the standard of care, procedure-related complications and poor long-term cognitive and motor milestone outcomes are still considerable, justifying the need for safer alternatives. Endoscopic third ventriculostomy (ETV) has emerged as a promising prospect especially in non-communicating hydrocephalus (NCH). Aims and Objectives: To compare the beneficial effects of ETV versus ventriculoperitoneal shunt in patients of NCH. Materials and Methods: The present prospective study was conducted at the Department of Neurosurgery, Bangur Institute of Neurosciences, IPGMER and SSKM Hospital, Kolkata from July 2021 to December 2022 among 60 patients admitted with NCH. Out of 60 patients; 30 patients underwent ETV and the remaining 30 patients VP shunting. All included patients had their history taken and relevant clinical and radiological examination done pre-operatively. They were discharged on the third post-operative day or later depending on their clinical condition and recovery. Results: Aqueductal stenosis was the most common etiology for NCH in both the groups. Post-intervention, complications and reoperation rate were reported more in VP group as compared to ETV group. Overall 3 subjects died, out of which 2 belonged to VP group and 1 to ETV group. Success was found in 70% and 86.67% of the subjects in VP and ETV group respectively. Conclusion: In patients with non-communicating or obstructive hydrocephalus, ETV was reported to be superior to VPS in terms of reoperation and complication rate at 4th, 12th, and 24th weeks after the treatment.

Fetal macrocephaly: Pathophysiology, prenatal diagnosis and management.

Macrocephaly means a large head and is defined as a head circumference (HC) above the 98th percentile or greater than +2SD above the mean for gestational age. Macrocephaly can be primary and due to increased brain tissue (megalocephaly), which in most cases is familial and benign or secondary. The latter may be due to various causes, including but not limited to communicating or non-communicating hydrocephalus, cerebral edema, focal and pericerebral increased fluid collections, thickened calvarium and brain tumors. Megalocephaly can be syndromic or non-syndromic. In the former, gyral and structural CNS anomalies are common. It is important to exercise caution when considering a diagnosis of megalocephaly due to limitations in the accuracy of HC measurement, lack of nomograms for specific populations, inconsistencies between prenatal and postnatal HC growth curves and progression over time. The degree of macrocephaly is important, with mild macrocephaly ≤2.5SD carrying a good prognosis, especially when one of the parents has macrocephaly and normal development. Cases in which the patient history and/or physical exam are positive or when parental HC are normal are more worrisome and warrant a neurosonogram, fetal MRI and genetic testing to better delineate the underlying etiology and provide appropriate counseling.

Idiopathic bilateral occlusion of Foramen of Monro treated by septostomy with unilateral foraminoplasty: a rare case report

Introduction: Idiopathic occlusion of the Foramen of Monro is extremely rare in adults. The occlusion is classified into four types, with the first being the most infrequent. This condition induces noncommunicating hydrocephalus with the ensuing increased intracranial pressure symptoms. Headache is usually the chief complaint. Presentation of the case: The authors present a case of a 28-year-old female who presented with a chronic headache that was unresponsive to analgesics. No other neurological deficits were present. Fundoscopic examination revealed the presence of bilateral papillary edema. Computed tomography scan results showed bilateral enlargement of the lateral ventricles of the brain. A subsequent MRI scan ruled out secondary causes of occlusion, such as colloid cysts, meningiomas, or choroid plexus tumors, which entailed an idiopathic etiology. Treatment options include ventriculoperitoneal shunt insertion and septostomy with foraminoplasty. The former option is currently the treatment of choice, yet it is notorious for its ramifications, including foreign body reaction, breakage, and mechanical problems. The latter option is free of these risks; however, it requires meticulousness and precision to avoid damaging the fornix, which leads to impaired memory function. Conclusion: Septostomy with unilateral foraminoplasty could yield better outcomes if it is performed fastidiously.

Minimally invasive third ventriculostomy with stereotactic internal shunt placement for the treatment of tumor-associated noncommunicating hydrocephalus

BackgroundIntracranial tumors can cause obstructive hydrocephalus (OH). Most often, symptomatic treatment is pursued through ventriculoperitoneal shunt (VS) or endoscopic third ventriculostomy (ETV). In this study, we propose stereotactic third ventriculostomy with internal shunt placement (sTVIP) as an alternative treatment option and assess its safety and efficacy.MethodsIn this single-center, retrospective analysis, clinical symptoms, procedure-related complications, and revision-free survival of all patients with OH due to tumor formations treated by sTVIP between January 2010 and December 2021 were evaluated.ResultsClinical records of thirty-eight patients (11 female, 27 male) with a mean age of 40 years (range 5–88) were analyzed. OH was predominantly (in 92% of patients) caused by primary brain tumors (with exception of 3 cases with metastases). Following sTVIP, 74.2% of patients experienced symptomatic improvement. Preoperative headache was a significant predictor of postoperative symptomatic improvement (OR 26.25; 95% CI 4.1–521.1; p = 0.0036). Asymptomatic hemorrhage was detected along the stereotactic trajectory in 2 cases (5.3%). One patient required local revision due to CSF fistula (2.6%); another patient had to undergo secondary surgery to connect the catheter to a valve/abdominal catheter due to CSF malabsorption. However, in the remaining 37 patients, shunt independence was maintained during a median follow-up period of 12 months (IQR 3–32 months). No surgery-related mortality was observed.ConclusionssTVIP led to a significant symptom control and was associated with low operative morbidity, along with a high rate of ventriculoperitoneal shunt independency during the follow-up period. Therefore, sTVIP constitutes a highly effective and minimally invasive treatment option for tumor-associated obstructive hydrocephalus, even in cases with a narrow prepontine interval.

Compare the safety and efficacy of endoscopic third ventriculostomy and ventriculoperitoneal shunt placement in infants and children with hydrocephalus: a systematic review and meta-analysis

Purpose Endoscopic third ventriculostomy (ETV) and ventriculoperitoneal shunt placement are two surgical options used for treatment of non-communicating hydrocephalus. The purpose of this study was to compare the efficiency and safety of these techniques in pediatric patients. Materials and methods An extensive literature review regarding the clinical outcome, safety and efficiency of ETV and shunting in treatment of hydrocephalus was conducted in Medline, PubMed, Cochrane and Google Scholar databases up to 27 November 2015. Patient demographics, ETV and shunting success and failure rates were extracted. Results A total of seven two-arm studies were included for quantitative analysis and 25 single-arm studies were included for systematic review. The two-arm studies recruited a total of 6995 patients: 1046 in the ETV group and 5949 in the shunt group. The pooled results showed that the 1 year success rate of ETV and shunt-placement procedure were similar (pooled RR = 0.870, 95% CI = 0.680–1.112, P = 0.266). The failure rate in the ETV treatment group was 0.9 times higher than in the shunt group; however, the results did not reach statistical significance (pooled RR = 0.893, 95% CI = 0.576–1.383, P = 0.611). Conclusions Both ETV and shunts are associated with similar 1 year success and failure rates. Therefore, there are no current indications to recommend one mode of treatment over the other. Future studies designed to assess the effectiveness of ETV and shunt procedures depending on patient’s age and etiology are warranted.

Evaluation of Overshunting between Low and Medium Pressure Ventriculoperitoneal Shunts in Dogs with Severe Hydrocephalus Using Frameless Stereotactic Ventricular Shunt Placement

Hydrocephalus is a neurological disorder characterized by an abnormal accumulation of cerebrospinal fluid (CSF) within the ventricular system of the brain, leading to cerebral ventricular dilation, brain parenchyma compression, and neuronal cell loss. Surgery is an effective method of draining excessive amounts of CSF. Ventriculoperitoneal shunt (VPS) allows excess CSF to divert into the abdomen; this device is the most commonly used in the treatment of hydrocephalus both in veterinary and human patients. This study aims to describe the application of two types of VPS, low-pressure valve and medium-pressure valve, using a frameless stereotactic neuronavigational system in eight severe hydrocephalus in dogs and, in particular, analyze the prevalence of postoperative overshunting. Non-communicating hydrocephalus was found in seven dogs, whereas the rest of them had communicating hydrocephalus caused by traumatic brain injury with a skull fracture. The criteria for pressure valve selection depended on the intraoperative intraventricular pressure (IVP) that was determined by the adaptive manometer, according to the human protocol. Low-pressure valve placement was performed in five dogs, and the others received medium-pressure valve placement. The follow-up period was 2 weeks, 4–12 weeks, and 12 weeks to 12 months. Pre- and postoperative information including neurological signs, CT-Scan or MRI, medical treatment, complications, and ventricular volume were compared in all dogs. Seven dogs showed neurological improvement within 2 weeks after surgery. Overshunting was seen in four dogs who received low-pressure valve placement. Three of them had shunt infections within 4 to 6 weeks after surgery. One dog underwent shunt revision from a low-pressure valve to a medium-pressure valve caused by severe overshunting and progressive neurological signs. In addition, cognitive and learning improvements were evaluated based on the owners’ feedback, and neurological signs were examined during the follow-up period in two dogs that received low-pressure valve placement. We conclude that a medium-pressure valve is recommended for overshunting prevention. However, low-pressure valve placement seems to improve cognitive function and learning ability, which is related to an increase in the brain parenchyma observed during long-term monitoring. Moreover, we also report our experience and surgical procedure for frameless stereotactic ventricular shunt placement (FSVSP) in VPS surgery in dogs affected by hydrocephalus.

CEREBRAL ABSCESS WITH HYDROCEPHALUS MANIFESTATION: A CASE REPORT IN 10-MONTH-OLD INFANT

<p class="p1"><strong>Background </strong>Alongside hydrocephalus, cerebral abscess poses as space-occupying lesion altering consciousness and intracranial pressure. Cerebral abscesses commonly presented vague clinical symptoms in infants, including weeks of fever and late-onset neurologic deterioration. However, limited studies denote cerebral abscesses, especially in children under one year old.<span class="Apple-converted-space"> </span></p><p class="p1"><strong>Objective </strong>We reported a case of a 10-month-old male infant with cerebral abscess and hydrocephalus.</p><p class="p1"><strong>Case description</strong> A 10-month-old male infant was taken to the hospital due to 6 days progressing fever. Neither clinical nor laboratory findings were abnormal. After being discharged from the hospital, the patient has admitted again 2 days later, reserved for 5 days of fever until unfortunate symptoms of raised intracranial pressure coincide with hypothermic body temperature. A brain CT-Scan showed an area of hypodense lesion in the parieto-occipital region suspected of brain abscess- resulting in non-communicating hydrocephalus. After a total of 12 days of intensive treatment with antibiotics, anti-convulsant, and steroid agents, the patient was comatose and passed away due to respiratory failure.<span class="Apple-converted-space"> </span></p><p class="p1"><strong>Conclusion</strong> Brain abscesses should be investigated thoroughly despite the probable absence of a pathognomonic feature. Radiology imaging ought to demonstrate the early process of abscess pathogenesis. To the best of our knowledge, this is the first case report published in Indonesia of an infant with a cerebral abscess resulting in hydrocephalus.</p>

Management of Peri-mesencephalic Hemorrhage leading to acute hydrocephalus in an infant following Mild Trauma (P12-5.030)

<h3>Objective:</h3> To characterize etiology, risk factors, and management of peri-mesencephalic hemorrhage and severity of clinical presentation in pediatric populations <h3>Background:</h3> Peri-mesencephalic hemorrhage (PMH) is a form of mild subarachnoid hemorrhage (SAH) where the bleed is localized near the midbrain or just anterior to the pons without intraparenchymal or ventricular extension. It is typically a non-aneurysmal SAH (NASAH) with no clear source of bleeding after extensive vessel imaging including angiogram. Many hypotheses have been proposed such as spontaneous rupture of a perforating artery or an entirely venous source. Traumatic causes are rarely described. Outcomes are typically much better than aneurysmal SAH and other forms of NASAH with very low risk of rebleed, hydrocephalus, and little to no long-term neurologic deficits. <h3>Design/Methods:</h3> case study <h3>Results:</h3> An 8-month-old developmentally appropriate girl with no prior history of trauma who presented with three episodes of vomiting and lethargy 3–4 hours after a fall from standing position due to loss of balance while she was holding on to a folding chair. She fell backwards onto a tile floor and chair fell on top of her. CTH was obtained which showed prepontine and pontocerebellar hemorrhage spreading to ambient cisterns, IVH of the lateral and 3rd ventricles with acute noncommunicating hydrocephalus and no fracture. CTA with contrast and later MRI brain, MRA, and angiogram did not show any aneurysm or AVM per neurosurgery. EVD was placed with improvement in mental status. Repeat MRI brain was stable with very slight interval increase ventricle, and patient discharged home after 3rd ventriculostomy with no deficits. <h3>Conclusions:</h3> Though rare, trauma is a potential cause of PMH in pediatric populations and can present with acute hydrocephalus due to obstruction of ventricular system successfully treated with EVD placement and 3rd ventriculostomy with positive outcome. Hemorrhage may potentially be due to rupture of small perforating arteries through a sheering force. <b>Disclosure:</b> Dr. Johnson has nothing to disclose. Dr. Ming has nothing to disclose. Dr. Heshmati has nothing to disclose.

Bi-allelic variations in CRB2, encoding the crumbs cell polarity complex component 2, lead to non-communicating hydrocephalus due to atresia of the aqueduct of sylvius and central canal of the medulla

Congenital hydrocephalus is a common condition caused by the accumulation of cerebrospinal fluid in the ventricular system. Four major genes are currently known to be causally involved in hydrocephalus, either isolated or as a common clinical feature: L1CAM, AP1S2, MPDZ and CCDC88C. Here, we report 3 cases from 2 families with congenital hydrocephalus due to bi-allelic variations in CRB2, a gene previously reported to cause nephrotic syndrome, variably associated with hydrocephalus. While 2 cases presented with renal cysts, one case presented with isolated hydrocephalus. Neurohistopathological analysis allowed us to demonstrate that, contrary to what was previously proposed, the pathological mechanisms underlying hydrocephalus secondary to CRB2 variations are not due to stenosis but to atresia of both Sylvius Aqueduct and central medullar canal. While CRB2 has been largely shown crucial for apico-basal polarity, immunolabelling experiments in our fetal cases showed normal localization and level of PAR complex components (PKCι and PKCζ) as well as of tight (ZO-1) and adherens (β-catenin and N-Cadherin) junction molecules indicating a priori normal apicobasal polarity and cell–cell adhesion of the ventricular epithelium suggesting another pathological mechanism. Interestingly, atresia but not stenosis of Sylvius aqueduct was also described in cases with variations in MPDZ and CCDC88C encoding proteins previously linked functionally to the Crumbs (CRB) polarity complex, and all 3 being more recently involved in apical constriction, a process crucial for the formation of the central medullar canal. Overall, our findings argue for a common mechanism of CRB2, MPDZ and CCDC88C variations that might lead to abnormal apical constriction of the ventricular cells of the neural tube that will form the ependymal cells lining the definitive central canal of the medulla. Our study thus highlights that hydrocephalus related to CRB2, MPDZ and CCDC88C constitutes a separate pathogenic group of congenital non-communicating hydrocephalus with atresia of both Sylvius aqueduct and central canal of the medulla.

Use of Ventriculoperitoneal Shunt Reservoir as an Alternative to Lumbar Puncture, Case Series

Hydrocephalus is a common neurological disorder in both childhood and adulthood. Non-communicating hydrocephalus may occur due to obstruction of the cerebrospinal fluid (CSF) flow pathways by structural anomalies such as tumors, infections, adhesions, and developmental defects while communicating hydrocephalus might develop due to CSF absorption disorders or excess production. In symptomatic cases, treatment is divided into two approaches as medical and surgical. The most commonly used method in surgical treatment is the ventriculoperitoneal (VP) shunt system. The VP shunt system can have numerous advantages and complications and is expected to yield continuous and long-term solutions. One of its advantages is that CSF samples can be taken from the reservoir located on it. In cases suspected of intracranial infection but for whom Lumbar puncture (LP) cannot be performed, the shunt reservoir in the patient provides sufficient opportunity for CSF retrieval.

Non-communicating hydrocephalus a complication of tuberculous meningitis

This paper explores the topic of non-communicating hydrocephalus as a complication of Tuberculous meningitis (TBM). It covers various aspects related to TBM and its associated complications, including clinical presentation, diagnostic procedures, management strategies, and patient care. The importance of early diagnosis, initiation of antituberculous therapy, and surgical interventions such as endoscopic septum pellucidotomy and external ventricular drain placement are discussed in relation to managing hydrocephalus in TBM patients. The significance of close monitoring, supportive care, adherence to medication, and infection control measures is emphasized. Additionally, the paper highlights the need for patient education, family support, and addressing financial concerns in the holistic care of individuals with TBM. Overall, this paper provides valuable insights into the understanding and management of non-communicating hydrocephalus as a complication of Tuberculous meningitis.

Multidetector Computed Tomographic Evaluation of Hydrocephalus

Introduction: Hydrocephalus is characterized by imbalance of cerebrospinal fluid formation and absorption. It is manifested as a dilatation of the ventricular system. Computed tomography (CT) is useful in determining the ventricular size and shape as well as the amount of the cerebral cortex present in the evaluation of suspected hydrocephalus. Aim and Objectives: Detection of hydrocephalus and determining the cause of hydrocephalus. Differentiating communicating from noncommunicating (obstructive) hydrocephalus. to assess the severity of the hydrocephalus and seek for any consequences. Materials and Methods: This prospective study included 50 patients referred to the Acharya Vinoba Bhave Rural Hospital, Sawangi (Meghe), Wardha, for 1 year. Patients clinically diagnosed with hydrocephalus were included in the study. Multidetector CT (MDCT) imaging was performed on Siemens 16 Slice MDCT machine. Multiplanar reformation and three-dimensional reconstruction were done wherever necessary. Results: 20% were diagnosed to have meningitis, 10% had Intraparenchymal haemorrhage and Intraventricular extension, 12% had aqueduct stenosis, and 12% had communicating hydrocephalus. In the study, 40% of them had communicating-type hydrocephalus or extraventricular obstructive hydrocephalus and 60% had obstructive hydrocephalus. On the CT scan, it was observed that at the lateral ventricle, dilatation was observed in four regions. Frontal horn dilatation (98%), body dilatation (98%), and 100% dilatation were seen at the temporal horn and occipital horn. Among 100 patients, 14% had cortical thinning and thus were classified as severe hydrocephalus with a poor prognosis, and 20% had periventricular edema. Conclusion: CT is the best means of obtaining images as it is easily available, fast, reliable, and compatible with standard life support devices.

Minimal-invasive third ventriculostomy with stereotactic internal shunt placement for the treatment of tumor-associated non-communicating hydrocephalus

Minimal-invasive third ventriculostomy with stereotactic internal shunt placement for the treatment of tumor-associated non-communicating hydrocephalus