Supratentorial Hydrocephalus Research Articles

Response to external ventricular drainage in spontaneous intracerebral hemorrhage with hydrocephalus

We retrospectively reviewed consecutive intensive care unit patients with spontaneous supratentorial intracerebral hemorrhage (i.c.h.) and hydrocephalus who were treated with ventriculostomy to determine intracranial pressure (i.c.p.), Glasgow Coma Scale (GCS) score, and ventricular volume before and after ventriculostomy. Of 22 patients studied, ICP was controlled at < 20 mm Hg in 20. Only one patient had an improvement in both hydrocephalus and GCS. The three patients who survived to 3 months (modified Rankin scores of 0, 0, and 1) were characterized by very small ICH volumes and stable or improving hydrocephalus and GCS.

Tectal plate gliomas. Part I: Microsurgery of the tectal plate gliomas.

A series of 12 patients with tectal plate gliomas, is presented treated by direct surgery. Mean age was 19 years. All patients presented with signs of raised intracranial pressure and supratentorial hydrocephalus on CT scan. Diplopia was the most common local sign. CT scan and MR imaging showed 4 intrinsic, 6 exophytic, and 2 ventrally infiltrating tectal tumours. The histological diagnosis was low-grade astrocytoma in 7, high-grade astrocytoma in 2, oligodendroglioma in one, oligo-astrocytoma in one, and ependymoma in one case. The suboccipital supra- and transtentorial approach was used in every cases. Tumour resection was generous at the level of the superior colliculi, but on the contrary, resection was limited at the level of inferior colliculi due to the auditory risk. Tumour removal was total (macroscopically) in 9 cases and partial in 3 cases. There were 4 surgical complications and one death related to surgery. Parinaud's syndrome was the most-common postoperative sequelae. Auditory hallucinations and the acoustic neglect syndrome were seen once. In three cases additional radiotherapy and chemotherapy were given once with severe sequelae. The treatment of tectal plate gliomas is controversial. The role of different therapeutic options remains open. We consider the tectal plate as a relatively safer territory for surgery than the ventral part of the midbrain. The brain stem auditory evoked potentials (BAEPs) and middle latency potentials (MLPs) monitoring can help to determine the appropriate limit of surgery.

Hydromyelic hydrocephalus

The clinical features and pathophysiology of specific forms of hydromyelia are analyzed in this report together with the chronological changes of associated hydrocephalus. Nine patients were studied; all had hydromyelia with varying degrees of associated hydrocephalus. Clinically applicable classification systems were used to evaluate the progression of hydrocephalus (Stages I to IV) and to define the compartment isolated after shunting in the previously communicating cerebral ventricles (Types I to IV). Four patients had Stage IV disease (holoneural canal dilatation); one had Stage II and four had Stage I disease (both Stages I and II with supratentorial hydrocephalus). All patients were initially treated by ventriculoperitoneal shunting at an average age of 9.9 years. Five patients had progressive spinal symptoms before or after treatment of their hydrocephalus. Two patients had Type III isolation (an isolated rhombencephalic ventricle) with a functioning ventricular shunt; ventriculography confirmed a communication between the fourth ventricle and the hydromyelia, and both patients improved after placement of a shunt in the fourth ventricle. The remaining patients had Type IV isolation (isolated central canal dilatation) with a functioning ventricular shunt. This study indicates that in some cases the pathophysiology of hydromyelia is closely related to associated hydrocephalus. A new concept of the development of an isolated compartment after shunting is proposed to explain the progression of hydromyelia in these cases.

Double Compartment Hydrocephalus—a New Clinical Entity

We are reporting eight patients who demonstrated double compartment hydrocephalus, i.e., supratentorial and infratentorial hydrocephalus in clinical sequence and separately. One infant with veil occlusion of the aqueduct was operated on to remove the veil and then later demonstrated panhydrocephalus. Six patients had been treated months to years earlier by the performance of a ventriculoperitoneal shunt for aqueductal hydrocephalus and then developed characteristic cerebellar-brain stem deficits from 4th ventricle enlargement. The work-up included computed tomographic scan, air study, isotope cerebrospinal fluid flow study, and direct 4th ventricle pressure studies. Operation with removal of a veil occlusion of the upper 4th ventricle aqueduct produced immediate recovery in five of six patients. The conversion of aqueductal stenosis to veil occlusion is postulated as the mechanism of "primary" veil obstruction found in infants. This new clinical entity is more common than realized. We report one patient with compartmental 4th ventricular hydrocephalus.