The arrest of treated hydrocephalus in children

1984 ◽  
Vol 61 (4) ◽  
pp. 752-756 ◽  
Author(s):  
Ian H. Johnston ◽  
Robert Howman-Giles ◽  
Ian R. Whittle
Keyword(s):  
Cerebrospinal Fluid ◽  
Clinical Findings ◽  
Communicating Hydrocephalus ◽  
Csf Dynamics ◽  
Aqueduct Stenosis ◽  
Content Type ◽  
A Prospective Study ◽  
Neonates And Infants ◽  
Radionuclide Scanning ◽  
Fine Print

✓ A prospective study was made of the incidence of arrest of treated non-neoplastic hydrocephalus in 30 neonates and infants over a 5-year period. Radionuclide assessment of shunt function and cerebrospinal fluid (CSF) dynamics was carried out at intervals over this period, using a method that allowed injection of the radionuclide into the ventricular system independent of the shunt apparatus. The radionuclide scanning results were correlated with computerized tomography and clinical findings. Of 24 patients still available for analysis at the end of 5 years, four patients showed restoration of CSF circulation independent of the shunt apparatus and, in three of these, the shunt has either been clipped or clipped and removed without any ill effects. Clinical details of these three patients are provided. Two initially had communicating hydrocephalus, and one had probable aqueduct stenosis.

Evaluation of the central canal of the spinal cord in experimentally induced hydrocephalus

1978 ◽  
Vol 48 (6) ◽  
pp. 970-974 ◽  
Author(s):  
A. Everette James ◽  
William J. Flor ◽  
Gary R. Novak ◽  
Ernst-Peter Strecker ◽  
Barry Burns
Keyword(s):  
Spinal Cord ◽  
Cerebrospinal Fluid ◽  
Experimental Model ◽  
Alternative Pathway ◽  
Central Canal ◽  
Communicating Hydrocephalus ◽  
Csf Flow ◽  
Content Type ◽  
Histological Appearance ◽  
Fine Print

✓ The central canal of the spinal cord has been proposed as a significant compensatory alternative pathway of cerebrospinal fluid (CSF) flow in hydrocephalus. Ten dogs were made hydrocephalic by a relatively atraumatic experimental model that simulates the human circumstance of chronic communicating hydrocephalus. The central canal was studied by histopathology and compared with 10 normal control dogs. In both groups the central canal of the spinal cord was normal in size, configuration, and histological appearance. In this experimental model dilatation of the canal and increased movement of CSF does not appear to be a compensatory alternative pathway.

Recurrent spontaneous spinal cerebrospinal fluid leaks and intracranial hypotension: a prospective study

2003 ◽  
Vol 99 (5) ◽  
pp. 840-842 ◽  
Author(s):  
Wouter I. Schievink ◽  
M. Marcel Maya ◽  
Mary Riedinger
Keyword(s):  
Cerebrospinal Fluid ◽  
Intracranial Hypotension ◽  
Surgical Repair ◽  
Csf Leak ◽  
Content Type ◽  
Cerebrospinal Fluid Leaks ◽  
The Mean ◽  
A Prospective Study ◽  
Fine Print

Object. Intracranial hypotension due to a spontaneous spinal cerebrospinal fluid (CSF) leak is an increasingly recognized cause of postural headaches, but reliable follow-up data are lacking. The authors undertook a study to determine the risk of a recurrent spontaneous spinal CSF leak. Methods. The patient population consisted of a consecutive group of 18 patients who had been evaluated for consideration of surgical repair of a spontaneous spinal CSF leak. The mean age of the 15 women and three men was 38 years (range 22–55 years). The mean duration of follow up was 36 months (range 6–132 months). The total follow-up time was 654 months. A recurrent spinal CSF leak was defined on the basis of computerized tomography myelography evidence of a CSF leak in a previously visualized but unaffected spinal location. Five patients (28%) developed a recurrent spinal CSF leak; the mean age of these four women and one man was 36 years. A recurrent CSF leak developed in five (38%) of 13 patients who had undergone surgical CSF leak repair, compared with none (0%) of five patients who had been treated non-surgically (p = 0.249). The recurrent leak occurred between 10 and 77 months after the initial CSF leak, but within 2 or 3 months of successful surgical repair of the leak in all patients. Conclusions. Recurrent spontaneous spinal CSF leaks are not rare, and the recent successful repair of such a leak at another site may be an important risk factor.

Changes in cerebrospinal fluid hydrodynamics following endoscopic third ventriculostomy for shunt-dependent noncommunicating hydrocephalus

2003 ◽  
Vol 98 (5) ◽  
pp. 1027-1031 ◽  
Author(s):  
Kenichi Nishiyama ◽  
Hiroshi Mori ◽  
Ryuichi Tanaka
Keyword(s):  
Cerebrospinal Fluid ◽  
Absorptive Capacity ◽  
Endoscopic Third Ventriculostomy ◽  
Third Ventriculostomy ◽  
Csf Dynamics ◽  
Shunt System ◽  
Independent State ◽  
Content Type ◽  
Noncommunicating Hydrocephalus ◽  
Fine Print

Object. The aim of this study was to analyze physiological changes in cerebrospinal fluid (CSF) dynamics following endoscopic third ventriculostomy (ETV) for shunt-dependent noncommunicating hydrocephalus. Methods. Clinical data obtained in 15 patients treated with ETV for shunt malfunction were analyzed. Magnetic resonance imaging studies demonstrated the obstruction of the ventricular system preoperatively. After ETV, the existing shunt system was removed and a continuous extraventricular drain, set at 30 cm H2O in height, was installed to measure daily amounts of CSF outflow. Cerebrospinal fluid dynamics after ETV were also evaluated using 111In-diethylenetriamine pentaacetic acid radioisotope cisternography in six of 15 patients within 1 month of the procedure. Three patients underwent cisternography at 6 months after ETV. Cisternograms were obtained at 1, 5, 24, and 48 hours after injection of the radioisotope. To study CSF absorptive capacity, ratios of radioisotope counts at 48 and 5 hours after injection were calculated (C48:C5). Seven of 15 patients had daily outflows of CSF of less than 20 ml; this volume decreased quickly within a few days. The other eight patients demonstrated an outflow of more than 150 ml of CSF for several days, three of whom had signs of transiently increased intracranial pressure. Their CSF outflow volume decreased gradually and symptoms improved within 1 week. Ratios of C48:C5 were within normal limits in five of six patients who had undergone cisternography 1 month after ETV. These ratios were decreased in all three patients who had undergone cisternography at 6 months after ETV compared with that measured at 1 month after the procedure. Conclusions. Our data suggest that CSF dynamics convert from a shunt-dependent state to a shunt-independent state within 1 week following ETV in patients with shunt-dependent noncommunicating hydrocephalus. Nonetheless, intraventricular pressure does not decrease quickly in certain cases. Cerebrospinal fluid absorptive capacity or CSF circulation through the subarachnoid space may show further improvement several months after ETV.

Variations of intraventricular pressure during pneumoencephalography

1974 ◽  
Vol 40 (1) ◽  
pp. 101-106 ◽  
Author(s):  
Jacques Philippon ◽  
Bernard George ◽  
Jean Metzger
Keyword(s):  
Cerebrospinal Fluid ◽  
Intracranial Hypertension ◽  
Normal Pressure Hydrocephalus ◽  
Initial Pressure ◽  
Normal Pressure ◽  
Intraventricular Pressure ◽  
Csf Dynamics ◽  
Content Type ◽  
Fine Print

✓ Intraventricular pressure was studied in eight patients during and after diagnostic pneumoencephalography. In cases with normal initial pressure and normal cerebrospinal fluid (CSF) dynamics, variations in pressure were moderate, immediate, and disappeared at the end of the examination. In cases of normal-pressure hydrocephalus, there was a slow but relatively important elevation that continued for at least 24 hours. In cases with intracranial hypertension, there was a rapid significant increase; return to normal depended principally upon the flow from a large CSF compartment.

Normal rate of cerebrospinal fluid formation five years after bilateral choroid plexectomy

1976 ◽  
Vol 44 (6) ◽  
pp. 735-739 ◽  
Author(s):  
Thomas H. Milhorat ◽  
Mary K. Hammock ◽  
Techen Chien ◽  
Donald A. Davis
Keyword(s):  
Cerebrospinal Fluid ◽  
Standard Deviation ◽  
Ventriculoperitoneal Shunt ◽  
Normal Rate ◽  
Communicating Hydrocephalus ◽  
Perfusion Technique ◽  
Content Type ◽  
Normal Limits ◽  
Fluid Formation ◽  
Fine Print

✓ A ventricular perfusion technique was used to determine the rate of cerebrospinal fluid (CSF) formation in a 5-year-old child who had undergone bilateral choroid plexectomy for communicating hydrocephalus during infancy. At the time of the study, the patient had a failed ventriculoperitoneal shunt and was suffering from progressive ventriculomegaly. The calculated rate of CSF formation, 0.35 ml/min, ± 0.02 standard deviation, was within normal limits.

Documentation of fourth ventricle entrapment by metrizamide ventriculography with CT scanning

1981 ◽  
Vol 55 (5) ◽  
pp. 838-840 ◽  
Author(s):  
Mauricio Collada ◽  
Joseph Kott ◽  
David G. Kline
Keyword(s):  
Cerebrospinal Fluid ◽  
Computerized Tomography ◽  
Fourth Ventricle ◽  
Ct Scanning ◽  
Ct Scans ◽  
Communicating Hydrocephalus ◽  
Content Type ◽  
Ventriculoperitoneal Shunts ◽  
Fine Print

✓ Documentation by metrizamide ventriculography with computerized tomography (CT) of fourth ventricle entrapment is presented. Reevaluation of the cerebrospinal fluid pathways is suggested whenever fourth ventricle enlargment is seen on CT scans of patients with ventriculoperitoneal shunts for communicating hydrocephalus.

Management of vestibular schwannoma by fractionated stereotactic radiotherapy and associated cerebrospinal fluid malabsorption

2003 ◽  
Vol 99 (4) ◽  
pp. 685-692 ◽  
Author(s):  
Yutaka Sawamura ◽  
Hiroki Shirato ◽  
Touru Sakamoto ◽  
Hidefumi Aoyama ◽  
Keishiro Suzuki ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Vestibular Schwannoma ◽  
Stereotactic Radiotherapy ◽  
Hearing Preservation ◽  
Fractionated Stereotactic Radiotherapy ◽  
Maximum Diameter ◽  
Tumor Control ◽  
Communicating Hydrocephalus ◽  
Content Type ◽  
Fine Print

Object. The goal of this study was to investigate outcomes in patients with vestibular schwannoma (VS) who were treated with fractionated stereotactic radiotherapy (SRT). Methods. One hundred one patients with VS were treated with fractionated SRT at a radiation level of 40 to 50 Gy administered in 20 to 25 fractions over a 5- to 6-week period. The median tumor size in these patients was 19 mm (range 3–40 mm), and 27 tumors were larger than 25 mm. Patients were consistently followed up using magnetic resonance imaging every 6 months for 5 years in principle. The median follow-up period was 45 months. The actuarial 5-year rate of tumor control (no growth > 2 mm and no requirement for salvage surgery) was 91.4% (95% confidence interval 85.2–97.6%). Three patients with progressive tumors underwent salvage tumor resection. The actuarial 5-year rate of useful hearing preservation (Gardner—Robertson Class I or II) was 71%. The observed complications of fractionated SRT included transient facial nerve palsy (4% of patients), trigeminal neuropathy (14% of patients), and balance disturbance (17% of patients). No new permanent facial weakness occurred after fractionated SRT. Eleven patients (11%) who had progressive communicating hydrocephalus (cerebrospinal fluid malabsorption) and no evidence of tumor growth after fractionated SRT required a shunt. The symptoms of this type of hydrocephalus were similar to those of normal-pressure hydrocephalus and occurred 4 to 20 months (median 12 months) after fractionated SRT. The mean size (± standard deviation) of tumors causing symptomatic hydrocephalus (25.5 ± 7.8 mm) was significantly larger than that of other tumors (18.2 ± 8.7 mm) (p = 0.011). Only four of the 72 patients with tumors smaller than 25 mm in maximum diameter received a shunt. Conclusions. Fractionated SRT resulted in an excellent tumor control rate, even for relatively large tumors, and produced a high rate of hearing preservation that was comparable to the best results of single-fraction radiosurgery. The progression of communicating hydrocephalus should be monitored closely, particularly in patients harboring a large VS.

Management of recurrent CSF rhinorrhea of the middle and posterior fossa

1978 ◽  
Vol 49 (3) ◽  
pp. 393-397 ◽  
Author(s):  
Robert F. Spetzler ◽  
Charles B. Wilson
Keyword(s):  
Posterior Fossa ◽  
Csf Leak ◽  
Recent Experience ◽  
Csf Dynamics ◽  
Csf Rhinorrhea ◽  
Content Type ◽  
Dural Opening ◽  
Radionuclide Scanning ◽  
Fine Print ◽  
Csf Leaks

✓ The authors review 39 patients with cerebrospinal fluid (CSF) leaks originating from the middle or posterior fossa. They evaluate the usefulness of preoperative investigative procedures, including cisternal radionuclide scanning and the deliberate increase of intracranial pressure. The results in this series emphasize the important role that abnormal CSF dynamics play in the recurrence of problematic cases of rhinorrhea or otorrhea. The following guidelines are recommended by the authors on the basis of their recent experience: 1) if hydrocephalus is present, if the cisternogram is abnormal, or if the CSF leak is intermittent and slight, the initial treatment should be insertion of a lumboperitoneal shunt; 2) if the leak is localized in the sellar or parasellar area, a transsphenoidal approach to obliterate the leak is advised; 3) if the CSF leak originates through a dural opening into the middle ear, an intracranial repair is indicated.

Primary empty sella syndrome in a series of 142 patients

2005 ◽  
Vol 103 (5) ◽  
pp. 831-836 ◽  
Author(s):  
Giulio Maira ◽  
Carmelo Anile ◽  
Annunziato Mangiola
Keyword(s):  
Cerebrospinal Fluid ◽  
Intracranial Hypertension ◽  
Empty Sella ◽  
Csf Leak ◽  
Csf Shunt ◽  
Csf Dynamics ◽  
Empty Sella Syndrome ◽  
Content Type ◽  
Fine Print ◽  
Primary Empty Sella

Object. The primary empty sella syndrome (ESS) represents a heterogeneous clinical picture characterized by endocrine disturbances and signs of intracranial hypertension. An increase in intracranial pressure (ICP) is proposed to be one of the involved pathogenetic factors. Methods. The series included 142 patients who were observed during a period of 20 years. All patients underwent an ICP and cerebrospinal fluid (CSF) dynamics evaluation through the use of a lumbar constant-rate infusion test. Impairment of ICP and CSF dynamics was observed in 109 patients (76.8%). In 35 of the 36 patients affected by severe intracranial hypertension without rhinorrhea, improvement in adverse neurological symptoms was achieved after implanting a CSF shunt. Visual function, already seriously compromised before surgery, remained severely altered in one patient. In the group of 34 patients affected by rhinorrhea, CSF leakage was controlled using different surgical treatments: CSF shunt placement in 16 cases, surgical repair of the sellar floor in three, and both procedures in the remaining 13. Two patients refused any surgical treatment. Conclusions. The role of increased ICP in the pathogenesis and perpetuation of primary ESS has been confirmed. Adverse neurological signs and a CSF leak are correlated with an actual increase in ICP and are relieved after CSF shunt insertion. Cerebrospinal fluid rhinorrhea is more common than generally thought. Its resolution can be achieved using a careful diagnostic protocol and sometimes may require different surgical procedures.

CSF dynamics and pressure-volume relationships in communicating hydrocephalus

1986 ◽  
Vol 64 (1) ◽  
pp. 45-52 ◽  
Author(s):  
Michael Kosteljanetz
Keyword(s):  
Cerebrospinal Fluid ◽  
Bolus Injection ◽  
Formation Rate ◽  
Cerebral Atrophy ◽  
Pulse Amplitude ◽  
Volume Index ◽  
Communicating Hydrocephalus ◽  
Csf Dynamics ◽  
Content Type ◽  
Normal Individuals

✓ Twenty-nine patients consecutively admitted with a diagnosis of communicating hydrocephalus underwent 1) continuous intracranial pressure (ICP) monitoring; 2) pressure-volume studies; and 3) measurement of resistance to outflow of cerebrospinal fluid (Rout). The two latter calculations were made by the bolus injection and pressure-volume index (PVI) techniques. In 19 patients mean ICP never exceeded 15 mm Hg. In the other 10 patients varying degrees of mildly raised ICP was noted. The frequency of waves at ½ to 2/min varied from 3% to 58%. The ICP pulse amplitude ranged from 0.5 to 10 mm Hg, and PVI from 4.6 to 18.2 ml. The Rout ranged from 2.5 to 31.4 mm Hg/ml/min, and was linearly correlated to the ICP. Thus, patients with a higher Rout also had a higher ICP as compared with patients with lower Rout, yet ICP could still be within limits considered normal. The cerebrospinal fluid dynamics (formation rate × resistance) contributed much more to the ICP than in normal individuals. It is postulated that communicating hydrocephalus represents one endpoint of a continuum, where the preceding phase is high-pressure and high-resistance hydrocephalus as, for instance, is seen after subarachnoid hemorrhage. In some patients, there is a possibility of cerebral atrophy accompanied by otherwise insignificant increased Rout. In this study, the PVI technique proved to be a fast and safe method of measuring Rout.

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