The syndrome of normal-pressure hydrocephalus

✓ A series of 40 patients with the syndrome of normal-pressure hydrocephalus is presented. Diagnosis was based on clinical and computerized tomography (CT) scan criteria and was followed by the insertion of a ventriculoperitoneal shunt in every instance. All patients responded favorably to treatment (four of them had a fair outcome), and this response was maintained. There was one postoperative death, but no other serious complications. This study demonstrates that it is possible to diagnose the syndrome of normal-pressure hydrocephalus on the basis of clinical and CT scan criteria without any other invasive investigations. Such patients should respond favorably to an adequately functioning shunting system.

Ventricular dilatation and communicating hydrocephalus following spontaneous subarachnoid hemorrhage

✓ Ventricular dilatation following spontaneous subarachnoid hemorrhage (SAH) is a well recognized phenomenon. Its clinical significance, however, remains controversial. Two phases are distinguished, the acute or early, occurring soon after the ictus, and the chronic or late, developing after the second week. The authors studied the ventricular size in 210 patients with spontaneous SAH through the course of their illness and convalescence by means of serial computerized tomography (CT) scans. Their findings suggest that ventricular dilatation soon after SAH is not always clinically significant and does not necessarily require shunting before definitive surgery. Delayed symptomatic ventricular enlargement (communicating hydrocephalus) occurs in 7% of the patients and can be safely diagnosed on the basis of the clinical picture and CT scan appearances. Treatment with a ventricular shunting system is almost invariably rewarding.

A volume control system for the treatment of hydrocephalus: laboratory and clinical experience

✓ To eliminate dependence on shunts in the care of hydrocephalus, we have used a “volume control valve” in 18 children who required shunting procedures. This system permits the passage of fluid only when the valve is maintained in a depressed state by transcutaneous compression. Following surgery, an attempt was made to gradually wean the infant from the shunting system. This was done in the hope of ultimately facilitating an arrest of the underlying condition and to avoid a state of shunt dependency. It is believed that by permitting some degree of ventricular dilatation, alternate transventricular absorptive pathways become functional.