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Assessment of fetal brain abnormalities
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
The term of “hydrocephalus” does not identify a specified disease, but is a generic term that means a group of pathologic conditions due to abnormal circulation of CSF. Treatment method of hydrocephalus should be selected according to age of onset and symptoms. Congenital hydrocephalus is classified into three categories by causes that disturb CSF circulation pathway: simple hydrocephalus, dysgenetic hydrocephalus, and secondary hydrocephalus (15,26).
Disorders of Circulation of the Cerebrospinal Fluid
Published in Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw, Hankey's Clinical Neurology, 2020
Aqueductal stenosis with hydrocephalus may become apparent either in infancy (shortly after birth) or in adulthood. The incidence of congenital hydrocephalus at birth is estimated to be 0.2–0.8 children per 1000 live births.2 Accurate figures of incidence of adult-onset aqueductal stenosis are not available.
Basics of CSF production
Published in Jyotirmay S. Hegde, Hemanth Vamanshankar, CSF Rhinorrhea, 2020
Hemanth Vamanshankar, Jyotirmay S Hegde
Hippocrates first discussed CSF as water surrounding the brain while describing congenital hydrocephalus. However, the discovery of CSF is credited to the Swedish philosopher and scientist, Emanuel Swedenborg, who in his manuscript written in the early 18th century, described CSF as a “spiritous lymph” produced in the fourth ventricle and going down into the spinal cord. CSF is formed in the cerebral ventricles – mainly the choroid plexus, ependyma, and parenchyma.1 Produced at the rate of 500 mL/day or 03–0.4 mL/min, a total of 90–150 mL volume is present in an adult. Of this total, 25% is present in the ventricular system (35 mL), 20–50% is present in the spinal canal (30–70 mL) and about 25–55% is to be found in the cranial subarachnoid space (35–75 mL).2,3 Out of the 1600–1700 ml intracranial space which encloses the brain, about 100–150 mL is occupied by the CSF. But, interestingly, this small volume of CSF has the capacity to reduce the actual weight of the brain (1500 gm) to as much as 50 mg, hence reducing the risk of brain injury, as well as tension on nerve roots and vessels.4–8
Survival status and predictors of mortality among children who underwent ventriculoperitoneal shunt surgery at public hospitals in Addis Ababa, Ethiopia
Published in International Journal of Neuroscience, 2023
Azene Bantie Wubie, Girum Sebsibe Teshome, Wudie Eneyew Ayele, Fikirtemariam Abebe, Tewodros Mulugeta Nigussie, Yalemgeta Biyazin Alemu, Migbar Sibhat Mekonnen
Children were followed for a minimum of half a month and a maximum of 36 months, with the majority of them followed for three months after VP shunt insertion. The finding also revealed that 99 (29.4%) children died during the follow-up period, and 238 (70.6%) were censored. Among those considered as censored, 204 (85.7%) have been alive up to the end of the follow-up period, 27 (11.6%) lost, and seven (2.7%) were transferred to other institutions. The total person-time observation was 1695.39 child-months with cumulative incidence mortality of 58.4 per 1000 child-month observations or 70 per 100 child-year observations. The incidence of mortality among children diagnosed with congenital hydrocephalus was 30.1 per 1000 child-month observations whereas it was 26 per 1000 child-month observations among those with acquired hydrocephalus. The median survival time of patients after VPS surgery was 12 months (95%CI: 9.04–14.96). In addition, the cumulative probabilities of survival at the end of 6, 12, 18, and 24 months were found to be 0.75, 0.55, 0.30, and 0.13 consecutively. The overall cumulative survival at 36 months of follow-up after VPS surgery was 13% (95% CI, 6.09 to 18.67%).
An eye on the future for defeating hydrocephalus, ciliary dyskinesia-related hydrocephalus: review article
Published in British Journal of Neurosurgery, 2022
Amr Ali Hasanain, Mohamed A. R. Soliman, Reem Elwy, Ahmed A. M. Ezzat, Sameh H. Abdel-Bari, Sascha Marx, Alistair Jenkins, Ehab El Refaee, Ahmed Zohdi
Even though efforts are being made to improve current techniques, all of the currently known management protocols of hydrocephalus usually necessitate multiple interventions due to a high incidence of complications, which increases the long-term usage of healthcare resources.4,8 Various types of cerebrospinal fluid (CSF) diversion devices such as programmable shunts, and anti-siphoned devices did not show an advantage over one another,9 and the utilization of flexible endoscopes to facilitate ventriculostomy or choroid plexus cauterization procedures showed inconclusive results.10 However, these current measures aim at reducing CSF production or creating a CSF diversion.11 Apart from aqueductoplasty, none of the available surgical treatment modalities for congenital hydrocephalus addresses the cause of outflow obstruction or the decreased CSF flow, but rather diverting CSF.2,12 CSF diversion is a treatment of the effect and not the cause of hydrocephalus and comes with the burdens of its perioperative complications.8,11,12 This lead to a vicious circle of complications and trials to solve these complications.
A Natural History of Silent Brain Syndrome over 36 Years: A case report
Published in Orbit, 2021
Nathan Pirakitikulr, David T. Tse
Fourteen cases of bilateral enophthalmos presenting in the context of cerebral shunting have been reported in the literature (Table 1). In 1996, Meyer described three patients with congenital hydrocephalus who underwent ventricular shunt placement.2 (The patient described herein was also known to those authors through personal communication and referenced in the article as a fourth similar case.) Bernardini later coined the term “silent brain syndrome” to describe the insidious progression of bony changes analogous to the more commonly described silent sinus syndrome.3 Across all published studies, the average age of shunting was 12 years and ranged from infancy to age 25.2–4,8–12 There was a slight male predominance with a male-to-female ratio of 3:2. The most common indication for shunting was congenital hydrocephalus followed by elevated intracranial pressure (ICP) secondary to tumor and trauma. The average age at presentation was 26 and ranged from 16 to 37. Patients presented with ocular symptoms that varied from ocular irritation to diplopia and corneal ulcers. All articles reported visual acuity, ocular findings, characteristic facial features and radiographic imaging. Only two articles commented on body weight, body habitus or facial atrophy, and in the five cases described, the physical exam was noted to be grossly normal.2,3