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Fulltext Consensus statement from the international consensus meeting on post-traumatic cranioplasty

Iaccarino C, Kolias A, Adelson PD, Rubiano AM, Viaroli E, Buki A, et al.

Acta Neurochir (Wien), 2021 02;163(2):423-440.
PMID: 33354733 DOI: 10.1007/s00701-020-04663-5

BACKGROUND: Due to the lack of high-quality evidence which has hindered the development of evidence-based guidelines, there is a need to provide general guidance on cranioplasty (CP) following traumatic brain injury (TBI), as well as identify areas of ongoing uncertainty via a consensus-based approach.
METHODS: The international consensus meeting on post-traumatic CP was held during the International Conference on Recent Advances in Neurotraumatology (ICRAN), in Naples, Italy, in June 2018. This meeting was endorsed by the Neurotrauma Committee of the World Federation of Neurosurgical Societies (WFNS), the NIHR Global Health Research Group on Neurotrauma, and several other neurotrauma organizations. Discussions and voting were organized around 5 pre-specified themes: (1) indications and technique, (2) materials, (3) timing, (4) hydrocephalus, and (5) paediatric CP.
RESULTS: The participants discussed published evidence on each topic and proposed consensus statements, which were subject to ratification using anonymous real-time voting. Statements required an agreement threshold of more than 70% for inclusion in the final recommendations.
CONCLUSIONS: This document is the first set of practical consensus-based clinical recommendations on post-traumatic CP, focusing on timing, materials, complications, and surgical procedures. Future research directions are also presented.

Matched MeSH terms: Hydrocephalus/surgery
Preliminary report on spiegelberg pre and post-operative monitoring of severe head-injured patients who received decompressive craniectomy

Abdullah J, Zamzuri I, Awang S, Sayuthi S, Ghani A, Tahir A, et al.

Acta Neurochir. Suppl., 2005;95:311-4.
PMID: 16463872

The monitoring of craniospinal compliance is uncommonly used clinically despite it's value. The Spiegelberg compliance monitor calculates intracranial compliance (C = deltaV/deltaP) from a moving average of small ICP perturbations (deltaP) resulting from a sequence of up to 200 pulses of added volume (deltaV = 0.1 ml, total V = 0.2 ml) made into a double lumen intraventricular balloon catheter. The objective of this study was thus to determine the effectiveness of the decompressive craniectomy done on the worst brain site with regard to compliance (Cl), pressure volume index (PVI), jugular oximetry (SjVo2), autoregulation abnormalties, brain tissue oxygen (TiO2) and cerebral blood flow (CBF). This is a prospective cohort study of 17 patients who were enrolled after consent and approval of the ethics committee between the beginning of the year 2001 and end of the year 2002. For pre and post assessment on compliance and PVI, all 12 patients who survived were reported to become normal after decompressive craniectomy. There is no significant association between pre and post craniectomy assessment in jugular oxymetry (p > 0.05), autoregulation (p > 0.05), intracranial brain oxymetry (p = 0.125) and cerebral blood flow (p = 0.375). Compliance and PVI improved dramatically in all alive patients who received decompressive craniectomy. Compliance and PVI monitoring may be crucial in improving the outcome of severe head injured patients after decompressive craniectomy.

Matched MeSH terms: Hydrocephalus/diagnosis*; Hydrocephalus/epidemiology; Hydrocephalus/surgery*
Fulltext Current Updates on Idiopathic Normal Pressure Hydrocephalus

Liew BS, Takagi K, Kato Y, Duvuru S, Thanapal S, Mangaleswaran B

Asian J Neurosurg, 2019 9 10;14(3):648-656.
PMID: 31497081 DOI: 10.4103/ajns.AJNS_14_19

Idiopathic normal pressure hydrocephalus (iNPH) is one of the neurodegenerative diseases which can be treated surgically with favorable outcome. The gait disturbance, cognitive, and urinary symptoms are known as the clinical triad of iNPH. In this review, we have addressed the comorbidities, differential diagnoses, clinical presentations, and pathology of iNPH. We have also summarized the imaging studies and clinical procedures used for the diagnosis of iNPH. The treatment modality, outcomes, and prognosis were also discussed.

Matched MeSH terms: Hydrocephalus, Normal Pressure
Fulltext Early experience in endoscopic management of massive intraventricular hemorrhage with literature review

Idris Z, Raj J, Abdullah JM

Asian J Neurosurg, 2014 Jul-Sep;9(3):124-9.
PMID: 25685202 DOI: 10.4103/1793-5482.142731

Massive intraventricular hemorrhage (IVH) is nearly always associated with hydrocephalus and is often treated with prolonged external ventricular drainage (EVD); however this procedure can lead to bacterial ventriculitis and meningitis, which can worsen the clinical outcomes. Endoscopic burr hole surgery to remove the hematomas in lateral and third ventricles is an alternative treatment option. We describe the surgical techniques and benefits of endoscopic surgery for acute massive IVH in four patients and discuss the current published literature-related to this condition. Four patients were treated endoscopically for massive IVH. Three patients presented with secondary IVH due to vascular malformation, tumoral bleed and chronic hypertension, while one case presented as massive primary IVH. Endoscopic wash out and removal of hematomas was normally performed together with an endoscopic third ventriculostomy. Recombinant factor VIIa was only administered prior to surgery for IVH secondary to vascular malformation and for cases with postoperative rebleeding which required second endoscopic surgery. Weaning from ventilator and EVD commenced on day 4 postoperatively. All treated patients recovered and did not require further shunt surgery. Good outcomes obtained may be related to early removal of hematomas, creation of new cerebrospinal fluid diversion pathway after thorough wash-out, early weaning from ventilator and EVD. Endoscopic surgery is beneficial in treating poor grade IVH with Graeb score of more than 6.

Matched MeSH terms: Hydrocephalus
Fulltext Comparison between Ventriculosubgaleal Shunt and Extraventricular Drainage to Treat Acute Hydrocephalus in Adults

Nee LS, Harun R, Sellamuthu P, Idris Z

Asian J Neurosurg, 2017 Oct-Dec;12(4):659-663.
PMID: 29114279 DOI: 10.4103/ajns.AJNS_122_16

Context: Hydrocephalus, due to subarachnoid or intraventricular hemorrhage (IVH), meningitis, or tumor compression, is usually transient and may resolve after treatment. There are several temporary methods of cerebrospinal fluid (CSF) diversion, none of it is superior to the other, and the decision is based on its various etiologies and factors. Ventriculosubgaleal shunt (VSGS) is one of those temporary measures, which is a simple and rapid CSF decompression method without causing electrolyte and nutritional losses.

Aims: The aim is to study the efficacy of VSGS for temporary CSF diversion, compared to extraventricular drainage (EVD) in adult hydrocephalus patients; to evaluate the outcome in terms of avoiding a permanent shunt, and to look for incidences of their complications.

Settings and Design: This was a retrospective observational study.

Subjects and Methods: The data were acquired from case notes of fifty patients with acute hydrocephalus: 26 secondary to IVH, 10 from aneurysm rupture, 8 posttrauma, and 6 from infection. All these patients had undergone CSF diversion in Hospital Queen Elizabeth II, Sabah, Malaysia, between 2013 and 2015. The patients were followed up from the date of treatment until the resolution of hydrocephalus, where parameters such as shunt dependency and complications were documented.

Statistical Analysis Used: All analyses were carried out using Statistical Packages for the Social Sciences Version 22.0. Chi-squared test or Fisher's exact test is used for univariate analysis of categorical variables.

Results: A total of 21 (42%) patients underwent EVD insertion and 29 (58%) underwent VSGS insertion. Thirty-seven (74%) patients did not require a permanent shunt; 24 (64.8%) of them were from the VSGS group (P = 0.097). EVD had more intracranial complications (44.1%) compared with VSGS (23.5%), with a statistically significant P = 0.026.

Conclusions: VSGS is a safe and viable option for adult hydrocephalus patients, with the possibility of continuation of the treatment for such patients in nonneurosurgical centers, as opposed to patients with EVDs. Furthermore, even though this method had no statistical difference in avoiding a permanent ventriculoperitoneal shunt, VSGS has statistically significant less intracranial complications compared with EVD.

Matched MeSH terms: Hydrocephalus
A fatal case of malignant neurocysticercosis

Ong SCL, Koh KC

BMJ Case Rep, 2017 Sep 27;2017.
PMID: 28954760 DOI: 10.1136/bcr-2017-222281
Matched MeSH terms: Hydrocephalus/etiology
Fulltext Dandy-walker syndrome in a child at rural Kelantan, Malaysia

Low, Qin Jia, Huan, Nai Chien, Tan, Wei Lun

Borneo Journal of Medical Sciences, 2018;12(2):41-45.
MyJurnal

Dandy-Walker syndrome is a rare congenital malformation of the brain that involves the cerebellum and the fourth ventricle. It is characterised by a classical triad of hydrocephalus, cystic dilatation of the fourth ventricle and complete or partial agenesis of the vermis. Majority of cases are diagnosed during neonatal or early infantile period. In this case report, a seven-year-old boy complained of recurrent headaches for the past one year. Physical examination was unremarkable. Examination of the fundus on the same day revealed bilateral papilloedema. His subsequent computed tomography scan of the brain done at a major district hospital demonstrated features in keeping with Dandy-Walker malformation. Our case highlighted the importance of embarking on a detailed and thorough approach when dealing with a child with chronic headache, especially in rural settings where advanced medical equipment is not readily available.

Matched MeSH terms: Hydrocephalus
Neonatal post-hemorrhagic hydrocephalus resulting in foraminal septae-radiological technique and surgical implications

Fadzli F, Ramli NM, Rahmat K, Ganesan D

Childs Nerv Syst, 2013 Jan;29(1):159-62.
PMID: 22996826 DOI: 10.1007/s00381-012-1923-5

Intraventricular haemorrhage is the most common cause of hydrocephalus in a pre-term baby and may require surgical intervention depending on severity.

Matched MeSH terms: Hydrocephalus/diagnosis; Hydrocephalus/etiology*
Case report: the unexpected culprit for multiple shunt revisions

Fitzrol D, Idris B

Childs Nerv Syst, 2019 06;35(6):1063-1065.
PMID: 30806764 DOI: 10.1007/s00381-019-04089-0

Silicone allergy in patients with ventricular shunts is uncommon hence easily missed. However, there are clinical features that could assist in identifying and diagnosing this condition. We discuss a case where a patient with a ventriculoperitoneal (VP) shunt presented to us with features suggestive of silicone allergy.

Matched MeSH terms: Hydrocephalus/surgery
Neuroendoscopy for post-infective hydrocephalus in children

Deopujari CE, Padayachy L, Azmi A, Figaji A, Samantray SK

Childs Nerv Syst, 2018 10;34(10):1905-1914.
PMID: 30099619 DOI: 10.1007/s00381-018-3901-z

The treatment of hydrocephalus has changed in recent years with better imaging and introduction of endoscopic procedures as well as enhanced shunts. Indications of endoscopic third ventriculostomy (ETV) are now more refined with better quantification of outcome. This article reviews the current state of neuroendoscopy for infective hydrocephalus in children. The roles of third ventriculostomy as a primary procedure or after shunt malfunction, endoscopic interventions in multiloculated hydrocephalus and introduction of intraventricular lavage to salvage severely infected children are evaluated.

Matched MeSH terms: Hydrocephalus/etiology; Hydrocephalus/surgery*
A giant mastoid cholesteatoma with posterior cranial extension causing mass effect and obstructive hydrocephalus

Sabir BI, Rahmat K, Bux SI, Rajagopal NS, Looi LM, Sia SF

Clin Neurol Neurosurg, 2013 Oct;115(10):2192-6.
PMID: 23791432 DOI: 10.1016/j.clineuro.2013.05.023
Matched MeSH terms: Hydrocephalus/etiology; Hydrocephalus/pathology*
Mural nodules in multiple cavernous haemangioma

Nair SR, Rahmat K, Alhabshi SM, Ramli N, Seong MK, Waran V

Clin Neurol Neurosurg, 2013 Jul;115(7):1150-3.
PMID: 23031746 DOI: 10.1016/j.clineuro.2012.09.014
Matched MeSH terms: Hydrocephalus/complications
Fulltext Leptomeningeal Carcinomatosis With Optic Nerve Metastasis Secondary to Breast Cancer

Chew C, Wan Hitam WH, Ahmad Tajudin LS

Cureus, 2021 Mar 31;13(3):e14200.
PMID: 33936906 DOI: 10.7759/cureus.14200

Leptomeningeal carcinomatosis (LC) and optic nerve metastasis are uncommon occurrences in breast cancer. We report a rare case of LC with optic nerve infiltration secondary to breast cancer. A 45-year-old lady who was a known case of treated right breast carcinoma six years ago presented with a blurring of vision in both eyes, floaters, and diplopia for one month. She also had recurrent attacks of seizure-like episodes, headache, and vomiting. Examination revealed high blood pressure with tachycardia. Her right eye visual acuity was counting fingers at two feet and 6/36 in the left eye. She had right abducens nerve palsy. Fundoscopy showed bilateral optic disc swelling with pre-retinal, flame-shaped haemorrhages and macular oedema. CT scan of brain and orbit was normal. She was admitted for further investigations. While in the ward, her vision deteriorated further. Her visual acuity in both eyes was at the level of no perception to light. She also developed bilateral abducens nerve palsy and right facial nerve palsy. Subsequently, she started having bilateral hearing loss. There were few episodes of fluctuations in conscious awareness. MRI brain showed mild hydrocephalus. Both optic nerves were thickened and enhanced on T1-weighted and post-gadolinium. Lumbar puncture was performed. There was high opening pressure. Cerebrospinal fluid cytology showed the presence of malignant cells. Family members opted for palliative care in view of poor prognosis. Unfortunately, she succumbed after a month's stay in hospital. Diagnosis of LC and optic nerve infiltration presents a formidable challenge to clinicians especially in the early stages where neuroimaging appears normal and lumbar puncture has high false negatives. Multiple high-volume taps are advised if clinical suspicion of LC is high.

Matched MeSH terms: Hydrocephalus
Fulltext Intraventricular Tuberculoma with Profound Visual Loss: A Case Report and Literature Review

Tengku-Fatishah A, Besari AM, Tharakan J, Shatriah I

Cureus, 2018 Jun 14;10(6):e2807.
PMID: 30123729 DOI: 10.7759/cureus.2807

Intracranial tuberculoma is a rare manifestation of tuberculosis involving the central nervous system. The involvement of the ventricular system is extremely uncommon. We describe a young woman with bilateral papilledema secondary to intraventricular tuberculoma with hydrocephalus. She was treated with anti-tuberculosis therapy and intravenous dexamethasone. Her visual acuity deteriorated after one month of treatment. We provide a literature review of this uncommon ocular sequelae.

Matched MeSH terms: Hydrocephalus
Structure and function of proprotein convertase subtilisin/kexin type 9 (PCSK9) in atherosclerosis

Zhang L, Hussain Z, Ren Z

Curr Drug Targets, 2019 Feb 14.
PMID: 30767742 DOI: 10.2174/1389450120666190214141626

BACKGROUND: Normal pressure hydrocephalus (NPH) is a critical brain disorder in which excess cerebrospinal fluid (CSF) is accumulated in the brain's ventricles causing damage or disruption of the brain tissues. Amongst various signs and symptoms, difficulty in walking, blurred speech, impaired decision making and critical thinking, and loss of bladder and bowl control are considered the hallmark features of NPH.
OBJECTIVE: The current review was aimed to present a comprehensive overview and critical appraisal of majorly employed neuroimaging techniques for rational diagnosis and effective monitoring of effectiveness of employed therapeutic intervention for NPH. Moreover, a critical overview of recent developments and utilization of pharmacological agents for treatment of hydrocephalus has also been appraised.
RESULTS: Considering the complications associated with the shunt-based surgical operations, consistent monitoring of shunting via neuroimaging techniques hold greater clinical significance. Despite having extensive applicability of MRI and CT scan, these conventional neuroimaging techniques are associated with misdiagnosis or several health risks to patients. Recent advances in MRI (i.e., Sagittal-MRI, coronal-MRI, Time-SLIP (time-spatial-labeling-inversion-pulse), PC-MRI and diffusion-tensor-imaging (DTI)) have shown promising applicability in diagnosis of NPH. Having associated with several adverse effects with surgical interventions, non-invasive approaches (pharmacological agents) have earned greater interest of scientists, medical professional, and healthcare providers. Amongst pharmacological agents, diuretics, isosorbide, osmotic agents, carbonic anhydrase inhibitors, glucocorticoids, NSAIDs, digoxin, and gold-198 have been employed for management of NPH and prevention of secondary sensory/intellectual complications.
CONCLUSION: Employment of rational diagnostic tool and therapeutic modalities avoids misleading diagnosis and sophisticated management of hydrocephalus by efficient reduction of cerebrospinal fluid (CSF) production, reduction of fibrotic and inflammatory cascades secondary to meningitis and hemorrhage, and protection of brain from further deterioration.

Matched MeSH terms: Hydrocephalus, Normal Pressure
Recent Advances in Rational Diagnosis and Treatment of Normal Pressure Hydrocephalus: A Critical Appraisal on Novel Diagnostic, Therapy Monitoring and Treatment Modalities

Zhang L, Hussain Z, Ren Z

Curr Drug Targets, 2019;20(10):1041-1057.
PMID: 30767741 DOI: 10.2174/1389450120666190214121342

BACKGROUND: Normal pressure hydrocephalus (NPH) is a critical brain disorder in which excess Cerebrospinal Fluid (CSF) is accumulated in the brain's ventricles causing damage or disruption of the brain tissues. Amongst various signs and symptoms, difficulty in walking, slurred speech, impaired decision making and critical thinking, and loss of bladder and bowl control are considered the hallmark features of NPH.
OBJECTIVE: The current review was aimed to present a comprehensive overview and critical appraisal of majorly employed neuroimaging techniques for rational diagnosis and effective monitoring of the effectiveness of the employed therapeutic intervention for NPH. Moreover, a critical overview of recent developments and utilization of pharmacological agents for the treatment of hydrocephalus has also been appraised.
RESULTS: Considering the complications associated with the shunt-based surgical operations, consistent monitoring of shunting via neuroimaging techniques hold greater clinical significance. Despite having extensive applicability of MRI and CT scan, these conventional neuroimaging techniques are associated with misdiagnosis or several health risks to patients. Recent advances in MRI (i.e., Sagittal-MRI, coronal-MRI, Time-SLIP (time-spatial-labeling-inversion-pulse), PC-MRI and diffusion-tensor-imaging (DTI)) have shown promising applicability in the diagnosis of NPH. Having associated with several adverse effects with surgical interventions, non-invasive approaches (pharmacological agents) have earned greater interest of scientists, medical professional, and healthcare providers. Amongst pharmacological agents, diuretics, isosorbide, osmotic agents, carbonic anhydrase inhibitors, glucocorticoids, NSAIDs, digoxin, and gold-198 have been employed for the management of NPH and prevention of secondary sensory/intellectual complications.
CONCLUSION: Employment of rational diagnostic tool and therapeutic modalities avoids misleading diagnosis and sophisticated management of hydrocephalus by efficient reduction of Cerebrospinal Fluid (CSF) production, reduction of fibrotic and inflammatory cascades secondary to meningitis and hemorrhage, and protection of brain from further deterioration.

Matched MeSH terms: Hydrocephalus, Normal Pressure/therapy*
Fulltext Hemangioblastoma in the setting of von hippel lindau disease: a case report

Raajini Devi K, Aida Zairani MI, Hazlita MI, Jemaima CH, Farizal F, Safinaz Mohd Khialdin

Journal of Surgical Academia, 2016;6(1):54-58.
MyJurnal

A 21-year-old Chinese gentleman with no known medical illness, presented with a history of right painless blurring of vision with central scotoma of two weeks duration. He also had a history of multiple episodes of seizures prior to presentation. Visual acuity was 1/60 with unremarkable anterior segment findings and no relative afferent pupillary defect. Fundus examination of the right eye revealed dilated and tortuous retinal veins with multiple retinal capillary hemangiomas and sub retinal hard exudates at the macula with edema. A diagnosis of Von Hippel Lindau disease was made when a posterior fossa mass suggestive of hemangioblastoma with obstructive hydrocephalus was seen on computed tomography of the brain. Craniotomy with nodule excision was performed. The retinal capillary hemangiomas were treated with the combination of laser photocoagulation and intravitreal Ranibizumab injections. Visual acuity subsequently improved to 6/36.

Matched MeSH terms: Hydrocephalus
Fulltext Hydrocephaly Analysis Supported by Computerized Tomography and Nuclear Magnetic Resonance

Zhang T, Zhou Y, Su G, Shi D, Gopinath SCB, Lakshmipriya T, et al.

J Anal Methods Chem, 2019;2019:5872347.
PMID: 31662948 DOI: 10.1155/2019/5872347

Hydrocephalus is widely known as "hydrocephaly" or "water in the brain," a building up of abnormal cerebrospinal fluid in the brain ventricles. Due to this abnormality, the size of the head becomes larger and increases the pressure in the skull. This pressure compresses the brain and causes damage to the brain. Identification by imaging techniques on the hydrocephalus is mandatory to treat the disease. Various methods and equipment have been used to image the hydrocephalus. Among them, computerized tomography (CT) scan and nuclear magnetic resonance (NMR) are the most considered methods and gives accurate result of imaging. Apart from imaging, cerebrospinal fluid-based biomarkers are also used to identify the condition of hydrocephalus. This review is discussed on "hydrocephalus" and its imaging captured by CT scan and NMR to support the biomarker analysis.

Matched MeSH terms: Hydrocephalus
Factor V inhibitor in neonatal intracranial hemorrhage secondary to severe congenital factor V deficiency

Lee WS, Chong LA, Begum S, Abdullah WA, Koh MT, Lim EJ

J Pediatr Hematol Oncol, 2001 May;23(4):244-6.
PMID: 11846304

We report a newborn infant girl, born to consanguineous parents, with recurrent intracranial hemorrhage secondary to congenital factor V deficiency with factor V inhibitor. Repeated transfusions of fresh-frozen plasma (FFP) and platelet concentrates, administrations of immunosuppressive therapy (prednisolone and cyclophosphamide), and intravenous immunoglobulin failed to normalize the coagulation profiles. Exchange transfusion followed-up by administrations of activated prothrombin complex and transfusions of FFP and platelet concentrates caused a temporary normalization of coagulation profile, enabling an insertion of ventriculoperitoneal (VP) shunt for progressive hydrocephalus. The treatment was complicated by thrombosis of left brachial artery and ischemia of left middle finger. The child finally died from another episode of intracranial hemorrhage 10 days after insertion of the VP shunt.

Matched MeSH terms: Hydrocephalus/etiology; Hydrocephalus/surgery
Fulltext Communicating Hydrocephalus in a Case of Long-Term Primary Hyperparathyroidism

Ooi CP, Mustafa N, Kew TY

J ASEAN Fed Endocr Soc, 2018;33(1):49-52.
PMID: 33442110 DOI: 10.15605/jafes.033.01.08

We present the rare case of a 47-year-old woman with protracted primary hyperparathyroidism complicated by communicating hydrocephalus and cerebellar tonsillar herniation secondary to calvarial thickening. The parathyroid glands remained elusive, despite the use of advanced preoperative imaging modalities and three neck explorations. The serum calcium was optimally controlled with cinacalcet and alfacalcidol. Awareness of this rare complication is essential for early diagnosis and prompt intervention to prevent fatal posterior brain herniation.

Matched MeSH terms: Hydrocephalus

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