HYDROCEPHALUS Edited by Sadip Pant and Iype Cherian Hydrocephalus Edited by Sadip Pant and Iype Cherian Published by InTech Janeza Trdine 9, 51000 Rijeka, Croatia Copyright © 2012 InTech All chapters are Open Access distributed under the Creative Commons Attribution 3.0 license, which allows users to download, copy and build upon published articles even for commercial purposes, as long as the author and publisher are properly credited, which ensures maximum dissemination and a wider impact of our publications. After this work has been published by InTech, authors have the right to republish it, in whole or part, in any publication of which they are the author, and to make other personal use of the work. Any republication, referencing or personal use of the work must explicitly identify the original source. 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Publishing Process Manager Anja Filipovic Technical Editor Teodora Smiljanic Cover Designer InTech Design Team First published February, 2012 Printed in Croatia A free online edition of this book is available at www.intechopen.com Additional hard copies can be obtained from orders@intechweb.org Hydrocephalus, Edited by Sadip Pant and Iype Cherian p. cm. ISBN 978-953-51-0162-8 Contents Preface IX Chapter 1 Hydrocephalus: An Overview 1 Milani Sivagnanam and Neilank K. Jha Chapter 2 Intraventricular Cerebrovascular Pathologies of Hydrocephalus and Managements 19 Ahmet Metin Şanlı, Hayri Kertmen and Bora Gürer Chapter 3 Clinical Presentation of Hydrocephalus 43 Sadip Pant and Iype Cherian Chapter 4 Interpretation of Cerebrospinal Fluid Parameters in Children with Hydrocephalus 57 Daniel Fulkerson Chapter 5 Management of Hydrocephalus 69 Parvaneh Karimzadeh Chapter 6 Complications Associated with Surgical Treatment of Hydrocephalus 75 Takeshi Satow, Masaaki Saiki and Takayuki Kikuchi Chapter 7 External Ventricular Drain Infections 87 Anderson C.O. Tsang and Gilberto K.K. Leung Chapter 8 Role of Endoscopy in Management of Hydrocephalus 99 Nasser M. F. El-Ghandour Chapter 9 Transcranial Doppler Ultrasonography in the Management of Neonatal Hydrocephalus 131 Branislav Kolarovszki and Mirko Zibolen Chapter 10 Novel Method for Controlling Cerebrospinal Fluid Flow and Intracranial Pressure by Use of a Tandem Shunt-Valve System 153 Yasuo Aihara VI Contents Chapter 11 Complex Hydrocephalus 167 Nasser M. F. El-Ghandour Chapter 12 Recognition of Posture and Gait Disturbances in Patients with Normal Pressure Hydrocephalus Using a Posturography and Computer Dynography Systems 189 L. Czerwosz, E. Szczepek, B. Sokołowska, J. Jurkiewicz and Z. Czernicki Preface A child with a large head and a sick malnourished body was the epitome of poverty from the older days… But, the large head started getting noticed in children from well to do families as well. And then as the studies on Hydrocephalus progressed, simple ways of shunting the fluid away from the ventricles to any other cavity like the atrium, pleural cavity and peritoneal cavity evolved after considerable attempts to destroy the choroid plexus, but did not bear as much fruits. The reasons for hydrocephalus (of course, the ones other than abject poverty) were looked into and the disease was classified to be either obstructive or non-obstructive (also termed communicative, a misnomer actually)… and then the logical ways of dealing with each appeared. The shunt was a panacea for both, but then Endoscopy came along. The third ventriculostomy literally changed the scene with no implants, and thus abolishing the most feared complication of all, shunt infections. Posterior third ventriculostomy, septostomy, stents across the aqueduct of sylvius and so on and so forth were treatments aimed at getting around the obstruction. And they proved to be successful as well, to an extent. As is the usual cycle, time revealed the limitations of endoscopy. The shunts evolved into modern gadgets with programmability… and the evolution continues. Lamina Terminalis was recognized as the anterior boundary of the third ventricle and fenestration of this thin membrane was thought to be helpful in resolution of hydrocephalus with subarachnoid hemorrhage. This was applied in very few cases in our center where Endoscopic third ventriculostomy could not be done due to a very thick and opalescent third ventricular floor. We did fenestration of Lamina terminalis through an eyebrow incision and a keyhole approach. We do think that in cases where an ETV is difficult or risky and the type of hydrocephalus is obstructive, this is something which could be an alternative to a shunt. Of course more work needs to be done to assess the feasibility. However few things which were not considered earlier like the compliance of the brain and the fragile balance of the CSF system were studied later on and treatments X Preface started taking these factors into account as well. So evolved treatments for communicating hydrocephalus and normal pressure hydrocephalus where the compliance of the brain is important. In the present scenario, surgeons have a lot to choose from. However, before doing anything it goes without saying that the surgeon weighs his options and goes ahead with the treatment, based on the familiarity and efficacy of a particular way of treating the hydrocephalus. After all, no surgeon would want a mismanaged case of hydrocephalus on his hands. Dr. Sadip Pant University of Arkansas for Medical Sciences, AR, USA Dr. Iype Cherian College of Medical Sciences, Bharatpur, Nepal [...]... a form of hydrocephalus called normal pressure hydrocephalus (NPH), which primarily affects the elderly population Congenital hydrocephalus is present at birth, and can be caused by Dandy-Walker malformations, porenchphaly, spina bifida, Chairi I and II malformations, arachnoid cysts, and most commonly aquaductal stenosis Very few cases of congenital hydrocephalus are inherited (X-linked hydrocephalus) ... limited control in the head and trunk regions Left untreated, this can progress and can result in seizures and/ or coma 5.2 Children and adults Children presenting with hydrocephalus, may have had a pre-existing and unrecognized hydrocephalus and may have normal or delayed neurological development These children have slightly enlarged heads, optic atrophy or papilloedma caused by increased ICP These children... caused by a disruption of CSF equilibrium Rarely, hydrocephalus can be caused by an abundance of CSF production, as a result of a choroid plexus papilloma or carcinoma Hydrocephalus is typically the underlying condition when CSF absorption is impaired, and can be caused by a complication after an infection or by hemorrhagic complications Patients are often treated using a shunt 2.3 Normal Pressure Hydrocephalus. .. noncommunicating hydrocephalus suggests treatment with endoscopic third ventriculostomy (ETV) Regardless of etiology, both groups present with ventriculomegaly and elevated intracranial pressure, which are responsible for the similar symptoms seen in both communicating and non-communicating forms of hydrocephalus 2 Hydrocephalus 2.1 Obstructive (Non-communicating) hydrocephalus Obstructive hydrocephalus. .. limbs and hyperreflexia In school, they may present with learning difficulties, and often have lower performance IQ than verbal IQ When hydrocephalus occurs in children and adults (after fontanelles have fused), hydrocephalus will manifest with different symptoms Affected individuals will have normal head size and present with headache, vomiting, irritability, alerted consciousness, lethargy and ventriculomegaly... treatment of obstructive hydrocephalus in adults Neurological Research Vol 29, No 1, (January 2007), pp 27-31 2 Intraventricular Cerebrovascular Pathologies of Hydrocephalus and Managements Ahmet Metin Şanlı, Hayri Kertmen and Bora Gürer Ministery of Health Diskapi Yildirim Beyazit Education and Research Hospital Turkey 1 Introduction Hydrocephalus, “water in the brain”, had been amazed and challenged clinicians... 100 000 people (Krauss and Halve, 2004) 4 Hydrocephalus 5 Clinical presentation of hydrocephalus As noted earlier, irrespective of etiology, patient symptoms will present in a similar manner However, depending on the type of hydrocephalus, age of onset, and severity, symptoms will vary greatly 5.1 Infants (0-2 years) In infants, the accumulation of CSF, enlargements of ventricles and increase in intracranial... advanced hydrocephalus due to compression of the optic chiasma as a result of a dilated 3rd ventricle Stretching of periventricular structures can cause abducent nerve paresis, presenting in nystagmus and random eye movement Infants with advanced hydrocephalus may also present with increased deep tendon reflexes and muscle tone in lower extremities, growth failure, delayed neurological development, and. .. on the age of onset Major developments in the treatment of hydrocephalus have occurred since the 20th century, with the use of shunts and neurosurgical interventions being the most successful Currently, no cure has been found for hydrocephalus 2 Types and classification Hydrocephalus can be grouped based on two broad criteria: 1) pathology and 2) etiology Pathology can be grouped as either obstructive... to serve as a cushion for the brain, and plays a role in haemostasis and metabolism of the brain It is produced by the choroid plexus, found in the body and inferior horn of the lateral ventricle, the foramen of Monroe, roof of the third ventricle and inferior roof of the fourth ventricle The flow of CSF through the ventricles is as follows: begins in the left and right lateral ventricles interventricular . HYDROCEPHALUS Edited by Sadip Pant and Iype Cherian Hydrocephalus Edited by Sadip Pant and Iype Cherian Published by InTech Janeza Trdine. Hydrocephalus, Edited by Sadip Pant and Iype Cherian p. cm. ISBN 978-953-51-0162-8 Contents Preface IX Chapter 1 Hydrocephalus: An Overview 1 Milani Sivagnanam and. Cerebrovascular Pathologies of Hydrocephalus and Managements 19 Ahmet Metin Şanlı, Hayri Kertmen and Bora Gürer Chapter 3 Clinical Presentation of Hydrocephalus 43 Sadip Pant and Iype Cherian Chapter 4