Current literature reveals different opinions about the effectiveness of endoscopic third ventriculostomy in the treatment of hydrocephalus in children less than 2 years of age. Performing a retrospective evaluation of our own experience in this age group, we aimed to contribute to the growing data on the controversial issues related to this procedure in children. In a series of 97 endoscopic third ventriculostomy procedures, 25 were performed in children less than 2 years of age as an initial treatment for hydrocephalus. A retrospective analysis of our data revealed that the overall success rate of endoscopic third ventriculostomy in this age group was 56%. However, analysis of the results in subgroups with different etiologies of hydrocephalus showed that the success rate of the procedure was 83% in patients with defined anatomic obstruction, 66.6% in post-hemorrhagic hydrocephalus, 50% in infection related hydrocephalus and 41.6% in hydrocephalus accompanied by myelomeningocele. This article considers our data and the features of endoscopic third ventriculostomy procedure in this age group, with a detailed review of the literature. In our experience, the success of endoscopic third ventriculostomy is etiology related rather than age-dependent. We suggest that there are no grounds for denying children younger than 2 years this chance for a shunt-free life.

Hydrocephalus causes damage to periventricular white matter at least in part through chronic ischemia. Emphasizing the periventricular ischemia/hypoxia in hydrocephalus, various authors indicated the secondary biochemical impairment and oxidative damage in experimentally induced and congenital hydrocephalic rat brain. (-)-Epigallocatechin gallate (EGCG), the main constituent of green tea polyphenols, has been shown to be of some protective value in various models of neurological injury as a free oxygen radical scavenger. In the present study the effects of EGCG were examined on the periventricular oxidative damage in experimental childhood-onset hydrocephalus. Hydrocephalus was induced in 3 weeks-old rat pups by kaolin injection into the cisterna magna. A single daily dose of 50 mg/kg of EGCG injected into the peritoneum of the rats for 15 days significantly reduced periventricular white matter malondialdehyde levels when compared to non-treated hydrocephalic animals. Our results indicate that EGCG may have a protective effect against periventricular white matter oxidative damage in hydrocephalus induced infantile rats.

Early removal of intraventricular blood degradation products and residual hematoma via neuroendoscopic ventricular irrigation is feasible and safe for the treatment of PHH in neonates with IVH. Neuroendoscopic technique seems to offer significantly lower shunt rates and fewer complications such as infection and development of multiloculated hydrocephalus in those cases.

Study Design: The e ect of epidural space perfusion with chilled saline solution (% 0.9 NaCl) on lipid peroxidation after experimental spinal cord injury in rats was evaluated. Objectives: The extent of lipid peroxidation is a useful parameter for evaluating the cellular disturbance caused by spinal cord trauma in experimental conditions. The protective e ects of hypothermia against neurological injury resulting from trauma or ischemia both in experimental and clinical situations have been demonstrated. Setting: Departments of Neurosurgery and Biochemistry, Cerrahpasa Medical School, Istanbul, Turkey. Methods: Twenty-®ve female Wistar Albino rats were used. There were ®ve rats in group I (sham-operated), seven rats in group II (trauma), and eight rats in group III (epidural cooling). The remaining ®ve rats were used for the pilot study to determine the spinal cord and body temperature. A clip compression method was used to produce acute spinal cord injury. In group III, 30 min after the trauma the injured spinal cord was cooled by perfusion of the epidural space with chilled saline solution (% 0.9 NaCl) with a¯ow rate of 5 ml/min for 30 min. At 2 h after trauma, all rats other than the ones used in the pilot study, were sacri®ced and the spinal cords were excised. The extent of lipid peroxidation in the spinal cord was assessed by measuring the tissue content of malonil dialdehyde (MDA). Results: The tissue MDA contents were 1.58 micromol MDA/gram wet weight (gww) in group 1 (sham-operated), 2.58 micromol MDA/gww in group 2 (trauma), and 1.77 micromol/ gww in group 3 (epidural cooling), the di erences being statistically signi®cant. Conclusion:The results indicated that epidural cooling of traumatized spinal cord is e ective in preventing secondary damage due to the peroxidation of lipid membranes.

Our results suggest that "pure neuroendoscopic" approach can be used safely in the management of SACs in children. We recommend at least two fenestration sites for an effective marsupialization of the cyst within the basal cisterns. In pediatric cases, the use of a small diameter rigid endoscope allows to reach safely the planned target areas.

In reports on children with congenital segmental costovertebral malformations who showed neural tube defects, cases with type I split cord malformation are quite rare. Up to now such association has been reported only in two cases with Jarcho-Levin syndrome. Here, a 7-year-old girl presenting with spondylocostal dysostosis and type I split cord malformation is reported. To the best of our knowledge, this is the first case documented in the literature. The association of segmental costovertebral malformations and neural tube defects is discussed. Genetic and embryological studies are also briefly reviewed.

AIm:The effect of memantine administration on hippocampal neurons of the infantile rats with kaolin induced hydrocephalus was investigated. mAterIAl and methOds: Hydrocephalus was induced by injecting kaolin into the cisterna magna of 3-weeks old Sprague-Dawley rat pups. One group received a single daily dose of 20mg/kg memantine i.p. following hydrocephalus induction for a period of two weeks. By the end of the two-week period, animals were radiologically evaluated by magnetic resonance imaging and then sacrificed to get their cerebrums removed. Both immunohistochemical analysis of nitric oxide synthase activity and quantification of spared neurons in CA1, CA2 and CA3 regions of hippocampus were performed. results:In hydrocephalus-induced rats considerable neuronal loss associated with significantly increased nitric oxide synthase immunoreactivity were determined in all hippocampal regions. However, memantine treated rats showed significantly higher number of spared neuron counts and reduced nitric oxide synthase immunoreactivity in CA1 and CA2 regions compared with the non-treated rats. COnClusIOn:The findings of the study show that hippocampal neurons may constitute important targets for injury secondary to hydrocephalic process in experimental infantile hydrocephalus. Early anti-excitotoxic treatment with memantine seems to have a neuroprotective effect especially in the CA1 and CA2 subunits of the hippocampus.KeywOrds: Hippocampus, Hydrocephalus, Memantine, Neuroprotection, Rat ÖZ AmAÇ: İnfant sıçanda kaolin ile oluşturulan hidrosefali modelinde memantin tedavisinin hipokampal nöronlar üzerindeki etkisi araştırılmıştır. yÖntem ve GereÇ: Üç haftalık Sprague-Dawley türü sıçan yavrularında sisterna magna içerisine kaolin süspansiyonu enjeksiyonu ile hidrosefali oluşturulmuştur. Hidrosefali indüksiyonunu takiben bir grup deneğe iki hafta süreyle günlük 20mg/kg dozunda intraperitoneal yolla memantin verilmiştir. İki haftalık sürenin bitiminde tüm denekler manyetik rezonans görüntüleme ile incelendikten sonra sakrifiye edilerek serebrumları çıkartılmış ve hipokampus CA1, CA2 ve CA3 bölgelerinde sağlam nöron sayımı ile birlikte nöronal nitrik oksit sentaz aktivitesinin immünhistokimyasal analizi yapılmıştır.BulGulAr: Hidrosefali oluşturulan gruplarda tüm hipokampal bölgelerde anlamlı nitrik oksit sentaz immünoreaktivitesi artışı ile birlikte nöron sayısında farkedilir azalma gözlenmiştir. Ancak memantin uygulanan deneklerin CA1 ve CA2 bölgelerinde nöron sayılarındaki azalmanın ve nitrik oksit sentaz immünoreaktivitesi artışın anlamlı düzeyde daha az olduğu saptanmıştır. sOnuÇ: Bu deneysel infantil hidrosefali çalışmasının sonuçları, hipokampal nöronların hidrosefalik sürece ikincil gelişen hasarlanma açısından önemli hedefler olduğunu göstermektedir. Memantin ile yapılan erken anti-eksitotoksik tedavinin özellikle hipokampus CA1 ve CA2 bölgeleri üzerinde nöron-koruyucu etki gösterdiği söylenebilir

The authors of this paper describe two patients with achondroplasia in whom triventricular hydrocephalus has been successfully treated using endoscopic third ventriculostomy (ETV). The authors performed ETVs in two children with achondroplasia involving a moderate macrocranium and enlarged lateral and third ventricles with intermittent clinical evidence of increased intracranial pressure. The endoscopic procedure revealed a significant deformation of the floor of the third ventricle in both patients caused by longstanding hydrocephalus. Because of the anatomical variations such as empty sella and the persistence of the infundibular recess, the ETV procedure became technically demanding. The standard ventriculostomy on the tuber cinereum was not possible. Ventriculostomies were performed on the part of the third ventricular floor that was hanging ventral to the pons. Both patients became symptom free postoperatively, and phase-contrast cine magnetic resonance (MR) imaging studies confirmed the patency and effectivity of the ventriculostomy sites. The authors suggest that ETVs may constitute an alternative for ventriculoperitoneal shunt therapy as the treatment of choice for patients with achondroplasia who have triventricular hydrocephalus and clinical symptoms. Attention should be paid to the shape of the floor of the third ventricle, however, especially in cases of longstanding hydrocephalus. An association of the empty sella or the persistence of the infundibular recess must be carefully evaluated using MR imaging studies before attempting ETVs in such patients.