Hydrocephalus and CSF Disorders

Farb, Richard I.

doi:10.1007/978-3-030-38490-6_2

Cited by 14 publications

(11 citation statements)

References 31 publications

(40 reference statements)

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“…[ 23 ] Waiting for the hydrocephalus to be resolved after PFBT surgeries put patients with PFBT-related ventricular dilatation at a considerable likelihood to develop intracranial hypertension, CSF leakage, pseudomeningocele, and pseudobulbar palsy. [ 7 ] The rate of complications in our study (9%) falls within the range of rates of complication documented in the previous studies (6–20%). The previous literature has reported serious and fatal complications that included but was not limited to intraoperative bleeding (either venous or arterial), seizures, leakage of CSF, infection, cerebral aneurysms, and brain hematomas.…”

Section: Discussionsupporting

confidence: 88%

Endoscopic third ventriculostomy for the management of hydrocephalus secondary to posterior fossa tumors: A retrospective study

Salah¹,

Elhuseny²,

Youssef³

2022

Surgical Neurology International

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Background: Endoscopic third ventriculostomy (ETV) is an effective alternative to ventriculoperitoneal shunting as well as external ventricular drainage for the urgent management of acute hydrocephalus. We performed this study to investigate the efficacy and safety of ETV before tumor resection in managing hydrocephalus in patients with posterior fossa brain tumors (PFBT) in our neurosurgery department. Methods: We conducted this retrospective observational study between February 2018 and February 2020 on all cases diagnosed with PFBT associated with triventricular obstructive hydrocephalus. We retrospectively reviewed the demographic characteristics, operative procedures, and radiological investigations of all cases. During the follow-up period, clinical, as well as radiological success were evaluated. Results: Twenty-two ETV procedures were performed in 22 cases of PFBT (mean age = 22.1 years, SD = 11.4). Of the 22 cases, 8 cases (36.4%) had ependymoma, 7 cases (31.8%) had cerebellar astrocytoma, and 5 cases (22.7 %) had medulloblastoma, while 2 cases (9.1%) had diffuse pontine gliomas. The median follow-up duration was 9 months (range 3–13 months). The most commonly reported clinical presentation was the significant intracranial pressure increase. All operations were performed successfully in all cases. Only two ETV post-tumor resection failures were documented during the follow-up period. Conclusion: Preoperative ETV has shown to be an effective long-term cerebrospinal fluid diversion procedure to manage PFBT-associated hydrocephalus, with a relatively low rate of complications. Further prospective studies are required to assess the regular use of ETV before complete tumor resection.

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Section: Discussionsupporting

confidence: 88%

Endoscopic third ventriculostomy for the management of hydrocephalus secondary to posterior fossa tumors: A retrospective study

Salah¹,

Elhuseny²,

Youssef³

2022

Surgical Neurology International

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“…However, bilateral papilledema and ONSE were still noticeable. In general, papilledema and ONSE are visible on MRI and are considered good indices of IH [17]. There are two hypothetical explanations for the dissociation: compound hydrocephalus and adaptation period.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, caring clinicians should be careful regarding acute visual loss for 1 week after ETV. Preservation or recovery of vision is one of the major goals in treating IH [17]. When visual deterioration is evident, an urgent countermeasure must be considered to reduce the optic nerve pressure for saving visual function.…”

Section: Discussionmentioning

confidence: 99%

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Impending Blindness by Obstructive Hydrocephalus Intractable to Endoscopic Third Ventriculostomy: Case Report

Shirasaka

Yasuda

Takeuchi

et al. 2021

SN Compr. Clin. Med.

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Endoscopic third ventriculostomy (ETV) has been accepted for obstructive hydrocephalus (OH). We herein present a case of OH and optic nerve sheath edema (ONSE). Although ETV was successful, ONSE worsened. Discussion is focused on the relationship among intracranial hypertension (IH), ETV, and ONSE. The patient was a 19-year-old woman with complaints of headache and emesis. Papilledema was prominent. Radiological examination showed OH as an aqueductal tumor. Endoscopic tumorectomy and ETV were accomplished. Although headache and emesis disappeared, papilledema persisted. On the 4th day, the patient lost light perception. On magnetic resonance imaging, the third ventricular stroma and aqueduct were patent. Nevertheless, ONSE was prominent. After lumbar drainage, her vision was restored. Finally, ventriculoperitoneal shunting was performed, following which ONSE disappeared. IH is not always accompanied by ONSE. However, once it occurs, it may act separately from IH, and ETV may even exacerbate ONSE due to alteration of cerebrospinal fluid (CSF) flow into the chiasmatic cistern. In the optic nerve sheath, CSF pressure is not easily transmitted across different areas; this should explain the dissociation between ONSE and other symptoms of IH. Furthermore, we suggest that ONSE and acute optic dysfunction should be considered an independent crisis as “hydronervus opticus.”

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“…Other tumors that impede CSF flow include hypothalamic and optic nerve glia, choroid plexus papilloma, craniopharyngioma, pituitary adenoma, posterior fossa tumors, and metastatic tumors. Once noncommunicating HCP is diagnosed, the primary goal is to locate the obstacle blocking CSF for safe removal (Farb R & Rovira À., 2020). If the obstruction cannot be removed, then the path of CSF must be diverged to reduce the patient's ICP.…”

Section: Pathophysiology and Disruption Of Circulation And Dynamics I...mentioning

confidence: 99%

CSF Dynamics: Implications for Hydrocephalus and Glymphatic Clearance

Bissenas

Fleeting

Patel

et al. 2022

CRMS

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Beyond its neuroprotective role, CSF functions to rid the brain of toxic waste products through glymphatic clearance. Disturbances in the circulation of CSF and glymphatic exchange are common among those experiencing HCP syndrome, which often results from SAH. Normally, the secretion of CSF follows a two-step process, including filtration of plasma followed by the introduction of ions, bicarbonate, and water. Arachnoid granulations are the main site of CSF absorption, although there are other influencing factors that affect this process. The pathway through which CSF is through to flow is from its site of secretion, at the choroid plexus, to its site of absorption. However, the CSF flow dynamics are influenced by the cardiovascular system and interactions between CSF and CNS anatomy. One, two, and three-dimensional models are currently methods researchers use to predict and describe CSF flow, both under normal and pathological conditions. They are, however, not without their limitations. “Rest-of-body” models, which consider whole-body compartments, may be more effective for understanding the disruption to CSF flow due to hemorrhages and hydrocephalus. Specifically, SAH is thought to prevent CSF flow into the basal cistern and paravascular spaces. It is also more subject to backflow, caused by the presence of coagulation cascade products. In regard to the fluid dynamics of CSF, scar tissue, red blood cells, and protein content resulting from SAH may contribute to increased viscosity, decreased vessel diameter, and increased vessel resistance. Outside of its direct influence on CSF flow, SAH may result in one or both forms of hydrocephalus, including noncommunicating (obstructive) and communicating (nonobstructive) HCP. Imaging modalities such as PC-MRI, Time-SLIP, and CFD model, a mathematical model relying on PC-MRI data, are commonly used to better understand CSF flow. While PC-MRI utilizes phase shift data to ultimately determine CSF speed and flow, Time-SLIP compares signals generated by CSF to background signals to characterizes complex fluid dynamics. Currently, there are gaps in sufficient CSF flow models and imaging modalities. A prospective area of study includes generation of models that consider “rest-of-body” compartments and elements like arterial pulse waves, respiratory waves, posture, and jugular venous posture. Going forward, imaging modalities should work to focus more on patients in nature in order to appropriately assess how CSF flow is disrupted in SAH and HCP.

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Hydrocephalus and CSF Disorders

Cited by 14 publications

References 31 publications

Endoscopic third ventriculostomy for the management of hydrocephalus secondary to posterior fossa tumors: A retrospective study

Endoscopic third ventriculostomy for the management of hydrocephalus secondary to posterior fossa tumors: A retrospective study

Impending Blindness by Obstructive Hydrocephalus Intractable to Endoscopic Third Ventriculostomy: Case Report

CSF Dynamics: Implications for Hydrocephalus and Glymphatic Clearance

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