Hydrocephalus: historical analysis and considerations for treatment

Abstract

Hydrocephalus is a serious condition that affects patients of all ages, resulting from a multitude of causes. While the etiologies of hydrocephalus are numerous, many of the acute and chronic symptoms of the condition are shared. These symptoms include disorientation and pain (headaches), cognitive and developmental changes, vision and sleep disturbances, and gait abnormalities. This collective group of symptoms combined with the effectiveness of CSF diversion as a surgical intervention for many types of the condition suggest that the various etiologies may share common cellular and molecular dysfunctions. The incidence rate of pediatric hydrocephalus is approximately 0.1–0.6% of live births, making it as common as Down syndrome in infants. Diagnosis and treatment of various forms of adult hydrocephalus remain understudied and underreported. Surgical interventions to treat hydrocephalus, though lifesaving, have a high incidence of failure. Previously tested pharmacotherapies for the treatment of hydrocephalus have resulted in net zero or negative outcomes for patients potentially due to the lack of understanding of the cellular and molecular mechanisms that contribute to the development of hydrocephalus. Very few well-validated drug targets have been proposed for therapy; most of these have been within the last 5 years. Within the last 50 years, there have been only incremental improvements in surgical treatments for hydrocephalus, and there has been little progress made towards prevention or cure. This demonstrates the need to develop nonsurgical interventions for the treatment of hydrocephalus regardless of etiology. The development of new treatment paradigms relies heavily on investment in researching the common molecular mechanisms that contribute to all of the forms of hydrocephalus, and requires the concerted support of patient advocacy organizations, government- and private-funded research, biotechnology and pharmaceutical companies, the medical device industry, and the vast network of healthcare professionals.

Correlation between cerebrospinal fluid abnormalities before ventriculoperitoneal shunt and postoperative intracranial infection in adult patients with hydrocephalus: A clinical study

“…A few patients with idiopathic hydrocephalus also have this situation. However, patients with such hydrocephalus often need to be checked for improved CSF indicators through repeated lumbar punctures, external lumbar cistern drainage, and external lateral ventricle drainage, among other, thus missing the best time for operation, ultimately delaying or even aggravating the condition ( 2 , 13 , 14 ). Rammos et al ( 15 ) reported that the average time for external ventricular drainage before the conversion to internal drainage was 14.1 days, though this could sometime last as long as 45 days.…”

“…Hydrocephalus refers to the imbalance between cerebrospinal fluid (CSF) production and absorption, and/or the obstruction of its pathways, resulting in disturbed CSF dynamics and the abnormal accumulation of excess CSF in either the ventricle or subarachnoid space, which then dilatates these areas ( 1 , 2 ). Hydrocephalus commonly occurs in neurosurgical patients ranging from newborns to adults.…”

“…A ventriculoperitoneal shunt is the most common and effective method for the treatment of hydrocephalus ( 4 – 6 ). Early shunt surgery in patients leads to a better prognosis ( 2 , 7 , 8 ), therefore, early treatment is imperative.…”

The compensatory mechanism and clinical significance of hydrocephalus after cranioplasty

“…Inclusion criteria: x History of DC; y hydrocephalus diagnosed by CT or MRI (15)(16)(17); (Evan's index >0.3, or associated with periventricular interstitial edema; Other causes of ventricular enlargement were excluded. z The presence of hydrocephalusrelated symptoms, such as headache, neurological dysfunction, etc., normal pressure hydrocephalus contains at least one of the following symptoms: gait disorders, cognitive disorders, urinary incontinence (18)(19)(20). { At least 4 weeks after DC.…”

Hydrocephalus Associated with Myelomeningocele

“…Hydrocephalus may be defined as abnormal accumulation of cerebrospinal fluid (CSF) within the ventricles of the brain, leading to ventricular expansion or enlargement and usually associated with raised intracranial pressure [1,2]. Hydrocephalus (HCP) is one of the most common associations of myelomeningocele, and it may be overt and present at birth or be latent and develop following the repair of myelomeningocele.…”