Integrated understanding of hydrocephalus — a practical approach for a complex disease

Abstract

Most of childhood hydrocephalus are originating during infancy. It is considered to be a complex disease since it is developed on the basis of heterogeneous pathophysiological mechanisms and different pathological conditions as well as during different age groups. Hence, it is of relevant importance to have a practical concept in mind, how to categorize hydrocephalus to surgically better approach this disease. The current review should offer further basis of discussion on a disease still most frequently seen in Pediatric Neurosurgery. Current literature on pathophysiology and classification of pediatric hydrocephalus has been reviewed to integrate the different published concepts of hydrocephalus for pediatric neurosurgeons. The current understanding of infant and childhood hydrocephalus pathophysiology is summarized. A simplified concept based on seven factors of CSF dynamics is elaborated and discussed in the context of recent discussions. The seven factors such as pulsatility, CSF production, major CSF pathways, minor CSF pathways, CSF absorption, venous outflow, and respiration may have different relevance and may also overlap for the individual hydrocephalic condition. The surgical options available for pediatric neurosurgeons to approach hydrocephalus must be adapted to the individual condition. The heterogeneity of hydrocephalus causes mostly developing during infancy warrant a simplified overview and understanding for an everyday approach. The proposed guide may be a basis for further discussion and may serve for a more or less simple categorization to better approach hydrocephalus as a pathophysiological complex disease.

Treatment Strategies and Challenges to Avoid Cerebrospinal Fluid Shunting for Pediatric Hydrocephalus

“…Additionally, arachnoid granulation is not present in early infancy, which means that CSF absorption is primarily responsible for the minor pathway. 30 , 31 , 34 ) As mentioned earlier, the effect of ETV is both to restore CSF communication and to reduce transmantle pulsatile stress; hence, early infancy is a period of special circumstances in which neither is achieved.…”

“…The seven factors, including pulsatility, CSF production, major CSF pathways, minor CSF pathways, CSF absorption, venous outflow, and respiration, may have different degrees of relevance and may also overlap for the individual hydrocephalic condition. 31 ) The effect of ETV is to solve the problems related to the CSF major pathways and pulsatility. Specifically, ETV has two main effects, i.e., restoring CSF communication between the ventricle and the subarachnoid space and reducing transmantle pulsatile stress by increasing the compliance of the ventricular wall.…”

“…Specifically, ETV has two main effects, i.e., restoring CSF communication between the ventricle and the subarachnoid space and reducing transmantle pulsatile stress by increasing the compliance of the ventricular wall. 31 , 32 )…”

Neue neurochirurgische Therapieverfahren in der Neonatologie – Möglichkeiten und Voraussetzungen

“…Im Gegensatz zum Hydrozephalus in späteren Lebensabschnitten müssen verschiedene anatomische Besonderheiten berücksichtigt werden. Diese sind die noch nicht geschlossenen Schädelnähte und das rapide Hirnwachstum, welches in dieser Altersgruppe stattfindet und maßgeblich durch eine Liquorzirkulationsstörung mit einer Ventrikelerweiterung beeinträchtigt werden kann [23].…”

Benign Enlargement of Subarachnoid Spaces in Infants

“…Також залишається невідомою відповідь на питання про довгострокову клінічну значущість ДРСП і не зовсім зрозуміло, чи є зміни венозного кровотоку тільки причиною, а може й наслідком субарахноїдального розширення у майбутньому [18,[55][56][57][58][59][60]. Таким чином, питання хронічно підвищеного внутрішньочерепного тиску внаслідок порушення венозного відтоку має бути з'ясовано для немовлят із розширенням субарахноїдальних просторів у майбутніх дослідженнях.…”