Nonsurgical therapy for hydrocephalus: a comprehensive and critical review

Abstract

Pharmacological interventions have been tested experimentally and clinically to prevent hydrocephalus and avoid the need for shunting beginning in the 1950s. Clinical trials of varied quality have not demonstrated lasting and convincing protective effects through manipulation of cerebrospinal fluid production, diuresis, blood clot fibrinolysis, or manipulation of fibrosis in the subarachnoid compartment, although there remains some promise in the latter areas. Acetazolamide bolus seems to be useful for predicting shunt response in adults with hydrocephalus. Neuroprotection in the situation of established hydrocephalus has been tested experimentally beginning more recently. Therapies designed to modify blood flow or pulsation, reduce inflammation, reduce oxidative damage, or protect neurons are so far of limited success; more experimental work is needed in these areas. As has been recommended for preclinical studies in stroke and brain trauma, stringent conditions should be met for preclinical studies in hydrocephalus.Electronic supplementary materialThe online version of this article (doi:10.1186/s12987-016-0025-2) contains supplementary material, which is available to authorized users.

Congenital aqueduct stenosis: Progressive brain findings in utero to birth in the presence of severe hydrocephalus

“…The destructive impact of hydrocephalus on the brain is well‐recognized microscopically. Pathologic changes include loss of the ependymal lining and germinal matrix with destruction and gliotic changes of periventricular axons and secondary neuronal loss . In the presence of hydrocephalus, we noted progressive loss of the septum pellucidum leaflets in 47% of our cases, which persisted on delayed imaging.…”

“…Pathologic changes include loss of the ependymal lining and germinal matrix with destruction and gliotic changes of periventricular axons and secondary neuronal loss. 14,15 In the presence of hydrocephalus, we noted progressive loss of the septum pellucidum leaflets in 47% of our cases, which persisted on delayed imaging. In the areas of ventricular rupture, the cerebral parenchyma was not detectable.…”

Thrombin disrupts vascular endothelial‐cadherin and leads to hydrocephalus via protease‐activated receptors‐1 pathway

“…Hydrocephalus is an independent predictor of poor outcome for intraventricular hemorrhage (IVH), which occurs in nearly half of patients of spontaneous intracerebral hemorrhage (ICH) However, neither the mechanisms of IVH‐induced hydrocephalus nor efficacy treatments have been suggested . Heparinized blood injection resulted in less hydrocephalus compared with the whole blood injection, indicating that coagulation cascade played a critical role in the IVH‐induced hydrocephalus .…”

New Concepts of Cerebrospinal Fluid Physiology and Development of Hydrocephalus

“…During the period of CSF drainage, an intensive nonsurgical therapy for hydrocephalus is recommended [45,67] . That way, enough time could be gained to cure inflammation, remediate the consequences of bleeding into the CSF, improve brain parenchyma blood perfusion, restore CSF isoosmolarity, and resolve other possible pathophysiological causes of hydrocephalus before the decision of permanent shunting.…”