The constant flow ventricular infusion test: a simple and useful study in the diagnosis of third ventriculostomy failure

Aquilina, Kristian; Pople, Ian; Sacree, Jenny; Carter, Michael R.; Edwards, Richard J.

doi:10.3171/2011.10.jns1140

Cited by 10 publications

(4 citation statements)

References 58 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Intracranial compliance (C i ) and CSF resistance (R CSF ) describe the ability of the entire intracranial space (including brain, meninges, and outflow routes) to accommodate an increasing CSF volume that would otherwise increase intracranial pressure (ICP). In humans, these parameters are measured by a CSF constant rate infusion test [50][51][52] , and can aid in diagnosis and evaluation of conditions like hydrocephalus, which has decreased C i 2 . ICP and R CSF have been previously measured in rats 53 using a similar test, quantifying ICP based on mmH 2 O in a glass capillary.…”

Section: Resultsmentioning

confidence: 99%

Choroid plexus NKCC1 mediates cerebrospinal fluid clearance during mouse early postnatal development

Fame

Sadegh

et al. 2021

Nat Commun

View full text Add to dashboard Cite

Cerebrospinal fluid (CSF) provides vital support for the brain. Abnormal CSF accumulation, such as hydrocephalus, can negatively affect perinatal neurodevelopment. The mechanisms regulating CSF clearance during the postnatal critical period are unclear. Here, we show that CSF K+, accompanied by water, is cleared through the choroid plexus (ChP) during mouse early postnatal development. We report that, at this developmental stage, the ChP showed increased ATP production and increased expression of ATP-dependent K+ transporters, particularly the Na+, K+, Cl−, and water cotransporter NKCC1. Overexpression of NKCC1 in the ChP resulted in increased CSF K+ clearance, increased cerebral compliance, and reduced circulating CSF in the brain without changes in intracranial pressure in mice. Moreover, ChP-specific NKCC1 overexpression in an obstructive hydrocephalus mouse model resulted in reduced ventriculomegaly. Collectively, our results implicate NKCC1 in regulating CSF K+ clearance through the ChP in the critical period during postnatal neurodevelopment in mice.

show abstract

Section: Resultsmentioning

confidence: 99%

Choroid plexus NKCC1 mediates cerebrospinal fluid clearance during mouse early postnatal development

Fame

Sadegh

et al. 2021

Nat Commun

View full text Add to dashboard Cite

show abstract

“…Intracranial compliance (C i ) and CSF resistance (R CSF ) describe the ability of the entire intracranial space (including brain, meninges, and outflow routes) to accommodate an increasing CSF volume that would otherwise increase intracranial pressure (ICP). In humans, these parameters are measured by a CSF constant rate infusion test (Aquilina et al, 2012, Eide, 2018, Lalou et al, 2018 and can aid in diagnosis and evaluation of conditions like hydrocephalus, which has decreased C i (Kahle et al, 2016). We developed a miniaturized version of this test to determine the C i and R CSF in mice.…”

Section: Chp Nkcc1 Actively Mediates Csf Clearance During the Early Pmentioning

confidence: 99%

Non-canonical, potassium-driven cerebrospinal fluid clearance

Fame

Sadegh

et al. 2020

Preprint

View full text Add to dashboard Cite

Cerebrospinal fluid (CSF) provides vital support for the brain. Abnormal CSF accumulation is deleterious for perinatal neurodevelopment, but how CSF leaves the brain during this critical period is unknown. We found in mice a postnatal neurodevelopmental transition phase featuring precipitous CSF K+ clearance, accompanied by water, through the choroid plexus (ChP). The period corresponds to a human fetal stage when canonical CSF clearance pathways have yet to form and congenital hydrocephalus begins to manifest. Unbiased ChP metabolic and ribosomal profiling highlighted this transition phase with increased ATP yield and activated energy-dependent K+ transporters, in particular the Na+-K+-Cl- and water cotransporter NKCC1. ChP-targeted NKCC1 overexpression enhanced K+-driven CSF clearance and enabled more permissive cerebral hydrodynamics. Moreover, ventriculomegaly in an obstructive hydrocephalus model was improved by ChP-targeted NKCC1 overexpression. Collectively, we identified K+-driven CSF clearance through ChP during a transient but critical neurodevelopmental phase, with translational value for pathologic conditions.

show abstract

“…Most patients with outflow resistance (Rout) of the CSF system < 13 mm Hg/mL/minute experienced resolution of symptoms; Rout > 13 mm Hg/ mL/minute was associated with ETV failure at further follow-up. 60 Patients who undergo ETV for infective hydrocephalus and Dandy-Walker malformation should receive long-term follow-up because late closure of the stoma may occur progressively and slowly. Intraoperative observation of thickened arachnoid membranes at interpeduncular cisterns at the first ETV and a progressive decrease of CSF flow through the stoma on routine cine MR imaging should be considered unfavorable elements entailing a significant risk of deterioration.…”

Section: Postoperative Carementioning

confidence: 99%

Avoiding Complications in Endoscopic Third Ventriculostomy

Yadav

Parihar

Ratre

et al. 2015

J Neurol Surg A Cent Eur Neurosurg

View full text Add to dashboard Cite

Endoscopic neurosurgical techniques hold the potential for reducing morbidity. But they are also associated with limitations such as the initial learning curve, proximal blind spot, visual obscurity, difficulty in controlling bleeding, disorientation, and loss of stereoscopic image. Although some of the surgical techniques in neuroendoscopy and microsurgery are similar, endoscopy requires additional skills. A thorough understanding of endoscopic techniques and their limitations is required to get maximal benefit. Knowledge of possible complications and techniques to avoid such complications can improve results in endoscopic third ventriculostomy (ETV). The surgeon must be able to manage complications and have a second strategy such as a cerebrospinal fluid shunt if ETV fails. It is better to abandon the procedure if there is disorientation or a higher risk of complications such as bleeding or a thick and opaque floor without any clear visualization of anatomy. Attending live workshops, practice on models and simulators, simpler case selection in the initial learning curve, and hands-on cadaveric workshops can reduce complications. Proper case selection, good surgical technique, and better postoperative care are essential for a good outcome in ETV. Although it is difficult to make a preoperative diagnosis of complex hydrocephalus (combination of communicating and obstructive), improving methods to detect the exact type of hydrocephalus before surgery could increase the success rate of ETV and avoid an unnecessary ETV procedure in such cases.

show abstract

The constant flow ventricular infusion test: a simple and useful study in the diagnosis of third ventriculostomy failure

Abstract: The VIT is a useful and safe adjunct to clinical and MR imaging evaluation when ETV failure is suspected.

Cited by 10 publications

References 58 publications

Choroid plexus NKCC1 mediates cerebrospinal fluid clearance during mouse early postnatal development

Choroid plexus NKCC1 mediates cerebrospinal fluid clearance during mouse early postnatal development

Non-canonical, potassium-driven cerebrospinal fluid clearance

Avoiding Complications in Endoscopic Third Ventriculostomy

Contact Info

Product

Resources

About