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  1. Home
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  3. Adult Hydrocephalus
  • Cited by 10
Publisher:
Cambridge University Press
Online publication date:
February 2014
Print publication year:
2014
Online ISBN:
9781139382816
DOI:
https://doi.org/10.1017/CBO9781139382816
Subjects:
Neurology and Clinical Neuroscience, Medicine, Surgery
Information

Book description

Adult hydrocephalus is an insidious yet treatable condition that develops slowly, with usual onset around 60 years of age. It is poorly recognized and many cases are not diagnosed until late in the course of disease, leading to poorer patient outcomes and a high financial cost to healthcare providers. The resulting neurological symptoms include gait/balance problems, loss of bladder control, and a cognitive decline leading to dementia, which is often mistaken for Alzheimer's disease. This book - the first published on this topic since 1993 - provides comprehensive guidelines to improve the speed and accuracy of diagnosis, and covers various neurosurgical techniques used to treat the disease, including the insertion of different types of shunts and endoscopic third ventriculostomy. This is essential reading for neurologists, neurosurgeons, family physicians, and radiologists who may well encounter adult patients with hydrocephalus more often than they realize.

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Contents

Page 2 of 2

Contents
  • 19 - Endoscopic third ventriculostomy
    pp 218-231
  • Indications, technique, outcome, and complications
  • View abstract

    Summary

    Various imaging modalities are useful in confirming the diagnosis, determining the etiology of adult hydrocephalus, providing intraoperative guidance, and improving the follow-up of patients who have undergone treatment including cerebrospinal fluid (CSF) shunting or endoscopic third ventriculostomy (ETV). These include: conventional X-rays, ultrasonography, computerized axial tomography (CT), magnetic resonance imaging (MRI), and radionuclide shunt patency (SP) imaging. CT scans are performed to obtain a baseline image postoperatively to demonstrate the location of the proximal catheter in the ventricular system, the baseline size of the ventricles, and any postoperative intraventricular hemorrhage. CTs are helpful in diagnosing shunt malfunctions in younger patients. MRI provides excellent multiplanar anatomic definition of the ventricular system, subarachnoid spaces, and brain parenchyma. The SP study is a valuable tool in the diagnosis of shunt malfunction particularly in the idiopathic normal pressure hydrocephalus (iNPH) patient population.
  • 20 - Outcome of idiopathic normal pressure hydrocephalus
    pp 232-246
  • View abstract

    Summary

    Phase-contrast magnetic resonance imaging (PC-MRI) was at first mainly used for vascular flow quantization and many software packages were developed by MR vendors to measure blood flows in vessels. Cerebrospinal fluid (CSF) and blood flow values were calculated using the PC-MRI post-processing software. Available processing software, using automatic segmentation, makes it possible to quickly obtain a reproducible time evolution curve during the cardiac cycle. After background correction using a manually drawn area, flow parameters such as CSF stroke volume are directly calculated. PC-MRI is a valuable tool to investigate and quantify these CSF and blood flow interactions throughout the cardiac cycle. The most commonly encountered CSF disorders observed using radiological images are hydrocephalus in the brain and syringomyelia in the spine. This chapter shows how PC-MRI of CSF can help clinicians to diagnose and understand these disorders as well as how it can help neurosurgeons to guide treatment.
  • Section 5 - Associated conditions
    pp 247-303
  • View abstract

    Summary

    This chapter describes the cerebrospinal fluid (CSF) dynamics and how fluid inside the central nervous system (CNS) is generated, stored, and absorbed within the context of a mathematical model developed by A. Marmarou. It explains the main Lumbar infusion techniques in theory and their practical applications by various clinics. Clinical prognostic applications of infusion methods can be classified into two groups: transient and steady-state. External lumbar drainage (ELD) is a prognostic tool for which the accuracy of prediction rate can be more than 90%. The test is based on the idea of simulating the shunt operation in real life by withdrawing CSF for relatively long time durations at drainage rates roughly comparable to regular shunt drainage. ELD yields the most accurate prognostic indications since it simulates the shunt for an extended time duration, which also helps to exclude some placebo effects.
  • 22 - Low-pressure syndromes and cerebrospinal fluid leaks
    pp 256-263
  • Diagnosis and management
  • View abstract

    Summary

    The current range of clinical applications for cerebrospinal fluid (CSF) dynamics testing includes hydrocephalus, idiopathic intracranial hypertension, craniosynostosis, and traumatic brain injury. CSF dynamics depends on interaction between four components: CSF production, flow, absorption, and pulsations. The mathematical model of CSF pressure-volume compensation provides a theoretical basis for the differential diagnosis in hydrocephalus. Components of this model are identified in many clinical scenarios and are in use in clinical diagnostic procedures. In all pressure-volume testing techniques, parameters of model are estimated using various algorithms and various volume-adding techniques. Pulse amplitude of intracranial pressure (ICP) is synchronized with pulse amplitude of arterial pressure and the pulse amplitude of blood flow velocity in the middle cerebral artery. Pulse amplitude increases proportionally to mean CSF pressure during the infusion study. The resistance to CSF outflow demonstrates significant associations with cerebrovascular reactivity: patients with lower Rout tend to have more frequently disturbed cerebrovascular reactivity.
  • 23 - Management of the adult with congenital hydrocephalus
    pp 264-274
  • View abstract

    Summary

    This chapter attempts to develop biomarkers specific for idiopathic normal pressure hydrocephalus (iNPH) to distinguish it from other neurodegenerative conditions. The case for emerging biomarkers in iNPH has arisen because of similar developments in other common causes of dementia and the increasing awareness of both the epidemiology of NPH and its impact on the quality of life of elderly patients. Changes in the neurochemical composition of cerebrospinal fluid (CSF) due to hydrocephalus have been widely documented. The problem with identifying diagnostic biomarkers between NPH and Alzheimer's disease (AD) is that NPH was used in those studies more as a comparative control group rather than as the primary studied group, apart from a few exceptions. The difficulty in the differential diagnosis of PD with patients with NPH lies in the features of the gait disorder. There have been much fewer studies developing prognosis biomarkers when compared with those assessing diagnostic biomarkers.
  • 24 - Management of hydrocephalus with associated cerebrospinal fluid pathologies
    pp 275-290
  • View abstract

    Summary

    This chapter describes many of the techniques and protocols that can be used to minimize the risk of shunt failure, focusing on the surgical procedure at each anatomic location for proximal and distal catheter placement. It includes the extended discussions of ventricular and lumbar proximal catheters, and peritoneal, atrial, pleural, and other distal catheters. Valves can be divided into four different categories: differential pressure valves, flow-regulated valves, antisiphon valves, and adjustable valves. Antisiphon valves are used to prevent the siphoning of cerebrospinal fluid (CSF) into the distal compartment. Antisiphon devices (ASDs) are primarily used in management of normal pressure hydrocephalus (NPH) patients in the adult population to prevent the formation of subdural hematomas and hygromas, and in the management of hydrocephalus in the pediatric population to prevent the slit ventricle syndrome and proximal catheter obstruction.
  • 26 - Pseudotumor cerebri syndrome
    pp 296-303
  • View abstract

    Summary

    Hydrocephalus is caused by different etiological factors, but the common final pathway creates a vicious circle of altered cerebrospinal fluid (CSF) circulation, cerebral blood flow, and metabolism that affects brain homeostasis. In communicating hydrocephalus, draining of CSF appears to be the simplest way of interrupting this circle by improving the CSF circulation. The mathematical model of CSF pressure volume compensation provides a theoretical basis for the differential diagnosis of hydrocephalus. Eighteen nonprogrammable and eight programmable valves reveal the common hydrodynamic properties of contemporary shunts. Any repetitive variations of proximal pressure have a tendency to decrease the nominal operating pressure of shunts with unidirectional valves. Shunt operating pressure is the value of intracranial pressure (ICP) that should be fixed when the opened shunt is draining CSF with the rate equal to that of its production. It is slightly higher than shunt opening pressure.
  • Epilogue
    pp 304-304
  • View abstract

    Summary

    This chapter reviews the types of shunt complications, their likelihood, and some clinical examples. Cerebrospinal fluid (CSF) shunting and particularly ventriculoperitoneal shunting is a common procedure used to treat a variety of CSF flow dynamic pathologies including obstructive, communicating, and normal pressure hydrocephalus (NPH) from a variety of etiologies. There are several types of specific long-term complications associated with shunting procedures in addition to those more likely seen in the NPH population in particular. These include underdrainage of CSF, overdrainage of CSF, mechanical failures of the hardware such as alterations in valve resistance over time, malposition of the tubing, and frank breakage, CSF leak, subdural hemorrhage or hygroma, seizure, and infection. Underdrainage conditions arise when shunt systems develop increased resistance across the valve over time, disconnection or kinking of the system components, or migration of the tubing out of an appropriate position for proper drainage and/or reabsorption.

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