• Journal of Korean Neurosurgical Society
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• v.29 no.5
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• pp.609-614
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• 2000

Objective : A retrograde clinical study was undertaken to determine the effect of opening lamina terminalis on the development of hydrocephalus after aneurysmal subarachnoid hemorrhage(SAH). We compared the incidence ratios of the development of hydrocephalus with and without opening lamina terminalis during operation after aneurysmal SAH. Patients and Methods : From Oct. 1996 to Sep. 1998, we performed 138 aneurysm surgery for 122 patients. In 98 cases, the lamina terminalis was opened to make direct cerebrospinal fluid flow from the third ventricle to subarachnoid space for prevention of delayed hydrocephalus. We compared the incidence of hydrocephalus after opening lamina terminalis to those without opened lamina terminalis. Results : In 95 cases, the hydrocephalus was noticed in 2 cases(2.2%). It is significantly lower in the group with opening lamina terminalis than the group without opening lamina terminalis(about 10%). Conclusion : It is simple and easy procedure to open the lamina terminalis during aneurysm surgery. With this maneuver, we could reduce the incidence of hydrocephalus after aneurysmal spontaneous SAH. Thus, it is considered that the opening lamina terminalis is one of the effective methods for preventing the development of hydrocephalus after aneurysmal spontaneous SAH.

• Journal of Korean Neurosurgical Society
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• v.47 no.6
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• pp.415-419
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• 2010

Objective : It is usually difficult to perform the neuroendoscopic procedure in patients without hydrocephalus due to difficulties with ventricular cannulation. The purpose of this study was to find out the value of navigation guided neuroendoscopic biopsy in patients with peri- or intraventricular tumors without hydrocephalus. Methods : Six patients with brain tumors without hydrocephalus underwent navigation-guided neuroendoscopic biopsy. The procedure was indicated for verification of the histological diagnosis of the neoplasm, which was planned to be treated by chemotherapy and/or radiotherapy as the first line treatment, or establishment of the pathological diagnosis for further choice of the most appropriate treatment strategy. Results : Under the guidance of navigation, targeted lesion was successfully approached in all patients. Navigational tracking was especially helpful in entering small ventricles and in approaching the third ventricle through narrow foramen Monro. The histopathologic diagnosis was established in all of 6 patients : 2 germinomas, 2 astrocytomas, 1 dysembryoplastic neuroepithelial tumor and 1 pineocytoma. The tumor biopsy sites were pineal gland (n = 2), suprasellar area (n = 2), subcallosal area (n = 1) and thalamus (n = 1). There were no operative complications related to the endoscopic procedure. Conclusion : Endoscopic biopsy or resection of peri- or intraventricular tumors in patients without hydrocephalus is feasible. Image-guided neuroendoscopic procedure improved the accuracy of the endoscopic approach and minimized brain trauma. The absence of ventriculomegaly in patients with brain tumor may not be served as a contraindication to endoscopic tumor biopsy.

• Journal of Korean Neurosurgical Society
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• v.30 no.sup1
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• pp.99-107
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• 2001

Objective : Hydrocephalus and vasospasm are the common complications following subarachnoid hemorrhage (SAH). In spite of development of perioperative management and operative technique, hydrocephalus cause neurological deficit and poor prognosis. Usually CSF drainage procedure(external ventricular drainage(EVD) or shunt) is needed in hydrocephalus following SAH. The aim of this study was to investigate whether the need for shunting and the outcome after shunting in hydrocephaus following SAH can be related to the duration, daily and total amount of cerebrospinal fluid(CSF) drainage at EVD. Material and Method : IVH is one of several factors which cause hydrocephalus. In this retrospective study, firstly we investigated the incidence of IVH in total cases and frequency of IVH according to aneurysmal site and then prognosis of IVH following SAH. Among 629 patients with SAH, hydrocephalus was diagnosed by CT scan and symptoms. And then those 102 hydrocephalus following SAH were divided into two groups which were hydrocephalus with IVH group and without IVH group. In these two groups, we investigated and compared the incidence of hydrocephalus in all case, frequency of hydrocephalus according to aneurysmal site, the outcome according to H-H grade on admission and the need rate of shunt, etc. Of those hydrocephalus, 100 EVD procedures were done. The duration, daily and total amount of CSF drainage at EVD were investigated. Fifty cases expired during EVD was excluded. We analyzed whether the need rate of shunt and the final outcome after shunting can be related to IVH, the duration and daily and total amount of CSF drainage. Result : The incidence of hydrocephalus following SAH was 20%(with IVH group ; 64%, without IVH group ; 11%). As H-H grade on admission was better, the outcome of hydrocephalus was also better. The mortality rate of hydrocephalus with IVH was 64% which was higher than 40% that of hydrocephalus without IVH. The need rate of shunt in all cases of hydrocephalus following SAH was 20%, but those with IVH group excluding expired patients before shunt was 40%. This was very similar to 41% of the need rate of shunt in hydrocephalus without IVH. The total amount of CSF drainage was statistically related to the need rate of shunt(total amount : need rate of shunt/<1000cc : 15%, 1000-2000cc : 40%, >2000cc : 50%). The duration and daily amount of CSF drainage were not statistically related to the need rate of shunt, but as daily amount of CSF drainage was more and duration was longer, the need rate of shunt was increased(daily amount : need rate of shunt /<100cc : 16%, 100-200cc : 25%, >200cc : 40%//duration : need rate of shunt/<1week : 8%, 1-2weeks : 30%, >2weeks : 47%), and also the final outcome after shunting was poor. Especially the total amount of CSF drainage was significant related to the final outcome after shunting(total amount : GOS/<1000cc : I&II(3/4), 1000-2000cc : II(2/4), III(2/4), >2000cc : III&IV(6/7)). Conclusion : This study revealed that the incidence and mortality rate of hydrocephalus following SAH were influenced by IVH. So SAH associated IVH has the higher incidence of hydrocephalus and poor outcome. As the CSF drainage amount was more and duration of drainage was longer, the need rate of shunt was increased and the final outcome after shunting was poor. Especially the total amount of CSF drainage were strongly related to the need rate of shunt and the outcome after shunting.

• Journal of Korean Neurosurgical Society
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• v.47 no.3
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• pp.191-198
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• 2010

Objective : This study is planned to determine the neurocognitive difficulties of hydrocephalic adults. Methods : The research group contained healthy adults (control group, n : 15), and hydrocephalic adults (n : 15). Hydrocephalic group consisted of patients with idiopathic aquaduct stenosis and post-meningitis hydrocephalus. All patients were followed with shunted hydrocephalus and not gone to shunt revision during last two years. They were chosen from either asymptomatic or had only minor symptoms without motor and sensorineural deficit. A neuropsychological test battery (Raven Standart Progressive Matrices, Bender-Gestalt Test, Cancellation Test, Clock Drawing Test, Facial Recognition Test, Line Orientation Test, Serial Digit Learning Test, Stroop Color Word Interference Test-TBAG Form, Verbal Fluency Test, Verbal Fluency Test, Visual-Aural Digit Span Test-B) was applied to all groups. Results : Neuropsychological assessment of hydrocephalic patients demonstrated that they had poor performance on visual, semantic and working memory, visuoconstructive and frontal functions, reading, attention, motor coordination and executive function of parietal lobe which related with complex and perseverative behaviour. Eventually, these patients had significant impairment on the neurocognitive functions of their frontal, parietal and temporal lobes. On the other hand, the statistical analyses performed on demographic data showed that the aetiology of the hydrocephalus, age, sex and localization of the shunt (frontal or posterior parietal) did not affect the test results. Conclusion : This prospective study showed that adult patients with hydrocephalus have serious neuropsychological problems which might be directly caused by the hydrocephalus; and these problems may cause serious adaptive difficulties in their social, cultural, behavioral and academic life.

• Journal of Korean Neurosurgical Society
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• v.30 no.1
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• pp.60-65
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• 2001

Objective : The popular grading systems in use, such as Hunt-Hess grade and Fisher scale score, are based primarily on the patient's clinical conditions or computerized tomography score after aneurysmal subarachnoid hemorrhage(SAH). The author investigated whether the need for ventriculoperitoneal(VP) shunt for chronic hydrocephalus and outcome can be predicted by Hunt-Hess grade and Fisher scale. Methods : A series of 146 patients admitted to our hospital from August 1991 to July 1999, who presented with SAH and underwent craniotomy for aneurysm clipping were studied retrospectively. Chronic hydrocephalus was defined as clinically and radiographically demonstrated hydrocephalus that lasted 2 weeks or longer after initial hemorrhage which required shunting. Patients were evaluated based on following factors : Hunt-Hess grade, Fisher scale, age, sex, hypertension, aneurysm location, and intervals from aneurysm rupture to operation. Results : The overall mortality rate of the study group was 8.2%. Hunt-Hess grade(p=0.001) or Fisher scale (p=0.001) at all pretreatment times was significantly correlated with outcome. In addition, there was an increased risk of poor outcome in older age(65<). However, there were statistically no significant relationship between outcome and sex, location of aneurysm, hypertension, and interval from aneurysmal rupture to operation(p>0.05). Of 134 surviving patients, 16 patients(12%) underwent VP shunt placement secondary to chronic hydrocephalus. Hunt-Hess grade(p=0.001) is more predictive of chronic hydrocephalus than Fisher scale(p=0.146). Aneurysm location was significantly correlated with development of chronic hydrocephalus (p<0.05), without significant correlations in sex, age, hypertension. IVH, and ICH. Conclusion : This study suggests that there is a high clinical correlation between outcome and Hunt-Hess grades and Fisher scales on admission, but Hunt-Hess grade is more predictive for chronic hydrocephalus than Fisher scale. In addition, age(<65 yrs) is the significant factor for prediction of outcome. There was a trend of increasing risk for chronic hydrocephalus according to aneurymal location.

• Journal of Korean Neurosurgical Society
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• v.66 no.3
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• pp.281-288
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• 2023

While the standard management for posthemorrhagic hydrocephalus (PHH) has not been determined, many patients initially receive temporary treatment such as a ventricular drainage, a ventricular reservoir, or a ventriculosubgaleal shunt. Subsequently, approximately 15% of patients with PHH will require permanent cerebrospinal fluid diversion. Shunt placement is most commonly performed for PHH as permanent treatment. However, shunting still has high complication rates. Since the development of the neuroendoscopic technique has progressed, and indication has been expanded, endoscopic third ventriculostomy with or without choroid plexus cauterization has performed more frequently in recent years in patients with PHH. In this paper, the permanent treatment for PHH will be reviewed based on the latest evidence.

• Journal of Korean Neurosurgical Society
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• v.57 no.1
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• pp.68-71
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• 2015

We report a case of non communicating hydrocephalus due to membranous obstruction of Magendie's foramen. A 37-year-old woman presented with intracranial hypertension symptoms caused by the occlusion of Magendie's foramen by a membrane probably due to arachnoiditis. As far as the patient's past medical history is concerned, an Epstein-Barr virus infectious mononucleosis was described. Fundoscopic examination revealed bilateral papilledema. Brain magnetic resonance imaging demonstrated a significant ventricular dilatation of all ventricles and turbulent flow of cerebelospinal fluid (CSF) in the fourth ventricle as well as back flow of CSF through the Monro's foramen to the lateral ventricles. The patient underwent a suboccipital craniotomy with C1 laminectomy. An occlusion of Magendie's foramen by a thickened membrane was recognized and it was incised and removed. We confirm the existence of hydrocephalus caused by fourth ventricle outflow obstruction by a membrane. The nature of this rare entity is difficult to demonstrate because of the complex morphology of the fourth ventricle. Treatment with surgical exploration and incision of the thickened membrane proved to be a reliable method of treatment without the necessity of endoscopic third ventriculostomy or catheter placement.

• The Korean Journal of Nuclear Medicine
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• v.34 no.4
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• pp.366-369
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• 2000

We report a case of a patient with cystic subdural hygroma who underwent pre-operative Tc-99m DTPA cistrenoscintigraphy to determine the course of operation. A 68-year-old female was admitted to the department of neurosurgery because of acute subarachnoid hemorrhage. After emergency ventricular drainage, the hydrocephalus and cystic subdural hygroma in the right fronto-temporal area developed. She underwent Tc-99m DTPA cisternoscintigraphy to evaluate the type of hydrocephalus, which revealed obstructive communicating hydrocephalus and the communication between the subdural hygroma and the subarachnoid space. As a result of these findings, she underwent the ventriculo-peritoneal shunt operation without removal of the subdural hygroma. Post-operative brain CT showed nearly normalized shape and size of the right ventricle and disappearance of subdural hygroma. We recommend the pre-operative cisternoscintigraphy in patients with complex hygroma to evaluate the communication between subdural hygroma and the subarachnoid space.

• Journal of Veterinary Clinics
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• v.40 no.1
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• pp.56-61
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• 2023

A 5-month-old female domestic short-haired cat presented with a history of seizure episodes for two months following an animal bite injury to the head. There were no remarkable findings on physical and neurological examination or blood analysis. Computed tomography revealed a fracture of the left parietal bone with an inward displacement of the bone fragment while magnetic resonance imaging revealed an enlarged temporal horn of the left lateral ventricle and a pseudomeningocele compressing the adjacent cerebral parenchyma. Subsequently, cerebrospinal fluid analysis results were normal. The patient was diagnosed with traumatic brain injury (TBI), with subsequent post-traumatic hydrocephalus (PTH) and pseudomeningocele. Despite treatment with phenobarbital and levetiracetam, seizures were not sufficiently controlled. Craniectomy for bone fragment removal and duraplasty were performed after a week. The patient then returned to normal condition with no further seizure activity. On repeated MRI two months after discharge, the hydrocephalus of the lateral ventricle and pseudomeningocele were enlarged; however, the patient maintained a good clinical status without any neurological signs. To the best of our knowledge, PTH and intracranial pseudomeningoceles have not yet been reported in cats. PTH and pseudomeningocele are among the complications of TBI and may not have any significant relevance with the clinical signs in this case. Thus, to broaden our knowledge about PTH and pseudomeningocele in cats, we describe serial changes in the clinical findings of this cat over the treatment period.

• Journal of Korean Neurosurgical Society
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• v.30 no.5
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• pp.575-580
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• 2001

Purpose : In general, pineal region tumors are managed by using microsurgical approach or stereoctactic biopsy. However, in selected cases endoscopic approach to pineal lesions might prove to be as effective as microsurgery and less invasive. We report an alternative surgical strategy for managing certain patients with pineal neoplasms that allows treatment of the symptomatic hydrocephalus as well as tumor biopsy under direct vision in the same sitting. Materials and Methods : Twenty-two patients with pineal region tumors with associated hydrocephalus were treated in one session by endoscopic third ventriculostomy and endoscopic tumor biopsy at our institution from October 1996 to January 2000. All patients were retrospectively evaluated. Results : There was no operative mortality. There was one cause of significant bleeding during biopsy, but was controlled endoscopically, and the patient recovered completely without neurologic deficit resulting from intra-operative bleeding. The symptoms related to increased intracranial pressure(ICP) have resolved in all patients, and the need for a shunt is completely eliminated. Histological diagnosis was achieved in 21 of the 22 patients by this procedure. A biopsy was not obtained in one patient. Although this pineal region tumor was seen endoscopically, this could not be biopsied because of technical difficulties in working around an enlarged massa intermedia. The lesions included fourteen germinomas, three mixed germ cell tumors, and one each of the followings: pineocytoma, pineoblastoma, pineocytoma/pineoblastoma(intermediate type), meningioma, and low grade glioma. Five of the 22 patients subsequently underwent formal microsurgical tumor removal. Additional chemotherapy or radiotherapy could then be initiated according to the histological diagnosis. Conclusion : We consider that endoscopy affords a minimally invasive way of reaching three objectives by one-step surgery in the management of pineal region tumors with associated hydrocephalus : 1) cerebrospinal fluid(CSF) sample for analysis of tumour markers and cytology, 2) treatment of hydrocephalus by third ventriculostomy, and 3) several biopsy specimens can be obtained identifying tumors which will require further open surgery or adjuvant radiation and/or chemotherapy. However, complications and morbidities should be emphasized so as to be avoided with further technical experience.