• Journal of Korean Neurosurgical Society
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• v.51 no.6
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• pp.328-333
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• 2012

Objective : The aim of this study is to determine the association between the cerebrospinal fluid (CSF) biomarkers and inflammation, and the predictive value of these CSF biomarkers for subsequent shunt associated infection. Methods : We obtained CSF samples from the patients with hydrocephalus during ventriculoperitoneal (VP) shunt operations. Twenty-two patients were enrolled for this study and divided into 3 groups: subarachnoid hemorrhage (SAH)-induced hydrocephalus, idiopathic normal pressure hydrocephalus (INPH) and hydrocephalus with a subsequent shunt infection. We analyzed the transforming growth factor-${\beta}1$, tumor necrosis factor-${\alpha}$, vascular endothelial growth factor (VEGF) and total tau in the CSF by performing enzyme-linked immunosorbent assay. The subsequent development of shunt infection was confirmed by the clinical presentations, the CSF parameters and CSF culture from the shunt devices. Results : The mean VEGF concentration (${\pm}$standard deviation) in the CSF of the SAH-induced hydrocephalus, INPH and shunt infection groups was $236{\pm}138$, $237{\pm}80$ and $627{\pm}391$ pg/mL, respectively. There was a significant difference among the three groups (p=0.01). Between the SAH-induced hydrocephalus and infection groups and between the INPH and infection groups, there was a significant difference of the VEGF levels (p<0.01). However, the other marker levels did not differ among them. Conclusion : The present study showed that only the CSF VEGF levels are associated with the subsequent development of shunt infection. Our results suggest that increased CSF VEGF could provide a good condition for bacteria that are introduced at the time of surgery to grow in the brain, rather than reflecting a sequel of bacterial infection before VP shunt.

• Journal of Life Science
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• v.15 no.4 s.71
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• pp.664-667
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• 2005

Hydrosyringomyelia is a dilation of the spinal cord central canal. In human it may be caused by congenital malformations such as Dandy-Walker syndrome and Chiari malformations or may be acquired as a result of infection, trauma or neoplasia. Hydrocephalus is an excessive accumulation of cerebrospinal fluid within the ventricles and occipital dysplasia is the dorsal extension of the foramen magnum. Hydrosyringomyelia and hydrocephalus can be confirmed by computed tomography or magnetic resonance imaging (MRI). A 3-year-old male maltese was presented with a history of long-term seizure. Blood examination was all unremarkable. On rostrodorsal-caudoventral oblique radiograph of the skull showed severe occipital dysplasia. On brain sonography through the persistent fontanelle, severe lateral ventriculomegaly was revealed. MRI examination revealed hydrocephalus and hydrosyringomyelia. Diuretic therapy didn't reduce clinical symptoms and surgical decompression was conducted. The dog responded well with ventriculo-peritoneal shunting. MRI is the most superior modality to diagnose hydrocephalus and hydrosyringomyelia, to plan therapy and to determine the prognosis.

• The Journal of the Korean life insurance medical association
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• v.2 no.1
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• pp.245-252
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• 1985

Ultrasonographic examination in the obstetrics not only makes easy of the diagnosis of Hydrocephalus, placenta previa, anencephalus and ectopic pregnancy, etc, but also guaranteed its excellence in the diagnosis of women gynecology disease. Especially in case that it doesn't affect radiation hazard on the embryo, its efficiency keeps increasing and it is spotlighted to many clinic doctors. Even though in general hospital we often observe congenital hydrocephalus in Med. Dept. which entirly undergoes the medical examination to the insured, we don't observe even the women delivered with child and it is very difficult to find a rare congenital hydrocephlus throughout other present insurance companies. We inspected a congenital hydrocephalus, which other medical equipments of present insurance companies have many difficulties in the medical examination, accompanied by meningoencephalocele by ultrasonic diagnosis. We analyzed and compared the data by ultrasonic diagnosis with that of surgical diagnosis and the results are follows; 1) We could correctly describe meningoencephalocele by ultrasonic diagnosis. 2) It was able to be diagnosed in LMP 22 weeks. 3) BPD has about 10 mm higher than normal value in LMP 22 weeks. 4) Dilatation of lateral ventricle was observed in LMP 22 weeks. 5) As paralled with ultrasonic diagnosis in pregnancy medical examination, accepting declines including the risk rate can be restrained.

• 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.

• Journal of Korean Neurosurgical Society
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• v.29 no.3
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• pp.434-437
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• 2000

Unilateral hydrocephalus is an uncommon disease which may result from obstruction of the foramen of Monro. Congenital or acquired lesions obstructing this foramen have been reported. We present a case of prenatally diagnosed fetal unilateral hydrocephalus. Ventriculoperitoneal shunt operation was performed and following the procedure, ventricular size was decreased and patients neurological status was improved.

• Journal of Korean Neurosurgical Society
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• v.30 no.6
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• pp.729-733
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• 2001

Objective : Antifibrinolytic treatment after aneurysmal subarachnoid hemorrhage has been shown to have no significant effect on outcome since a reduction in the rate of rebleeding was offset by an increase in the incidence of hydrocephalus and ischemic events. As the results of early aneurysm surgery and a change of strategy in the intensive medical treatment, outcome in patients with cerebral ischemia has been improved. On the other hand, rebleeding still remains as a major cause of death. A short course of tranexamic acid(TA) was tried to study its efficacy and safety in reducing the incidence of rebleeding before aneurysm surgery. Methods : A total of 507 patients with ruptured cerebral aneurysm operated within 3 days after the attack from 1990 to 1999 were included in this study. Group A consisted of 302 consecutive patients treated from 1990 through 1995 served as control. Two hundred-five patients in group B were treated with TA from 1996 through 1999. Both groups were evaluated for comparability of demographic and clinical variables including age, Hunt-Hess grade, Fisher grade, aneurysm location, hypertension, day of surgery, and initial hydrocephalus. The relationships of TA with rebleeding, ischemia, and chronic hydrocephalus were also studied. Results : There was no significant difference in patient demographics and clinical characteristics between group A and group B. Sixteen patients(5.3%) suffered a recurrent hemorrhage in group A and three(1.5%) in group B(p<0.05). Chronic hydrocephalus requiring a shunt was found in a significantly greater proportion in group B than in group A(p<0.05). The incidence of cerebral ischemia was not elevated in group B compared with group A. Conclusion : Considering the fact that the reduction of fatal rebleeding outweighed the increased incidence of hydrocephalus, the authors believe that a short course of TA is beneficial in diminishing the risk of rebleeding prior to early surgical intervention.

• Journal of Korean Neurosurgical Society
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• v.39 no.1
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• pp.20-25
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• 2006

Objective : The authors analyze prospectively the result of transcranial doppler[TCD] in normal pressure hydrocephalus and compared its cerebral blood flow parameters to radionuclide cerebrospinal fluid[CSF] flow study, postoperative brain computed tomography[CT] findings and clinical outcome, and studied the relationship between cerebral hemodynamics and clinical performance. Methods : Twenty five patients with hydrocephalus undertook pre- and post-operative TCD but only preoperative CSF flow study was performed. Mean flow velocity[Vm], pulsatility index[PI] and resistance index[RI] were assessed through TCD and changes in ventricle size and cortical gyral atrophy were checked through brain CT. Results : Postoperative hydrocephalus showed an increase in Vm[ACA P=0.037, MCA P=0.034], decrease in PI[ACA P=0.019, MCA P=0.017] and decrease in RI [ACA P=0.017, MCA P=0.021] compared to preoperative TCD parameters in the postoperative improvement group. In the postoperative improvement group, postoperative TCD parameters correlated with CSF flow study grade [Vm : $R^2=-0.75$, PI : $R^2=0.86$, RI : $R^2=0.78$] and ventriculocranial ratio change correlated with PI change [$R^2=0.73$]. The convexity gyral atrophy and initial TCD parameters showed close relationship to outcome. Conclusion : PI and RI can be used as an indicator of post operative prognosis, and with the addition of CSF flow study values, can also be used as a tool to predict pre-op and post-op patient status and successful shunt surgery.

• Journal of Korean Neurosurgical Society
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• v.29 no.2
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• pp.231-239
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• 2000

Objectives : A postoperative hydrocephalus is compromises the clinical outcome of patients with aneurysmal clippings as one of the major complications of SAH. Subdural hygroma is often complicated after aneurysmal clippings, which subsides spontaneously as simple hygroma, or progresses to shunt-dependent hydrocephalus (SDHC). To predict development of SDHC from the hygroma, and to improve clinical outcome of patients with aneurysmal clippings, we analyzed clinical predisposing factors between 2 subgroups, simple hygroma and SDHC. Patients and Methods : A retrospective study of 232 consecutive cases of clipped aneurysmal patient was undertaken in our hospital for last two years. The 46 patients(19.8%) developed hygromas after aneurysmal clippings. There were 22 cases with simple hygroma(9.5%), and 24 patients with SDHC(10.3%). Comparison of 2 subgroups was made for various clinical and radiological factors. Results : Older age(p＝0.03), poor preoperative clinical grade(p＝0.01), high Fisher grade(p＝0.005), large amount of hygroma(p＝0.014) and increased size of lateral ventricle ipsilateral to hygroma(p＝0.001) were correlated significantly with SDHC. There was no statistical significance in sex, aneurysmal location and presence of acute preoperative ventricular dilatation between 2 subgroups. Conclusion : The clinical factors, such as older age, poor preoperative clinical grade, high Fisher grade, large amount of hygroma and increased size of lateral ventricle ipsilateral to hygroma showed statistical sinificance for differentiating SDHC from simple hygroma.

• Journal of Genetic Medicine
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• v.10 no.2
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• pp.113-116
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• 2013

Alexander disease is a rare degenerative leukodystrophy caused by dominant mutations in glial fibrillary acidic protein (GFAP). The neonatal form of Alexander disease may manifest as frequent and intractable seizures or obstructive hydrocephalus, with rapid progression leading to severe disability or death within two years. We report a case of a 50-day-old male who presented with intractable seizures and obstructive hydrocephalus. His initial magnetic resonance imaging (MRI) suggested a tumor-like lesion in the tectal area causing obstructive hydrocephalus. Despite endoscopic third ventriculostomy and multiple administrations of antiepileptic drugs, the patient experienced intractable seizures with rapid deterioration of his clinical status. After reviewing serial brain MRI scans, Alexander disease was suspected. Subsequently, we confirmed the de novo missense mutation in GFAP (c.1096T>C, Y366H). Although the onset was slightly delayed from the neonatal period (50 days old), we concluded that the overall clinical features were consistent with the neonatal form of Alexander disease. Furthermore, we also suspected that a Y366 residue might be closely linked to the neonatal form of Alexander disease based on a literature review.

• Journal of Yeungnam Medical Science
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• v.25 no.2
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• pp.160-164
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• 2008

A two-month-old girl with a history of an incidental arachnoid cyst in the prenatal period (38 weeks) presented with persistent irritability. A follow-up computed tomographic (CT) scan revealed an enlarged arachnoid cyst with hydrocephalus. We performed craniotomy and fenestration, but the cyst size did not decrease, and hydrocephalus had worsened on a follow-up CT scan performed 13 months after fenestration. The patient was treated with cystoperitoneal shunting. Follow-up magnetic resonance imaging (MRI) performed 5 years later revealed that the arachnoid cyst had decreased in size and that the hydrocephalus had resolved. Enlarging arachnoid cysts are not common, and optimal surgical treatment is uncertain. Based on the features of this case, we believe cystoperitoneal shunting is an advisable surgical intervention for patients with enlarging arachnoid cysts presenting with hydrocephalus.