• Title, Summary, Keyword: hydrocephalus

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Clinical Analysis of Post-traumatic Hydrocephalus

  • Kim, Seok-Won;Lee, Seung-Myung;Shin, Ho
    • Journal of Korean Neurosurgical Society
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    • v.38 no.3
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    • pp.211-214
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    • 2005
  • Objective : Post-traumatic hydrocephalus is a complication of head injury and can present with several different clinical symptoms. However, the developing factors of post-traumatic hydrocephalus and treatment are still not well known. The authors design the study to focus on incidence, causing diseases and treatment of post-traumatic hydrocephalus. Methods : The 789patients of traumatic head injury followed by admission treatment over 7days from Jan. 1997 to Dec. 2001, were divided shunt group and shunt free group. We analyzed age, sex, causing diseases, developing time of hydrocephalus and effects of shunt operation in post-traumatic hydrocephalus. Results : The incidence of post-traumatic hydrocephalus for requiring shunt was 9.2% [64cases]. Chronic hydrocephalus which developed after 14days of injury was higher incidence [51cases]. We found following variables were significantly related to shunt-dependent hydrocephalus : low GCS score at admission, initial CT finding of traumatic subarachnoid hemorrhage and intracerebral hemorrhage [including intraventricular hemorrhage]. The effect of shunt operation was not related with the spinal pressure, but had statistically significant correlation with the response of lumbar drainage. Conclusion : We conclude that development of hydrocephalus after head trauma is related to low GCS score, intracerebral hemorrhage [including intraventricular hemorrhage] and subarachnoid hemorrhage. The effect of preoperative lumbar drainage has a significant role in predicting the result of shunt operation in patient with post-traumatic hydrocephalus.

Predisposing Factors Related to Shunt-Dependent Chronic Hydrocephalus after Aneurysmal Subarachnoid Hemorrhage

  • Kwon, Jae-Hyun;Sung, Soon-Ki;Song, Young-Jin;Choi, Hyu-Jin;Huh, Jae-Taeck;Kim, Hyung-Dong
    • Journal of Korean Neurosurgical Society
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    • v.43 no.4
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    • pp.177-181
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    • 2008
  • Objective : Hydrocephalus is a common sequelae of aneurysmal subarachnoid hemorrhage (SAH) and patients who develop hydrocephalus after SAH typically have a worse prognosis than those who do not. This study was designed to identify factors predictive of shunt-dependent chronic hydrocephalus among patients with aneurysmal SAH, and patients who require permanent cerebrospinal fluid diversion. Methods : Seven-hundred-and-thirty-four patients with aneurysmal SAH who were treated surgically between 1990 and 2006 were retrospectively studied. Three stages of hydrocephalus have been categorized in this paper, i.e., acute (0-3 days after SAH), subacute (4-13 days after SAH), chronic (${\geqq}14$ days after SAH). Criteria indicating the occurrence of hydrocephalus were the presence of significantly enlarged temporal horns or ratio of frontal horn to maximal biparietal diameter more than 30% in computerized tomography. Results : Overall, 66 of the 734 patients (8.9%) underwent shunting procedures for the treatment of chronic hydrocephalus. Statistically significant associations among the following factors and shunt-dependent chronic hydrocephalus were observed. (1) Increased age (p < 0.05), (2) poor Hunt and Hess grade at admission (p < 0.05), (3) intraventricular hemorrhage (p < 0.05), (4) Fisher grade III, IV at admission (p < 0.05), (5) radiological hydrocephalus at admission (p < 0.05), and (6) post surgery meningitis (p < 0.05) did affect development of chronic hydrocephalus. However the presence of intracerebral hemorrhage, multiple aneurysms, vasospasm, and gender did not influence the development of shunt-dependent chronic hydrocephalus. In addition, the location of the ruptured aneurysms in posterior cerebral circulation did not show significant correlation of development of shunt-dependent chronic hydrocephalus. Conclusion : Hydrocephalus after aneurysmal subarachnoid hemorrhage seems to have a multifactorial etiology. Understanding predisposing factors related to the shunt-dependent chronic hydrocephalus may help to guide neurosurgeons for better treatment outcomes.

The Causal Relationship of the Hydrocephalus in Patients with Aneurysmal Subarachnoid Hemorrhage

  • Shin, Tae-Sob;Jung, Chul-Ku;Kim, Hyun-Woo;Park, Keung-Suk;Kim, Jae-Myung
    • Journal of Korean Neurosurgical Society
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    • v.42 no.3
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    • pp.173-178
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    • 2007
  • Objective : Hydrocephalus is one of the major complications following spontaneous subarachnoid hemorrhage (SAH). However, the risk factors of the hydrocephalus after SAH are not still well known. This study was focused on verification of the causal relationships between the development of hydrocephalus and SAH. Methods : The patients who developed hydrocephalus after rupture of aneurysms were studied. To obtain prognostic factors regarding to hydrocephalus, several parameters such as age, sex, hypertension, location of aneurysm, existence of intraventricular hemorrhage (IVH) and intracerebral hemorrhage (ICH), Glasgow coma scale (GCS), Hunt-Hess SAH classification & Fisher Grade on admission and the ratio of frontal harn of lateral ventricle diameter to skull inner table diameter at this level (FH/ID) were studied retrospectively. Results : The development of hydrocephalus following SAH is multifactorial. The age, IVH, FH/ID ratio were related to hydrocephalus in analysis. There is a low clinical correlation between sex, hypertension, location of aneurysm, existence of ICH, GCS, Hunt-Hess SAH classification, Fisher Grade on admission and hydrocephalus. Conclusion : Knowledge on risk factors related to the occurrence of hydrocephalus may help guide neurosurgeons in the long-term care of patients who have experienced aneurysmal SAH.

Factors Associated Postoperative Hydrocephalus in Patients with Traumatic Acute Subdural Hemorrhage

  • Kim, Han;Lee, Heui Seung;Ahn, Sung Yeol;Park, Sung Chun;Huh, Won
    • Journal of Korean Neurosurgical Society
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    • v.60 no.6
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    • pp.730-737
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    • 2017
  • Objective : Postoperative hydrocephalus is a common complication following craniectomy in patients with traumatic brain injury, and affects patients' long-term outcomes. This study aimed to verify the risk factors associated with the development of hydrocephalus after craniectomy in patients with acute traumatic subdural hemorrhage (tSDH). Methods : Patients with acute traumatic SDH who had received a craniectomy between December 2005 and January 2016 were retrospectively assessed by reviewing the coexistence of other types of hemorrahges, measurable variables on computed tomography (CT) scans, and the development of hydrocephalus during the follow-up period. Results : Data from a total of 63 patients who underwent unilateral craniectomy were analyzed. Postoperative hydrocephalus was identified in 34 patients (54%) via brain CT scans. Preoperative intraventricular hemorrhage (IVH) was associated with the development of hydrocephalus. Furthermore, the thickness of SDH (p=0.006) and the extent of midline shift before craniectomy (p=0.001) were significantly larger in patients with postoperative hydrocephalus. Indeed, multivariate analyses showed that the thickness of SDH (p=0.019), the extent of midline shift (p<0.001) and the coexistence of IVH (p=0.012) were significant risk factors for the development of postoperative hydrocephalus. However, the distance from the midline to the craniectomy margin was not an associated risk factor for postoperative hydrocephalus. Conclusion : In patients with acute traumatic SDH with coexisting IVH, a large amount of SDH, and a larger midline shift, close follow-up is necessary for the early prediction of postoperative hydrocephalus. Furthermore, craniectomy margin need not be limited in acute traumatic SDH patients for the reason of postoperative hydrocephalus.

Does Neurosurgical Clipping or Endovascular Coiling Lead to More Cases of Delayed Hydrocephalus in Patients with Subarachnoid Hemorrhage?

  • Eom, Tae Oong;Park, Eun Suk;Park, Jun Bum;Kwon, Soon Chan;Sim, Hong Bo;Lyo, In Uk;Kim, Min Soo
    • Journal of Cerebrovascular and Endovascular Neurosurgery
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    • v.20 no.2
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    • pp.87-95
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    • 2018
  • Objective : We investigated whether clipping or endovascular treatment (EVT) can reduce the incidence of delayed hydrocephalus. We also investigated whether additional procedures, namely lumbar drainage and extra-ventricular drainage (EVD), decrease the incidence of delayed hydrocephalus in patients with subarachnoid hemorrhage (SAH). Materials and Methods : One-hundred and fifty-two patients who had undergone an operation for SAH were enrolled in this study. Clinical data, radiological data, and procedural data were investigated. Procedural data included the operating technique (clipping vs. EVT) and the use of additional procedures (no procedure, lumbar drainage, or EVD). Delayed hydrocephalus was defined as a condition in which the Evan's index was 0.3 or higher, as assessed using brain computed tomography more than 2 weeks after surgery, requiring shunt placement due to neurological deterioration. Results : Of the 152 patients, 45 (29.6%) underwent surgical clipping and 107 (70.4%) underwent EVT. Twenty-five (16.4%) patients developed delayed hydrocephalus. Age (p = 0.019), procedure duration (p = 0.004), and acute hydrocephalus (p = 0.030) were significantly correlated with the incidence of delayed hydrocephalus. However, the operation technique (p = 0.593) and use of an additional procedure (p = 0.378) were not significantly correlated with delayed hydrocephalus incidence. Conclusion : No significant difference in the incidence of delayed hydrocephalus was associated with operation technique or use of an additional procedure in patients with SAH. However, delayed hydrocephalus was significantly correlated with old age, long procedural duration, and acute hydrocephalus. Therefore, we recommend that additional procedures should be discontinued as soon as possible.

A case of Hydrocephalus in S/D Rat with the Closure of Mesencephalic Aqueduct (중뇌수도관 폐쇄에 의한 S/D계통 랫드 수뇌증 1예)

  • Cho, Ik-Hyun;Han, Kyu-Bo;Chang, Byung-Joon
    • Korean Journal of Veterinary Research
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    • v.42 no.3
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    • pp.429-436
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    • 2002
  • Hydrocepbalus may be an acquired or a congenital condition. We have studied the macroscopic and microscopic changes in the hydrocephalus of an inbred Sprague-Dawley rat at postnatal week 8. The animal suspected with the hydrocephalus showed clinical syndromes such as depression, severe ataxia, eye abnormalities, dome-shaped head, and persistent fontanelle. With the postmortem examination, the suspected animal was clearly revealed as a severe internal hydrocephalus. In this animal, severe ventriculomegaly was limited to the third and lateral ventricles, and cortical thining was most apparent in the parieto-occipital region. With the routine histological examination, brain tissue showed aqueductal obstruction, thinning of the cerebral cortex, severe ependymal damage, subependymal edema, damage of choroid plexus of fourth ventricle, enlarged cortical vessels, and expanded ventricles. Aqueductal obstruction was observed with the appearance of simple stenosis at the level of rostral colliculus. Subsequently, the other structures of brain such as septal nucleus, caudate nucleus, and hippocampus etc. were abnormally reconstructed by hydrocephalus. This study suggests that the hydrocephalus can be taken place by primary aqueductal obstruction and this type of hydrocephalus is classified as uncommunicating type. Though the mechanism of aqueductal obstruction is not clear, the morphological studies of this case may be helpful for the further study of hydrocephalus.

The Risk Factors for Hydrocephalus and Subdural Hygroma after Decompressive Craniectomy in Head Injured Patients

  • Ki, Hee Jong;Lee, Hyung-Jin;Lee, Hong-Jae;Yi, Jin-Seok;Yang, Ji-Ho;Lee, Il-Woo
    • Journal of Korean Neurosurgical Society
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    • v.58 no.3
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    • pp.254-261
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    • 2015
  • Objective : The present study aims to investigate 1) the risk factors for hydrocephalus and subdural hygroma (SDG) occurring after decompressive craniectomy (DC), and 2) the association between the type of SDG and hydrocephalus. Methods : We retrospectively reviewed the clinical and radiological features of 92 patients who underwent DC procedures after severe head injuries. The risk factors for developing post-traumatic hydrocephalus (PTH) and SDG were analyzed. Types of SDGs were classified according to location and their relationship with hydrocephalus was investigated. Results : Ultimately, 26.09% (24/92) of these patients developed PTH. In the univariate analyses, hydrocephalus was statically associated with large bone flap diameter, large craniectomy area, bilateral craniectomy, intraventricular hemorrhage, contralateral or interhemisheric SDGs, and delayed cranioplasty. However, in the multivariate analysis, only large craniectomy area (adjusted OR=4.66; p=0.0239) and contralateral SDG (adjusted OR=6.62; p=0.0105) were significant independent risk factors for developing hydrocephalus after DC. The incidence of overall SDGs after DC was 55.43% (51/92). Subgroup analysis results were separated by SDG types. Statistically significant associations between hydrocephalus were found in multivariate analysis in the contralateral (adjusted OR=5.58; p=0.0074) and interhemispheric (adjusted OR=17.63; p=0.0113) types. Conclusion : For patients who are subjected to DC following severe head trauma, hydrocephalus is associated with a large craniectomy area and contralateral SDG. For SDGs after DC that occur on the interhemispherical or controlateral side of the craniectomy, careful follow-up monitoring for the potential progression into hydrocephalus is needed.

Communicating Hydrocephalus Onset Following a Traumatic Tension Pneumocephalus

  • Lee, Jin-Sung;Ahn, Sora;Eom, Ki Seong
    • Archives of Craniofacial Surgery
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    • v.17 no.4
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    • pp.225-228
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    • 2016
  • The entrapment of intracranial air from the check valve system results in a tension pneumocephalus. It should be distinguished from simple pneumocephalus because they are intracranial space-occupying masses that can threaten life. Communicating hydrocephalus is a serious and frequent complication of post-traumatic head injury. Head injury is one of the most common causes in etiopathogenesis of communicating hydrocephalus. Here, we describe a case of a 65-year-old man who developed communicating hydrocephalus after a post-traumatic tension pneumocephalus. To the best of our knowledge, this is the first reported case of communicating hydrocephalus developed after a post-traumatic tension pneumocephalus. Although the exact pathogenic mechanisms underlying the cascade following trauma remain unclear, communicating hydrocephalus after a tension pneumocephalus could be considered a possible complication.

Obstructive Hydrocephalus Induced Tremor in Patient with Mesencephalic Lacunae

  • Lee, Kyung-Jin;Joo, Won-Il;Kim, Moon-Chan;Choi, Chang-Rak
    • Journal of Korean Neurosurgical Society
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    • v.37 no.6
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    • pp.456-458
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    • 2005
  • We report a case of hydrocephalus in a 8-year-old boy who presented bilateral hand tremor. The hydrocephalus was caused by the aqueductal stenosis due to expanding lacunae in the mesencephalothalamic area on MR findings. The tremor was improved after CSF drainage by spinal tap and ventriculoperitoneal shunt. The authors present the possible mechanism of hydrocephalus induced tremor.

Lumbar Schwannoma Associated with Hydrocephalus

  • Kim, Young-Don;Kim, Dae-Hyun
    • Journal of Korean Neurosurgical Society
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    • v.37 no.3
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    • pp.228-231
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    • 2005
  • We describe a rare case of 52-year-old woman with lumbar schwannoma associated with hydrocephalus. In our case, the signs and symptoms of intracranial hypertension were not resolved even after the complete removal of the lumbar schwannoma. We also reviewed the literature on the association of hydrocephalus with spinal cord tumor.