1
|
Zhou F, Yang Z, Tang Z, Zhang Y, Wang H, Sun G, Zhang R, Jiang Y, Zhou C, Hou X, Liu L. Outcomes and prognostic factors of infantile acquired hydrocephalus: a single-center experience. BMC Pediatr 2023; 23:260. [PMID: 37226122 DOI: 10.1186/s12887-023-04034-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Accepted: 04/26/2023] [Indexed: 05/26/2023] Open
Abstract
AIM To assess the etiologies and adverse outcomes of infantile acquired hydrocephalus and predict prognosis. METHODS A total of 129 infants diagnosed with acquired hydrocephalus were recruited from 2008 to 2021. Adverse outcomes included death and significant neurodevelopmental impairment which was defined as Bayley Scales of Infant and Toddler Development III score < 70, cerebral palsy, visual or hearing impairment, and epilepsy. Chi-squared was used to evaluate the prognostic factors of adverse outcomes. A receiver operating characteristic curve was calculated to determine the cutoff value. RESULTS Of 113 patients with outcome data, 55 patients (48.7%) had adverse outcomes. Late surgical intervention time (13 days) and severe ventricular dilation were associated with adverse outcomes. The combination of surgical intervention time and cranial ultrasonography (cUS) indices was a better predictive marker compared with any of them (surgical intervention time, P = 0.05; cUS indices, P = 0.002). Post-hemorrhage (54/113, 48%), post-meningitis (28/113, 25%), and hydrocephalus arising from both hemorrhage and meningitis (17/113, 15%) accounted for a large proportion of the etiologies in our study. Hydrocephalus occurs secondary to post-hemorrhage and had a favorable outcome compared with other etiologies in both preterm and term groups. A significant difference in adverse outcomes between the inherited error of metabolism as a cause and other etiologies (P = 0.02). CONCLUSION Late surgical treatment times and severe ventricular dilation can predict adverse outcomes in infants with acquired hydrocephalus. It is crucial to identify the causes of acquired hydrocephalus to predict the adverse outcomes. Research into measures of improving adverse outcomes following infantile acquired hydrocephalus is urgently necessary.
Collapse
Affiliation(s)
- Faliang Zhou
- Department of Pediatrics, Peking University First Hospital, No.1 courtyard, Xi'anmen Street, Xicheng District, Beijing, China
| | - Zhao Yang
- Office of Academic Research, Peking University First Hospital, Beijing, China
| | - Zezhong Tang
- Department of Pediatrics, Peking University First Hospital, No.1 courtyard, Xi'anmen Street, Xicheng District, Beijing, China
| | - Yang Zhang
- Department of Neurosurgery, Peking University First Hospital, Beijing, China
| | - Hongmei Wang
- Department of Pediatrics, Peking University First Hospital, No.1 courtyard, Xi'anmen Street, Xicheng District, Beijing, China
| | - Guoyu Sun
- Department of Pediatrics, Peking University First Hospital, No.1 courtyard, Xi'anmen Street, Xicheng District, Beijing, China
| | - Rui Zhang
- Department of Pediatrics, Peking University First Hospital, No.1 courtyard, Xi'anmen Street, Xicheng District, Beijing, China
| | - Yi Jiang
- Department of Pediatrics, Peking University First Hospital, No.1 courtyard, Xi'anmen Street, Xicheng District, Beijing, China
| | - Congle Zhou
- Department of Pediatrics, Peking University First Hospital, No.1 courtyard, Xi'anmen Street, Xicheng District, Beijing, China
| | - Xinlin Hou
- Department of Pediatrics, Peking University First Hospital, No.1 courtyard, Xi'anmen Street, Xicheng District, Beijing, China
| | - Lili Liu
- Department of Pediatrics, Peking University First Hospital, No.1 courtyard, Xi'anmen Street, Xicheng District, Beijing, China.
| |
Collapse
|
2
|
Prediction of 6 months endoscopic third ventriculostomy success rate in patients with hydrocephalus using a multi-layer perceptron network. Clin Neurol Neurosurg 2022; 219:107295. [DOI: 10.1016/j.clineuro.2022.107295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 04/12/2022] [Accepted: 05/13/2022] [Indexed: 11/20/2022]
|
3
|
Requena-Jimenez A, Nabiuni M, Miyan JA. Profound changes in cerebrospinal fluid proteome and metabolic profile are associated with congenital hydrocephalus. J Cereb Blood Flow Metab 2021; 41:3400-3414. [PMID: 34415213 PMCID: PMC8669293 DOI: 10.1177/0271678x211039612] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 07/07/2021] [Accepted: 07/12/2021] [Indexed: 11/15/2022]
Abstract
The aetiology of congenital hydrocephalus (cHC) has yet to be resolved. cHC manifests late in rodent gestation, and by 18-22 weeks in human fetuses, coinciding with the start of the major phase of cerebral cortex development. Previously we found that cerebrospinal fluid (CSF) accumulation is associated with compositional changes, folate metabolic impairment and consequential arrest in cortical development. Here, we report a proteomics study on hydrocephalic and normal rat CSF using LC-MSMS and a metabolic pathway analysis to determine the major changes in metabolic and signalling pathways. Non-targeted analysis revealed a proteome transformation across embryonic days 17-20, with the largest changes between day 19 and 20. This provides evidence for a physiological shift in CSF composition and identifies some of the molecular mechanisms unleashed during the onset of cHC. Top molecular regulators that may control the shift in the CSF metabolic signature are also predicted, with potential key biomarkers proposed for early detection of these changes that might be used to develop targeted early therapies for this condition. This study confirms previous findings of a folate metabolic imbalance as well as providing more in depth metabolic analysis and understanding of cHC CSF.
Collapse
Affiliation(s)
- Alicia Requena-Jimenez
- Faculty of Biology, Medicine and Health, The University of Manchester, Division of Neuroscience & Experimental Psychology, The University of Manchester, Manchester, UK
| | - Mohammad Nabiuni
- Faculty of Biology, Medicine and Health, The University of Manchester, Division of Neuroscience & Experimental Psychology, The University of Manchester, Manchester, UK
| | - Jaleel A Miyan
- Faculty of Biology, Medicine and Health, The University of Manchester, Division of Neuroscience & Experimental Psychology, The University of Manchester, Manchester, UK
| |
Collapse
|
4
|
Agarwal N, Lariviere WR, Henry LC, Faramand A, Koschnitzky JE, Friedlander RM. Observations from Social Media Regarding the Symptomatology of Adult Hydrocephalus Patients. World Neurosurg 2019; 122:e307-e314. [DOI: 10.1016/j.wneu.2018.10.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 10/02/2018] [Accepted: 10/03/2018] [Indexed: 11/30/2022]
|
5
|
Obeidat N, Sallout B, Albaqawi B, Al AlAali W. The impact of fetal middle cerebral artery Doppler on the outcome of congenital hydrocephalus. J Matern Fetal Neonatal Med 2017; 31:413-417. [DOI: 10.1080/14767058.2017.1286318] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Nail Obeidat
- Department of Obstetrics and Gynecology, King Abdullah University Hospital, Jordan University of Science and Technology, Irbid, Jordan
- Department of Fetal Medicine and Ultrasound, Women’s’ Specialized Hospital, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Bahauddin Sallout
- Department of Fetal Medicine and Ultrasound, Women’s’ Specialized Hospital, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Badi Albaqawi
- Department of Fetal Medicine and Ultrasound, Women’s’ Specialized Hospital, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Wajeih Al AlAali
- Department of Fetal Medicine and Ultrasound, Women’s’ Specialized Hospital, King Fahad Medical City, Riyadh, Saudi Arabia
| |
Collapse
|
6
|
Aojula A, Botfield H, McAllister JP, Gonzalez AM, Abdullah O, Logan A, Sinclair A. Diffusion tensor imaging with direct cytopathological validation: characterisation of decorin treatment in experimental juvenile communicating hydrocephalus. Fluids Barriers CNS 2016; 13:9. [PMID: 27246837 PMCID: PMC4888658 DOI: 10.1186/s12987-016-0033-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 05/20/2016] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND In an effort to develop novel treatments for communicating hydrocephalus, we have shown previously that the transforming growth factor-β antagonist, decorin, inhibits subarachnoid fibrosis mediated ventriculomegaly; however decorin's ability to prevent cerebral cytopathology in communicating hydrocephalus has not been fully examined. Furthermore, the capacity for diffusion tensor imaging to act as a proxy measure of cerebral pathology in multiple sclerosis and spinal cord injury has recently been demonstrated. However, the use of diffusion tensor imaging to investigate cytopathological changes in communicating hydrocephalus is yet to occur. Hence, this study aimed to determine whether decorin treatment influences alterations in diffusion tensor imaging parameters and cytopathology in experimental communicating hydrocephalus. Moreover, the study also explored whether diffusion tensor imaging parameters correlate with cellular pathology in communicating hydrocephalus. METHODS Accordingly, communicating hydrocephalus was induced by injecting kaolin into the basal cisterns in 3-week old rats followed immediately by 14 days of continuous intraventricular delivery of either human recombinant decorin (n = 5) or vehicle (n = 6). Four rats remained as intact controls and a further four rats served as kaolin only controls. At 14-days post-kaolin, just prior to sacrifice, routine magnetic resonance imaging and magnetic resonance diffusion tensor imaging was conducted and the mean diffusivity, fractional anisotropy, radial and axial diffusivity of seven cerebral regions were assessed by voxel-based analysis in the corpus callosum, periventricular white matter, caudal internal capsule, CA1 hippocampus, and outer and inner parietal cortex. Myelin integrity, gliosis and aquaporin-4 levels were evaluated by post-mortem immunohistochemistry in the CA3 hippocampus and in the caudal brain of the same cerebral structures analysed by diffusion tensor imaging. RESULTS Decorin significantly decreased myelin damage in the caudal internal capsule and prevented caudal periventricular white matter oedema and astrogliosis. Furthermore, decorin treatment prevented the increase in caudal periventricular white matter mean diffusivity (p = 0.032) as well as caudal corpus callosum axial diffusivity (p = 0.004) and radial diffusivity (p = 0.034). Furthermore, diffusion tensor imaging parameters correlated primarily with periventricular white matter astrocyte and aquaporin-4 levels. CONCLUSIONS Overall, these findings suggest that decorin has the therapeutic potential to reduce white matter cytopathology in hydrocephalus. Moreover, diffusion tensor imaging is a useful tool to provide surrogate measures of periventricular white matter pathology in communicating hydrocephalus.
Collapse
Affiliation(s)
- Anuriti Aojula
- />Institute of Metabolism and Systems Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
- />Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, B15 2TH UK
- />Neurotrauma, College of Medicine and Dentistry, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
| | - Hannah Botfield
- />Institute of Metabolism and Systems Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
- />Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, B15 2TH UK
- />Neurotrauma, College of Medicine and Dentistry, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
| | - James Patterson McAllister
- />Department of Neurosurgery, Division of Pediatric Neurosurgery at the Washington University School of Medicine and the Saint Louis Children’s Hospital, St. Louis, MO 63110 USA
| | - Ana Maria Gonzalez
- />Institute of Metabolism and Systems Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
- />Neurotrauma, College of Medicine and Dentistry, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
| | - Osama Abdullah
- />Department of Bioengineering, University of Utah, Salt Lake City, UT 84112 USA
| | - Ann Logan
- />Department of Bioengineering, University of Utah, Salt Lake City, UT 84112 USA
- />Neurotrauma, College of Medicine and Dentistry, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
| | - Alexandra Sinclair
- />Institute of Metabolism and Systems Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
- />Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, B15 2TH UK
- />Neurotrauma, College of Medicine and Dentistry, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
- />Department of Neurology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, B15 2TH UK
| |
Collapse
|
7
|
Appelbe OK, Bollman B, Attarwala A, Triebes LA, Muniz-Talavera H, Curry DJ, Schmidt JV. Disruption of the mouse Jhy gene causes abnormal ciliary microtubule patterning and juvenile hydrocephalus. Dev Biol 2013; 382:172-85. [PMID: 23906841 DOI: 10.1016/j.ydbio.2013.07.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Revised: 06/10/2013] [Accepted: 07/05/2013] [Indexed: 11/30/2022]
Abstract
Congenital hydrocephalus, the accumulation of excess cerebrospinal fluid (CSF) in the ventricles of the brain, affects one of every 1000 children born today, making it one of the most common human developmental disorders. Genetic causes of hydrocephalus are poorly understood in humans, but animal models suggest a broad genetic program underlying the regulation of CSF balance. In this study, the random integration of a transgene into the mouse genome led to the development of an early onset and rapidly progressive hydrocephalus. Juvenile hydrocephalus transgenic mice (Jhy(lacZ)) inherit communicating hydrocephalus in an autosomal recessive fashion with dilation of the lateral ventricles observed as early as postnatal day 1.5. Ventricular dilation increases in severity over time, becoming fatal at 4-8 weeks of age. The ependymal cilia lining the lateral ventricles are morphologically abnormal and reduced in number in Jhy(lacZ/lacZ) brains, and ultrastructural analysis revealed disorganization of the expected 9+2 microtubule pattern. Rather, the majority of Jhy(lacZ/lacZ) cilia develop axonemes with 9+0 or 8+2 microtubule structures. Disruption of an unstudied gene, 4931429I11Rik (now named Jhy) appears to underlie the hydrocephalus of Jhy(lacZ/lacZ) mice, and the Jhy transcript and protein are decreased in Jhy(lacZ/lacZ) mice. Partial phenotypic rescue was achieved in Jhy(lacZ/lacZ) mice by the introduction of a bacterial artificial chromosome (BAC) carrying 60-70% of the JHY protein coding sequence. Jhy is evolutionarily conserved from humans to basal vertebrates, but the predicted JHY protein lacks identifiable functional domains. Ongoing studies are directed at uncovering the physiological function of JHY and its role in CSF homeostasis.
Collapse
Affiliation(s)
- Oliver K Appelbe
- Department of Biological Sciences, University of Illinois at Chicago, Chicago, IL 60607, United States
| | | | | | | | | | | | | |
Collapse
|
8
|
Nigrovic LE, Lillis K, Atabaki SM, Dayan PS, Hoyle J, Tunik MG, Jacobs ES, Monroe D, Wootton-Gorges SW, Miskin M, Holmes JF, Kuppermann N. The Prevalence of Traumatic Brain Injuries After Minor Blunt Head Trauma in Children With Ventricular Shunts. Ann Emerg Med 2013; 61:389-93. [DOI: 10.1016/j.annemergmed.2012.08.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2012] [Revised: 08/23/2012] [Accepted: 08/28/2012] [Indexed: 10/27/2022]
|
9
|
Abstract
The pathophysiology of congenital and neonatal hydrocephalus is not well understood although the prognosis for patients with this disorder is far from optimal. A major obstacle to advancing our knowledge of the causes of this disorder and the cellular responses that accompany it is the multifactorial nature of hydrocephalus. Not only is the epidemiology varied and complex, but the injury mechanisms are numerous and overlapping. Nevertheless, several conclusions can be made with certainty: the age of onset strongly influences the degree of impairment; injury severity is dependent on the magnitude and duration of ventriculomegaly; the primary targets are periventricular axons, myelin, and microvessels; cerebrovascular injury mechanisms are prominent; gliosis and neuroinflammation play major roles; some but not all changes are preventable by draining cerebrospinal fluid with shunts and third ventriculostomies; cellular plasticity and physiological compensation probably occur but this is a major under-studied area; and pharmacologic interventions are promising. Rat and mouse models have provided important insights into the pathogenesis of congenital and neonatal hydrocephalus. Ependymal denudation of the ventricular lining appears to affect the development of neural progenitors exposed to cerebrospinal fluid, and alterations of the subcommissural organ influence the patency of the cerebral aqueduct. Recently these impairments have been observed in patients with fetal-onset hydrocephalus, so experimental findings are beginning to be corroborated in humans. These correlations, coupled with advanced genetic manipulations in animals and successful pharmacologic interventions, support the view that improved treatments for congenital and neonatal hydrocephalus are on the horizon.
Collapse
Affiliation(s)
- James P McAllister
- Department of Neurosurgery, Division of Pediatric Neurosurgery, University of Utah and Primary Children's Medical Center, Salt Lake City, UT 84132, USA.
| |
Collapse
|
10
|
Huge hydrocephalus: definition, management, and complications. Childs Nerv Syst 2011; 27:95-100. [PMID: 20549215 DOI: 10.1007/s00381-010-1177-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2010] [Accepted: 05/07/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Lack of comprehensive knowledge and numerous socioeconomic problems may make the parents leave hydrocephalic children untreated, leading to progressive hydrocephalus and eventual unordinary big head. Management of huge hydrocephalus (HH) differs from common hydrocephalus. We present our experience in the management of these children. METHODS HH is defined as head circumference larger than the height of the infant. Nine infants with HH have been shunted in Children's Hospital Medical Center and followed up for 0.5 to 7 years. RESULTS The most common cause of hydrocephalus was aqueductal stenosis. The mean age of patients during shunting was 3 months. The head circumference ranged from 56 to 94 cm with the average of 67 cm. Cognitive statuses were appropriate based on their age in five patients. Motor development was normal only in one patient. Complications were found in most cases which included subdural effusion (six patients), shunt infection (four patients), skin injury (three patients), proximal catheter coming out of ventricle to the subdural space (two patients), and shunt exposure (one patient). Three patients died due to shunt infection and sepsis. CONCLUSION Numerous complications may occur in patients with HH after shunt operation such as subdural effusion, ventricular collapse, electrolyte disturbance, skull deformity, scalp injury, and shunt infection. Mental and motor disabilities are very common in patients with HH. Many of these complications can be related to overdrainage; therefore, drainage control using programmable shunts is advisable.
Collapse
|
11
|
Paulsen AH, Lundar T, Lindegaard KF. Twenty-year outcome in young adults with childhood hydrocephalus: assessment of surgical outcome, work participation, and health-related quality of life. J Neurosurg Pediatr 2010; 6:527-35. [PMID: 21121726 DOI: 10.3171/2010.9.peds09548] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Shunting of CSF is one of the most commonly performed operations in the pediatric neurosurgeon's repertoire. The 1st decade after initial shunt insertion has been addressed in several previous reports. The goals of the authors' study, therefore, were to determine 20-year outcomes in young adults with childhood hydrocephalus and to assess their health-related quality of life (HRQOL). METHODS Patients younger than 15 years of age, in whom a first-time shunt insertion was performed for hydrocephalus in the calendar years 1985-1988, were included in a retrospective study on surgical morbidity, mortality rates, academic achievement, and/or work participation. Information concerning perceived health and functional status was assessed using the 36-Item Short Form Health Survey (SF-36) and Barthel Index, which were completed by patients still alive by September 1, 2009. RESULTS Overall, 138 patients participated, no patient being lost to follow-up. For the 20-year period, the overall mortality rate was 21.7%. The mortality rate was not significantly higher in the 1st decade after initial shunt insertion than in the 2nd decade (p = 0.10). Ten percent of the patients surviving still live with their primary shunt in place, whereas 81% required at least one revision, and among these individual the mean number of revisions was 4.2 (median 3, range 0-26). There was a significantly higher revision rate during the 1st decade after initial shunt insertion compared with the 2nd decade (p = 0.027). The majority of patients live lives comparable with those of their peers. At follow-up, 56% were employed in open-market jobs or were still students, 23% had sheltered employment, and 21% were unemployed. The HRQOL was slightly lower in the hydrocephalic cohort than in the normative population. A significant difference was found in 2 of 8 SF-36 domains-Physical Functioning and General Health. CONCLUSIONS During the 20-year follow-up period, 81% of the patients required at least one revision of the CSF shunt. The mortality rate was high: 24 patients died in the 1st decade and 6 died in the 2nd decade after implantation of the initial shunt. In total, 4 deaths (2.9%) were due to shunt failure. Shunt placement to treat childhood hydrocephalus has a substantial effect on social functioning in later life, although perceived health was positively found to be better than expected in young adults with hydrocephalus.
Collapse
|
12
|
Saxena AK. Congenital Anomalies of Soft Tissues: Birth Defects Depending on Tissue Engineering Solutions and Present Advances in Regenerative Medicine. TISSUE ENGINEERING PART B-REVIEWS 2010; 16:455-66. [DOI: 10.1089/ten.teb.2009.0700] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
- Amulya K. Saxena
- Department of Pediatric and Adolescent Surgery, Medical University of Graz, Graz, Austria
| |
Collapse
|
13
|
Metwalley KA, Farghalley HS, Abd-Elsayed AA. Congenital hydrocephalus in an Egyptian baby with trisomy 18: a case report. J Med Case Rep 2009; 3:114. [PMID: 19946592 PMCID: PMC2783055 DOI: 10.1186/1752-1947-3-114] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2008] [Accepted: 11/09/2009] [Indexed: 11/10/2022] Open
Abstract
Abstract
Introduction
Trisomy 18 is the second most common autosomal trisomy after Down syndrome (trisomy 21). A variety of anomalies of the central nervous system are observed in cases of trisomy 18. The association between trisomy 18 and congenital hydrocephalus is very rare.
Case presentation
A 4-month-old male Egyptian baby boy was referred to Assiut University hospital for evaluation of his large-sized head. The initial clinical examination revealed facial dysmorphism including a prominent wide forehead, wide anterior fontanel, bushy eyebrows, synophrosis, small palpebral fissures, ocular hypertelorism, high arched palate, depressed nasal bridge, low-set ears, micrognathia, bilateral clenched hands with over lapping fingers, rocker-bottom feet and penile hypospadius. A computed tomography scan of the patient's head showed a dilatation of all the ventricular systems of the brain that suggested hydrocephalus. A chromosome analysis of his peripheral blood confirmed a trisomy of chromosome 18 (47, XX+18). The hydrocephalus was treated with a ventriculoperitoneal shunt because of the abnormal increase in his head circumference. He was discharged home on nasogastric feeds at the age of 5 months. Despite the advice of the medical team, his parents did not bring him for further follow up. He died at the age of 7 months due to a sudden cardiorespiratory arrest at home.
Conclusion
Microcephaly is not mandatory for the diagnosis of trisomy 18 syndrome because some cases of trisomy 18 can be associated with other anomalies of the central nervous system, including hydrocephalus. There is no proven explanation for this association, and the management of hydrocephalus in such a situation is not different from the usual course of management.
Collapse
|
14
|
Abstract
PURPOSE Ventricular shunt-induced craniosynostosis is a widely recognised cause of secondary craniosynostosis. We reviewed the management and long-term outcome of the cases of cranial deformity post cerebrospinal fluid shunting in our unit and compared these with previously published series. METHODS The Australian Craniofacial Unit and Department of Neurosurgery database was searched to identify cases of ventricular shunt-induced cranial deformity and a case note review was undertaken. RESULTS Eight cases were identified, and all were shunted within 6 months of birth. Our patients required shunting with a low pressure valve for hydrocephalus secondary to either aqueduct stenosis or intraventricular haemorrhage. The diagnosis was made following computed tomography (CT) three-dimensional surface reconstruction of the skull. Two cases of confirmed suture fusion were treated with cranial vault remodelling and programmable shunt insertion. In six cases, the sutures were not completely fused on the CT images despite a scaphocephalic head shape. These patients were managed conservatively with close monitoring. CONCLUSION Cranial vault remodelling together with insertion of programmable shunt valve is indicated in CT confirmed cases of secondary craniosynostosis.
Collapse
|
15
|
Abstract
PURPOSE The purpose of this study is to evaluate the changing epidemiology of paediatric hydrocephalus over the past three decades in a single institution. METHODS All children treated for newly diagnosed hydrocephalus during the 1985-1990 (group A) and the 2000-2005 periods (group B) were enrolled and classified according to the associated cause of hydrocephalus. RESULTS A significant 8.8% decrease of the incidence of hydrocephalus was noticed between the two time periods, resulting from the reduction of hydrocephalus associated to myelomeningocele, aqueduct stenosis (p = 0.04), CNS infection (p = 0.03), cranio-cerebral malformation and head injuries; post-haemorrhagic hydrocephalus remained stable, while the tumour-associated one increased (p < 0.0001). No consistent differences in terms of rate of adjunctive surgery (30.3% versus 23.9%) and number revision procedures (200 versus 104) were recorded. CONCLUSIONS The present study confirmed data from the literature about the declined incidence of paediatric hydrocephalus, which mainly results from the decrease of congenital malformations. In spite of the recent advances in neuroendoscopy and in the shunting valve design, the impact of hydrocephalus in the paediatric neurosurgical practice remains high.
Collapse
|
16
|
Takahashi A, Shiroishi T, Koide T. Multigenic factors associated with a hydrocephalus-like phenotype found in inter-subspecific consomic mouse strains. Mamm Genome 2008; 19:333-8. [PMID: 18509705 DOI: 10.1007/s00335-008-9112-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2008] [Accepted: 05/01/2008] [Indexed: 11/25/2022]
Abstract
Hydrocephalus is a significant clinical condition in humans and is known to be a multifactorial neurologic disorder. It has been thought that genetic factors are closely involved in the etiology of congenital hydrocephalus, but further investigation is required to elucidate the genetic architecture of hydrocephalus. By analyzing breeding records of a panel of inter-subspecific consomic mouse strains, we found that consomic strains with MSM/Ms (MSM) chromosomes 4, 5, 7, 11, 15, and 17 showed a significantly higher incidence of hydrocephalus, whereas both parental strains, MSM and C57BL/6J (B6), rarely showed this abnormality. Further analysis of the consomic Chr 17 strain revealed that apparently normal individuals of this strain also exhibited increased brain ventricle size compared to B6 and had larger individual variation of ventricle size within the strain. Thus, we concluded that hydrocephalus is an extreme phenotype of individual ventricle size variation. We then established and analyzed several subconsomic strains of Chr 17 to identify genetic factors related to hydrocephalus-like phenotype and successfully mapped one genetic locus around the proximal region of Chr 17.
Collapse
Affiliation(s)
- Aki Takahashi
- Mouse Genomics Resource Laboratory, National Institute of Genetics, 1111 Yata, Mishima, Shizuoka 411-8540 [corrected] Japan
| | | | | |
Collapse
|
17
|
Green AL, Pereira EAC, Kelly D, Richards PG, Pike MG. The changing face of paediatric hydrocephalus: a decade's experience. J Clin Neurosci 2007; 14:1049-54. [PMID: 17822902 DOI: 10.1016/j.jocn.2006.11.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2006] [Accepted: 11/25/2006] [Indexed: 10/22/2022]
Abstract
All 253 children receiving neurosurgical intervention for hydrocephalus (HCP) at a single British Neurosurgical Unit over a decade were investigated by retrospective case note review. Referral rates and mean age at presentation remained stable throughout, as did proportions of children presenting due to myelomeningocoele or meningitis. Comparing the first and second halves of the decade, the predominant aetiologies (intraventricular haemorrhage [IVH] at <1 year and brain tumour at 1-16 years) reduced from comprising half (70/129) of all cases to just over one-third (43/124). Other significant changes included a 45% reduction in neonatal IVH and a 179% increase in rare miscellaneous disorders. Outcome after 4 years of follow-up for all patients showed 44.4% without deficit, 11.9% with non-cognitive neurological deficits only, 11.5% with cognitive impairment only, 13.5% with both cognitive and neurological impairments, and 15.5% mortality.
Collapse
Affiliation(s)
- Alexander L Green
- Department of Neurosurgery, The Radcliffe Infirmary, Woodstock Road, Oxford, OX2 6HE, United Kingdom
| | | | | | | | | |
Collapse
|
18
|
Miller JM, McAllister II JP. Reduction of astrogliosis and microgliosis by cerebrospinal fluid shunting in experimental hydrocephalus. Cerebrospinal Fluid Res 2007; 4:5. [PMID: 17555588 PMCID: PMC1899521 DOI: 10.1186/1743-8454-4-5] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2006] [Accepted: 06/07/2007] [Indexed: 11/23/2022] Open
Abstract
Background Reactive gliosis has the potential to alter biomechanical properties of the brain, impede neuronal regeneration and affect plasticity. Determining the onset and progression of reactive astrogliosis and microgliosis due to hydrocephalus is important for designing better clinical treatments. Methods Reactive astrogliosis and microgliosis were evaluated as the severity of hydrocephalus increased with age in hydrocephalic H-Tx rats and control littermates. Previous studies have suggested that gliosis may persist after short-term drainage (shunt treatment) of the cerebrospinal fluid. Therefore shunts were placed in 15d hydrocephalic rats that were sacrificed after 6d (21d of age) or after 21d (36d of age). Tissue was processed for Western blot procedures and immunohistochemistry, and probed for the astrocytic protein, Glial Fibrillary Acidic Protein (GFAP) and for microglial protein, Isolectin B4 (ILB4). Results In the parietal cortex of untreated hydrocephalic animals, GFAP levels increased significantly at 5d and at 12d compared to age-matched control rats. There was a continued increase in GFAP levels over control at 21d and at 36d. Shunting prevented some of the increase in GFAP levels in the parietal cortex. In the occipital cortex of untreated hydrocephalic animals, there was a significant increase over control in levels of GFAP at 5d. This trend continued in the 12d animals, although not significantly. Significant increases in GFAP levels were present in 21d and in 36d animals. Shunting significantly reduced GFAP levels in the 36d shunted group. Quantitative grading of immuno-stained sections showed similar changes in GFAP stained astrocytes. Immuno-stained microglia were altered in shape in hydrocephalic animals. At 5d and 12d, they appeared to be developmentally delayed with a lack of processes. Older 21d and 36d hydrocephalic animals exhibited the characteristics of activated microglia, with thicker processes and enlarged cell bodies. Following shunting, fewer activated microglia were present. Histologic examination of the periventricular area and the periaqueductal area showed similar findings with the 21d and 36d animals having increased populations of both astrocytes and microglia which were reduced following shunting with a more dramatic reduction in the long term shunted animals. Conclusion Overall, these results suggest that reactive astrocytosis and microgliosis are associated with progressive untreated ventriculomegaly, but that shunt treatment can reduce the gliosis occurring with hydrocephalus.
Collapse
Affiliation(s)
- Janet M Miller
- Department of Neurosurgery, Wayne State University, Detroit, Michigan, USA
- Department of Physiology, Wayne State University, Detroit, Michigan, USA
- Department of Pediatric Neurosurgery, Children's Hospital of Michigan, Detroit, Michigan USA
| | - James P McAllister II
- Department of Neurosurgery, Wayne State University, Detroit, Michigan, USA
- Department of Physiology, Wayne State University, Detroit, Michigan, USA
- Department of Anatomy and Cell Biology, Wayne State University, Detroit Michigan, USA
- Department of Pediatric Neurosurgery, Children's Hospital of Michigan, Detroit, Michigan USA
| |
Collapse
|
19
|
Boros CA, Spence D, Blaser S, Silverman ED. Hydrocephalus and macrocephaly: new manifestations of neonatal lupus erythematosus. ACTA ACUST UNITED AC 2007; 57:261-6. [PMID: 17330304 DOI: 10.1002/art.22543] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Neurologic involvement has been reported to occur in infants with neonatal lupus erythematosus (NLE), although the significance of these findings is unknown. The purpose of this study was to determine if hydrocephalus/macrocephaly is a manifestation of NLE. METHODS Infants from the Hospital for Sick Children in Toronto, Canada whose mothers had anti-Ro antibodies were followed prospectively. A total of 87 infants were seen in the study period (1999-2004). The maternal autoantibody status of all infants was documented, and all infants underwent full clinical examination at each visit. RESULTS Of the 87 infants, 47 had NLE. Five of the 47 infants with NLE and 2 of the healthy infants had hydrocephalus, resulting in a prevalence of 8.0% (95% confidence interval 4.0-15.0%) in the entire cohort. This is significantly higher than the prevalence in the general population of 0.048-0.081%. Head circumference measurements of infants in the Toronto cohort were largest between 12-24 months of age (Z score difference = 0.71, P = 0.008). CONCLUSION We suggest that hydrocephalus and macrocephaly are manifestations of NLE and that infants born to mothers with anti-Ro antibodies should be carefully monitored for hydrocephalus as part of their routine physical examination.
Collapse
Affiliation(s)
- Christina A Boros
- University of Adelaide, Department of Paediatrics, Women's and Children's Hospital, North Adelaide, Australia.
| | | | | | | |
Collapse
|
20
|
Miller JM, Kumar R, McAllister JP, Krause GS. Gene expression analysis of the development of congenital hydrocephalus in the H-Tx rat. Brain Res 2006; 1075:36-47. [PMID: 16469303 DOI: 10.1016/j.brainres.2005.12.094] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2005] [Revised: 12/23/2005] [Accepted: 12/25/2005] [Indexed: 01/13/2023]
Abstract
To discover candidate genes in the pathogenesis of congenital hydrocephalus, gene arrays were utilized to analyze transcripts from the midbrain region of 5-day-old H-Tx rats; these animals develop hydrocephalus due to closure of their cerebral aqueduct between embryonic day 18 and post-natal day 5. Of the 15,924 transcripts assayed, we detected 47 differentially expressed transcripts representing 23 genes and 24 expressed sequence tags (ESTs); 17 transcripts (7 genes and 10 ESTs) were upregulated and 30 (16 genes and 14 ESTs) were downregulated in the hydrocephalic animals relative to control non-hydrocephalic animals. Seven of these genes, Cck, Nfix, Lgals3, Gsta1, Xdh, Tnf, and Tfpi-2, can be linked to hydrocephalus. In addition, 17 genes that displayed altered expression in our study are not currently known to be associated with the presence or development of hydrocephalus. These results indicate that a relatively few number of transcripts were found to be altered in the development of hydrocephalus in this model. This is the first experiment of its kind to identify changes in gene expression in a congenital model of rodent hydrocephalus that are occurring locally in the area surrounding the cerebral aqueduct. Studies are now needed to examine these candidate genes and their cognate proteins to delineate their role in hydrocephalus.
Collapse
Affiliation(s)
- Janet M Miller
- Department of Neurosurgery, Wayne State University School of Medicine, MI 48201, USA.
| | | | | | | |
Collapse
|
21
|
Affiliation(s)
- P Chumas
- Departments of Neurosurgery and Paediatric Neurology, Division of Paediatric Neurosciences Leeds General Infirmary, Leeds LS1 3EX, UK
| | | | | |
Collapse
|
22
|
Verhagen WI, Bartels RH, Fransen E, van Camp G, Renier WO, Grotenhuis JA. Familial congenital hydrocephalus and aqueduct stenosis with probably autosomal dominant inheritance and variable expression. J Neurol Sci 1998; 158:101-5. [PMID: 9667786 DOI: 10.1016/s0022-510x(98)00097-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
A kindred is reported on with suspected autosomal dominant congenital hydrocephalus and aqueduct stenosis. In contrast to patients with X-linked congenital hydrocephalus with stenosis of the aqueduct of Sylvius (HSAS) our patients were not mentally retarded and they did not show any pyramidal tract dysfunction or clasped thumbs; the pyramids were not affected either, as was confirmed by autopsy, CT or MRI. Molecular genetic studies in our patients have not revealed abnormalities of eight exons of the L1 neural adhesion molecule gene that is related to HSAS.
Collapse
Affiliation(s)
- W I Verhagen
- Department of Neurology, Canisius Wilhelmina Hospital, Nijmegen, Netherlands
| | | | | | | | | | | |
Collapse
|
23
|
|