Can the Treatment of Normal-Pressure Hydrocephalus Induce Normal-Tension Glaucoma? A Narrative Review of a Current Knowledge

Ventriculoperitoneal shunt placement is the most commonly used treatment of normal-pressure hydrocephalus (NPH). It has been hypothesized that normal-tension glaucoma (NTG) is caused by the treatment of NPH by using the shunt to reduce intracranial pressure (ICP). The aim of this study is to review the literature published regarding this hypothesis and to emphasize the need for neuro-ophthalmic follow-up for the concerned patients. The source literature was selected from the results of an online PubMed search, using the keywords “hydrocephalus glaucoma” and “normal-tension glaucoma shunt”. One prospective study on adults, one prospective study on children, two retrospective studies on adults and children, two case reports, three review papers including medical hypotheses, and one prospective study on monkeys were identified. Hypothesis about the association between the treatment of NPH using the shunt to reduce ICP and the development of NTG were supported in all reviewed papers. This suggests that a safe lower limit of ICP for neurological patients, especially shunt-treated NPH patients, should be kept. Thus, we proposed to modify the paradigm of safe upper ICP threshold recommended in neurosurgery and neurology into the paradigm of safe ICP corridor applicable in neurology and ophthalmology, especially for shunt-treated hydrocephalic and glaucoma patients.

Accuracy of cranial ultrasound in the diagnosis of hydrocephalus in children under 6 months of age keeping CT scan as a gold standard

Background: CT and MRI modalities are considered a gold standard for the diagnosis of hydrocephalus. The more readily available and cheap options like sonography are being sought out for the diagnosis of this entity. Objectives: To determine the accuracy of cranial ultrasonography in the diagnosis of hydrocephalus keeping CT scan as a gold standard. Study design: Cross-sectional study Place and duration of study: Department of Pediatrics, Combined Military Hospital, Rawalpindi, from 01-01-2017 to 30-06-2017 Materials and Methods: A total of 121 children with a clinical diagnosis of hydrocephalus were selected and subjected to ultrasound of the head. Subsequently, a CT scan of the head was done and both modalities were compared. The diagnostic accuracy of the ultrasound was determined to keep CT findings as to the gold standard. Results: The mean age was 51.36 ± 34.01 days. The male gender was dominant as 81 (66.9%) patients were males. Ultrasonography of the head detected 93 (76.9%) patients with hydrocephalus while CT scan detected 90 (74.4%). Sensitivity, specificity, PPV, NPV and accuracy of USG to diagnosed hydrocephalus were 88.9%, 58.1%, 86.0%, 64.3% and 80.99% respectively Conclusion: Ultrasonography of head is a valuable screening tool for the diagnosis of hydrocephalus. Keywords: Hydrocephalus, Tomography, X-Ray Computed, Ultrasonography

Dekompensuota arezorbcinė hidrocefalija po aneurizminės subarachnoidinės hemoragijos

Gytis Šustickas, Saulius Širšinaitis, Gunaras TerbetasVilniaus greitosios pagalbos universitetinės ligoninės Neurochirurgijos skyriusVilniaus universiteto Neurologijos ir neurochirurgijos klinika Įvadas / tikslas Straipsnyje aprašomos hidrocefalijos priežastys, raidos stadijos, klinikiniai ir rentgeniniai diagnostikos metodai, gydymo būdai ir rezultatai. Analizuojami aneurizminės subarachnoidinės hemoragijos prognoziniai veiksniai, turintys didžiausią įtaką lėtinės arezorbcinės dekompensuotos hidrocefalijos raidai. Apžvelgiama likvoro cirkuliacijos patologinė anatomija ir patologinė fiziologija. Ligoniai ir metodai Vilniaus greitosios pagalbos universitetinės ligoninės (VGPUL) Neurochirurgijos skyriuje 2000–2002 metais atliktos 7 (10,6 %) ventrikuloperitoneostomijos (VPS) operacijos nuo lėtinės dekompensuotos hidrocefalijos, kurios priežastis buvo likvoro rezorbcijos sutrikimas plyšus intrakranijinei aneurizmai (IAn) ir po aneurizminės subarachnoidinės hemoragijos (AnSAH). Nė vienam ligoniui nereikėjo jungties operacijos, esant nežinomos kilmės subarachnoidinei hemoragijai (SAH). Iš viso stebėti 66 ligoniai, hospitalizuoti dėl plyšusios IAn ir išgyvenę daugiau kaip 6 mėnesius po aneurizmos klipsavimo operacijos. Rezultatai Laiku atliktas hidrocefalijos gydymas jungties operacija buvo veiksmingas 6 iš 7 ligonių (85,7 %). Išvados Lėtinė arezorbcinė dekompensuota hidrocefalija nustatyta 10,6 % ligonių, operuotų nuo plyšusių IAn, ir turi būti gydoma chirurgiškai, praėjus 1–2 mėnesiams po AnSAH. Būdingiausia aneurizmos lokalizacija, nustačius dekompensuotą arezorbcinę hidrocefaliją, – a. communicans anterior ir a.communicans posterior. Intrakranijinio kraujo kiekis plyšus aneurizmai yra blogas prognozinis veiksnys (vertinta pagal Fisherio skalę). Prasminiai žodžiai: hidrocefalija, intrakranijinė aneurizma, subarachnoidinė hemoragija, insultas, likvoro cirkuliacija, prognoziniai veiksniai. Aresorbtive hydrocephalus after aneurysmal subarachnoid hemorrhage Gytis Šustickas, Saulius Širšinaitis, Gunaras Terbetas Background / objective The origin, terms of hydrocephalus development, methods of treatment and results are reviewed. Methods Sixty-six consecutive patients, operated on for ruptured intracranial aneurysm (IAn) and surviving within 6 months were included into the study. Seven ventriculoperitoneostomies due to aresorbtive hydrocephalus after 66 aneurysmal subarachnoid hemorrhage (AnSAH) cases were performed in the Department of Neurosurgery, Vilnius University Emergency Hospital (2000–2002). The follow up period after AnSAH was 1 year. All cases of aresorbtive hydrocephalus were determined within 2 months after AnSAH. Results Surgical treatment of aresorbtive hydrocephalus was effective in 6 patients out of 7 (85.7%). Conclusions Our results suggest a significant role of predictive signs on initial computer tomography, location of IAn and patient’s age in the development of aresorbtive hydrocephalus. Keywords: hydrocephalus, intracranial aneurysm, subarachnoid hemorrhage, stroke, cerebrospinal fluid, predictive signs.