Open Access Medical Books



Edited by Sadip Pant and Iype Cherian .

Open Access .
226 pages .

A child with a large head and a sick malnourished body was the epitome of poverty from the older days… But, the large head started getting noticed in children from well to do families as well. And then as the studies on Hydrocephalus progressed, simple ways of shunting the fluid away from the ventricles to any other cavity like the atrium, pleural cavity and peritoneal cavity evolved after considerable attempts to destroy the choroid plexus, but did not bear as much fruits.
The reasons for hydrocephalus (of course, the ones other than abject poverty) were looked into and the disease was classified to be either obstructive or non-obstructive (also termed communicative, a misnomer actually)… and then the logical ways of dealing with each appeared.
The shunt was a panacea for both, but then Endoscopy came along. The third ventriculostomy literally changed the scene with no implants, and thus abolishing the most feared complication of all, shunt infections. Posterior third ventriculostomy, septostomy, stents across the aqueduct of sylvius and so on and so forth were treatments aimed at getting around the obstruction. And they proved to be successful as well, to an extent.
As is the usual cycle, time revealed the limitations of endoscopy. The shunts evolved into modern gadgets with programmability… and the evolution continues. Lamina Terminalis was recognized as the anterior boundary of the third ventricle and fenestration of this thin membrane was thought to be helpful in resolution of hydrocephalus with subarachnoid hemorrhage. This was applied in very few cases in our center where Endoscopic third ventriculostomy could not be done due to a very thick and opalescent third ventricular floor. We did fenestration of Lamina terminalis through an eyebrow incision and a keyhole approach. We do think that in cases where an ETV is difficult or risky and the type of hydrocephalus is obstructive, this is something which could be an alternative to a shunt. Of course more work needs to be done to assess the feasibility.
However few things which were not considered earlier like the compliance of the brain and the fragile balance of the CSF system were studied later on and treatments started taking these factors into account as well. So evolved treatments for communicating hydrocephalus and normal pressure hydrocephalus where the compliance of the brain is important.
In the present scenario, surgeons have a lot to choose from. However, before doing anything it goes without saying that the surgeon weighs his options and goes ahead with the treatment, based on the familiarity and efficacy of a particular way of treating the hydrocephalus. After all, no surgeon would want a mismanaged case of hydrocephalus on his hands.

Dr. Sadip Pant
University of Arkansas for Medical Sciences, AR,
Dr. Iype Cherian
College of Medical Sciences, Bharatpur,


 1 Hydrocephalus: An Overview 1 Milani Sivagnanam and Neilank K. Jha

 2 Intraventricular Cerebrovascular Pathologies of Hydrocephalus and Managements 19 Ahmet Metin Şanlı, Hayri Kertmen and Bora Gürer

 3 Clinical Presentation of Hydrocephalus 43 Sadip Pant and Iype Cherian

 4 Interpretation of Cerebrospinal Fluid Parameters in Children with Hydrocephalus 57 Daniel Fulkerson

 5 Management of Hydrocephalus 69 Parvaneh Karimzadeh

 6 Complications Associated with Surgical Treatment of Hydrocephalus 75 Takeshi Satow, Masaaki Saiki and Takayuki Kikuchi

 7 External Ventricular Drain Infections 87 Anderson C.O. Tsang and Gilberto K.K. Leung

 8 Role of Endoscopy in Management of Hydrocephalus 99 Nasser M. F. El-Ghandour

 9 Transcranial Doppler Ultrasonography in the Management of Neonatal Hydrocephalus 131 Branislav Kolarovszki and Mirko Zibolen

 10 Novel Method for Controlling Cerebrospinal Fluid Flow and Intracranial Pressure by Use of a Tandem Shunt-Valve System 153 Yasuo Aihara

 11 Complex Hydrocephalus 167 Nasser M. F. El-Ghandour

 12 Recognition of Posture and Gait Disturbances in Patients with Normal Pressure Hydrocephalus Using a Posturography and Computer Dynography Systems 189 L. Czerwosz, E. Szczepek, B. Sokołowska, J. Jurkiewicz and Z. Czernicki

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Published by: younes younes - Tuesday, May 28, 2013


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