Prenatal aqueductal stenosis as a cause of congenital hydrocephalus in the inbred rat LEW/Jms.

We studied the microscopic morphological changes in congenital hydrocephalus in the inbred rat, LEW/Jms, on gestational days 17, 18, and 20 and during the neonatal period to clarify the etiopathogenesis, focusing particularly on the aqueductal changes. At 1 day of age, ventriculomegaly was limited to the lateral and III ventricles, and the aqueduct was obstructed, with the appearance of simple stenosis. On gestational days 20 and 18, the hydrocephalic rats showed occluded aqueducts, which paralleled the finding of hydrocephalus in the newborn rats. On gestational day 17, all eight models examined showed the same size ventricles. However, an aqueductal obstruction was observed in one of them. The other seven rats showed the aqueduct patent. From these observations, it can be concluded that the rat shows an aqueductal obstruction on gestational day 17 and appears to develop hydrocephalus with age. The aqueductal obstruction was considered to be the primary change and not a secondary phenomenon. The site of obstruction was the anterior part of the aqueduct (level of anterior colliculus) at every stage. Aqueductal obstruction following the developmental anomaly of the midbrain in the embryonic stage might thus be the primary cause of congenital hydrocephalus in rats LEW/Jms.

Radical cranio-orbital reconstructive procedures for cloverleaf skull deformity in adult: operative technique for the longest survivor--case report.

Cosmetic cranio-orbital reconstructive surgery was carried out on a 22-year-old male, the longest surviving case of cloverleaf skull syndrome reported. He previously underwent classical linear suturectomy for synostotic sutures and temporal cranioplasty. Fortunately, hydrocephalus became arrested so did not require continuous cerebrospinal fluid drainage through shunt tube. His intelligence quotient was in the 40s. The present problem was mainly of cosmetic cranio-orbital corrections of shallow orbits with resultant exophthalmos, frontal dysgenesis, and marked temporal bossings. Bilateral orbital advance, lateral canthal/pterional reshaping, frontal remodeling, and temporal reduction cranioplasty were performed. The postoperative outcome was satisfactory. The cloverleaf skull deformity is etiologically and pathologically heterogeneous, so radical surgical reconstructive procedures should be planned and designed individually.

Factors affecting prognosis of intrauterine hydrocephalus diagnosed in the third trimester--computerized data analysis on controversies in fetal surgery.

Twenty hydrocephalic patients diagnosed in the third trimester of fetal life were evaluated and followed during a 7-year period. The factors affecting the prognosis, including the type of hydrocephalus, underlying conditions, associated anomalies, time of diagnosis and delivery, fetal period after diagnosis, head circumference and degree of ventriculomegaly at birth, and age at treatment, were comprehensively analyzed. The difference between final outcomes as assessed by developmental quotient (DQ) or intelligence quotient (IQ) were statistically tested with computation by means of STAX packages in an NEC 9801 VX. Hydrocephalus as an isolated defect occurred in six cases (30%), was associated with other central nervous system anomalies in nine (45%), and was secondary to intrauterine intraventricular hemorrhage or brain tumor in five (25%). The average age at the time of diagnosis was 33.9 weeks of gestation (range, 27-40 weeks). One fetus was treated by transabdominal cephalocentesis, but the majority of patients underwent ventriculoperitoneal shunt postnatally. The final IQ or DQ scores ranged from 20 to 120 (mean score, 50.6). The data analyses revealed that the only significant factor affecting outcome was the fetal period after diagnosis of hydrocephalus (r = -0.5076, p less than 0.01). Our data supports the fact that the results of an on-going hydrocephalic state may become irreversible during fetal life. It is emphasized that establishment of a more precise pathophysiological evaluation, and a less invasive but more reliable decompressive technique for fetal hydrocephalus, is urgent.

Fatal intracranial hemorrhage after balloon occlusion of an extracranial vertebral arteriovenous fistula. Case report.

A patient is presented who developed a fatal hemorrhage immediately after balloon occlusion of an extracranial vertebral arteriovenous fistula. The fistula was associated with marked retrograde flow not only from the contralateral vertebral artery but also from the carotid artery system through the posterior communicating artery and the basilar artery. The bleeding appeared to be caused by acute hemodynamic effects following abrupt occlusion of the long-standing fistula. A gradual staged occlusion or trapping procedure should be considered for the treatment of such vertebral arteriovenous fistulae.

Intragastric migration of a ventriculoperitoneal shunt catheter.

A child developed bacterial meningitis and shunt dysfunction 2 years after the insertion of a ventriculoperitoneal shunt for posttraumatic hydrocephalus. The distal end of the shunt catheter had penetrated the gastric wall. We found no other report of intragastric shunt catheter migration with successful treatment.