• Journal of Korean Neurosurgical Society
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• v.29 no.5
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• pp.609-614
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• 2000

Objective : A retrograde clinical study was undertaken to determine the effect of opening lamina terminalis on the development of hydrocephalus after aneurysmal subarachnoid hemorrhage(SAH). We compared the incidence ratios of the development of hydrocephalus with and without opening lamina terminalis during operation after aneurysmal SAH. Patients and Methods : From Oct. 1996 to Sep. 1998, we performed 138 aneurysm surgery for 122 patients. In 98 cases, the lamina terminalis was opened to make direct cerebrospinal fluid flow from the third ventricle to subarachnoid space for prevention of delayed hydrocephalus. We compared the incidence of hydrocephalus after opening lamina terminalis to those without opened lamina terminalis. Results : In 95 cases, the hydrocephalus was noticed in 2 cases(2.2%). It is significantly lower in the group with opening lamina terminalis than the group without opening lamina terminalis(about 10%). Conclusion : It is simple and easy procedure to open the lamina terminalis during aneurysm surgery. With this maneuver, we could reduce the incidence of hydrocephalus after aneurysmal spontaneous SAH. Thus, it is considered that the opening lamina terminalis is one of the effective methods for preventing the development of hydrocephalus after aneurysmal spontaneous SAH.

• Korean Journal of Radiology
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• v.22 no.3
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• pp.435-441
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• 2021

Objective: To evaluate the usefulness of the ventricular volume percentage quantified using three-dimensional (3D) brain computed tomography (CT) data for interpreting serial changes in hydrocephalus. Materials and Methods: Intracranial and ventricular volumes were quantified using the semiautomatic 3D threshold-based segmentation approach for 113 brain CT examinations (age at brain CT examination ≤ 18 years) in 38 patients with hydrocephalus. Changes in ventricular volume percentage were calculated using 75 serial brain CT pairs (time interval 173.6 ± 234.9 days) and compared with the conventional assessment of changes in hydrocephalus (increased, unchanged, or decreased). A cut-off value for the diagnosis of no change in hydrocephalus was calculated using receiver operating characteristic curve analysis. The reproducibility of the volumetric measurements was assessed using the intraclass correlation coefficient on a subset of 20 brain CT examinations. Results: Mean intracranial volume, ventricular volume, and ventricular volume percentage were 1284.6 ± 297.1 cm³, 249.0 ± 150.8 cm³, and 19.9 ± 12.8%, respectively. The volumetric measurements were highly reproducible (intraclass correlation coefficient = 1.0). Serial changes (0.8 ± 0.6%) in ventricular volume percentage in the unchanged group (n = 28) were significantly smaller than those in the increased and decreased groups (6.8 ± 4.3% and 5.6 ± 4.2%, respectively; p = 0.001 and p < 0.001, respectively; n = 11 and n = 36, respectively). The ventricular volume percentage was an excellent parameter for evaluating the degree of hydrocephalus (area under the receiver operating characteristic curve = 0.975; 95% confidence interval, 0.948-1.000; p < 0.001). With a cut-off value of 2.4%, the diagnosis of unchanged hydrocephalus could be made with 83.0% sensitivity and 100.0% specificity. Conclusion: The ventricular volume percentage quantified using 3D brain CT data is useful for interpreting serial changes in hydrocephalus.

• Journal of Korean Neurosurgical Society
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• v.47 no.3
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• pp.191-198
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• 2010

Objective : This study is planned to determine the neurocognitive difficulties of hydrocephalic adults. Methods : The research group contained healthy adults (control group, n : 15), and hydrocephalic adults (n : 15). Hydrocephalic group consisted of patients with idiopathic aquaduct stenosis and post-meningitis hydrocephalus. All patients were followed with shunted hydrocephalus and not gone to shunt revision during last two years. They were chosen from either asymptomatic or had only minor symptoms without motor and sensorineural deficit. A neuropsychological test battery (Raven Standart Progressive Matrices, Bender-Gestalt Test, Cancellation Test, Clock Drawing Test, Facial Recognition Test, Line Orientation Test, Serial Digit Learning Test, Stroop Color Word Interference Test-TBAG Form, Verbal Fluency Test, Verbal Fluency Test, Visual-Aural Digit Span Test-B) was applied to all groups. Results : Neuropsychological assessment of hydrocephalic patients demonstrated that they had poor performance on visual, semantic and working memory, visuoconstructive and frontal functions, reading, attention, motor coordination and executive function of parietal lobe which related with complex and perseverative behaviour. Eventually, these patients had significant impairment on the neurocognitive functions of their frontal, parietal and temporal lobes. On the other hand, the statistical analyses performed on demographic data showed that the aetiology of the hydrocephalus, age, sex and localization of the shunt (frontal or posterior parietal) did not affect the test results. Conclusion : This prospective study showed that adult patients with hydrocephalus have serious neuropsychological problems which might be directly caused by the hydrocephalus; and these problems may cause serious adaptive difficulties in their social, cultural, behavioral and academic life.

• Journal of Korean Neurosurgical Society
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• v.65 no.1
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• pp.151-160
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• 2022

Continuous monitoring of intracranial pressure is a well established medical procedure. Still, little is known about long-term behavior of intracranial pressure in normal pressure hydrocephalus. The present study is designed to evaluate periodicity of intracranial pressure over long-time scales using intraventricular pressure monitoring in patients with normal pressure hydrocephalus. In addition, the circadian and diurnal patterns of blood pressure and body temperature in those patients are studied. Four patients, selected with "probable" normal pressure hydrocephalus, were monitored for several dozen hours. Intracranial pressure, blood pressure, and body temperature were recorded hourly. Autocorrelation functions were calculated and cross-correlation analysis were carried out to study all the time-series data. Autocorrelation results show that intracranial pressure, blood pressure, and body temperature values follow bimodal (positive and negative) curves over a day. The cross-correlation functions demonstrate causal relationships between intracranial pressure, blood pressure, and body temperature. The results show that long-term fluctuations in intracranial pressure exhibit cyclical patterns with periods of about 24 hours. Continuous intracranial pressure recording in "probable" normal pressure hydrocephalus patients reveals circadian fluctuations not related to the day and night cycle. These fluctuations are causally related to changes in blood pressure and body temperature. The present study reveals the complete loss of the diurnal blood pressure and body temperature rhythmicities in patients with "probable" normal pressure hydrocephalus.

• 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.

• Journal of Korean Neurosurgical Society
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• v.40 no.3
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• pp.193-195
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• 2006

Hydrocephalus is usually defined as the condition of ventricular dilatation due to the overproduction of cerebrospinal fluid[CSF] or dysfunction of absorption. The pattern of the CSF circulation may change after a cranioplasty secondary to previous decompressive craniectomy for refractory intracranial hypertension after head injury. The effect of the cranioplasty on CSF hydrodynamics has not been explored exactly. We report two cases of acute hydrocephalus developed after cranioplasty and discuss about the clinical importance with review of literatures.

• Journal of Korean Neurosurgical Society
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• v.66 no.3
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• pp.263-273
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• 2023

While the survival rate of preterm infants has increased dramatically over the last few decades, intraventricular hemorrhage and subsequent hydrocephalus remain major unsolved problems in neonatal intensive care. Once intraventricular hemorrhage occurs, severe neurological sequelae are inevitable. Treatment of this complicated pathology and achievement of favorable neurofunctional outcomes in fragile infants are crucial challenges for pediatric neurosurgeons. Fibrinolytic therapy, which chemically dissolves hematoma, is a promising and useful treatment method. In this paper, the historical background of fibrinolytic therapy for post-intraventricular hemorrhagic hydrocephalus in preterm infants is reviewed and a recent method of fibrinolytic therapy using urokinase is introduced.

• Journal of Korean Neurosurgical Society
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• v.49 no.4
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• pp.217-221
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• 2011

Objective : This paper presents data from a retrospective study of endoscopic third ventriculostomy (ETV) in patients with shunt malfunction and proposes a simple and reasonable post-operative protocol that can detect ETV failure. Methods : We enrolled 19 consecutive hydrocephalus patients (11 male and 8 female) who were treated with ETV between April 2001 and July 2010 after failure of previously placed shunts. We evaluated for correlations between the success rate of ETV and the following parameters : age at the time of surgery, etiology of hydrocephalus, number of shunt revisions, interval between the initial diagnosis of hydrocephalus or the last shunt placement and ETV, and the indwelling time of external ventricular drainage. Results : At the time of ETV after shunt failure, 14 of the 19 patients were in the pediatric age group and 5 were adults, with ages ranging from 14 months to 42 years (median age, 12 years). The patients had initially been diagnosed with hydrocephalus between the ages of 1 month 24 days and 32 years (median age, 6 years 3 months). The etiology of hydrocephalus was neoplasm in 7 patients; infection in 5; malformation, such as aqueductal stenosis or megacisterna magna in 3; trauma in 1; and unknown in 3. The overall success rate during the median follow-up duration of 1.4 years (9 days to 8.7 years) after secondary ETV was 68.4%. None of the possible contributing factors for successful ETV, including age (p=0.97) and the etiology of hydrocephalus (p=0.79), were statistically correlated with outcomes in our series. Conclusion: The use of ETV in patients with shunt malfunction resulted in shunt independence in 68.4% of cases. Age, etiology of hydrocephalus, and other contributing factors were not statistically correlated with ETV success. External ventricular drainage management during the immediate post-ETV period is a good means of detecting ETV failure.

• Journal of Korean Neurosurgical Society
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• v.48 no.6
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• pp.480-484
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• 2010

Objective : To evaluate the role of lumbar drainage in the prevention of shunt-dependent hydrocephalus after treatment of ruptured intracranial aneurysms by coil embolization in good-grade patients. Methods : One-hundred-thirty consecutive patients with aneurysmal subarachnoid hemorrhage in good-grade patients (Hunt & Hess grades I-III), who were treated by coil embolization between August 2004 and April 2010 were retrospectively evaluated. Poor-grade patients (Hunt & Hess grades IV and V), a history of head trauma preceding the development of headache, negative angiograms, primary subarachnoid hemorrhage (SAH), and loss to follow-up were excluded from the study. We assessed the effects on lumbar drainage on the risk of shunt-dependent hydrocephalus related to coil embolization in patients with ruptured intracranial aneurysms. Results : One-hundred-twenty-six patients (96.9%) did not develop shunt-dependent hydrocephalus. The 2 patients (1.5%) who developed acute hydrocephalus treated with temporary external ventricular drainage did not require permanent shunt diversion. Overall, 4 patients (3.1%) required permanent shunt diversion; acute hydrocephalus developed in 2 patients (50%). There was no morbidity or mortality amongst the patients who underwent a permanent shunt procedure. Conclusion : Coil embolization of ruptured intracranial aneurysms may be associated with a lower risk for developing shunt-dependent hydrocephalus, possibly by active management of lumbar drainage, which may reflect less damage for cisternal anatomy than surgical clipping. Coil embolization might have an effect the long-term outcome and decision-making for ruptured intracranial aneurysms.

• 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.