RESUMO
BACKGROUND: An important feature of hydrocephalus is the alteration of the cerebral spinal fluid (CSF) homeostasis. New insights in the understanding of production, secretion, and absorption of CSF, along with the discovery of the glymphatic system (GS), can be useful for a better understanding and treatment of hydrocephalus in disorders with CSF overproduction. CASE DESCRIPTION: A 1-year-old patient was diagnosed with communicating hydrocephalus; ventricle peritoneal shunt (VPS) is installed and ascites developed. VPS is exposed, yielding volumes of 1000-1200ml/day CSF per day. MRI is performed showing generalized choroidal plexus hyperplasia. Bilateral endoscopic coagulation of thechoroid plexus was performed in 2 stages (CPC) however the high rate of CSF production persisted, needing a bilateral plexectomy through septostomy, which finally decreased the CSF outflow. DISCUSSION: New knowledge about the CSF physiology will help to propose better treatment depending on the cause of the hydrocephalus. The GS is becoming an additional reason to better study and develop new therapies focused of the modulation of alternative CSF reabsorption. CONCLUSION: Despite the current knowledge about hydrocephalus, we remain without a complete understanding of the pathophysiology of this condition. GS could be more important than conventional concept of reabsorption of CSF in the arachnoid villi, therefore GS could be a new key point, which will guide future investigations.
Assuntos
Sistema Glinfático , Hidrocefalia , Ventrículos Cerebrais , Plexo Corióideo/diagnóstico por imagem , Plexo Corióideo/patologia , Plexo Corióideo/cirurgia , Humanos , Hidrocefalia/diagnóstico por imagem , Hidrocefalia/patologia , Hidrocefalia/cirurgia , Hiperplasia/patologia , LactenteRESUMO
La coagulación de plexo coroideo (CPC) es un procedimiento que nace del intento histórico de tratar la hidrocefalia. Desarrollado en la primera mitad del siglo XX, pero posteriormente abandonado por su baja tasa de éxito y alta tasa de complicaciones. Con el advenimiento de la neuroendoscopía moderna se adapta la idea de la CPC en un intento de dar cabida a alternativas a la derivación de líquido cefalorraquídeo (LCR) como procedimiento estándar para tratar la hidrocefalia. Actualmente su uso se ha difundido mayormente en conjunto con la tercer ventriculostomía endoscópica como una opción eï¬caz, más barata y exenta de los riesgos inherentes de una derivación de LCR. No obstante, se ha reportado su éxito como procedimiento aislado en casos seleccionados como en hidrocefalia comunicante lentamente progresiva, hidranencefalia y un posible rol en el tratamiento de la hiperplasia de plexo coroideo. El objetivo de esta revisión es determinar la efectividad de la CPC aislada como tratamiento para la hidrocefalia en diversos escenarios clínicos e identiï¬car las variables asociadas a su éxito.
Choroid plexus coagulation (CPC) is a procedure born of historic attempts to treat hydrocephalus. Developed in the ï¬rst half of the 20th century, it was later abandoned because of its low success rate and high rate of complications. With the advent of modern neuro-endoscopy the CPC was adapted in an attempt to open the way for alternatives to CSF shunt as the standard procedure for treating hydrocephalus. Its use has spread mainly in conjunction with endoscopic third ventriculostomy as an option which is eï¬ective, cheaper and without the risks inherent in a CSF shunt. However, there have been reports of its success as an isolated procedure in selected cases such as chronic progressive communicating hydrocephalus, hydranencephaly and it has a possible role in the treatment of choroid plexus hyperplasia. The objective of this review is to determine the eï¬ectiveness of isolated CPC as treatment for hydrocephalus in various clinical setti ngs and identify the variables associated with its success.
RESUMO
A 2-day-old Mangalarga Marchador colt was presented with clinical signs of severe mental depression, unable to stand, and lacking a suckling reflex. Despite intensive medical care, there was no improvement and the colt died 30 hours later. Gross lesions were characterized by aplasia of the cerebellar vermis, cystic dilatation of the fourth ventricle, communicant hydrocephalus involving all ventricles and villous hyperplasia of the choroid plexus in the fourth ventricle. The cerebral parenchyma adjacent to lateral ventricles was markedly reduced. In addition, there was aspiration pneumonia. Aplasia of the cerebellar vermis and cystic dilatation of the fourth ventricle could be compared to the Dandy-Walker-syndrome (DWS). Nevertheless, congenital cerebellar anomalies combined with villous hyperplasia of the choroid plexus in the fourth ventricle and hydrocephalus are describing for the first time in animals, alerting clinicians and pathologists for future investigations about the incidence and etiology of the condition.
Assuntos
Animais , Cavalos , Displasia Ectodérmica/veterinária , Hidrocefalia/veterinária , Plexo Corióideo , Vermis Cerebelar/patologia , Animais Recém-NascidosRESUMO
A 2-day-old Mangalarga Marchador colt was presented with clinical signs of severe mental depression, unable to stand, and lacking a suckling reflex. Despite intensive medical care, there was no improvement and the colt died 30 hours later. Gross lesions were characterized by aplasia of the cerebellar vermis, cystic dilatation of the fourth ventricle, communicant hydrocephalus involving all ventricles and villous hyperplasia of the choroid plexus in the fourth ventricle. The cerebral parenchyma adjacent to lateral ventricles was markedly reduced. In addition, there was aspiration pneumonia. Aplasia of the cerebellar vermis and cystic dilatation of the fourth ventricle could be compared to the Dandy-Walker-syndrome (DWS). Nevertheless, congenital cerebellar anomalies combined with villous hyperplasia of the choroid plexus in the fourth ventricle and hydrocephalus are describing for the first time in animals, alerting clinicians and pathologists for future investigations about the incidence and etiology of the condition.(AU)