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Hydrocephalus and Chiari type I malformation

Concezio Di Rocco1, Paolo Frassanito, Luca Massimi

  • 1Pediatric Neurosurgery, Catholic University Medical School, Policlinic A. Gemelli, Largo Agostino Gemelli, 8, 00168 Rome, Italy.

Child'S Nervous System : Chns : Official Journal of the International Society for Pediatric Neurosurgery
|September 20, 2011
PubMed

Insights

Hydrocephalus and Chiari type I malformation (CIM) association has complex causes. Understanding these diverse pathogenetic mechanisms is key to effective treatment strategies for CIM and hydrocephalus.

Area of Science:

  • Neuroscience
  • Neurosurgery
  • Pediatric Neurology

Background:

  • The association between hydrocephalus and Chiari type I malformation (CIM) is long-recognized.
  • The underlying pathogenetic mechanisms linking these two conditions remain complex and debated.

Purpose of the Study:

  • To explore the heterogeneous pathogenetic mechanisms underlying the association of hydrocephalus and Chiari type I malformation.
  • To discuss the implications of these mechanisms for therapeutic approaches.

Main Methods:

  • Review of clinical and radiological data from patients with complex craniosynostosis.
  • Analysis of pathogenetic hypotheses including supratentorial pressure and cephalo-cranial disproportion.
  • Consideration of jugular foramen stenosis and venous hypertension.

Main Results:

  • Multiple pathogenetic pathways may lead to the radiological association of ventricular enlargement and hindbrain herniation.
  • Supratentorial hypertensive hydrocephalus can exert pressure causing CIM.
  • Cephalo-cranial disproportion in complex craniosynostosis can lead to secondary hydrocephalus and CIM.

Conclusions:

  • The diverse etiologies of hydrocephalus and CIM necessitate tailored therapeutic strategies.
  • Endoscopic third ventriculocisternostomy is an emerging treatment option for its physiological correction of CSF dynamics.
  • This endoscopic approach offers minimal interference with developmental processes involved in hydrocephalus and CIM.
Abstract

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