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Cerebrospinal fluid circulation and hydrocephalus

Ville Leinonen1, Ritva Vanninen2, Tuomas Rauramaa3

  • 1Department of Neurosurgery, Institute of Clinical Medicine, University of Eastern Finland and Department of Neurosurgery, NeuroCenter, Kuopio University Hospital, Kuopio, Finland.

Handbook of Clinical Neurology
|October 9, 2017
PubMed

Insights

Hydrocephalus (HC) involves cerebrospinal fluid (CSF) imbalance, causing enlarged ventricles. Diagnosis and treatment depend on obstruction site, with idiopathic normal-pressure hydrocephalus (iNPH) being a common chronic form.

Area of Science:

  • Neurology
  • Neurosurgery
  • Pathology

Background:

  • Hydrocephalus (HC) is characterized by cerebrospinal fluid (CSF) production-absorption imbalance, leading to ventricular enlargement.
  • Causative factors include brain tumors obstructing CSF flow, necessitating classification by obstruction site for treatment.
  • Acute and chronic forms exist, with idiopathic normal-pressure hydrocephalus (iNPH) being the most frequent chronic type.

Purpose of the Study:

  • To define hydrocephalus (HC) and its classifications.
  • To discuss the incidence and diagnostic challenges of HC, particularly iNPH.
  • To highlight the role of neuropathology in identifying HC causes and comorbidities.

Main Methods:

  • Review of hydrocephalus (HC) definitions and classifications.
  • Analysis of incidence data for congenital HC and idiopathic normal-pressure hydrocephalus (iNPH).
  • Discussion of radiological and neuropathological diagnostic considerations.

Main Results:

  • HC is defined by CSF imbalance and ventricular enlargement, with varied incidence rates.
  • Congenital HC incidence is 0.4-0.6/1,000 newborns; iNPH incidence ranges from 0.5-5.5/100,000 annually.
  • Radiological findings can be nonspecific, and differentiating iNPH requires careful neuropathologic examination.

Conclusions:

  • Hydrocephalus classification guides treatment, such as endoscopic third ventriculostomy or CSF shunts.
  • Accurate diagnosis, especially for iNPH, can be challenging due to nonspecific imaging.
  • Neuropathologic examination is crucial for detecting comorbid diseases and potential etiologic factors in HC.

Keywords:
cerebrospinal fluidhydrocephalusimagingneuropathologynormal-pressure hydrocephalus

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