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Neuronavigation and Laparoscopy Guided Ventriculoperitoneal Shunt Insertion for the Treatment of Hydrocephalus
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Chiari type I and hydrocephalus.

Luca Massimi1,2,3, Giovanni Pennisi4, Paolo Frassanito4

  • 1Fondazione Policlinico Gemelli IRCCS, Neurochirurgia Infantile, Roma, Italy. lmassmi@email.it.

Child'S Nervous System : Chns : Official Journal of the International Society for Pediatric Neurosurgery
|June 23, 2019
PubMed
Summary
This summary is machine-generated.

The association between Chiari type I malformation (CIM) and hydrocephalus involves complex, multifactorial mechanisms. Endoscopic third ventriculostomy (ETV) is the preferred initial treatment for hydrocephalus in these patients, showing high success rates.

Keywords:
Chiari I malformationEndoscopic third ventriculostomyHydrocephalusPosterior cranial fossa

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Area of Science:

  • Neurosurgery
  • Pediatric Neurology
  • Medical Pathogenesis

Background:

  • The relationship between Chiari type I malformation (CIM) and hydrocephalus is not fully understood, impacting treatment strategies.
  • Investigating the pathogenesis and management of CIM with hydrocephalus is crucial due to its clinical significance.

Purpose of the Study:

  • To review existing theories on the cause-effect relationship between CIM and hydrocephalus.
  • To analyze the efficacy of current management strategies for this combined condition.

Main Methods:

  • A comprehensive literature review was conducted, focusing on studies addressing CIM and hydrocephalus, and their treatment.
  • Author's personal experience with managing these cases was also incorporated.

Main Results:

  • Hydrocephalus-induced increased intracranial pressure can cause transient ectopia, distinct from CIM.
  • A complex hypothesis suggests venous engorgement from posterior cranial fossa hypoplasia can lead to both CIM and hydrocephalus in some cases.
  • In non-syndromic CIM, hydrocephalus may stem from basal cerebrospinal fluid pathway occlusion, affecting a minority of patients.
  • Endoscopic third ventriculostomy (ETV) demonstrated high success rates (90.5%) in treating hydrocephalus, with significant improvements in CIM (74%) and syringomyelia (89%) symptoms and radiology.

Conclusions:

  • The association between CIM and hydrocephalus likely arises from diverse, multifactorial, and incompletely understood mechanisms.
  • Patients with both CIM and hydrocephalus represent a distinct subgroup requiring specific management approaches.
  • ETV is confirmed as the optimal initial treatment strategy for hydrocephalus in patients with CIM.