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Idiopathic communicating hydrocephalus: the prognostic significane of ventricular size after shunting
Insights
Ventriculo-atrial shunting led to significant recovery in three patients with communicating hydrocephalus. Diagnostic methods like CAT scans and CSF removal tests can predict successful shunting outcomes.
Area of Science:
- Neurology
- Neurosurgery
Background:
- Communicating hydrocephalus can cause dementia and neurological deficits.
- Idiopathic cases present diagnostic challenges.
Purpose of the Study:
- To report on the recovery of patients with idiopathic communicating hydrocephalus after ventriculo-atrial shunting.
- To review diagnostic and predictive methods for successful shunting.
Main Methods:
- Ventriculo-atrial shunting was performed on three neurologically impaired patients.
- Literature review was conducted to assess diagnostic tools and predictive factors.
Main Results:
- All three patients showed dramatic and sustained neurological recovery post-shunting.
- Ventricular size did not significantly change after the procedure in these patients.
- CAT scan and intrathecal cisternography are valuable for patient selection.
- Cerebrospinal fluid (CSF) removal tests show promise in predicting shunting success.
Conclusions:
- Ventriculo-atrial shunting can be highly effective for idiopathic communicating hydrocephalus.
- CAT scans and CSF removal tests are recommended for patient selection and outcome prediction.
- Cortical atrophy, symptom onset duration, and pre/post-shunting ventricular size are unreliable predictors of shunting success.
Abstract:
A description is given of the dramatic, sustained recovery of 3 demented and neurologically disable patients with idiopathic communicating hydrocephalus after they underwent ventriculo-atrial shunting. In those patients there was no significant change in ventricular size after the ventriculo-atrial shunting. 1 of the patients also had cortical atrophy. Hypertensive vasculopathy and multiple infarcts may be the explanation in 2 of the patients. Reveiw of the literature results in the following conclusions: 1) the CAT scan alone, perhaps combined with intrathecal "Amipaque' cisternography, provides the maximum information with the last trauma and may assist in the selection of patients for shunting. 2) Test removal of 20 to 30ml of CSF may be as satisfactory as pressure monitoring and infusion techniques in the prediction of successful shunting. The following do not have a reliable predictive value: a) The presence of cortical atrophy (shunting may sometimes be effective in mild to moderate cortical atrophy) b) The period of onset of symptoms c) The ventricular size before shunting and its alteration after shunting.