Is there an ideal shunt? A panoramic view of 110 years in CSF diversions and shunt systems used for the treatment of hydrocephalus: from historical events to current trends.

Object: The goal of this study is to evaluate whether an "ideal shunt" exists.

Methods: This is a retrospective analysis based on original papers in the field of Hydrocephalus and Shunts. Patients of all age groups, who had hydrocephalus, and underwent some form of CSF diversion were included.

Safety and diagnostic accuracy of neuroendoscopic biopsies: an international multicenter study.

Object: Analysis of the safety and morbidity of neuroendoscopic biopsies (NEBs), as well as the reliability in obtaining an accurate diagnosis, has until now been based on studies with relatively small sample sizes. Through the cooperative efforts of several international medical centers, authors of the present study collected data on a large number of patients to obtain better insight into this issue. When possible, they compared pathology obtained through an NEB with the "gold-standard" pathology obtained in open surgery.

Theories of cerebrospinal fluid dynamics and hydrocephalus: historical trend.

According to the CSF bulk flow theory, hydrocephalus is caused by an imbalance between CSF formation and absorption, or a block at various locations in the major CSF pathway. New theories, however, have been proposed in which minor CSF pathways may play a significant role in the development of congenital hydrocephalus. The authors review major contributions to the literature and analyze the evolution of theories of CSF dynamics in relation to hydrocephalus, dividing their development into 4 stages on the basis of historical trends.

Myeloschisis repair in a premature neonate with a birth weight of 599 g.

This report describes the case of a neonate with myeloschisis weighing 599 g that underwent an operation for spinal cord reconstruction resulting in substantial neuronal functional recovery. At 28 weeks of gestation, oligohydramnios was detected and the female fetus was diagnosed with intrauterine growth retardation. At birth by emergency caesarean section, she showed lumbosacral myeloschisis and complete paralysis of the lower extremities.

Guideline for management and treatment of fetal and congenital hydrocephalus: Center Of Excellence-Fetal and Congenital Hydrocephalus Top 10 Japan Guideline 2011.

Hydrocephalus does not indicate a single clinical entity, but includes a variety of clinicopathological conditions caused by excessive cerebrospinal fluid (CSF) based on the disturbed circulation. Recent progress in prenatal neuroimagings such as MRI and ultrasound echoencephalography on fetus enables to understand clinicopathological conditions of CSF circulation disorder in conjunction with morphological changes in the central nervous system properly. It has been revealed that the CSF dynamics develop in the theory of evolution from the immature brain, as in the animals with the minor CSF pathway predominance, towards matured adult human brain together with the completion of the major CSF pathway: the "Evolution Theory in CSF Dynamics".

Classification of hydrocephalus: critical analysis of classification categories and advantages of "Multi-categorical Hydrocephalus Classification" (Mc HC).

Objective: Hydrocephalus is a complex pathophysiology with disturbed cerebrospinal fluid (CSF) circulation. There are numerous numbers of classification trials published focusing on various criteria, such as associated anomalies/underlying lesions, CSF circulation/intracranial pressure patterns, clinical features, and other categories. However, no definitive classification exists comprehensively to cover the variety of these aspects.

Giant syringobulbia associated with cerebellopontine angle arachnoid cyst and hydrocephalus.

The aim in reporting this case was to discuss the pathophysiology and treatment issues in an infant with a giant syringobulbia associated with a right cerebellopontine angle (CPA) arachnoid cyst causing noncommunicating hydrocephalus. This 7-month-old infant presented to the hospital with a history of delayed milestones and an abnormal increase in head circumference. Magnetic resonance images and CT scans of the brain showed a large CSF cavity involving the entire brainstem and a right CPA arachnoid cyst causing obstruction of the fourth ventricle and dilation of the lateral and third ventricles.

Immediate spontaneous shape correction using expantile zigzag craniectomy in infantile scaphocephaly -is there an improvement in the developmental quotient following surgery?-.

There is still debate over which method of the surgery is the most appropriate for the treatment of scaphocephalic infants. In addition, change in psychomotor development following these procedures is a very complex issue that has not yet been resolved. In this paper, the authors describe a surgical technique for immediate spontaneous shape correction of infantile scaphocephaly.

Aggressive large cell medulloblastoma extending to the extracranial region in brain-dead state.

Introduction: The authors describe the case of a 29-month-old boy who presented with acute non-communicating hydrocephalus caused by a small tumor in the fourth ventricle. He became brain-dead immediately and remained stable in that condition.

Materials And Methods: Six months later, despite being in a brain-dead state, a rapid direct tumor extension from the intracranial to extracranial region was observed, and chemoradiotherapy was performed following tumor biopsy.

Hydrocephalus associated with vestibular schwannomas: management options and factors predicting the outcome.

Object: The current, generally accepted optimal management for hydrocephalus related to vestibular schwannomas (VSs) is primary tumor removal, with further treatment reserved only for patients who remain symptomatic. Previous studies have shown, however, that this management can lead to an increase in surgery-related complications. In this study, the authors evaluated their experience with the treatment of such patients, with the aim of identifying the following: 1) the parameters correlating to the need for specific hydrocephalus treatment following VS surgery; and 2) patients at risk for developing hydrocephalus-related complications.

Hydrocephalus research update--controversies in definition and classification of hydrocephalus.

Classification of hydrocephalus is the most crucial but the most complicated academic challenge within the hydrocephalus research field. The major difficulty in this challenge arises from the fact that the classification is based on almost all subjects in hydrocephalus research, i.e.

[Clinical prognosis and therapeutic aspects in management of pediatric moyamoya disease].

We reviewed the clinical prognosis and therapeutic aspects in the management of pediatric moyamoya disease from our data base for the last 8 years since establishment of our institution. We found 99 cerebrovascular disease cases among the total of 1,159 cases, and 20 out of them were moyamoya disease. Only 13 cases were analyzed as the rest were not available for follow up.

Embryopathogenetic surgicoanatomical classification of dysraphism and surgical outcome of spinal lipoma: a nationwide multicenter cooperative study in Japan.

Object: The natural history of asymptomatic spinal lipoma in infancy remains unclear, and the indication for the prophylactic untethering operation is still debatable. To address this question, a multicenter cooperative study for the treatment of spinal lipoma was performed by the 7 most active institutions in neurosurgical care for spina bifida in Japan between 2001 and 2005.

Methods: Patients were classified using the embryopathogenetic surgicoanatomical classification.

Intradural arteriosynangiosis in pediatric moyamoya disease: modified technique of encephalo-duro-arterio-synangiosis with reduced operative damage to already growing revascularization.

Objective: Various operative procedures have been described for the treatment of pediatric moyamoya disease. However, the majority of invasive or radical procedures proposed have focused primarily on revascularization and few have discussed to maximizing preservation of the already growing neovascular network.

Methods: This present procedure describes the supratemporal artery is anastomosed to the inner layer of the dura mater and surrounded by the outer layer as a sandwich with a blunt procedure of dural layer separation.

Prenatal diagnosed cyst of the quadrigeminal cistern in Aicardi syndrome.

Aicardi syndrome is an X-linked dominant disorder characterized by the pathognonomic association of three clinical signs: agenesis of the corpus callosum, infantile spasms, and chorioretinal lacunae. This is a severe syndrome with an estimated survival rate of 76% at 6 years and 40% at 14 years and a maximum developmental level like a 12-month-old baby in 91% of cases. We illustrate a case of Aicardi syndrome with bilateral, small chorioretinal lacunae, infantile spasms with a typical hypsarrhythmia, defects of thoracic vertebra and bilateral absence of the 12th rib associated with an arachnoid cyst of the quadrigeminal cistern, and presence of the corpus callosum with a favorable outcome.

Application of neuroendoscopy to intraventricular lesions.

We present an overview of the history, development, technological advancements, current application, and future trends of cranial endoscopy. Neuroendoscopy provides a safe and effective management modality for the treatment of a variety of intracranial disorders, either tumoral or non-tumoral, congenital, developmental, and degenerative, and its knowledge, indications, and limits are fundamental for the armamentarium of the modern neurosurgeon.

Traumatic subacute subdural effusion in the posterior fossa associated with secondary acute hydrocephalus in a neonate. Case report.

The authors report on a neonatal patient with traumatic subacute subdural effusion in the posterior fossa associated with secondary acute hydrocephalus. The infant fell from his mother's hand onto the floor, injuring his left parietal region. Computed tomography (CT) scans of the patient's head revealed a linear fracture of the left parietal bone, a small contusion in the right temporal lobe, and a small subdural hematoma in the right posterior fossa with thin subdural effusion.

Historical trends of neuroendoscopic surgical techniques in the treatment of hydrocephalus.

The treatment of hydrocephalus nowadays is still a challenge for neurosurgery. Neuroendoscopy is a valuable alternative of the CSF shunts in hydrocephalus management. Because of the complicated and always changeable pathophysiology of hydrocephalus, the history of the endoscopic treatment of hydrocephalus is also a history of severe frustrations, great expectations, and significant achievements.

Neuroendoscopic foraminal plasty of foramen of Monro.

Objectives: The aims of this study were to describe and analyze the technique of neuroendoscopic foraminal plasty of foramen of Monro (NEFPFMO) in the treatment of isolated unilateral hydrocephalus (IUH) due to membranous occlusion, to evaluate its efficacy and safety, and to define the benefits of neuronavigational guidance of the procedure.

Materials And Methods: Two symptomatic neonates with IUH, as a result of congenital atresia of foramen of Monro, underwent NEFPFMO plus neuroendoscopic septostomy in the first case and neuronavigational guidance in the second one. Clinical results were excellent in both neonates.

Ventricular anatomy of hydrocephalus associated with myeloschisis and endoscopic third ventriculostomy.

Objects: To characterize the anatomical features of the ventricular regions in patients with myeloschisis and related to successful performance of endoscopic third ventriculostomy (ETV).

Methods: Radiological and endoscopic findings of 21 myeloschisis patients were retrospectively reviewed. Radiological features that could interfere with endoscopic procedures were (1) a huge massa intermedia (12/19), (2) sloping of the third ventricular floor (3/10), (3) narrow anteroposterior length of the third ventricular floor (2/10), and (4) narrow prepontine cistern (8/21).

Diagnosis of congenital hydrocephalus and delivery of its patients in Japan.

The study population included 193 patients with prenatally diagnosed (fetal) hydrocephalus and 181 with postnatally (12 or less than 12 months after birth) diagnosed (infantile) hydrocephalus identified by a nationwide questionnaire survey of congenital hydrocephalus performed in 2000. Of 180 patients with fetal, 101 (56.1%) were diagnosed before week 32 of gestation and 18 (10%) were diagnosed week 37 and later of gestation.

New transparent peel-away sheath with neuroendoscopic orientation markers. Technical note.

The peel-away sheath in neuroendoscopic surgery offers numerous advantages and has many potential applications. However, currently available nontransparent sheaths have a critical disadvantage in that disorientation can occur, given the limited visible operative field. To overcome this obstacle, the authors have developed and clinically applied a new transparent sheath with "navigational orientation markers.