Hydrocephalus And Its Treatment

Hydrocephalus is characterized by an increase in the volume of the cerebrospinal fluid, respectively, by a decrease in the volume of the brain tissue. The reason for the increase in the size of the ventricles of the brain can be the occlusion of the cerebrospinal fluid within the ventricular system (occlusive hydrocephalus) or the violation of the outflow (resorption) of the cerebrospinal fluid through the arachnoid villi into the dural cavity of the brain, which are the main ways of venous blood outflow from the brain (open hydrocephalus). So that the treatment of hydrocephalus was successful in finding out the mechanisms of its occurrence. To treat hydrocephalus, both conservative and surgical methods are used. In the surgical treatment of hydrocephalus, the ventriculoperitoneal shunt is most often performed by endoscopic perforation of the bottom of the third ventricle-endoscopic triventriculostomy. Unfortunately, these operations are not always effective and at the same time can lead to the development of complications (hyperdrilling syndrome, the formation of subdural hematomas, infection of the shunting system, etc.). Therefore, the choice of the most appropriate method for the treatment of hydrocephalus conservative surgical is very relevant. No less important is the question of the functioning of the already established shunting system, its adequacy. As a result of the studies performed, a fairly clear time was revealed in the center of neurology between open and occlusive hydrocephalus. With open hydrocephalus, both normal values of the elasticity of the craniovertebral contents were observed, and its significant increase was a significant decrease in comparison with the norm. At the same time, with occlusal hydrocephalus, only normal and increased values of elasticity were noted. At the same time, surgical treatment of hydrocephalus (ventriculoperitoneal shunting, endoscopic triventriculostomy) led to a significant and significant change in the venous blood circulation of the brain and craniovertebral volume relationships. Reduction of elasticity in comparison with the norm before the operation was detected only in patients with open hydrocephalus. At the same time, with occlusal hydrocephalus, there was no decrease in elasticity in comparison with the norm before the operation. At the same time, after surgery in the hospital with occlusive hydrocephalus, the elasticity decreased significantly in comparison with the results of the preoperative study. Open hydrocephalus can be caused by various etiological factors. In this case, it is necessary to take into account that in healthy people the death of neurons constantly occurs in the course of aging, which leads to atrophy of the brain substance and, accordingly, to an increase in the reserve spaces of the craniovertebral cavity. This natural process is called apoptosis. In Alzheimer's disease , accelerated aging occurs with pathological intracellular accumulation with the destruction of intracellular structures and, ultimately, the death of neurons. Of the most common clinical forms of open hydrocephalus, normotensive hydrocephalus is prominent, which is the main component of the Hakim-Adams symptom (1965) (Hakim S, Adams R,). This syndrome is characterized by an increase in the ventricles of the brain with normal intracranial pressure. In addition, the characteristic features of the Hakim-Adams syndrome are the development of dementia, unsteadiness and urinary incontinence. The condition of many patients with Hakim-Adams syndrome is significantly improved after the liquor-shunting operations. However, in a number of cases these operations prove to be ineffective. At the same time, liquor-shunting operations often lead to complications (in 13-50% according to the data of different researchers). Therefore, the selection of patients with Hakim-Adams syndrome for surgical treatment is very relevant. Currently, various invasive methods are widely used for this purpose (infusion of physiological solution into the cerebrospinal fluid with the study of the resulting changes in intracranial pressure, drainage of the CSF with evaluation of changes in the neurological status, etc.). The reliability of these tests significantly limits their use in the clinic . The greatest value of the quantitative study of craniovertebral volume relationships has in children with hydrocephalus, as well as in elderly people with increasing ventriculomegaly (increase in the size of the ventricles of the brain) and various variants of the development of the Hakim-Adams syndrome (memory, gait, urination). In our studies with the Hakim-Adams syndrome, the elasticity was usually normal or significantly reduced, and in patients with consequences of cerebral injury and severe mental disorders, the elasticity was normal or increased, and the difference between the two groups of patients reached statistical significance. The cause of dementia in the elderly may be the disintegration of information processes in the brain, due to various mechanisms (degenerative, vascular, metabolic processes). One of the causes of disorders in older people may be the development of Alzheimer's disease. At the same time, there is an opinion that it is extremely difficult to differentiate between vascular dementia and Alzheimer's disease on the basis of clinical data alone. At the same time, it has been established that in Alzheimer's disease the blood flow velocity in both extracranial and intracranial vessels is significantly reduced in comparison with healthy people. Alzheimer's disease is also characterized by a decrease in intracranial pressure and a decrease in the rate of production of cerebrospinal fluid.

The elasticity of craniovertebral contents, being a mechanical characteristic of the system, at the same time correlates to a certain extent with the functional state of the brain. We observed a gradual normalization of the cavity of craniovertebral contents, which occurred simultaneously with the normalization of the functional state of the brain (improvement of memory, intellectual functions, gait, normalization of urination). These changes occurred under the influence of active vascular, metabolic and dehydration therapy.

With open hydrocephalus, both normal values of the elasticity of the craniovertebral contents were observed, as well as its significant increase or significant decrease in comparison with the norm. At the same time, with occlusal hydrocephalus, only normal and increased values of elasticity were noted, while a decrease in elasticity in comparison with normal values was not observed. Surgical treatment of patients with occlusive hydrocephalus ventriculoperitoneal bypass, endoscopic triventriculostomy) led to a significant, statistically significant decrease in the elasticity of craniovertebral contents and the appearance of very low values of elasticity, the same as in some patients with open hydrocephalus). Thus, surgical treatment of occlusal hydrocephalus leads to a change in its Physiological mechanisms, as a result of which occlusive hydrocephalus becomes, as it were, an analog ary open hydrocephalus.

At the same time, after endoscopic triventriculostomy, a statistically significant decrease is observed only in the elasticity and velocity of venous blood flow, while no significant changes in reserve capacity of craniovertebral contents occur. The statistically significant decrease in elasticity after endoscopic triventriculostomy deserves special attention, since there were no significant changes in elasticity when using invasive infusion tests. Such negative results of invasive infusion tests are apparently due to the fact that the introduction of saline into the cerebrospinal fluid during the infusion test changes the conditions of interaction of the main volumes of craniovertebral contents (brain tissue, blood and lycourus), which can lead to erroneous results. Thus, a noninvasive study of the venous blood circulation of the brain, liquorodynamics and craniovertebral volumes of the ratios allows one to obtain important information about the pathophysiological mechanisms of intracranial hypoen- sion and hydrocephalus, and to evaluate the effectiveness of pathogenetic therapy.