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Gonçalves FG, Mahecha-Carvajal ME, Desa A, Yildiz H, Talbeya JK, Moreno LA, Viaene AN, Vossough A. Imaging of supratentorial intraventricular masses in children:a pictorial review- part 1. Neuroradiology 2024; 66:677-698. [PMID: 38466393 PMCID: PMC11031501 DOI: 10.1007/s00234-024-03314-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 02/12/2024] [Indexed: 03/13/2024]
Abstract
PURPOSE This article is the first in a two-part series designed to provide a comprehensive overview of the range of supratentorial intraventricular masses observed in children. Our primary objective is to discuss the diverse types of intraventricular masses that originate not only from cells within the choroid plexus but also from other sources. METHODS In this article, we review relevant epidemiological data, the current genetics/molecular classification as outlined in the fifth edition of the World Health Organization's Classification of tumours of the Central Nervous System and noteworthy imaging findings. We conduct an exhaustive analysis of primary choroid plexus tumours as well as other conditions such as choroid plexus hyperplasia, choroid plexus cyst, choroid plexus xanthogranuloma, atypical teratoid rhabdoid tumour, meningioma, arteriovenous malformation and metastasis. RESULTS We comprehensively evaluated each supratentorial intraventricular mass, providing an in-depth analysis of their unique clinical and histological characteristics. The fifth edition of the World Health Organization Classification of Tumours of the Central Nervous System introduces major modifications. These important changes could potentially have a profound impact on the management strategies and subsequent outcomes of these tumours. CONCLUSION Intraventricular masses in children can arise from various sources. Surgical intervention is key for certain supratentorial intraventricular masses in paediatric patients, with preoperative neuroimaging essential to decide the best treatment approach, surgical or otherwise, as some cases may not require surgery.
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Affiliation(s)
| | | | - Aishwary Desa
- Drexel University College of Medicine Philadelphia, Philadelphia, PA, USA
| | - Harun Yildiz
- Department of Radiology, Dortcelik Children's Hospital, Bursa, Turkey
| | | | - Luz Angela Moreno
- Pediatric Imaging, Department of Radiology, Fundación Hospital La Misericordia, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Angela N Viaene
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
- Pathology Department, Children's Hospital of Philadelphia, Philadelphia, USA
| | - Arastoo Vossough
- Radiology Department, Children's Hospital of Philadelphia, Philadelphia, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
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2
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Kim JW, Hisamura W, Kim SK, Phi JH. Choroid Plexus Hyperplasia : Report of Two Cases with Unique Radiologic Findings. J Korean Neurosurg Soc 2024; 67:376-381. [PMID: 37850226 PMCID: PMC11079559 DOI: 10.3340/jkns.2023.0126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 08/24/2023] [Accepted: 10/16/2023] [Indexed: 10/19/2023] Open
Abstract
Choroid plexus hyperplasia (CPH), also known as diffuse villous hyperplasia of choroid plexus, is a rare condition characterized by excessive production of cerebrospinal fluid (CSF), resulting in hydrocephalus. Diagnosing CPH can be challenging due to the absence of clear imaging criteria for choroid plexus hypertrophy and the inability to assess CSF production non-invasively. As a result, many CPH patients are initially treated with a ventriculoperitoneal (VP) shunt, but subsequently require additional surgical intervention due to intractable ascites. In our study, we encountered two CPH patients who presented with significantly enlarged subarachnoid spaces, reduced parenchymal volume, and prominent choroid plexus. Initially, we treated these patients with a VP shunt, but eventually opted for endoscopic choroid plexus cauterization (CPC) to address the intractable ascites. Following the treatment with endoscopic CPC, we observed a gradual reduction in subarachnoid spaces and an increase in parenchymal volume. In cases where bilateral prominent choroid plexus, markedly enlarged subarachnoid spaces, and cortical atrophy are present, CPH should be suspected. In these cases, considering initial treatment with combined endoscopic CPC and shunt may help minimize the need for multiple surgical interventions.
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Affiliation(s)
- Joo Whan Kim
- Division of Pediatric Neurosurgery, Seoul National University Children’s Hospital, Seoul National University College of Medicine, Seoul, Korea
| | | | - Seung-Ki Kim
- Division of Pediatric Neurosurgery, Seoul National University Children’s Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Ji Hoon Phi
- Division of Pediatric Neurosurgery, Seoul National University Children’s Hospital, Seoul National University College of Medicine, Seoul, Korea
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3
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Ben-Shoshan SD, Lolansen SD, Mathiesen TI, MacAulay N. CSF hypersecretion versus impaired CSF absorption in posthemorrhagic hydrocephalus: a systematic review. Acta Neurochir (Wien) 2023; 165:3271-3287. [PMID: 37642688 DOI: 10.1007/s00701-023-05746-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 07/31/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND The molecular mechanisms underlying development of posthemorrhagic hydrocephalus (PHH) remain elusive. The aim of this systematic review was to evaluate existing literature on increased CSF secretion and impaired CSF absorption as pathogenic contributors to CSF accumulation in neonatal and adult PHH. METHODS The systematic review was conducted in accordance with the PRISMA guidelines. Relevant studies published before March 11th, 2023, were identified from PubMed and reference lists. Studies were screened for eligibility using predefined inclusion and exclusion criteria. Data from eligible studies were extracted and potential sources of bias were evaluated. RESULTS Nineteen studies quantified CSF production rates and/or CSF absorption capacity in human patients with PHH or animals with experimentally induced PHH. Increased CSF production was reported as early as 24 h and as late as 28 days post ictus in six out of eight studies quantifying CSF production rates in animals with experimentally induced PHH. Impaired CSF absorption was reported in all four studies quantifying CSF absorption capacity in human patients with PHH and in seven out of nine studies quantifying CSF absorption capacity in animals with experimentally induced PHH. Impaired CSF absorption was reported as early as 30 min and as late as 10 months post ictus. CONCLUSIONS The pathological CSF accumulation in PHH likely arises from a combination of increased CSF secretion and impaired CSF absorption, which may manifest at different time scales following a hemorrhagic event. Emergent evidence on increased CSF secretion by the choroid plexus may herald a paradigm shift in our understanding of PHH.
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Affiliation(s)
- Shai David Ben-Shoshan
- Department of Neuroscience, University of Copenhagen, Blegdamsvej 3B, DK-2200, Copenhagen, Denmark
| | - Sara Diana Lolansen
- Department of Neuroscience, University of Copenhagen, Blegdamsvej 3B, DK-2200, Copenhagen, Denmark
- Department of Neurosurgery, University Hospital of Copenhagen - Rigshospitalet, Copenhagen, Denmark
| | - Tiit Illimar Mathiesen
- Department of Neurosurgery, University Hospital of Copenhagen - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Nanna MacAulay
- Department of Neuroscience, University of Copenhagen, Blegdamsvej 3B, DK-2200, Copenhagen, Denmark.
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4
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Nakajima S, Murofushi K, Matsuda S, Shimada S, Shimoji K, Nakao Y, Yamamoto T. A case report of hydrocephalus due to diffuse villous hyperplasia of the choroid plexus: surgical treatment by combination a flexible videoscope with a rigid endoscope. Childs Nerv Syst 2023; 39:2045-2051. [PMID: 37393333 DOI: 10.1007/s00381-023-06012-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 05/27/2023] [Indexed: 07/03/2023]
Abstract
PURPOSE Diffuse villous hyperplasia of the choroid plexus (DVHCP) and choroid plexus papilloma (CPP) are rare benign tumors usually diagnosed as a result of progressive hydrocephalus, especially in childhood. We present the case of a Japanese boy diagnosed with progressive hydrocephalus due to DVHCP. METHODS Case: A 2-year and 3-month-old Japanese boy was found to have delayed motor development (equivalent to 1 year and 2 months old), an enlarged head circumference of 51 cm within + 1.5 standard deviation (S.D.), and incomplete closure of the anterior fontanel. The magnetic resonance imaging (MRI) showed lobular enlargement of the bilateral choroid plexuses extending from the trigone to the body and inferior horn of the lateral ventricle. The endoscopic choroid plexus coagulation surgery was performed to reduce the CSF formation rate. RESULTS DVHCP was diagnosed both pathologically and clinically. Postoperatively, the patient progressed without complications, such as cerebrospinal fluid leakage. Although ventricular enlargement persisted, the anterior fontanel recessed, and the expansion of the head circumference stopped. CONCLUSION Few cases of bilateral DVHCP and CPP have been reported in the literature. We encountered a case in which effective choroid plexus coagulation was performed for hydrocephalus due to DVHCP using less invasive endoscopic technique. It also represented an association between DVHCP and the gain of chromosome 9p.
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Affiliation(s)
- Shintaro Nakajima
- Department of Neurosurgery, Juntendo University Shizuoka Hospital, Izunokuni City, Shizuoka, Japan
| | - Keisuke Murofushi
- Department of Neurosurgery, Juntendo University Shizuoka Hospital, Izunokuni City, Shizuoka, Japan
| | - Shinpei Matsuda
- Department of Pediatrics, Juntendo University Shizuoka Hospital, Izunokuni City, Shizuoka, Japan
| | - Shino Shimada
- Department of Pediatrics, Juntendo University Shizuoka Hospital, Izunokuni City, Shizuoka, Japan
| | - Kazuaki Shimoji
- Department of Neurosurgery, International University of Health and Welfare Hospital, Narita City, Chiba, Japan
| | - Yasuaki Nakao
- Department of Neurosurgery, Juntendo University Shizuoka Hospital, Izunokuni City, Shizuoka, Japan
| | - Takuji Yamamoto
- Department of Neurosurgery, Juntendo University Shizuoka Hospital, Izunokuni City, Shizuoka, Japan.
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5
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Maffie J, Sobieski E, Kanekar S. Imaging of Headaches due to Intracranial Pressure Disorders. Neurol Clin 2022; 40:547-562. [PMID: 35871784 DOI: 10.1016/j.ncl.2022.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Changes in intracranial pressure are a potentially serious etiology of headache. Headache secondary to changes in intracranial pressure frequently present with characteristic clinical features. Imaging plays a key role in the diagnosis and management of this category of headache. In this article, we will review the physiology, clinical presentation, and key imaging findings of major etiologies of changes in intracranial pressure resulting in headache including obstructive and nonobstructive hydrocephalous, idiopathic intracranial hypertension (IIH), and cerebrospinal fluid (CSF) leak.
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Affiliation(s)
- Jonathon Maffie
- Department of Radiology, Division of Neuroradiology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA.
| | - Eric Sobieski
- Pennsylvania State College of Medicine, Hershey, PA, USA
| | - Sangam Kanekar
- Department of Radiology, Division of Neuroradiology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
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Xu H, Miyajima M, Nakajima M, Ogino I, Kawamura K, Akiba C, Kamohara C, Sakamoto K, Karagiozov K, Nakamura E, Tada N, Arai H, Kondo A. Ptpn20 deletion in H-Tx rats enhances phosphorylation of the NKCC1 cotransporter in the choroid plexus: an evidence of genetic risk for hydrocephalus in an experimental study. Fluids Barriers CNS 2022; 19:39. [PMID: 35658898 PMCID: PMC9164390 DOI: 10.1186/s12987-022-00341-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 05/16/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Congenital hydrocephalus occurs with some inheritable characteristics, but the mechanisms of its development remain poorly understood. Animal models provide the opportunity to identify potential genetic causes in this condition. The Hydrocephalus-Texas (H-Tx) rat strain is one of the most studied animal models for investigating the causative genetic alterations and analyzing downstream pathogenetic mechanisms of congenital hydrocephalus. METHODS Comparative genomic hybridization (CGH) array on non-hydrocephalic and hydrocephalic H-Tx rats was used to identify causative genes of hydrocephalus. Targeted gene knockout mice were generated by CRISPR/Cas9 to study the role of this gene in hydrocephalus. RESULTS CGH array revealed a copy number loss in chromosome 16p16 region in hydrocephalic H-Tx rats at 18 days gestation, encompassing the protein tyrosine phosphatase non-receptor type 20 (Ptpn20), a non-receptor tyrosine phosphatase, without change in most non-hydrocephalic H-Tx rats. Ptpn20-knockout (Ptpn20-/-) mice were generated and found to develop ventriculomegaly at 8 weeks. Furthermore, high expression of phosphorylated Na-K-Cl cotransporter 1 (pNKCC1) was identified in the choroid plexus (CP) epithelium of mice lacking Ptpn20 from 8 weeks until 72 weeks. CONCLUSIONS This study determined the chromosomal location of the hydrocephalus-associated Ptpn20 gene in hydrocephalic H-Tx rats. The high level of pNKCC1 mediated by Ptpn20 deletion in CP epithelium may cause overproduction of cerebrospinal fluid and contribute to the formation of hydrocephalus in Ptpn20-/- mice. Ptpn20 may be a potential therapeutic target in the treatment of hydrocephalus.
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Affiliation(s)
- Hanbing Xu
- Department of Neurosurgery, Juntendo University Graduate School of Medicine, Hongo Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Masakazu Miyajima
- Department of Neurosurgery, Juntendo Tokyo Koto Geriatric Medical Center, 3-3-20 Shinsuna, Koto-ku, Tokyo, 136-0075, Japan.
| | - Madoka Nakajima
- Department of Neurosurgery, Juntendo University Graduate School of Medicine, Hongo Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Ikuko Ogino
- Department of Neurosurgery, Juntendo University Graduate School of Medicine, Hongo Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Kaito Kawamura
- Department of Neurosurgery, Juntendo University Graduate School of Medicine, Hongo Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Chihiro Akiba
- Department of Neurosurgery, Juntendo Tokyo Koto Geriatric Medical Center, 3-3-20 Shinsuna, Koto-ku, Tokyo, 136-0075, Japan
| | - Chihiro Kamohara
- Department of Neurosurgery, Juntendo University Graduate School of Medicine, Hongo Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Koichiro Sakamoto
- Department of Neurosurgery, Juntendo University Graduate School of Medicine, Hongo Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Kostadin Karagiozov
- Department of Neurosurgery, Juntendo University Graduate School of Medicine, Hongo Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Eri Nakamura
- Department of Genetic Analysis Model Laboratory, Juntendo University Graduate School of Medicine, Hongo Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Nobuhiro Tada
- Department of Genetic Analysis Model Laboratory, Juntendo University Graduate School of Medicine, Hongo Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Hajime Arai
- Department of Neurosurgery, Juntendo University Graduate School of Medicine, Hongo Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Akihide Kondo
- Department of Neurosurgery, Juntendo University Graduate School of Medicine, Hongo Bunkyo-ku, Tokyo, 113-8421, Japan
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Bilateral hyperplasia of choroid plexus with severe CSF production: a case report and review of the glymphatic system. Childs Nerv Syst 2021; 37:3521-3529. [PMID: 34410450 DOI: 10.1007/s00381-021-05325-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 08/04/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND An important feature of hydrocephalus is the alteration of the cerebral spinal fluid (CSF) homeostasis. New insights in the understanding of production, secretion, and absorption of CSF, along with the discovery of the glymphatic system (GS), can be useful for a better understanding and treatment of hydrocephalus in disorders with CSF overproduction. CASE DESCRIPTION A 1-year-old patient was diagnosed with communicating hydrocephalus; ventricle peritoneal shunt (VPS) is installed and ascites developed. VPS is exposed, yielding volumes of 1000-1200ml/day CSF per day. MRI is performed showing generalized choroidal plexus hyperplasia. Bilateral endoscopic coagulation of thechoroid plexus was performed in 2 stages (CPC) however the high rate of CSF production persisted, needing a bilateral plexectomy through septostomy, which finally decreased the CSF outflow. DISCUSSION New knowledge about the CSF physiology will help to propose better treatment depending on the cause of the hydrocephalus. The GS is becoming an additional reason to better study and develop new therapies focused of the modulation of alternative CSF reabsorption. CONCLUSION Despite the current knowledge about hydrocephalus, we remain without a complete understanding of the pathophysiology of this condition. GS could be more important than conventional concept of reabsorption of CSF in the arachnoid villi, therefore GS could be a new key point, which will guide future investigations.
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8
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Cumulative Damage: Cell Death in Posthemorrhagic Hydrocephalus of Prematurity. Cells 2021; 10:cells10081911. [PMID: 34440681 PMCID: PMC8393895 DOI: 10.3390/cells10081911] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 07/23/2021] [Accepted: 07/25/2021] [Indexed: 12/19/2022] Open
Abstract
Globally, approximately 11% of all infants are born preterm, prior to 37 weeks’ gestation. In these high-risk neonates, encephalopathy of prematurity (EoP) is a major cause of both morbidity and mortality, especially for neonates who are born very preterm (<32 weeks gestation). EoP encompasses numerous types of preterm birth-related brain abnormalities and injuries, and can culminate in a diverse array of neurodevelopmental impairments. Of note, posthemorrhagic hydrocephalus of prematurity (PHHP) can be conceptualized as a severe manifestation of EoP. PHHP impacts the immature neonatal brain at a crucial timepoint during neurodevelopment, and can result in permanent, detrimental consequences to not only cerebrospinal fluid (CSF) dynamics, but also to white and gray matter development. In this review, the relevant literature related to the diverse mechanisms of cell death in the setting of PHHP will be thoroughly discussed. Loss of the epithelial cells of the choroid plexus, ependymal cells and their motile cilia, and cellular structures within the glymphatic system are of particular interest. Greater insights into the injuries, initiating targets, and downstream signaling pathways involved in excess cell death shed light on promising areas for therapeutic intervention. This will bolster current efforts to prevent, mitigate, and reverse the consequential brain remodeling that occurs as a result of hydrocephalus and other components of EoP.
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Li Y, Chetty S, Feldstein VA, Glenn OA. Bilateral Choroid Plexus Papillomas Diagnosed by Prenatal Ultrasound and MRI. Cureus 2021; 13:e13737. [PMID: 33842115 PMCID: PMC8021277 DOI: 10.7759/cureus.13737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
We present a rare prenatal diagnosis of bilateral choroid plexus papillomas by obstetrical ultrasound and fetal MRI at 20 weeks 6 days gestation. The fetus demonstrated bilateral enlarged, echogenic choroid plexus with increased Doppler flow suggestive of vascularized choroid tissue. Same-day fetal MRI demonstrated that the choroid plexus appeared enlarged bilaterally without definite hemorrhage. The combined features on ultrasound and MRI suggested bilateral choroid plexus papillomas with increased cerebrospinal fluid production, leading to ventriculomegaly and enlarged extra-axial spaces. The diagnosis was confirmed by postnatal pathology, which demonstrated WHO grade II atypical choroid plexus papillomas.
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Affiliation(s)
- Yi Li
- Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, USA
| | - Shilpa Chetty
- Obstetrics and Gynecology, University of California San Francisco, San Francisco, USA
| | - Vickie A Feldstein
- Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, USA
| | - Orit A Glenn
- Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, USA
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10
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Diagnostica per immagini dell’idrocefalo del bambino. Neurologia 2020. [DOI: 10.1016/s1634-7072(20)43300-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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11
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Li D, Shokuhfar T, Pantalone J, Rothstein B, Alden TD, Shaibani A, Saratsis AM. Choroidal artery embolization in the management of cerebrospinal fluid overproduction: case report and review of the literature. J Neurosurg Pediatr 2019; 23:737-748. [PMID: 30901750 DOI: 10.3171/2019.1.peds18519] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 01/08/2019] [Indexed: 11/06/2022]
Abstract
Diffuse villous hyperplasia of the choroid plexus (DVHCP) is a rare cause of communicating hydrocephalus. DVHCP may be diagnosed radiographically and through histological evaluation. It may be associated with genetic abnormalities, particularly involving chromosome 9. Due to CSF overproduction, patients with DVHCP often fail management with shunting alone and may require adjuvant interventions. The authors present the case of a child with partial trisomy 9p and delayed diagnosis of hydrocephalus with radiographic evidence of DVHCP who was successfully managed with ventriculoperitoneal shunt (VPS) placement, adjuvant bilateral endoscopic choroid plexus coagulation (CPC), and the novel application of anterior choroidal artery embolization. In addition, a systematic MEDLINE search was conducted using the keywords "diffuse villous hyperplasia," "choroid plexus hypertrophy," and "idiopathic cerebrospinal fluid overproduction." Clinicopathological characteristics and outcomes of the present case were reviewed and compared to those in the literature.A 14-month-old girl with partial trisomy 9p presented with macrocephaly and radiographic evidence of communicating hydrocephalus and DVHCP. Ventriculoperitoneal shunting resulted in distal failure due to inadequate CSF absorption, and ventriculoatrial shunt (VAS) placement was not possible due to multiple cardiac anomalies. Daily CSF production was reduced via endoscopic third ventriculostomy and bilateral CPC, followed by distal choroidal artery embolization, enabling VPS re-internalization. The embolization was complicated by radiographic evidence of an iatrogenic cerebral infarct, but this was clinically occult. Thirty-two additional cases of communicating hydrocephalus due to DVHCP are reported in the literature: 27 pediatric, 3 adult, and 2 postmortem. Genetic abnormalities were noted in 14, with 7 (50%) involving chromosome 9. Twelve patients underwent plexectomy (9 bilateral, 2 unilateral, 1 partial), and 10 underwent CPC (4 bilateral, 3 unilateral, and 3 unspecified), with or without shunting. Eight patients were successfully managed with shunting alone (6 VASs, 2 VPSs), and none underwent arterial embolization.DVHCP is a rare cause of communicating hydrocephalus that may be associated with genetic abnormalities. A thorough review of the literature highlights diagnostic criteria and interventional options involved in managing this cause of CSF overproduction. The present case demonstrates that angiographic confirmation of prominent choroidal arteries may contribute to the diagnosis DVHCP. In addition, embolization of the distal choroidal arteries may be considered as a potential adjuvant treatment in patients for whom conventional treatments have failed or are not feasible.
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Affiliation(s)
- Daphne Li
- 1Department of Neurological Surgery, Loyola University Medical Center, Maywood, Illinois
| | - Tahaamin Shokuhfar
- 2Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Julia Pantalone
- 3University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Brian Rothstein
- 4Department of Surgery, Division of Pediatric Neurosurgery, Ann & Robert H. Lurie Children's Hospital, Chicago, Illinois; and
| | - Tord D Alden
- 4Department of Surgery, Division of Pediatric Neurosurgery, Ann & Robert H. Lurie Children's Hospital, Chicago, Illinois; and.,5Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Ali Shaibani
- 2Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,5Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Amanda M Saratsis
- 4Department of Surgery, Division of Pediatric Neurosurgery, Ann & Robert H. Lurie Children's Hospital, Chicago, Illinois; and.,5Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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12
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Forte D, Cardoso Diogo M, Conceição C, Sagarribay A. Benign Postnatal Outcome after Prenatal Diagnosis of Fetal Ventriculomegaly with Choroid Plexus Hyperplasia: A Case Report. Pediatr Neurosurg 2019; 54:258-264. [PMID: 31266045 DOI: 10.1159/000500763] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 05/05/2019] [Indexed: 11/19/2022]
Abstract
Prenatal counselling following the diagnosis of fetal ventriculomegaly is challenging. Fetal MRI (magnetic resonance imaging) can be helpful in characterizing ventriculomegaly severity and associated anomalies, hence contributing to prognosis establishment. Choroid plexus hyperplasia (CPH) is a rare entity characterized by enlargement of the choroid plexuses, usually progressing to severe hydrocephalus with an associated poor outcome. We present a case of CPH diagnosed by fetal MRI at 23 weeks of gestation following referral for ventriculomegaly. The pregnancy was carried to term and the child was monitored clinically and radiologically. Despite the persistence of enlarged choroid plexuses, the ventricular size has progressively decreased, and at the 4-year follow-up the child presented normal psychomotor development. This case highlights the added value of MRI in prenatal diagnosis of fetal ventriculomegaly and its management. The unusual benign outcome in this case can be considered for parental counselling when faced with a fetus with similar findings.
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Affiliation(s)
- Dalila Forte
- Department of Neurosurgery, Centro Hospitalar de Lisboa Central, Lisbon, Portugal,
| | - Mariana Cardoso Diogo
- Department of Neurorradiology, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
| | - Carla Conceição
- Department of Neurorradiology, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
| | - Amets Sagarribay
- Pediatric Neurosurgery Unit, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
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13
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Furey C, Antwi P, Duran D, Timberlake AT, Nelson-Williams C, Matouk CC, DiLuna ML, Günel M, Kahle KT. 9p24 triplication in syndromic hydrocephalus with diffuse villous hyperplasia of the choroid plexus. Cold Spring Harb Mol Case Stud 2018; 4:a003145. [PMID: 29895553 PMCID: PMC6169828 DOI: 10.1101/mcs.a003145] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 06/06/2018] [Indexed: 12/19/2022] Open
Abstract
Hydrocephalus, a disorder of impaired cerebrospinal fluid (CSF) homeostasis, often results from an imbalance between CSF production and reabsorption. Rarely, hydrocephalus is the consequence of CSF hypersecretion in the context of diffuse villous hyperplasia of the choroid plexus (DVHCP). The limited genetic information in previously reported cases suggests a high prevalence of gains of Chromosome 9p in this disease, although the critical genes involved in DVHCP pathogenesis have not been identified. Here, we report a patient with syndromic hydrocephalus with DVHCP associated with a novel 9p24.3-11.2 triplication and 15q13.2-q13.3 microdeletion. We review the clinical, radiological, and pathological features of DVHCP, as well as its surgical management. A better understanding of the genetic basis of DVHCP could spur the development of rational, targeted nonsurgical hydrocephalus treatments.
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Affiliation(s)
- Charuta Furey
- Department of Genetics, Yale University School of Medicine, New Haven, Connecticut 06510, USA
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut 06510, USA
| | - Prince Antwi
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut 06510, USA
| | - Daniel Duran
- Department of Genetics, Yale University School of Medicine, New Haven, Connecticut 06510, USA
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut 06510, USA
| | - Andrew T Timberlake
- Department of Genetics, Yale University School of Medicine, New Haven, Connecticut 06510, USA
- Department of Surgery, Section of Plastic and Reconstructive Surgery, Yale University School of Medicine, New Haven, Connecticut 06510, USA
| | - Carol Nelson-Williams
- Department of Genetics, Yale University School of Medicine, New Haven, Connecticut 06510, USA
| | - Charles C Matouk
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut 06510, USA
| | - Michael L DiLuna
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut 06510, USA
- Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut 06510, USA
| | - Murat Günel
- Department of Genetics, Yale University School of Medicine, New Haven, Connecticut 06510, USA
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut 06510, USA
- Department of Cellular and Molecular Physiology, Yale University School of Medicine, New Haven, Connecticut 06510, USA
| | - Kristopher T Kahle
- Department of Genetics, Yale University School of Medicine, New Haven, Connecticut 06510, USA
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut 06510, USA
- Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut 06510, USA
- Department of Cellular and Molecular Physiology, Yale University School of Medicine, New Haven, Connecticut 06510, USA
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14
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Boxill M, Becher N, Sunde L, Thelle T. Choroid plexus hyperplasia and chromosome 9p gains. Am J Med Genet A 2018; 176:1416-1422. [DOI: 10.1002/ajmg.a.38697] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 03/07/2018] [Accepted: 03/09/2018] [Indexed: 11/08/2022]
Affiliation(s)
- Martin Boxill
- Department of Pediatrics; Viborg Regional Hospital; Viborg Denmark
| | - Naja Becher
- Department of Clinical Genetics; Aarhus University Hospital; Aarhus Denmark
| | - Lone Sunde
- Department of Clinical Genetics; Aarhus University Hospital; Aarhus Denmark
- Department of Biomedicine; Aarhus University; Aarhus Denmark
| | - Thomas Thelle
- Department of Pediatrics; Viborg Regional Hospital; Viborg Denmark
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15
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Karimy JK, Duran D, Hu JK, Gavankar C, Gaillard JR, Bayri Y, Rice H, DiLuna ML, Gerzanich V, Marc Simard J, Kahle KT. Cerebrospinal fluid hypersecretion in pediatric hydrocephalus. Neurosurg Focus 2017; 41:E10. [PMID: 27798982 DOI: 10.3171/2016.8.focus16278] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Hydrocephalus, despite its heterogeneous causes, is ultimately a disease of disordered CSF homeostasis that results in pathological expansion of the cerebral ventricles. Our current understanding of the pathophysiology of hydrocephalus is inadequate but evolving. Over this past century, the majority of hydrocephalus cases has been explained by functional or anatomical obstructions to bulk CSF flow. More recently, hydrodynamic models of hydrocephalus have emphasized the role of abnormal intracranial pulsations in disease pathogenesis. Here, the authors review the molecular mechanisms of CSF secretion by the choroid plexus epithelium, the most efficient and actively secreting epithelium in the human body, and provide experimental and clinical evidence for the role of increased CSF production in hydrocephalus. Although the choroid plexus epithelium might have only an indirect influence on the pathogenesis of many types of pediatric hydrocephalus, the ability to modify CSF secretion with drugs newer than acetazolamide or furosemide would be an invaluable component of future therapies to alleviate permanent shunt dependence. Investigation into the human genetics of developmental hydrocephalus and choroid plexus hyperplasia, and the molecular physiology of the ion channels and transporters responsible for CSF secretion, might yield novel targets that could be exploited for pharmacotherapeutic intervention.
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Affiliation(s)
| | | | | | | | | | - Yasar Bayri
- Department of Neurosurgery, Marmara University School of Medicine, Istanbul, Turkey; and
| | | | | | | | - J Marc Simard
- Departments of 3 Neurosurgery and.,Pathology and Physiology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Kristopher T Kahle
- Departments of 1 Neurosurgery and.,Pediatrics, Cellular, and Molecular Physiology and Centers for Mendelian Genomics, Yale School of Medicine, New Haven, Connecticut
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16
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Abstract
Hydrocephalus is a common disorder of cerebral spinal fluid (CSF) physiology resulting in abnormal expansion of the cerebral ventricles. Infants commonly present with progressive macrocephaly whereas children older than 2 years generally present with signs and symptoms of intracranial hypertension. The classic understanding of hydrocephalus as the result of obstruction to bulk flow of CSF is evolving to models that incorporate dysfunctional cerebral pulsations, brain compliance, and newly characterised water-transport mechanisms. Hydrocephalus has many causes. Congenital hydrocephalus, most commonly involving aqueduct stenosis, has been linked to genes that regulate brain growth and development. Hydrocephalus can also be acquired, mostly from pathological processes that affect ventricular outflow, subarachnoid space function, or cerebral venous compliance. Treatment options include shunt and endoscopic approaches, which should be individualised to the child. The long-term outcome for children that have received treatment for hydrocephalus varies. Advances in brain imaging, technology, and understanding of the pathophysiology should ultimately lead to improved treatment of the disorder.
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Affiliation(s)
- Kristopher T Kahle
- Department of Neurosurgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Abhaya V Kulkarni
- Division of Neurosurgery, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - David D Limbrick
- Division of Neurosurgery, St Louis Children's Hospital, Washington University School of Medicine, St Louis, MO, USA
| | - Benjamin C Warf
- Department of Neurosurgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
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17
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Raybaud C. MR assessment of pediatric hydrocephalus: a road map. Childs Nerv Syst 2016; 32:19-41. [PMID: 26337698 DOI: 10.1007/s00381-015-2888-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 08/11/2015] [Indexed: 12/12/2022]
Abstract
PURPOSE This study was conducted to design a rational approach to the MR diagnosis of hydrocephalus based on a pathophysiologic reevaluation of its possible mechanisms and to apply it to the different etiological contexts. METHOD A review of the literature reports describing new physiologic models of production and absorption and of the hydrodynamics of the CSF was made. RESULTS Besides the secretion of CSF by the choroid plexuses, and its passive, pressure-dependent transdural absorption (arachnoid villi, dural clefts, cranial, and spinal nerve sheaths), water transporters, aquaporins, allow water (if not ions and organic molecules) to exchange freely between the brain parenchyma and the CSF spaces across the ependymal and the pial interfaces (including the Virchow-Robin spaces). Consequently, the CSF bulk flow is not necessarily global, and situations of balanced absorption-secretion may occur separately in different CSF compartments such as the ventricular, intracranial, or intraspinal CSF spaces. This means that rather than from a hypothetical pressure gradient from the plexuses to the dural sinuses, the dynamics of the CSF depend on the force provided in those different compartments by the arterial systolic pulsation of the pericerebral (mostly), intracerebral, and intraventricular (choroid plexuses) vascular beds. CONCLUSION Using MR imaging, diverse varieties of hydrocephalus may tentatively be explained by applying those concepts to the correspondingly diverse causal diseases. Hopefully, this may have an impact on the choice of the treatment strategies also.
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Affiliation(s)
- Charles Raybaud
- Division of Neuroradiology, Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.
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18
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NHERF1/EBP50 is an organizer of polarity structures and a diagnostic marker in ependymoma. Acta Neuropathol Commun 2015; 3:11. [PMID: 25775275 PMCID: PMC4352254 DOI: 10.1186/s40478-015-0197-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 02/18/2015] [Indexed: 12/01/2022] Open
Abstract
NHERF1/EBP50, an adaptor protein required for epithelial morphogenesis, has been implicated in the progression of various human malignancies. NHERF1-deficient mice have intestinal brush border structural defects and we report here that they also have disorganized ependymal cilia with development of non-obstructive hydrocephalus. Examination of mouse and human brain tissues revealed highest NHERF1 expression at the apical plasma membrane of ependymal cells. In ependymal tumors, NHERF1 expression was retained in polarized membrane structures, such as microlumens, rosettes and canals, where it co-localized with some of its ligands, such as moesin and PTEN. Analysis of a comprehensive panel of 113 tumors showed robust NHERF1 labeling of microlumens in 100% of ependymomas, subependymomas, and pediatric anaplastic ependymomas, and in 67% of adult anaplastic ependymomas. NHERF1 staining was present in 35% of ependymoma cases that lacked reactivity for EMA, the routine immunohistochemical marker used for ependymoma diagnosis. NHERF1 labeling of microlumens was either absent or rarely seen in other types of brain tumors analyzed, denoting NHERF1 as a reliable diagnostic marker of ependymal tumors. Anaplastic foci and a subset of adult anaplastic ependymomas showed complete absence of NHERF1-labeled polarity structures, consistent with a loss of differentiation in these aggressive tumors. These data highlight a role for NHERF1 in ependymal morphogenesis with direct application to the diagnosis of ependymal tumors.
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Centini G, Imperatore A, Morelli M, Rosignoli L, Passamonti U, Caprioli F, Lituania M. Bifid choroid plexus: always a normal fetal brain structure variant? Congenit Anom (Kyoto) 2013; 53:73-7. [PMID: 23751040 DOI: 10.1111/cga.12006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2012] [Accepted: 11/07/2012] [Indexed: 11/28/2022]
Abstract
Choroid plexus, a fetal organ developing approximately from the sixth week of gestation, plays a fundamental role in developing fetal brain organization. As relatively little is known about the relationship between anomalies of choroid plexuses structure and their role in brain function, we examined cases of bifid choroid plexus (BCP) and discussed their potential association with lateral ventriculomegaly, other abnormal ultrasound findings, and their potential role as markers of fetal chromosomal abnormalities. In the present study, we described 23 cases of fetal BCP found in 2145 routine second trimester ultrasounds. For each patient 2D and 3D ultrasound volumes were acquired. BCP was defined as a choroid plexus whose body was divided into two portions (arms) differently located and oriented on the three spatial axes in correspondence to the lateral ventricle, in one or both sides. The entity of the separation and reciprocal orientation of the two arms was examined. The presence of BCP in a low-risk population of pregnant women undergoing routine second trimester ultrasound was showed. Lateral ventricles significantly increased in the presence of BCP. Malformations were found in four of 23 fetuses with BCP. Pregnancy outcome was favorable only in one of these four cases. We suggest that in the presence of mono or bilateral BCP without associated abnormal ultrasound findings, a closer look at fetal brain or extra-cranial structures is recommended. If no related abnormalities are found, serial prenatal and postnatal sonographic follow-up should be considered. In the presence of concomitant abnormal findings, genetic counseling, fetal karyotyping and magnetic resonance imaging, if possible by gestational age, are strongly advised.
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Affiliation(s)
- Giovanni Centini
- Prenatal Diagnosis Center, University of Siena, Le Scotte Hospital, Siena, Italy
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20
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Hallaert GG, Vanhauwaert DJ, Logghe K, Van den Broecke C, Baert E, Van Roost D, Caemaert J. Endoscopic coagulation of choroid plexus hyperplasia. J Neurosurg Pediatr 2012; 9:169-77. [PMID: 22295923 DOI: 10.3171/2011.11.peds11154] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Hydrocephalus is a clinical disorder resulting from an imbalance between the production of CSF and its resorption, of which the latter is mostly a disadvantage. In rare cases of choroid plexus papilloma or carcinoma, hydrocephalus is due to an overproduction of CSF. Choroid plexus hyperplasia (CPH) is a distinct clinicopathological entity in which the enlarged choroid plexus produces large amounts of CSF. Historically, patients with CPH were treated by shunt procedures or by microsurgical removal of the choroid plexus, which is associated with a high complication rate. In this paper the authors show that endoscopic plexus coagulation can result in restoring the equilibrium of the intracranial fluid volumes, resulting in shunt independency. In this way, both the shunt-related complications and the bleeding risks of microsurgical plexectomy are avoided. In instances of hydrocephalus, thorough efforts should be made to demonstrate the underlying pathophysiology to choose the optimal treatment, of which shunt procedures should receive the least priority.
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21
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ANEI R, HAYASHI Y, HIROSHIMA S, MITSUI N, ORIMOTO R, UEMORI G, SAITO M, SATO M, WADA H, HODODUKA A, KAMADA K. Hydrocephalus Due to Diffuse Villous Hyperplasia of the Choroid Plexus -Case Report-. Neurol Med Chir (Tokyo) 2011; 51:437-41. [DOI: 10.2176/nmc.51.437] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Ryogo ANEI
- Department of Neurosurgery, Asahikawa Medical College
| | | | | | | | | | - Genki UEMORI
- Department of Neurosurgery, Asahikawa Medical College
| | - Masato SAITO
- Department of Neurosurgery, Asahikawa Medical College
| | - Masao SATO
- Department of Neurosurgery, Asahikawa Medical College
| | - Hajime WADA
- Department of Neurosurgery, Asahikawa Medical College
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22
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Cataltepe O, Liptzin D, Jolley L, Smith TW. Diffuse villous hyperplasia of the choroid plexus and its surgical management. J Neurosurg Pediatr 2010; 5:518-22. [PMID: 20433267 DOI: 10.3171/2009.12.peds0960] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Diffuse villous hyperplasia of the choroid plexus (DVHCP) is a very rare cause of hydrocephalus in children. Only 12 cases of DVHCP have been reported in the literature. In this report the authors describe a new case of a patient with DVHCP who was diagnosed prenatally with hydrocephalus. In a comprehensive literature review and discussion, the authors also discuss radiological and histological characteristics of the reported cases, treatment approaches, and surgical modalities that have been used in the treatment of these patients.
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Affiliation(s)
- Oguz Cataltepe
- Division of Neurosurgery, University of Massachusetts Medical Center, Suite S2-848, 55 Lake Avenue North, Worcester, Massachusetts 01655, USA.
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23
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Nimjee SM, Powers CJ, McLendon RE, Grant GA, Fuchs HE. Single-stage bilateral choroid plexectomy for choroid plexus papilloma in a patient presenting with high cerebrospinal fluid output. J Neurosurg Pediatr 2010; 5:342-5. [PMID: 20367337 DOI: 10.3171/2009.10.peds08454] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Cerebrospinal fluid overproduction resulting in communicating hydrocephalus is observed in patients who have choroid plexus papilloma or choroid plexus carcinoma. Less often, patients with these conditions have diffuse villous hyperplasia. Prior studies report CSF production greater than 3 L per day in these patients. These patients are treated with CSF shunting or by either unilateral choroid plexectomy or staged bilateral choroid plexectomy. The authors present a patient who had a number of congenital anomalies and a karyotype that revealed balanced translocations, 5 to 7 and 9 to 11. She presented with hydrocephalus and had CSF production of 5 L per day, greater output than ever previously reported. She was treated with a single-stage bilateral choroid plexectomy. Histopathological analysis revealed a bilateral choroid plexus papilloma. Postoperatively, the patient responded well clinically and showed radiographic improvement of her hydrocephalus. Bilateral choroid plexus papilloma has been reported in the literature as a cause for neonatal and congenital hydrocephalus. It can result in high CSF output and can be successfully treated with a single-stage bilateral choroid plexectomy. Further studies are ongoing to identify genes involved in embryogenesis of the choroid plexus.
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Affiliation(s)
- Shahid M Nimjee
- Department of Surgery, Division of Neurosurgery, Duke University Medical Center, Durham, North Carolina 27710, USA.
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24
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Bilateral choroid plexus hyperplasia: a case report and management strategies. Childs Nerv Syst 2009; 25:1617-22. [PMID: 19551390 DOI: 10.1007/s00381-009-0923-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2008] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Choroid plexus hyperplasia (CPH) is a rare cause of cerebrospinal fluid (CSF) overproduction and shunt-resistant hydrocephalus in infants. If treated with a ventriculoperitoneal (VP) shunt, these patients secondarily develop CSF accumulation along the shunt tract and within the peritoneum. The surgical management of this condition is not as clearly defined as in the case of a choroid plexus papilloma or carcinoma. CASE REPORT An 8-day-old male patient presented with bulging fontanelle, head circumference = 42 cm (>98th percentile), and cranial ultrasound demonstrating communicating hydrocephalus with enlarged choroid plexuses. A VP shunt was inserted, and secondarily progressive hydrocephalus, shunt tract fluid accumulation, and ascites developed. The infant underwent staged bilateral plexectomy and is tolerating CSF diversion. The pathology confirmed CPH. DISCUSSION Of the cases reported in the literature, treatments have included CSF shunting, endoscopic coagulation, and craniotomy with plexectomy. CSF shunting was required in the majority but not all. Only those having undergone bilateral choroid plexectomy have been rendered shunt free.
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25
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Stanković G, Nikolić V, Puskas N, Filipović B, Puskas L, Krivokuća D. [Relations of aqueduct with some structures of mesencephalon]. MEDICINSKI PREGLED 2009; 62:352-357. [PMID: 19902788 DOI: 10.2298/mpns0908352s] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
INTRODUCTION Aqueductus mesencephali is the biggest part of the ventricular system and that is why it is the most common place of intraventricular obstruction of cerebrospinal fluid. This study was done in order to study topographic characteristics of aqueduct more thoroughly. MATERIALS AND METHODS Transversal sections of mesencephalon were made in three levels. The first section was made caudally immediately from the posterior commissure. The second section was made in the middle part of the superior colliculi, and the third section was made in the rostral parts of the caudal sections of the superior colliculi. Distances of the aqueduct from structures of mesencephalon, obtained on the second section, are: 1. The distance of the aqueduct from the superior colliculi - 6.96 mm; 2. The distance of the aqueduct from the red nucleus - 6.02 mm; 3. The distance of the aqueduct from the substantia nigra - 12.29 mm; 4. The distance of the aqueduct from the interpeduncular fossa - 10.22 mm. CONCLUSION Knowledge of the anatomy of the aqueductus mesencephali is very important because of interpretation of patogenesis of hidrocefalus as well as of other syndromes that occure in some pathological processes in the system of ventricles.
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Abstract
Normal pressure hydrocephalus (NPH) is a reversible disorder characterized by gait impairment, subcortical dementia, and urinary urgency and incontinence associated with impaired cerebrospinal fluid circulation and ventriculomegaly. Treatment with shunt surgery is most likely to increase mobility, and may also improve dementia and urinary symptoms. An international, independent study group recently published guidelines for the diagnosis and management of idiopathic NPH. This article helps geriatricians identify patients who might have NPH, and care for these patients after shunt placement.
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Affiliation(s)
- Robin K Wilson
- Department of Neurology, The Johns Hopkins Hospital, Adult Hydrocephalus Program, 600 North Wolfe Street, Baltimore, MD 21287, USA
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27
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Tamburrini G, Caldarelli M, Di Rocco F, Massimi L, D'Angelo L, Fasano T, Di Rocco C. The role of endoscopic choroid plexus coagulation in the surgical management of bilateral choroid plexuses hyperplasia. Childs Nerv Syst 2006; 22:605-8. [PMID: 16555078 DOI: 10.1007/s00381-006-0070-2] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2005] [Indexed: 10/24/2022]
Abstract
BACKGROUND Bilateral choroid plexus hyperplasia is a rare condition often associated with cerebrospinal fluid (CSF) overproduction. CSF overproduction is usually so high that the placement of a CSF ventriculoperitoneal shunt almost always results in progressive ascites leading to the necessity of removing the inserted shunt device. A direct surgical treatment of the hyperplastic choroid plexuses is then mandatory. Endoscopic coagulation of the choroid plexuses has been recently proposed as an alternative to open surgical plexectomy. However, the effectiveness of the procedure in controlling CSF overproduction is still debated. TECHNIQUE We report a case of bilateral choroid plexus hyperplasia in which an extensive bilateral endoscopic coagulation of the choroid plexuses failed to reduce the CSF formation rate sufficiently. A one-stage bilateral open surgical plexectomy was performed. RESULTS The procedure succeeded to control CSF overproduction. Intraoperative blood loss during the surgical removal of the choroid plexuses was significantly reduced due to the previous coagulation of their surface. CONCLUSION On these grounds, we suggest that endoscopic choroid plexuses coagulation, even when failing to normalize CSF production, may still be considered as a valid adjuvant procedure in the management of this condition.
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Affiliation(s)
- Gianpiero Tamburrini
- Section of Pediatric Neurosurgery, Institute of Neurosurgery, Catholic University Medical School, Largo Gemelli 8, 00168, Rome, Italy
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