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Garcia-Bonilla M, Hariharan P, Gluski J, Ruiz-Cardozo MA, Otun A, Morales DM, Marupudi NI, Whitehead WE, Jea A, Rocque BG, McAllister JP, Limbrick DD, Harris CA. Ventricular catheter tissue obstruction and shunt malfunction in 9 hydrocephalus etiologies. J Neurosurg Pediatr 2024:1-10. [PMID: 38608296 DOI: 10.3171/2024.2.peds23356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 02/07/2024] [Indexed: 04/14/2024]
Abstract
OBJECTIVE Hydrocephalus is a neurological disorder with an incidence of 80-125 per 100,000 births in the United States. The most common treatment, ventricular shunting, has a failure rate of up to 85% within 10 years of placement. The authors aimed to analyze the association between ventricular catheter (VC) tissue obstructions and shunt malfunction for each hydrocephalus etiology. METHODS Patient information was collected from 5 hospitals and entered into a REDCap (Research Electronic Data Capture) database by hydrocephalus etiology. The hardware samples were fixed, and each VC tip drainage hole was classified by tissue obstruction after macroscopic analysis. Shunt malfunction data, including shunt revision rate, time to failure, and age at surgery, were correlated with the degree of tissue obstruction in VCs for each etiology. RESULTS Posthemorrhagic hydrocephalus was the most common etiology (48.9% of total cases). Proximal catheter obstruction was the most frequent cause of hardware removal (90.4%). Myelomeningocele (44% ± 29%), other congenital etiologies (48% ± 40%), hydrocephalus with brain tumors (45% ± 35%), and posthemorrhagic hydrocephalus (41% ± 35%) showed tissue aggregates in more than 40% of the VC holes. A total of 76.8% of samples removed because of symptoms of obstruction showed cellular or tissue aggregates. No conclusive etiological associations were detected when correlating the percentage of holes with tissue for each VC and age at surgery, shunt revision rates, or time between shunt implantation and removal. CONCLUSIONS The proximal VC obstruction was accompanied by tissue aggregates in 76.8% of cases. However, the presence of tissue in the VC did not seem to be associated with hydrocephalus etiology.
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Affiliation(s)
- Maria Garcia-Bonilla
- 1Department of Neurosurgery, Washington University in St. Louis School of Medicine, St. Louis, Missouri
- 2Department of Neurosurgery, Virginia Commonwealth University, Richmond, Virginia
| | | | - Jacob Gluski
- 4Chemical Engineering and Materials Science, Wayne State University, Detroit, Michigan
| | - Miguel A Ruiz-Cardozo
- 1Department of Neurosurgery, Washington University in St. Louis School of Medicine, St. Louis, Missouri
| | - Ayodamola Otun
- 1Department of Neurosurgery, Washington University in St. Louis School of Medicine, St. Louis, Missouri
| | - Diego M Morales
- 1Department of Neurosurgery, Washington University in St. Louis School of Medicine, St. Louis, Missouri
| | - Neena I Marupudi
- 5Department of Neurosurgery, Children's Hospital of Michigan, Detroit, Michigan
| | | | - Andrew Jea
- 7Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma; and
| | - Brandon G Rocque
- 8Division of Pediatric Neurosurgery, Department of Neurosurgery, University of Alabama at Birmingham, Alabama
| | - James P McAllister
- 1Department of Neurosurgery, Washington University in St. Louis School of Medicine, St. Louis, Missouri
| | - David D Limbrick
- 1Department of Neurosurgery, Washington University in St. Louis School of Medicine, St. Louis, Missouri
- 2Department of Neurosurgery, Virginia Commonwealth University, Richmond, Virginia
| | - Carolyn A Harris
- 4Chemical Engineering and Materials Science, Wayne State University, Detroit, Michigan
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Garcia-Bonilla M, Harris CA, Bandyopadhyay S, Moore J, Horbatiuk J, Limbrick DD, Swarup R, Crouthamel J, Jones A, Khasawneh A, Petroj A, Hehar S, Sierra M, Anderson J, Murray R, Talcott MR, McAllister JP. Reduction of cell surface attachment in experimental hydrocephalus using a novel ventricular catheter with modified tethered liquid perfluorocarbon. J Neurosurg 2024; 140:627-638. [PMID: 37542436 DOI: 10.3171/2023.5.jns2355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 05/19/2023] [Indexed: 08/07/2023]
Abstract
OBJECTIVE Ventriculoperitoneal shunting, the most common treatment for the neurological disorder hydrocephalus, has a failure rate of up to 98% within 10 years of placement, mainly because of proximal obstruction of the ventricular catheter (VC). The authors developed a new VC design modified with tethered liquid perfluorocarbon (TLP) and tested it in a porcine model of hydrocephalus. In this study, they aimed to determine if their TLP VC design reduced cell surface attachment and consequent shunt obstruction in the pig model. METHODS TLP VCs were designed to reduce drainage hole obstruction using modified TLP and slightly enlarged draining holes, but their number and placement remained very similar to standard VCs. First, the authors tested the device in nonhydrocephalic rats to assess biocompatibility. After confirming safety, they implanted the VCs in hydrocephalic pigs. Hydrocephalus was induced by intracisternal kaolin injections in 30-day-old domestic juvenile pigs. Surgical implantation of the ventriculoperitoneal shunt (clinical control or TLP) was performed 10-14 days postinduction and maintained up to 30 days posttreatment. MRI was performed to measure ventricular volume before treatment and 10 and 30 days after treatment. Histological and immunohistochemical analyses of brain tissue and explanted VCs, intracranial pressure measurement, and clinical scoring were performed when the animals were euthanized. RESULTS TLP VCs showed a similar surgical feel, kink resistance, and stiffness to control VCs. In rats (biocompatibility assessment), TLP VCs did not show brain inflammatory reactions after 30 or 60 days of implantation. In pigs, TLP VCs demonstrated increased survival time, improved clinical outcome scores, and significantly reduced total attached cells on the VCs compared with standard clinical control VCs. TLP VCs exhibited similar, but not worse, results related to ventriculomegaly, intracranial pressure, and the local tissue response around the cortical shunt track in pigs. CONCLUSIONS TLP VCs may be a strong candidate to reduce proximal VC obstruction and improve hydrocephalus treatment.
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Affiliation(s)
- Maria Garcia-Bonilla
- 1Department of Neurosurgery, Washington University in St. Louis School of Medicine, St. Louis, Missouri
| | - Carolyn A Harris
- 2Department of Chemical Engineering and Materials Science, Wayne State University, Detroit, Michigan
| | | | - Jason Moore
- 1Department of Neurosurgery, Washington University in St. Louis School of Medicine, St. Louis, Missouri
| | - Jeff Horbatiuk
- 2Department of Chemical Engineering and Materials Science, Wayne State University, Detroit, Michigan
| | - David D Limbrick
- 1Department of Neurosurgery, Washington University in St. Louis School of Medicine, St. Louis, Missouri
| | - Rajiv Swarup
- 1Department of Neurosurgery, Washington University in St. Louis School of Medicine, St. Louis, Missouri
| | - Jayne Crouthamel
- 1Department of Neurosurgery, Washington University in St. Louis School of Medicine, St. Louis, Missouri
| | - Andrew Jones
- 3FreeFlow Medical Devices LLC, Lancaster, Pennsylvania; and
| | - Ahmad Khasawneh
- 2Department of Chemical Engineering and Materials Science, Wayne State University, Detroit, Michigan
| | - Alexandra Petroj
- 2Department of Chemical Engineering and Materials Science, Wayne State University, Detroit, Michigan
| | - Simran Hehar
- 2Department of Chemical Engineering and Materials Science, Wayne State University, Detroit, Michigan
| | - Mariana Sierra
- 2Department of Chemical Engineering and Materials Science, Wayne State University, Detroit, Michigan
| | | | - Ryann Murray
- 3FreeFlow Medical Devices LLC, Lancaster, Pennsylvania; and
| | - Michael R Talcott
- 1Department of Neurosurgery, Washington University in St. Louis School of Medicine, St. Louis, Missouri
- 4AbbVie Inc., Chicago, Illinois
| | - James P McAllister
- 1Department of Neurosurgery, Washington University in St. Louis School of Medicine, St. Louis, Missouri
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Hariharan P, Gluski J, Sondheimer J, Petroj A, Jea A, Whitehead WE, Del Bigio MR, Marupudi NI, McAllister JP, Limbrick DD, Rocque BG, Harris CA. Exploration of clinical predictors of the degree of ventricular catheter obstruction: a multicenter retrospective study. J Neurosurg Pediatr 2023; 32:447-454. [PMID: 37503917 PMCID: PMC10416264 DOI: 10.3171/2023.5.peds22552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Accepted: 05/30/2023] [Indexed: 07/29/2023]
Abstract
OBJECTIVE The aim of this study was to explore how clinical factors, including the number of lifetime revision surgeries and the duration of implantation, affect the degree of obstruction and failure rates of ventricular catheters (VCs) used to manage hydrocephalus. METHODS A total of 343 VCs and their associated clinical data, including patient demographics, medical history, and surgical details, were collected from 5 centers and used for this analysis. Each VC was classified by the degree of obstruction after macroscopic analysis. Univariate, multivariate, and binned analyses were conducted to test for associations between clinical data and degree of VC obstruction. RESULTS VCs from patients with 0 to 2 lifetime revisions had a larger proportion of VC holes obstructed than VCs from patients with 10 or more revisions (p = 0.0484). VCs implanted for less than 3 months had fewer obstructed holes with protruding tissue aggregates than VCs implanted for 13 months or longer (p = 0.0225). Neither duration of implantation nor the number of lifetime revisions was a significant predictor of the degree of VC obstruction in the regression models. In the multinomial regression model, contact of the VCs with the ventricular wall robustly predicted the overall obstruction status of a VC (p = 0.005). In the mixed-effects model, the age of the patient at their first surgery emerged as a significant predictor of obstruction by protruding tissue aggregates (p = 0.002). VCs implanted through the parietal entry site were associated with more holes with nonobstructive growth and fewer empty holes than VCs implanted via other approaches (p = 0.001). CONCLUSIONS The number of lifetime revisions and duration of implantation are correlated with the degree of VC obstruction but do not predict it. Contact of the VC with the ventricular wall and the age of the patient at their first surgery are predictors of the degree of VC obstruction, while the entry site of the VC correlates with it.
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Affiliation(s)
| | - Jacob Gluski
- Department of Neurosurgery, Wayne State University School of Medicine, Detroit, Michigan
| | - Jeffrey Sondheimer
- Chemical Engineering and Materials Science, Wayne State University, Detroit, Michigan
| | - Alexandra Petroj
- Chemical Engineering and Materials Science, Wayne State University, Detroit, Michigan
| | - Andrew Jea
- Department of Neurosurgery, The University of Oklahoma College of Medicine and Oklahoma Children’s Hospital, Oklahoma City, Oklahoma
| | - William E. Whitehead
- Department of Neurosurgery, Baylor College of Medicine and Texas Children’s Hospital, Houston, Texas
| | - Marc R. Del Bigio
- Department of Pathology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Neena I. Marupudi
- Department of Neurosurgery, Wayne State University School of Medicine, Detroit, Michigan
- Department of Neurosurgery, Children’s Hospital of Michigan, Detroit, Michigan
| | - James P. McAllister
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri; and
| | - David D. Limbrick
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri; and
| | - Brandon G. Rocque
- Department of Neurosurgery, University of Alabama at Birmingham, Alabama
| | - Carolyn A. Harris
- Chemical Engineering and Materials Science, Wayne State University, Detroit, Michigan
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Garcia-Bonilla M, Nair A, Moore J, Castaneyra-Ruiz L, Zwick SH, Dilger RN, Fleming SA, Golden RK, Talcott MR, Isaacs AM, Limbrick DD, McAllister JP. Impaired neurogenesis with reactive astrocytosis in the hippocampus in a porcine model of acquired hydrocephalus. Exp Neurol 2023; 363:114354. [PMID: 36822393 PMCID: PMC10411821 DOI: 10.1016/j.expneurol.2023.114354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 02/03/2023] [Accepted: 02/18/2023] [Indexed: 02/23/2023]
Abstract
BACKGROUND Hydrocephalus is a neurological disease with an incidence of 0.3-0.7 per 1000 live births in the United States. Ventriculomegaly, periventricular white matter alterations, inflammation, and gliosis are among the neuropathologies associated with this disease. We hypothesized that hippocampus structure and subgranular zone neurogenesis are altered in untreated hydrocephalus and correlate with recognition memory deficits. METHODS Hydrocephalus was induced by intracisternal kaolin injections in domestic juvenile pigs (43.6 ± 9.8 days). Age-matched sham controls received similar saline injections. MRI was performed to measure ventricular volume, and/or hippocampal and perirhinal sizes at 14 ± 4 days and 36 ± 8 days post-induction. Recognition memory was assessed one week before and after kaolin induction. Histology and immunohistochemistry in the hippocampus were performed at sacrifice. RESULTS The hippocampal width and the perirhinal cortex thickness were decreased (p < 0.05) in hydrocephalic pigs 14 ± 4 days post-induction. At sacrifice (36 ± 8 days post-induction), significant expansion of the cerebral ventricles was detected (p = 0.005) in hydrocephalic pigs compared with sham controls. The area of the dorsal hippocampus exhibited a reduction (p = 0.035) of 23.4% in the hydrocephalic pigs at sacrifice. Likewise, in hydrocephalic pigs, the percentages of neuronal precursor cells (doublecortin+ cells) and neurons decreased (p < 0.01) by 32.35%, and 19.74%, respectively, in the subgranular zone of the dorsal hippocampus. The percentage of reactive astrocytes (vimentin+) was increased (p = 0.041) by 48.7%. In contrast, microglial cells were found to decrease (p = 0.014) by 55.74% in the dorsal hippocampus in hydrocephalic pigs. There was no difference in the recognition index, a summative measure of learning and memory, one week before and after the induction of hydrocephalus. CONCLUSION In untreated juvenile pigs, acquired hydrocephalus caused morphological alterations, reduced neurogenesis, and increased reactive astrocytosis in the hippocampus and perirhinal cortex.
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Affiliation(s)
- Maria Garcia-Bonilla
- Department of Neurosurgery, Washington University in St. Louis School of Medicine, St. Louis, MO 63110, USA.
| | - Arjun Nair
- Department of Neurosurgery, Washington University in St. Louis School of Medicine, St. Louis, MO 63110, USA
| | - Jason Moore
- Department of Neurosurgery, Washington University in St. Louis School of Medicine, St. Louis, MO 63110, USA
| | | | - Sarah H Zwick
- Department of Neurosurgery, Washington University in St. Louis School of Medicine, St. Louis, MO 63110, USA
| | - Ryan N Dilger
- Neuroscience Program, Department of Animal Sciences, University of Illinois, Urbana-Champaign, IL 61801, USA
| | - Stephen A Fleming
- Neuroscience Program, Department of Animal Sciences, University of Illinois, Urbana-Champaign, IL 61801, USA; Traverse Science, Champaign, IL 61801, USA
| | - Rebecca K Golden
- Neuroscience Program, Department of Animal Sciences, University of Illinois, Urbana-Champaign, IL 61801, USA
| | - Michael R Talcott
- Department of Neurosurgery, Washington University in St. Louis School of Medicine, St. Louis, MO 63110, USA; AbbVie, Inc., North Chicago, IL 60064, USA
| | - Albert M Isaacs
- Department of Neurological Surgery, Vanderbilt, University Medical Center, Nashville, TN 37232, USA
| | - David D Limbrick
- Department of Neurosurgery, Washington University in St. Louis School of Medicine, St. Louis, MO 63110, USA
| | - James P McAllister
- Department of Neurosurgery, Washington University in St. Louis School of Medicine, St. Louis, MO 63110, USA
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Khodadadei F, Arshad R, Morales DM, Gluski J, Marupudi NI, McAllister JP, Limbrick DD, Harris CA. The effect of A1 and A2 reactive astrocyte expression on hydrocephalus shunt failure. Fluids Barriers CNS 2022; 19:78. [PMID: 36171630 PMCID: PMC9516791 DOI: 10.1186/s12987-022-00367-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 08/18/2022] [Indexed: 11/13/2022] Open
Abstract
Background The composition of tissue obstructing neuroprosthetic devices is largely composed of inflammatory cells with a significant astrocyte component. In a first-of-its-kind study, we profile the astrocyte phenotypes present on hydrocephalus shunts. Methods qPCR and RNA in-situ hybridization were used to quantify pro-inflammatory (A1) and anti-inflammatory (A2) reactive astrocyte phenotypes by analyzing C3 and EMP1 genes, respectively. Additionally, CSF cytokine levels were quantified using ELISA. In an in vitro model of astrocyte growth on shunts, different cytokines were used to prevent the activation of resting astrocytes into the A1 and A2 phenotypes. Obstructed and non-obstructed shunts were characterized based on the degree of actual tissue blockage on the shunt surface instead of clinical diagnosis. Results The results showed a heterogeneous population of A1 and A2 reactive astrocytes on the shunts with obstructed shunts having a significantly higher proportion of A2 astrocytes compared to non-obstructed shunts. In addition, the pro-A2 cytokine IL-6 inducing proliferation of astrocytes was found at higher concentrations among CSF from obstructed samples. Consequently, in the in vitro model of astrocyte growth on shunts, cytokine neutralizing antibodies were used to prevent activation of resting astrocytes into the A1 and A2 phenotypes which resulted in a significant reduction in both A1 and A2 growth. Conclusions Therefore, targeting cytokines involved with astrocyte A1 and A2 activation is a promising intervention aimed to prevent shunt obstruction. Supplementary Information The online version contains supplementary material available at 10.1186/s12987-022-00367-3.
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Affiliation(s)
- Fatemeh Khodadadei
- Department of Chemical Engineering and Materials Science, Wayne State University, Detroit, MI, USA.
| | - Rooshan Arshad
- School of Medicine, Wayne State University, Detroit, MI, USA
| | - Diego M Morales
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Jacob Gluski
- Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI, USA
| | - Neena I Marupudi
- Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI, USA
| | - James P McAllister
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO, USA
| | - David D Limbrick
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Carolyn A Harris
- Department of Chemical Engineering and Materials Science, Wayne State University, Detroit, MI, USA. .,Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI, USA. .,Department of Biomedical Engineering, Wayne State University, Detroit, MI, USA.
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Garcia-Bonilla M, Castaneyra-Ruiz L, Zwick S, Talcott M, Otun A, Isaacs AM, Morales DM, Limbrick DD, McAllister JP. Acquired hydrocephalus is associated with neuroinflammation, progenitor loss, and cellular changes in the subventricular zone and periventricular white matter. Fluids Barriers CNS 2022; 19:17. [PMID: 35193620 PMCID: PMC8864805 DOI: 10.1186/s12987-022-00313-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 02/06/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Hydrocephalus is a neurological disease with an incidence of 80-125 per 100,000 births in the United States. Neuropathology comprises ventriculomegaly, periventricular white matter (PVWM) alterations, inflammation, and gliosis. We hypothesized that hydrocephalus in a pig model is associated with subventricular and PVWM cellular alterations and neuroinflammation that could mimic the neuropathology described in hydrocephalic infants. METHODS Hydrocephalus was induced by intracisternal kaolin injections in 35-day old female pigs (n = 7 for tissue analysis, n = 10 for CSF analysis). Age-matched sham controls received saline injections (n = 6). After 19-40 days, MRI scanning was performed to measure the ventricular volume. Stem cell proliferation was studied in the Subventricular Zone (SVZ), and cell death and oligodendrocytes were examined in the PVWM. The neuroinflammatory reaction was studied by quantifying astrocytes and microglial cells in the PVWM, and inflammatory cytokines in the CSF. RESULTS The expansion of the ventricles was especially pronounced in the body of the lateral ventricle, where ependymal disruption occurred. PVWM showed a 44% increase in cell death and a 67% reduction of oligodendrocytes. In the SVZ, the number of proliferative cells and oligodendrocyte decreased by 75% and 57% respectively. The decrease of the SVZ area correlated significantly with ventricular volume increase. Neuroinflammation occurred in the hydrocephalic pigs with a significant increase of astrocytes and microglia in the PVWM, and high levels of inflammatory interleukins IL-6 and IL-8 in the CSF. CONCLUSION The induction of acquired hydrocephalus produced alterations in the PVWM, reduced cell proliferation in the SVZ, and neuroinflammation.
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Affiliation(s)
- Maria Garcia-Bonilla
- Department of Neurosurgery, Washington University in St. Louis School of Medicine, St. Louis, MO, 63110, USA.
| | - Leandro Castaneyra-Ruiz
- Department of Neurosurgery, Washington University in St. Louis School of Medicine, St. Louis, MO, 63110, USA
| | - Sarah Zwick
- Department of Neurosurgery, Washington University in St. Louis School of Medicine, St. Louis, MO, 63110, USA
| | - Michael Talcott
- Department of Neurosurgery, Washington University in St. Louis School of Medicine, St. Louis, MO, 63110, USA.,Division of Comparative Medicine, Washington University in St. Louis School of Medicine, St. Louis, MO, 63110, USA
| | - Ayodamola Otun
- Department of Neurosurgery, Washington University in St. Louis School of Medicine, St. Louis, MO, 63110, USA
| | - Albert M Isaacs
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Calgary, Alberta, T2N 2T9, Canada
| | - Diego M Morales
- Department of Neurosurgery, Washington University in St. Louis School of Medicine, St. Louis, MO, 63110, USA
| | - David D Limbrick
- Department of Neurosurgery, Washington University in St. Louis School of Medicine, St. Louis, MO, 63110, USA
| | - James P McAllister
- Department of Neurosurgery, Washington University in St. Louis School of Medicine, St. Louis, MO, 63110, USA
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Isaacs AM, Neil JJ, McAllister JP, Dahiya S, Castaneyra-Ruiz L, Merisaari H, Botteron HE, Alexopoulos D, George A, Sun P, Morales DM, Shimony JS, Strahle J, Yan Y, Song SK, Limbrick DD, Smyser CD. Microstructural Periventricular White Matter Injury in Post-hemorrhagic Ventricular Dilatation. Neurology 2022; 98:e364-e375. [PMID: 34799460 PMCID: PMC8793106 DOI: 10.1212/wnl.0000000000013080] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 09/15/2021] [Accepted: 11/12/2021] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND AND OBJECTIVES The neurologic deficits of neonatal post-hemorrhagic hydrocephalus (PHH) have been linked to periventricular white matter injury. To improve understanding of PHH-related injury, diffusion basis spectrum imaging (DBSI) was applied in neonates, modeling axonal and myelin integrity, fiber density, and extrafiber pathologies. Objectives included characterizing DBSI measures in periventricular tracts, associating measures with ventricular size, and examining MRI findings in the context of postmortem white matter histology from similar cases. METHODS A prospective cohort of infants born very preterm underwent term equivalent MRI, including infants with PHH, high-grade intraventricular hemorrhage without hydrocephalus (IVH), and controls (very preterm [VPT]). DBSI metrics extracted from the corpus callosum, corticospinal tracts, and optic radiations included fiber axial diffusivity, fiber radial diffusivity, fiber fractional anisotropy, fiber fraction (fiber density), restricted fractions (cellular infiltration), and nonrestricted fractions (vasogenic edema). Measures were compared across groups and correlated with ventricular size. Corpus callosum postmortem immunohistochemistry in infants with and without PHH assessed intra- and extrafiber pathologies. RESULTS Ninety-five infants born very preterm were assessed (68 VPT, 15 IVH, 12 PHH). Infants with PHH had the most severe white matter abnormalities and there were no consistent differences in measures between IVH and VPT groups. Key tract-specific white matter injury patterns in PHH included reduced fiber fraction in the setting of axonal or myelin injury, increased cellular infiltration, vasogenic edema, and inflammation. Specifically, measures of axonal injury were highest in the corpus callosum; both axonal and myelin injury were observed in the corticospinal tracts; and axonal and myelin integrity were preserved in the setting of increased extrafiber cellular infiltration and edema in the optic radiations. Increasing ventricular size correlated with worse DBSI metrics across groups. On histology, infants with PHH had high cellularity, variable cytoplasmic vacuolation, and low synaptophysin marker intensity. DISCUSSION PHH was associated with diffuse white matter injury, including tract-specific patterns of axonal and myelin injury, fiber loss, cellular infiltration, and inflammation. Larger ventricular size was associated with greater disruption. Postmortem immunohistochemistry confirmed MRI findings. These results demonstrate DBSI provides an innovative approach extending beyond conventional diffusion MRI for investigating neuropathologic effects of PHH on neonatal brain development.
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Affiliation(s)
- Albert M Isaacs
- From the Department of Neuroscience (A.M.I.), Washington University in St. Louis, MO; Department of Clinical Neurosciences (A.M.I.), University of Calgary, Canada; and Departments of Neurology (J.J.N., D.A., C.D.S.), Neurosurgery (J.P.A., L.C.-R., H.E.B., D.M.M., J.S., D.D.L.), Pathology (S.D.), Public Health Sciences (Y.Y.,), and Pediatrics (C.D.S.), and Mallinckrodt Institute of Radiology (H.M., A.G., P.S., J.S., S.-K.S., C.D.S.), Washington University School of Medicine, St. Louis, MO.
| | - Jeffrey J Neil
- From the Department of Neuroscience (A.M.I.), Washington University in St. Louis, MO; Department of Clinical Neurosciences (A.M.I.), University of Calgary, Canada; and Departments of Neurology (J.J.N., D.A., C.D.S.), Neurosurgery (J.P.A., L.C.-R., H.E.B., D.M.M., J.S., D.D.L.), Pathology (S.D.), Public Health Sciences (Y.Y.,), and Pediatrics (C.D.S.), and Mallinckrodt Institute of Radiology (H.M., A.G., P.S., J.S., S.-K.S., C.D.S.), Washington University School of Medicine, St. Louis, MO
| | - James P McAllister
- From the Department of Neuroscience (A.M.I.), Washington University in St. Louis, MO; Department of Clinical Neurosciences (A.M.I.), University of Calgary, Canada; and Departments of Neurology (J.J.N., D.A., C.D.S.), Neurosurgery (J.P.A., L.C.-R., H.E.B., D.M.M., J.S., D.D.L.), Pathology (S.D.), Public Health Sciences (Y.Y.,), and Pediatrics (C.D.S.), and Mallinckrodt Institute of Radiology (H.M., A.G., P.S., J.S., S.-K.S., C.D.S.), Washington University School of Medicine, St. Louis, MO
| | - Sonika Dahiya
- From the Department of Neuroscience (A.M.I.), Washington University in St. Louis, MO; Department of Clinical Neurosciences (A.M.I.), University of Calgary, Canada; and Departments of Neurology (J.J.N., D.A., C.D.S.), Neurosurgery (J.P.A., L.C.-R., H.E.B., D.M.M., J.S., D.D.L.), Pathology (S.D.), Public Health Sciences (Y.Y.,), and Pediatrics (C.D.S.), and Mallinckrodt Institute of Radiology (H.M., A.G., P.S., J.S., S.-K.S., C.D.S.), Washington University School of Medicine, St. Louis, MO
| | - Leandro Castaneyra-Ruiz
- From the Department of Neuroscience (A.M.I.), Washington University in St. Louis, MO; Department of Clinical Neurosciences (A.M.I.), University of Calgary, Canada; and Departments of Neurology (J.J.N., D.A., C.D.S.), Neurosurgery (J.P.A., L.C.-R., H.E.B., D.M.M., J.S., D.D.L.), Pathology (S.D.), Public Health Sciences (Y.Y.,), and Pediatrics (C.D.S.), and Mallinckrodt Institute of Radiology (H.M., A.G., P.S., J.S., S.-K.S., C.D.S.), Washington University School of Medicine, St. Louis, MO
| | - Harri Merisaari
- From the Department of Neuroscience (A.M.I.), Washington University in St. Louis, MO; Department of Clinical Neurosciences (A.M.I.), University of Calgary, Canada; and Departments of Neurology (J.J.N., D.A., C.D.S.), Neurosurgery (J.P.A., L.C.-R., H.E.B., D.M.M., J.S., D.D.L.), Pathology (S.D.), Public Health Sciences (Y.Y.,), and Pediatrics (C.D.S.), and Mallinckrodt Institute of Radiology (H.M., A.G., P.S., J.S., S.-K.S., C.D.S.), Washington University School of Medicine, St. Louis, MO
| | - Haley E Botteron
- From the Department of Neuroscience (A.M.I.), Washington University in St. Louis, MO; Department of Clinical Neurosciences (A.M.I.), University of Calgary, Canada; and Departments of Neurology (J.J.N., D.A., C.D.S.), Neurosurgery (J.P.A., L.C.-R., H.E.B., D.M.M., J.S., D.D.L.), Pathology (S.D.), Public Health Sciences (Y.Y.,), and Pediatrics (C.D.S.), and Mallinckrodt Institute of Radiology (H.M., A.G., P.S., J.S., S.-K.S., C.D.S.), Washington University School of Medicine, St. Louis, MO
| | - Dimitrios Alexopoulos
- From the Department of Neuroscience (A.M.I.), Washington University in St. Louis, MO; Department of Clinical Neurosciences (A.M.I.), University of Calgary, Canada; and Departments of Neurology (J.J.N., D.A., C.D.S.), Neurosurgery (J.P.A., L.C.-R., H.E.B., D.M.M., J.S., D.D.L.), Pathology (S.D.), Public Health Sciences (Y.Y.,), and Pediatrics (C.D.S.), and Mallinckrodt Institute of Radiology (H.M., A.G., P.S., J.S., S.-K.S., C.D.S.), Washington University School of Medicine, St. Louis, MO
| | - Ajit George
- From the Department of Neuroscience (A.M.I.), Washington University in St. Louis, MO; Department of Clinical Neurosciences (A.M.I.), University of Calgary, Canada; and Departments of Neurology (J.J.N., D.A., C.D.S.), Neurosurgery (J.P.A., L.C.-R., H.E.B., D.M.M., J.S., D.D.L.), Pathology (S.D.), Public Health Sciences (Y.Y.,), and Pediatrics (C.D.S.), and Mallinckrodt Institute of Radiology (H.M., A.G., P.S., J.S., S.-K.S., C.D.S.), Washington University School of Medicine, St. Louis, MO
| | - Peng Sun
- From the Department of Neuroscience (A.M.I.), Washington University in St. Louis, MO; Department of Clinical Neurosciences (A.M.I.), University of Calgary, Canada; and Departments of Neurology (J.J.N., D.A., C.D.S.), Neurosurgery (J.P.A., L.C.-R., H.E.B., D.M.M., J.S., D.D.L.), Pathology (S.D.), Public Health Sciences (Y.Y.,), and Pediatrics (C.D.S.), and Mallinckrodt Institute of Radiology (H.M., A.G., P.S., J.S., S.-K.S., C.D.S.), Washington University School of Medicine, St. Louis, MO
| | - Diego M Morales
- From the Department of Neuroscience (A.M.I.), Washington University in St. Louis, MO; Department of Clinical Neurosciences (A.M.I.), University of Calgary, Canada; and Departments of Neurology (J.J.N., D.A., C.D.S.), Neurosurgery (J.P.A., L.C.-R., H.E.B., D.M.M., J.S., D.D.L.), Pathology (S.D.), Public Health Sciences (Y.Y.,), and Pediatrics (C.D.S.), and Mallinckrodt Institute of Radiology (H.M., A.G., P.S., J.S., S.-K.S., C.D.S.), Washington University School of Medicine, St. Louis, MO
| | - Joshua S Shimony
- From the Department of Neuroscience (A.M.I.), Washington University in St. Louis, MO; Department of Clinical Neurosciences (A.M.I.), University of Calgary, Canada; and Departments of Neurology (J.J.N., D.A., C.D.S.), Neurosurgery (J.P.A., L.C.-R., H.E.B., D.M.M., J.S., D.D.L.), Pathology (S.D.), Public Health Sciences (Y.Y.,), and Pediatrics (C.D.S.), and Mallinckrodt Institute of Radiology (H.M., A.G., P.S., J.S., S.-K.S., C.D.S.), Washington University School of Medicine, St. Louis, MO
| | - Jennifer Strahle
- From the Department of Neuroscience (A.M.I.), Washington University in St. Louis, MO; Department of Clinical Neurosciences (A.M.I.), University of Calgary, Canada; and Departments of Neurology (J.J.N., D.A., C.D.S.), Neurosurgery (J.P.A., L.C.-R., H.E.B., D.M.M., J.S., D.D.L.), Pathology (S.D.), Public Health Sciences (Y.Y.,), and Pediatrics (C.D.S.), and Mallinckrodt Institute of Radiology (H.M., A.G., P.S., J.S., S.-K.S., C.D.S.), Washington University School of Medicine, St. Louis, MO
| | - Yan Yan
- From the Department of Neuroscience (A.M.I.), Washington University in St. Louis, MO; Department of Clinical Neurosciences (A.M.I.), University of Calgary, Canada; and Departments of Neurology (J.J.N., D.A., C.D.S.), Neurosurgery (J.P.A., L.C.-R., H.E.B., D.M.M., J.S., D.D.L.), Pathology (S.D.), Public Health Sciences (Y.Y.,), and Pediatrics (C.D.S.), and Mallinckrodt Institute of Radiology (H.M., A.G., P.S., J.S., S.-K.S., C.D.S.), Washington University School of Medicine, St. Louis, MO
| | - Sheng-Kwei Song
- From the Department of Neuroscience (A.M.I.), Washington University in St. Louis, MO; Department of Clinical Neurosciences (A.M.I.), University of Calgary, Canada; and Departments of Neurology (J.J.N., D.A., C.D.S.), Neurosurgery (J.P.A., L.C.-R., H.E.B., D.M.M., J.S., D.D.L.), Pathology (S.D.), Public Health Sciences (Y.Y.,), and Pediatrics (C.D.S.), and Mallinckrodt Institute of Radiology (H.M., A.G., P.S., J.S., S.-K.S., C.D.S.), Washington University School of Medicine, St. Louis, MO
| | - David D Limbrick
- From the Department of Neuroscience (A.M.I.), Washington University in St. Louis, MO; Department of Clinical Neurosciences (A.M.I.), University of Calgary, Canada; and Departments of Neurology (J.J.N., D.A., C.D.S.), Neurosurgery (J.P.A., L.C.-R., H.E.B., D.M.M., J.S., D.D.L.), Pathology (S.D.), Public Health Sciences (Y.Y.,), and Pediatrics (C.D.S.), and Mallinckrodt Institute of Radiology (H.M., A.G., P.S., J.S., S.-K.S., C.D.S.), Washington University School of Medicine, St. Louis, MO
| | - Christopher D Smyser
- From the Department of Neuroscience (A.M.I.), Washington University in St. Louis, MO; Department of Clinical Neurosciences (A.M.I.), University of Calgary, Canada; and Departments of Neurology (J.J.N., D.A., C.D.S.), Neurosurgery (J.P.A., L.C.-R., H.E.B., D.M.M., J.S., D.D.L.), Pathology (S.D.), Public Health Sciences (Y.Y.,), and Pediatrics (C.D.S.), and Mallinckrodt Institute of Radiology (H.M., A.G., P.S., J.S., S.-K.S., C.D.S.), Washington University School of Medicine, St. Louis, MO
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8
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Otun A, Morales DM, Garcia-Bonilla M, Goldberg S, Castaneyra-Ruiz L, Yan Y, Isaacs AM, Strahle JM, McAllister JP, Limbrick DD. Biochemical profile of human infant cerebrospinal fluid in intraventricular hemorrhage and post-hemorrhagic hydrocephalus of prematurity. Fluids Barriers CNS 2021; 18:62. [PMID: 34952604 PMCID: PMC8710025 DOI: 10.1186/s12987-021-00295-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 12/06/2021] [Indexed: 12/05/2022] Open
Abstract
Background Intraventricular hemorrhage (IVH) and post-hemorrhagic hydrocephalus (PHH) have a complex pathophysiology involving inflammatory response, ventricular zone and cell–cell junction disruption, and choroid-plexus (ChP) hypersecretion. Increased cerebrospinal fluid (CSF) cytokines, extracellular matrix proteins, and blood metabolites have been noted in IVH/PHH, but osmolality and electrolyte disturbances have not been evaluated in human infants with these conditions. We hypothesized that CSF total protein, osmolality, electrolytes, and immune cells increase in PHH. Methods CSF samples were obtained from lumbar punctures of control infants and infants with IVH prior to the development of PHH and any neurosurgical intervention. Osmolality, total protein, and electrolytes were measured in 52 infants (18 controls, 10 low grade (LG) IVH, 13 high grade (HG) IVH, and 11 PHH). Serum electrolyte concentrations, and CSF and serum cell counts within 1-day of clinical sampling were obtained from clinical charts. Frontal occipital horn ratio (FOR) was measured for estimating the degree of ventriculomegaly. Dunn or Tukey’s post-test ANOVA analysis were used for pair-wise comparisons. Results CSF osmolality, sodium, potassium, and chloride were elevated in PHH compared to control (p = 0.012 − < 0.0001), LGIVH (p = 0.023 − < 0.0001), and HGIVH (p = 0.015 − 0.0003), while magnesium and calcium levels were higher compared to control (p = 0.031) and LGIVH (p = 0.041). CSF total protein was higher in both HGIVH and PHH compared to control (p = 0.0009 and 0.0006 respectively) and LGIVH (p = 0.034 and 0.028 respectively). These differences were not reflected in serum electrolyte concentrations nor calculated osmolality across the groups. However, quantitatively, CSF sodium and chloride contributed 86% of CSF osmolality change between control and PHH; and CSF osmolality positively correlated with CSF sodium (r, p = 0.55,0.0015), potassium (r, p = 0.51,0.0041), chloride (r, p = 0.60,0.0004), but not total protein across the entire patient cohort. CSF total cells (p = 0.012), total nucleated cells (p = 0.0005), and percent monocyte (p = 0.016) were elevated in PHH compared to control. Serum white blood cell count increased in PHH compared to control (p = 0.042) but there were no differences in serum cell differential across groups. CSF total nucleated cells also positively correlated with CSF osmolality, sodium, potassium, and total protein (p = 0.025 − 0.0008) in the whole cohort. Conclusions CSF osmolality increased in PHH, largely driven by electrolyte changes rather than protein levels. However, serum electrolytes levels were unchanged across groups. CSF osmolality and electrolyte changes were correlated with CSF total nucleated cells which were also increased in PHH, further suggesting PHH is a neuro-inflammatory condition. Supplementary Information The online version contains supplementary material available at 10.1186/s12987-021-00295-8.
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Affiliation(s)
- Ayodamola Otun
- Department of Neurosurgery, Washington University in St. Louis School of Medicine, St. Louis, MO, 63110, USA.
| | - Diego M Morales
- Department of Neurosurgery, Washington University in St. Louis School of Medicine, St. Louis, MO, 63110, USA
| | - Maria Garcia-Bonilla
- Department of Neurosurgery, Washington University in St. Louis School of Medicine, St. Louis, MO, 63110, USA
| | - Seth Goldberg
- Department of Nephrology, Washington University in St. Louis School of Medicine, St. Louis, MO, 63110, USA
| | | | - Yan Yan
- Department of Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, 63110, USA
| | - Albert M Isaacs
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Calgary, Calgary, AB, T2N 2T9, Canada
| | - Jennifer M Strahle
- Department of Neurosurgery, Washington University in St. Louis School of Medicine, St. Louis, MO, 63110, USA
| | - James P McAllister
- Department of Neurosurgery, Washington University in St. Louis School of Medicine, St. Louis, MO, 63110, USA
| | - David D Limbrick
- Department of Neurosurgery, Washington University in St. Louis School of Medicine, St. Louis, MO, 63110, USA
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9
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McAllister JP, Talcott MR, Isaacs AM, Zwick SH, Garcia-Bonilla M, Castaneyra-Ruiz L, Hartman AL, Dilger RN, Fleming SA, Golden RK, Morales DM, Harris CA, Limbrick DD. A novel model of acquired hydrocephalus for evaluation of neurosurgical treatments. Fluids Barriers CNS 2021; 18:49. [PMID: 34749745 PMCID: PMC8576945 DOI: 10.1186/s12987-021-00281-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 10/09/2021] [Indexed: 02/07/2023] Open
Abstract
Background Many animal models have been used to study the pathophysiology of hydrocephalus; most of these have been rodent models whose lissencephalic cerebral cortex may not respond to ventriculomegaly in the same way as gyrencephalic species and whose size is not amenable to evaluation of clinically relevant neurosurgical treatments. Fewer models of hydrocephalus in gyrencephalic species have been used; thus, we have expanded upon a porcine model of hydrocephalus in juvenile pigs and used it to explore surgical treatment methods. Methods Acquired hydrocephalus was induced in 33–41-day old pigs by percutaneous intracisternal injections of kaolin (n = 17). Controls consisted of sham saline-injected (n = 6) and intact (n = 4) animals. Magnetic resonance imaging (MRI) was employed to evaluate ventriculomegaly at 11–42 days post-kaolin and to plan the surgical implantation of ventriculoperitoneal shunts at 14–38-days post-kaolin. Behavioral and neurological status were assessed. Results Bilateral ventriculomegaly occurred post-induction in all regions of the cerebral ventricles, with prominent CSF flow voids in the third ventricle, foramina of Monro, and cerebral aqueduct. Kaolin deposits formed a solid cast in the basal cisterns but the cisterna magna was patent. In 17 untreated hydrocephalic animals. Mean total ventricular volume was 8898 ± 5917 SD mm3 at 11–43 days of age, which was significantly larger than the baseline values of 2251 ± 194 SD mm3 for 6 sham controls aged 45–55 days, (p < 0.001). Past the post-induction recovery period, untreated pigs were asymptomatic despite exhibiting mild-moderate ventriculomegaly. Three out of 4 shunted animals showed a reduction in ventricular volume after 20–30 days of treatment, however some developed ataxia and lethargy, from putative shunt malfunction. Conclusions Kaolin induction of acquired hydrocephalus in juvenile pigs produced an in vivo model that is highly translational, allowing systematic studies of the pathophysiology and clinical treatment of hydrocephalus. Supplementary Information The online version contains supplementary material available at 10.1186/s12987-021-00281-0.
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Affiliation(s)
- James P McAllister
- Department of Neurosurgery, Washington University in St. Louis School of Medicine, St. Louis, MO, 63110, USA. .,Department of Neurosurgery, BJC Institute of Health, 425 S. Euclid, Campus, Box 8057, St. Louis, MO, 63143, USA.
| | - Michael R Talcott
- Department of Neurosurgery, Washington University in St. Louis School of Medicine, St. Louis, MO, 63110, USA.,Division of Comparative Medicine, Washington University in St. Louis School of Medicine, St. Louis, MO, 63110, USA
| | - Albert M Isaacs
- Department of Surgery, Division of Neurosurgery, University of Calgary School of Medicine, Calgary, AB, T2N 2T9, Canada
| | - Sarah H Zwick
- Department of Neurosurgery, Washington University in St. Louis School of Medicine, St. Louis, MO, 63110, USA
| | - Maria Garcia-Bonilla
- Department of Neurosurgery, Washington University in St. Louis School of Medicine, St. Louis, MO, 63110, USA
| | - Leandro Castaneyra-Ruiz
- Department of Neurosurgery, Washington University in St. Louis School of Medicine, St. Louis, MO, 63110, USA
| | - Alexis L Hartman
- Department of Neurosurgery, Washington University in St. Louis School of Medicine, St. Louis, MO, 63110, USA
| | - Ryan N Dilger
- Department of Animal Sciences, Division of Nutritional Sciences, Neuroscience Program, University of Illinois, Champagne-Urbana, Illinois, 61801, USA.,Traverse Science, Champaign, IL, 61801, USA
| | - Stephen A Fleming
- Department of Animal Sciences, Division of Nutritional Sciences, Neuroscience Program, University of Illinois, Champagne-Urbana, Illinois, 61801, USA.,Traverse Science, Champaign, IL, 61801, USA
| | - Rebecca K Golden
- Department of Animal Sciences, Division of Nutritional Sciences, Neuroscience Program, University of Illinois, Champagne-Urbana, Illinois, 61801, USA
| | - Diego M Morales
- Department of Neurosurgery, Washington University in St. Louis School of Medicine, St. Louis, MO, 63110, USA
| | - Carolyn A Harris
- Department of Chemical Engineering and Materials Science, Wayne State University, Detroit, MI, 48202 , USA.,Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI, 48202, USA
| | - David D Limbrick
- Department of Neurosurgery, Washington University in St. Louis School of Medicine, St. Louis, MO, 63110, USA.,Department of Pediatrics, St. Louis Children's Hospital, St. Louis, MO, 63110, USA
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10
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Garcia-Bonilla M, McAllister JP, Limbrick DD. Genetics and Molecular Pathogenesis of Human Hydrocephalus. Neurol India 2021; 69:S268-S274. [PMID: 35102976 DOI: 10.4103/0028-3886.332249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Hydrocephalus is a neurological disorder with an incidence of 80-125 per 100,000 live births in the United States. The molecular pathogenesis of this multidimensional disorder is complex and has both genetic and environmental influences. This review aims to discuss the genetic and molecular alterations described in human hydrocephalus, from well-characterized, heritable forms of hydrocephalus (e.g., X-linked hydrocephalus from L1CAM variants) to those affecting cilia motility and other complex pathologies such as neural tube defects and Dandy-Walker syndrome. Ventricular zone disruption is one key pattern among congenital and acquired forms of hydrocephalus, with abnormalities in cadherins, which mediate neuroepithelium/ependymal cell junctions and contribute to the pathogenesis and severity of the disease. Given the relationship between hydrocephalus pathogenesis and neurodevelopment, future research should elucidate the genetic and molecular mechanisms that regulate ventricular zone integrity and stem cell biology.
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Affiliation(s)
- Maria Garcia-Bonilla
- Department of Neurosurgery, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - James P McAllister
- Department of Neurosurgery, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - David D Limbrick
- Department of Neurosurgery, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
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11
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Hariharan P, Sondheimer J, Petroj A, Gluski J, Jea A, Whitehead WE, Sood S, Ham SD, Rocque BG, Marupudi NI, McAllister JP, Limbrick D, Del Bigio MR, Harris CA. A multicenter retrospective study of heterogeneous tissue aggregates obstructing ventricular catheters explanted from patients with hydrocephalus. Fluids Barriers CNS 2021; 18:33. [PMID: 34289858 PMCID: PMC8293524 DOI: 10.1186/s12987-021-00262-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 06/16/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Implantation of ventricular catheters (VCs) to drain cerebrospinal fluid (CSF) is a standard approach to treat hydrocephalus. VCs fail frequently due to tissue obstructing the lumen via the drainage holes. Mechanisms driving obstruction are poorly understood. This study aimed to characterize the histological features of VC obstructions and identify links to clinical factors. METHODS 343 VCs with relevant clinical data were collected from five centers. Each hole on the VCs was classified by degree of tissue obstruction after macroscopic analysis. A subgroup of 54 samples was analyzed using immunofluorescent labelling, histology and immunohistochemistry. RESULTS 61.5% of the 343 VCs analyzed had tissue aggregates occluding at least one hole (n = 211) however the vast majority of the holes (70%) showed no tissue aggregates. Mean age at which patients with occluded VCs had their first surgeries (3.25 yrs) was lower than in patients with non-occluded VCs (5.29 yrs, p < 0.02). Mean length of time of implantation of occluded VCs, 33.22 months was greater than for non-occluded VCs, 23.8 months (p = 0.02). Patients with myelomeningocele had a greater probability of having an occluded VC (p = 0.0426). VCs with occlusions had greater numbers of macrophages and astrocytes in comparison to non-occluded VCs (p < 0.01). Microglia comprised only 2-6% of the VC-obstructing tissue aggregates. Histologic analysis showed choroid plexus occlusion in 24%, vascularized glial tissue occlusion in 24%, prevalent lymphocytic inflammation in 29%, and foreign body giant cell reactions in 5% and no ependyma. CONCLUSION Our data show that age of the first surgery and length of time a VC is implanted are factors that influence the degree of VC obstruction. The tissue aggregates obstructing VCs are composed predominantly of astrocytes and macrophages; microglia have a relatively small presence.
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Affiliation(s)
- Prashant Hariharan
- Wayne State University Dept. of Biomedical Engineering, 6135 Woodward Avenue, Detroit, MI, 48202, USA
| | - Jeffrey Sondheimer
- Wayne State University Dept. of Chemical Engineering and Materials Science, 6135 Woodward Avenue, Detroit, MI, 48202, USA
| | - Alexandra Petroj
- Wayne State University Dept. of Chemical Engineering and Materials Science, 6135 Woodward Avenue, Detroit, MI, 48202, USA
| | - Jacob Gluski
- Dept. of Neurosurgery, Wayne State University School of Medicine, 540 E. Canfield Avenue, Detroit, MI, 48201, USA
| | - Andrew Jea
- Riley Hospital for Children at IU Health, 705 Riley Hospital Drive, Indianapolis, IN, 46202, USA
| | | | - Sandeep Sood
- Departments of Neurosurgery and Pediatric Neurosurgery, Wayne State University School of Medicine and Children's Hospital of Michigan, 3901 Beaubien Boulevard, 2nd Floor Carl's Building, Detroit, MI, 48201, USA
| | - Steven D Ham
- Departments of Neurosurgery and Pediatric Neurosurgery, Wayne State University School of Medicine and Children's Hospital of Michigan, 3901 Beaubien Boulevard, 2nd Floor Carl's Building, Detroit, MI, 48201, USA
| | - Brandon G Rocque
- Department of Neurosurgery, University of Alabama At Birmingham, Birmingham, AL, USA
| | - Neena I Marupudi
- Children's Hospital of Michigan Dept. of Neurosurgery, 3901 Beaubien Boulevard, 2nd Floor Carl's Building, Detroit, MI, 48201, USA
| | - James P McAllister
- School of Medicine Dept. of Neurological Surgery, Washington University, 425 S. Euclid Avenue, St. Louis, MO, 63110, USA
| | - David Limbrick
- School of Medicine Dept. of Neurological Surgery, Washington University, 660 S. Euclid Avenue, St. Louis, MO, 6311, USA
| | - Marc R Del Bigio
- Department of Pathology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Carolyn A Harris
- Wayne State University Dept. of Chemical Engineering and Materials Science, 6135 Woodward Avenue, Detroit, MI, 48202, USA.
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12
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Harris CA, Morales DM, Arshad R, McAllister JP, Limbrick DD. Cerebrospinal fluid biomarkers of neuroinflammation in children with hydrocephalus and shunt malfunction. Fluids Barriers CNS 2021; 18:4. [PMID: 33514409 PMCID: PMC7845119 DOI: 10.1186/s12987-021-00237-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 01/09/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Approximately 30% of cerebrospinal fluid (CSF) shunt systems for hydrocephalus fail within the first year and 98% of all patients will have shunt failure in their lifetime. Obstruction remains the most common reason for shunt failure. Previous evidence suggests elevated pro-inflammatory cytokines in CSF are associated with worsening clinical outcomes in neuroinflammatory diseases. The aim of this study was to determine whether cytokines and matrix metalloproteinases (MMPs) contribute towards shunt failure in hydrocephalus. METHODS Using multiplex ELISA, this study examined shunt failure through the CSF protein concentration profiles of select pro-inflammatory and anti-inflammatory cytokines, as well as select MMPs. Interdependencies such as the past number of previous revisions, length of time implanted, patient age, and obstruction or non-obstruction revision were examined. The pro-inflammatory cytokines were IL-1β, IL-2, IL-5, IL-6, IL-8, IL-12, IL-17, TNF-α, GM-CSF, IFN-γ. The anti-inflammatory cytokines were IL-4 and IL-10, and the MMPs were MMP-2, MMP-3, MMP-7, MMP-9. Protein concentration is reported as pg/mL for each analyte. RESULTS Patient CSF was obtained at the time of shunt revision operation; all pediatric (< 18), totaling n = 38. IL-10, IL-6, IL-8 and MMP-7 demonstrated significantly increased concentrations in patient CSF for the non-obstructed subgroup. Etiological examination revealed IL-6 was increased in both obstructed and non-obstructed cases for PHH and congenital hydrocephalic patients, while IL-8 was higher only in PHH patients. In terms of number of past revisions, IL-10, IL-6, IL-8, MMP-7 and MMP-9 progressively increased from zero to two past revisions and then remained low for subsequent revisions. This presentation was notably absent in the obstruction subgroup. Shunts implanted for three months or less showed significantly increased concentrations of IL-6, IL-8, and MMP-7 in the obstruction subgroup. Lastly, only patients aged six months or less presented with significantly increased concentration of IL-8 and MMP-7. CONCLUSION Non-obstructive cases are reported here to accompany significantly higher CSF cytokine and MMP protein levels compared to obstructive cases for IL-10, IL-6, IL-8, MMP-7 and MMP-9. A closer examination of the definition of obstruction and the role neuroinflammation plays in creating shunt obstruction in hydrocephalic patients is suggested.
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Affiliation(s)
- Carolyn A Harris
- Wayne State University Dept. of Chemical Engineering and Materials Science, 6135 Woodward Avenue, Rm 1413, Detroit, MI, 48202, USA.
| | - Diego M Morales
- Department of Neurosurgery, Washington University in St. Louis, 425 S. Euclid, St. Louis, MO, 63110, USA
| | - Rooshan Arshad
- Wayne State University Dept. of Chemical Engineering and Materials Science, 6135 Woodward Avenue, Rm 1413, Detroit, MI, 48202, USA
| | - James P McAllister
- Department of Neurosurgery, Washington University in St. Louis, 425 S. Euclid, St. Louis, MO, 63110, USA
| | - David D Limbrick
- Division of Pediatric Neurosurgery, and Department of Pediatrics, Department of Neurosurgery, Washington University in St. Louis, 425 S. Euclid, St. Louis, MO, 63110, USA
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13
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Al-Saloum S, Zaranek M, Horbatiuk J, Gopalakrishnan P, Dumitrescu A, McAllister JP, Harris CA. Analysis of N-acetyl cysteine modified polydimethylsiloxane shunt for improved treatment of hydrocephalus. J Biomed Mater Res B Appl Biomater 2020; 109:1177-1187. [PMID: 33331125 DOI: 10.1002/jbm.b.34780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 11/17/2020] [Accepted: 12/02/2020] [Indexed: 11/06/2022]
Abstract
A major cause of hydrocephalus shunt failure is cell adhesion and obstruction of shunt catheter holes. An estimated 50% of pediatric shunts fail in the first 2 years of insertion, decreasing cell attachment and catheter obstruction can prolong the lifetime and effectiveness of the device. From previous studies, it was shown that treatment of the polydimethylsiloxane (PDMS) surface of a standard catheter with an N-acetyl-cysteine (NAC/1-ethyl-3-(3-dimethylanimopropyl)carbodiimide hydrochloride/N-hydroxysuccinimide) layer increases the wettability of the surface and has been shown to decrease cell adhesion. Other studies indicate that NAC's antioxidant behavior induces glutathione and in turn modulates cell inflammatory pathways. The current study explores the longevity of the NAC coating from the surface of the catheter over time and shows its effect on valve function. Using SEM imaging, contact angle testing, and nanodrop spectrophotometry, this release was quantified for shunt samples incubated for 0, 10, 30, 60, and 90 days. Contact angle showed a significant increase in wettability of the surface when shunts were treated with NAC, confirming successful surface modification. Pressure assays determined that if the coating is release it had no detrimental downstream effects, such as on the shunt valve mechanism. SEM imaging revealed slight deformations in surface coating indicative of salt deposition on the modified shunt samples, while nanodrop spectrophotometry and contact angle data trends suggested some discharge of the NAC coating from the catheter surfaces. The effects of NAC on cell activity may transform the way hydrocephalus is treated in the future by increasing the longevity of the shunt to protect from obstruction.
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Affiliation(s)
- Saja Al-Saloum
- Wayne State University Department of Chemical Engineering and Materials Science, Detroit, Michigan, USA
| | - Mira Zaranek
- Wayne State University Department of Chemical Engineering and Materials Science, Detroit, Michigan, USA
| | - Jeff Horbatiuk
- Wayne State University Department of Chemical Engineering and Materials Science, Detroit, Michigan, USA
| | - Pranav Gopalakrishnan
- Wayne State University Department of Chemical Engineering and Materials Science, Detroit, Michigan, USA
| | - Andrea Dumitrescu
- Wayne State University Department of Chemical Engineering and Materials Science, Detroit, Michigan, USA
| | | | - Carolyn A Harris
- Wayne State University Department of Chemical Engineering and Materials Science, Detroit, Michigan, USA
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Castaneyra-Ruiz L, McAllister JP, Morales DM, Brody SL, Isaacs AM, Limbrick DD. Preterm intraventricular hemorrhage in vitro: modeling the cytopathology of the ventricular zone. Fluids Barriers CNS 2020; 17:46. [PMID: 32690048 PMCID: PMC7372876 DOI: 10.1186/s12987-020-00210-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 07/13/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Severe intraventricular hemorrhage (IVH) is one of the most devastating neurological complications in preterm infants, with the majority suffering long-term neurological morbidity and up to 50% developing post-hemorrhagic hydrocephalus (PHH). Despite the importance of this disease, its cytopathological mechanisms are not well known. An in vitro model of IVH is required to investigate the effects of blood and its components on the developing ventricular zone (VZ) and its stem cell niche. To address this need, we developed a protocol from our accepted in vitro model to mimic the cytopathological conditions of IVH in the preterm infant. METHODS Maturing neuroepithelial cells from the VZ were harvested from the entire lateral ventricles of wild type C57BL/6 mice at 1-4 days of age and expanded in proliferation media for 3-5 days. At confluence, cells were re-plated onto 24-well plates in differentiation media to generate ependymal cells (EC). At approximately 3-5 days, which corresponded to the onset of EC differentiation based on the appearance of multiciliated cells, phosphate-buffered saline for controls or syngeneic whole blood for IVH was added to the EC surface. The cells were examined for the expression of EC markers of differentiation and maturation to qualitatively and quantitatively assess the effect of blood exposure on VZ transition from neuroepithelial cells to EC. DISCUSSION This protocol will allow investigators to test cytopathological mechanisms contributing to the pathology of IVH with high temporal resolution and query the impact of injury to the maturation of the VZ. This technique recapitulates features of normal maturation of the VZ in vitro, offering the capacity to investigate the developmental features of VZ biogenesis.
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Affiliation(s)
- Leandro Castaneyra-Ruiz
- Department of Neurological Surgery, Washington University School of Medicine and the St. Louis Children's Hospital, Campus Box 8057, 660 South Euclid Ave., St. Louis, MO, 63110, USA.
| | - James P McAllister
- Department of Neurological Surgery, Washington University School of Medicine and the St. Louis Children's Hospital, Campus Box 8057, 660 South Euclid Ave., St. Louis, MO, 63110, USA
| | - Diego M Morales
- Department of Neurological Surgery, Washington University School of Medicine and the St. Louis Children's Hospital, Campus Box 8057, 660 South Euclid Ave., St. Louis, MO, 63110, USA
| | - Steven L Brody
- Department of Medicine, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Albert M Isaacs
- Department of Neuroscience, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - David D Limbrick
- Department of Neurological Surgery, Washington University School of Medicine and the St. Louis Children's Hospital, Campus Box 8057, 660 South Euclid Ave., St. Louis, MO, 63110, USA
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, 63110, USA
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15
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Gluski J, Zajciw P, Hariharan P, Morgan A, Morales DM, Jea A, Whitehead W, Marupudi N, Ham S, Sood S, McAllister JP, Limbrick DD, Harris CA. Characterization of a multicenter pediatric-hydrocephalus shunt biobank. Fluids Barriers CNS 2020; 17:45. [PMID: 32682437 PMCID: PMC7368709 DOI: 10.1186/s12987-020-00211-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 07/13/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Pediatric hydrocephalus is a devastating and costly disease. The mainstay of treatment is still surgical shunting of cerebrospinal fluid (CSF). These shunts fail at a high rate and impose a significant burden on patients, their families and society. The relationship between clinical decision making and shunt failure is poorly understood and multifaceted, but catheter occlusion remains the most frequent cause of shunt complications. In order to investigate factors that affect shunt failure, we have established the Wayne State University (WSU) shunt biobank. METHODS To date, four hospital centers have contributed various components of failed shunts and CSF from patients diagnosed with hydrocephalus before adulthood. The hardware samples are transported in paraformaldehyde and transferred to phosphate-buffered saline with sodium azide upon deposit into the biobank. Once in the bank, they are then available for study. Informed consent is obtained by the local center before corresponding clinical data are entered into a REDCap database. Data such as hydrocephalus etiology and details of shunt revision history. All data are entered under a coded identifier. RESULTS 293 shunt samples were collected from 228 pediatric patients starting from May 2015 to September 2019. We saw a significant difference in the number of revisions per patient between centers (Kruskal-Wallis H test, p value < 0.001). The leading etiology at all centers was post-hemorrhagic hydrocephalus, a fisher's exact test showed there to be statistically significant differences in etiology between center (p = 0.01). Regression showed age (p < 0.01), race (p = 0.038) and hospital-center (p < 0.001) to explain significant variance in the number of revisions. Our model accounted for 31.9% of the variance in revisions. Generalized linear modeling showed hydrocephalus etiology (p < 0.001), age (p < 0.001), weight and physician (p < 0.001) to impact the number of ventricular obstructions. CONCLUSION The retrospective analysis identified that differences exist between currently enrolled centers, although further work is needed before clinically actionable recommendations can be made. Moreover, the variables collected from this chart review explain a meaningful amount of variance in the number of revision surgeries. Future work will expand on the contribution of different site-specific and patient-specific factors to identify potential cause and effect relationships.
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Affiliation(s)
- Jacob Gluski
- Wayne State University School of Medicine, 540 E. Canfield Avenue, Detroit, MI, 48201, USA
| | - Paul Zajciw
- Wayne State University Dept. of Chemical Engineering and Materials Science, 6135 Woodward Avenue, Rm 1413, Detroit, MI, 48202, USA
| | - Prashant Hariharan
- Wayne State University Dept. of Chemical Engineering and Materials Science, 6135 Woodward Avenue, Rm 1413, Detroit, MI, 48202, USA
| | - Amanda Morgan
- Washington University School of Medicine Dept. of Neurological Surgery, 660 S. Euclid Avenue, St. Louis, MO, 63110, USA
| | - Diego M Morales
- Washington University School of Medicine Dept. of Neurological Surgery, 660 S. Euclid Avenue, St. Louis, MO, 63110, USA
| | - Andrew Jea
- Riley Hospital for Children at IU Health, 705 Riley Hospital Drive, Indianapolis, IN, 46202, USA
| | - William Whitehead
- Texas Children's Hospital, Baylor College of Medicine, 6701 Fannin Street, Suite 1230.01, Houston, TX, 77030, USA
| | - Neena Marupudi
- Children's Hospital of Michigan Dept. of Neurosurgery, 3901 Beaubien Boulevard, 2nd Floor Carl's Building, Detroit, MI, 48201, USA
| | - Steven Ham
- Children's Hospital of Michigan Dept. of Neurosurgery, 3901 Beaubien Boulevard, 2nd Floor Carl's Building, Detroit, MI, 48201, USA
| | - Sandeep Sood
- Children's Hospital of Michigan Dept. of Neurosurgery, 3901 Beaubien Boulevard, 2nd Floor Carl's Building, Detroit, MI, 48201, USA
| | - James P McAllister
- Washington University School of Medicine Dept. of Neurological Surgery, 660 S. Euclid Avenue, St. Louis, MO, 63110, USA
| | - David D Limbrick
- Washington University School of Medicine Dept. of Neurological Surgery, 660 S. Euclid Avenue, St. Louis, MO, 63110, USA
| | - Carolyn A Harris
- Wayne State University Dept. of Chemical Engineering and Materials Science, 6135 Woodward Avenue, Rm 1413, Detroit, MI, 48202, USA.
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16
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Castaneyra-Ruiz L, Morales DM, McAllister JP, Brody SL, Isaacs AM, Strahle JM, Dahiya SM, Limbrick DD. Blood Exposure Causes Ventricular Zone Disruption and Glial Activation In Vitro. J Neuropathol Exp Neurol 2019; 77:803-813. [PMID: 30032242 DOI: 10.1093/jnen/nly058] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Intraventricular hemorrhage (IVH) is the most common cause of pediatric hydrocephalus in North America but remains poorly understood. Cell junction-mediated ventricular zone (VZ) disruption and astrogliosis are associated with the pathogenesis of congenital, nonhemorrhagic hydrocephalus. Recently, our group demonstrated that VZ disruption is also present in preterm infants with IVH. On the basis of this observation, we hypothesized that blood triggers the loss of VZ cell junction integrity and related cytopathology. In order to test this hypothesis, we developed an in vitro model of IVH by applying syngeneic blood to cultured VZ cells obtained from newborn mice. Following blood treatment, cells were assayed for N-cadherin-dependent adherens junctions, ciliated ependymal cells, and markers of glial activation using immunohistochemistry and immunoblotting. After 24-48 hours of exposure to blood, VZ cell junctions were disrupted as determined by a significant reduction in N-cadherin expression (p < 0.05). This was also associated with significant decrease in multiciliated cells and increase in glial fibrillary acid protein-expressing cells (p < 0.05). These observations suggest that, in vitro, blood triggers VZ cell loss and glial activation in a pattern that mirrors the cytopathology of human IVH and supports the relevance of this in vitro model to define injury mechanisms.
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Affiliation(s)
- Leandro Castaneyra-Ruiz
- Department of Neurological Surgery, Washington University School of Medicine and the St. Louis Children's Hospital, St. Louis, Missouri
| | - Diego M Morales
- Department of Neurological Surgery, Washington University School of Medicine and the St. Louis Children's Hospital, St. Louis, Missouri
| | - James P McAllister
- Department of Neurological Surgery, Washington University School of Medicine and the St. Louis Children's Hospital, St. Louis, Missouri
| | | | | | - Jennifer M Strahle
- Department of Neurological Surgery, Washington University School of Medicine and the St. Louis Children's Hospital, St. Louis, Missouri.,Department of Pediatrics
| | - Sonika M Dahiya
- Department of Pathology & Immunology, Washington University School of Medicine, St. Louis, Missouri
| | - David D Limbrick
- Department of Neurological Surgery, Washington University School of Medicine and the St. Louis Children's Hospital, St. Louis, Missouri.,Department of Pediatrics
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17
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Isaacs AM, Shimony JS, Morales DM, Castaneyra-Ruiz L, Hartman A, Cook M, Smyser CD, Strahle J, Smyth MD, Yan Y, McAllister JP, McKinstry RC, Limbrick DD. Feasibility of fast brain diffusion MRI to quantify white matter injury in pediatric hydrocephalus. J Neurosurg Pediatr 2019; 24:461-468. [PMID: 31323624 PMCID: PMC6982356 DOI: 10.3171/2019.5.peds18596] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 05/14/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Traditionally, diffusion MRI (dMRI) has been performed in parallel with high-resolution conventional MRI, which requires long scan times and may require sedation or general anesthesia in infants and young children. Conversely, fast brain MRI permits image acquisition without the need for sedation, although its short pulse sequences, susceptibility to motion artifact, and contrast resolution have limited its use to assessing ventricular size or major structural variations. Here, the authors demonstrate the feasibility of leveraging a 3-direction fast brain MRI protocol to obtain reliable dMRI measures. METHODS Fast brain MRI with 3-direction dMRI was performed in infants and children before and after hydrocephalus treatment. Regions of interest in the posterior limbs of the internal capsules (PLICs) and the genu of the corpus callosum (gCC) were drawn on diffusion-weighted images, and mean diffusivity (MD) data were extracted. Ventricular size was determined by the frontal occipital horn ratio (FOHR). Differences between and within groups pre- and posttreatment, and FOHR-MD correlations were assessed. RESULTS Of 40 patients who met inclusion criteria (median age 27.5 months), 15 (37.5%), 17 (42.5%), and 8 (20.0%) had posthemorrhagic hydrocephalus (PHH), congenital hydrocephalus (CH), or no intracranial abnormality (controls), respectively. A hydrocephalus group included both PHH and CH patients. Prior to treatment, the FOHR (p < 0.001) and PLIC MD (p = 0.027) were greater in the hydrocephalus group than in the controls. While the mean gCC MD in the hydrocephalus group (1.10 × 10-3 mm2/sec) was higher than that of the control group (0.98), the difference was not significant (p = 0.135). Following a median follow-up duration of 14 months, decreases in FOHR, PLIC MD, and gCC MD were observed in the hydrocephalus group and were similar to those in the control group (p = 0.107, p = 0.702, and p = 0.169, respectively). There were no correlations identified between FOHR and MDs at either time point. CONCLUSIONS The utility of fast brain MRI can be extended beyond anatomical assessments to obtain dMRI measures. A reduction in PLIC and gCC MD to levels similar to those of controls was observed within 14 months following shunt surgery for hydrocephalus in PHH and CH infants. Further studies are required to assess the role of fast brain dMRI for assessing clinical outcomes in pediatric hydrocephalus patients.
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Affiliation(s)
- Albert M. Isaacs
- Department of Neuroscience, Washington University School of Medicine, St. Louis, Missouri
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Joshua S. Shimony
- Department of Radiology, Washington University School of Medicine, St. Louis, Missouri
| | - Diego M. Morales
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri
| | | | - Alexis Hartman
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri
| | - Madison Cook
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri
| | - Christopher D. Smyser
- Department of Neurology, Washington University School of Medicine, St. Louis, Missouri
| | - Jennifer Strahle
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri
| | - Matthew D. Smyth
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri
| | - Yan Yan
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - James P. McAllister
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri
| | - Robert C. McKinstry
- Department of Radiology, Washington University School of Medicine, St. Louis, Missouri
| | - David D. Limbrick
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri
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18
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Koschnitzky JE, Keep RF, Limbrick DD, McAllister JP, Morris JA, Strahle J, Yung YC. Opportunities in posthemorrhagic hydrocephalus research: outcomes of the Hydrocephalus Association Posthemorrhagic Hydrocephalus Workshop. Fluids Barriers CNS 2018; 15:11. [PMID: 29587767 PMCID: PMC5870202 DOI: 10.1186/s12987-018-0096-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 03/09/2018] [Indexed: 12/19/2022] Open
Abstract
The Hydrocephalus Association Posthemorrhagic Hydrocephalus Workshop was held on July 25 and 26, 2016 at the National Institutes of Health. The workshop brought together a diverse group of researchers including pediatric neurosurgeons, neurologists, and neuropsychologists with scientists in the fields of brain injury and development, cerebrospinal and interstitial fluid dynamics, and the blood-brain and blood-CSF barriers. The goals of the workshop were to identify areas of opportunity in posthemorrhagic hydrocephalus research and encourage scientific collaboration across a diverse set of fields. This report details the major themes discussed during the workshop and research opportunities identified for posthemorrhagic hydrocephalus. The primary areas include (1) preventing intraventricular hemorrhage, (2) stopping primary and secondary brain damage, (3) preventing hydrocephalus, (4) repairing brain damage, and (5) improving neurodevelopment outcomes in posthemorrhagic hydrocephalus.
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Affiliation(s)
| | - Richard F. Keep
- University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI 48109 USA
| | - David D. Limbrick
- Washington University in St. Louis School of Medicine, 660 S. Euclid Ave, St. Louis, MO 63110 USA
| | - James P. McAllister
- Washington University in St. Louis School of Medicine, 660 S. Euclid Ave, St. Louis, MO 63110 USA
| | - Jill A. Morris
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Neuroscience Center, 6001 Executive Blvd, NSC Rm 2112, Bethesda, MD 20892 USA
| | - Jennifer Strahle
- Washington University in St. Louis School of Medicine, 660 S. Euclid Ave, St. Louis, MO 63110 USA
| | - Yun C. Yung
- Sanford Burnham Prebys Medical Discovery Institute, 10901 North Torrey Pines Rd., Building 7, La Jolla, CA 92037 USA
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19
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Habiyaremye G, Morales DM, Morgan CD, McAllister JP, CreveCoeur TS, Han RH, Gabir M, Baksh B, Mercer D, Limbrick DD. Chemokine and cytokine levels in the lumbar cerebrospinal fluid of preterm infants with post-hemorrhagic hydrocephalus. Fluids Barriers CNS 2017; 14:35. [PMID: 29228970 PMCID: PMC5725948 DOI: 10.1186/s12987-017-0083-0] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 11/12/2017] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Neuroinflammation has been implicated in the pathophysiology of post-hemorrhagic hydrocephalus (PHH) of prematurity, but no comprehensive analysis of signaling molecules has been performed using human cerebrospinal fluid (CSF). METHODS Lumbar CSF levels of key cytokines (IL-1α, IL-1β, IL-4, IL-6, IL-8, IL-10, IL-12, TNF-α, TGF-β1, IFN-γ) and chemokines (XCL-1, CCL-2, CCL-3, CCL-19, CXCL-10, CXCL-11, CXCL-12) were measured using conventional and multiplexed Enzyme-linked Immunosorbent Assays and compared between preterm infants with PHH and those with no known neurological injury. The relationships between individual biomarker levels and specific CSF cell counts were examined. RESULTS Total protein (TP) CSF levels were elevated in the PHH subjects compared to controls. CSF levels of IL-1α, IL-4, IL-6, IL-12, TNF-α, CCL-3, CCL-19, and CXCL-10 were significantly increased in PHH whereas XCL-1 was significantly decreased in PHH. When normalizing by TP, IL-1α, IL-1β, IL-10, IL-12, CCL-3, and CCL-19 levels were significantly elevated compared to controls, while XCL-1 levels remained significantly decreased. Among those with significantly different levels in both absolute and normalized levels, only absolute CCL-19 levels showed a significant correlation with CSF nucleated cells, neutrophils, and lymphocytes. IL-1β and CXCL-10 also were correlated with total cell count, nucleated cells, red blood cells, and neutrophils. CONCLUSIONS Neuroinflammation is likely to be an important process in the pathophysiology of PHH. To our knowledge, this is the first study to investigate CSF levels of chemokines in PHH as well as the only one to show XCL-1 selectively decreased in a diseased state. Additionally, CCL-19 was the only analyte studied that showed significant differences between groups and had significant correlation with cell count analysis. The selectivity of CCL-19 and XCL-1 should be further investigated. Future studies will further delineate the role of these cytokines and chemokines in PHH.
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Affiliation(s)
- Gakwaya Habiyaremye
- Department of Neurological Surgery, Washington University in St. Louis School of Medicine, One Children's Way, 4S20, St. Louis, MO, 63110, USA
| | - Diego M Morales
- Department of Neurological Surgery, Washington University in St. Louis School of Medicine, One Children's Way, 4S20, St. Louis, MO, 63110, USA.
| | - Clinton D Morgan
- Barrow Neurological Institute, 350 West Thomas Road, Phoenix, AZ, 85013, USA
| | - James P McAllister
- Department of Neurological Surgery, Washington University in St. Louis School of Medicine, One Children's Way, 4S20, St. Louis, MO, 63110, USA
| | - Travis S CreveCoeur
- Department of Neurological Surgery, Washington University in St. Louis School of Medicine, One Children's Way, 4S20, St. Louis, MO, 63110, USA
| | - Rowland H Han
- Department of Neurological Surgery, Washington University in St. Louis School of Medicine, One Children's Way, 4S20, St. Louis, MO, 63110, USA
| | - Mohamed Gabir
- Department of Neurological Surgery, Washington University in St. Louis School of Medicine, One Children's Way, 4S20, St. Louis, MO, 63110, USA
| | - Brandon Baksh
- Department of Neurological Surgery, Washington University in St. Louis School of Medicine, One Children's Way, 4S20, St. Louis, MO, 63110, USA
| | - Deanna Mercer
- Department of Neurological Surgery, Washington University in St. Louis School of Medicine, One Children's Way, 4S20, St. Louis, MO, 63110, USA
| | - David D Limbrick
- Department of Neurological Surgery and Pediatrics, Washington University in St. Louis School of Medicine, One Children's Way, 4S20, St. Louis, MO, 63110, USA
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20
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Morales DM, Silver SA, Morgan CD, Mercer D, Inder TE, Holtzman DM, Wallendorf MJ, Rao R, McAllister JP, Limbrick DD. Lumbar Cerebrospinal Fluid Biomarkers of Posthemorrhagic Hydrocephalus of Prematurity: Amyloid Precursor Protein, Soluble Amyloid Precursor Protein α, and L1 Cell Adhesion Molecule. Neurosurgery 2017; 80:82-90. [PMID: 27571524 DOI: 10.1227/neu.0000000000001415] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 06/15/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Intraventricular hemorrhage (IVH) is the most frequent, severe neurological complication of prematurity and is associated with posthemorrhagic hydrocephalus (PHH) in up to half of cases. PHH requires lifelong neurosurgical care and is associated with significant cognitive and psychomotor disability. Cerebrospinal fluid (CSF) biomarkers may provide both diagnostic information for PHH and novel insights into its pathophysiology. OBJECTIVE To explore the diagnostic ability of candidate CSF biomarkers for PHH. METHODS Concentrations of amyloid precursor protein (APP), soluble APPα (sAPPα), soluble APPβ, neural cell adhesion molecule-1 (NCAM-1), L1 cell adhesion molecule (L1CAM), tau, phosphorylated tau, and total protein (TP) were measured in lumbar CSF from neonates in 6 groups: (1) no known neurological disease (n = 33); (2) IVH grades I to II (n = 13); (3) IVH grades III to IV (n = 12); (4) PHH (n = 12); (5) ventricular enlargement without hydrocephalus (n = 10); and (6) hypoxic ischemic encephalopathy (n = 13). CSF protein levels were compared using analysis of variance, and logistic regression was performed to examine the predictive ability of each marker for PHH. RESULTS Lumbar CSF levels of APP, sAPPα, L1CAM, and TP were selectively increased in PHH compared with all other conditions (all P < .001). The sensitivity, specificity, and odds ratios of candidate CSF biomarkers for PHH were determined for APP, sAPPα, and L1CAM; cut points of 699, 514, and 113 ng/mL yielded odds ratios for PHH of 80.0, 200.0, and 68.75, respectively. CONCLUSION Lumbar CSF APP, sAPPα, L1CAM, and TP were selectively increased in PHH. These proteins, and sAPPα, in particular, hold promise as biomarkers of PHH and provide novel insight into PHH-associated neural injury and repair.
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Affiliation(s)
- Diego M Morales
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Shawgi A Silver
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Clinton D Morgan
- Depart-ment of Neurological Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Deanna Mercer
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Terri E Inder
- Department of Pediatrics, Harvard University School of Medicine, Boston, Massachusetts
| | - David M Holtzman
- Department of Neurology, Washington University School of Medicine, St. Louis, Missouri.,Hope Center for Neurological Disorders, Washington University School of Medi-cine, St. Louis, Missouri.,Knight Alzheimer's Disease Research Center, Washing-ton University School of Medicine, St. Louis, Missouri
| | - Michael J Wallendorf
- Division of Biostat-istics, Washington University School of Medicine, St. Louis, Missouri
| | - Rakesh Rao
- Depart-ment of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| | - James P McAllister
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - David D Limbrick
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri.,Hope Center for Neurological Disorders, Washington University School of Medi-cine, St. Louis, Missouri.,Depart-ment of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
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21
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McAllister JP, Guerra MM, Ruiz LC, Jimenez AJ, Dominguez-Pinos D, Sival D, den Dunnen W, Morales DM, Schmidt RE, Rodriguez EM, Limbrick DD. Ventricular Zone Disruption in Human Neonates With Intraventricular Hemorrhage. J Neuropathol Exp Neurol 2017; 76:358-375. [PMID: 28521038 DOI: 10.1093/jnen/nlx017] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
To determine if ventricular zone (VZ) and subventricular zone (SVZ) alterations are associated with intraventricular hemorrhage (IVH) and posthemorrhagic hydrocephalus, we compared postmortem frontal and subcortical brain samples from 12 infants with IVH and 3 nonneurological disease controls without hemorrhages or ventriculomegaly. Birth and expiration estimated gestational ages were 23.0-39.1 and 23.7-44.1 weeks, respectively; survival ranges were 0-42 days (median, 2.0 days). Routine histology and immunohistochemistry for neural stem cells (NSCs), neural progenitors (NPs), multiciliated ependymal cells (ECs), astrocytes (AS), and cell adhesion molecules were performed. Controls exhibited monociliated NSCs and multiciliated ECs lining the ventricles, abundant NPs in the SVZ, and medial vs. lateral wall differences with a complex mosaic organization in the latter. In IVH cases, normal VZ/SVZ areas were mixed with foci of NSC and EC loss, eruption of cells into the ventricle, cytoplasmic transposition of N-cadherin, subependymal rosettes, and periventricular heterotopia. Mature AS populated areas believed to be sites of VZ disruption. The cytopathology and extension of the VZ disruption correlated with developmental age but not with brain hemorrhage grade or location. These results corroborate similar findings in congenital hydrocephalus in animals and humans and indicate that VZ disruption occurs consistently in premature neonates with IVH.
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Affiliation(s)
- James P McAllister
- From the Department of Neurosurgery, Washington University School of Medicine, St Louis, Missouri (JPM, LCR, DMM, DDL); Instituto de Antomía, Histologia y Patologia, Facultad de Medicina, Universidad Austral de Chile, Valdivia, Chile (MMG, EMR); Instituto de Biología Celular, Genética y Fisiología Facultad de Ciencias, Universidad de Malaga, Malaga, Spain and Instituto de Investigación Biomédica (IBIMA), Malaga, Spain (AJJ, DDP); Departments of Pediatrics, Pathology and Medical Biology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands (DS, WD); Department of Pathology and Immunology, Washington University School of Medicine, St Louis, Missouri (RES); and Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri (DDL)
| | - Maria Montserrat Guerra
- From the Department of Neurosurgery, Washington University School of Medicine, St Louis, Missouri (JPM, LCR, DMM, DDL); Instituto de Antomía, Histologia y Patologia, Facultad de Medicina, Universidad Austral de Chile, Valdivia, Chile (MMG, EMR); Instituto de Biología Celular, Genética y Fisiología Facultad de Ciencias, Universidad de Malaga, Malaga, Spain and Instituto de Investigación Biomédica (IBIMA), Malaga, Spain (AJJ, DDP); Departments of Pediatrics, Pathology and Medical Biology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands (DS, WD); Department of Pathology and Immunology, Washington University School of Medicine, St Louis, Missouri (RES); and Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri (DDL)
| | - Leandro Castaneyra Ruiz
- From the Department of Neurosurgery, Washington University School of Medicine, St Louis, Missouri (JPM, LCR, DMM, DDL); Instituto de Antomía, Histologia y Patologia, Facultad de Medicina, Universidad Austral de Chile, Valdivia, Chile (MMG, EMR); Instituto de Biología Celular, Genética y Fisiología Facultad de Ciencias, Universidad de Malaga, Malaga, Spain and Instituto de Investigación Biomédica (IBIMA), Malaga, Spain (AJJ, DDP); Departments of Pediatrics, Pathology and Medical Biology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands (DS, WD); Department of Pathology and Immunology, Washington University School of Medicine, St Louis, Missouri (RES); and Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri (DDL)
| | - Antonio J Jimenez
- From the Department of Neurosurgery, Washington University School of Medicine, St Louis, Missouri (JPM, LCR, DMM, DDL); Instituto de Antomía, Histologia y Patologia, Facultad de Medicina, Universidad Austral de Chile, Valdivia, Chile (MMG, EMR); Instituto de Biología Celular, Genética y Fisiología Facultad de Ciencias, Universidad de Malaga, Malaga, Spain and Instituto de Investigación Biomédica (IBIMA), Malaga, Spain (AJJ, DDP); Departments of Pediatrics, Pathology and Medical Biology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands (DS, WD); Department of Pathology and Immunology, Washington University School of Medicine, St Louis, Missouri (RES); and Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri (DDL)
| | - Dolores Dominguez-Pinos
- From the Department of Neurosurgery, Washington University School of Medicine, St Louis, Missouri (JPM, LCR, DMM, DDL); Instituto de Antomía, Histologia y Patologia, Facultad de Medicina, Universidad Austral de Chile, Valdivia, Chile (MMG, EMR); Instituto de Biología Celular, Genética y Fisiología Facultad de Ciencias, Universidad de Malaga, Malaga, Spain and Instituto de Investigación Biomédica (IBIMA), Malaga, Spain (AJJ, DDP); Departments of Pediatrics, Pathology and Medical Biology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands (DS, WD); Department of Pathology and Immunology, Washington University School of Medicine, St Louis, Missouri (RES); and Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri (DDL)
| | - Deborah Sival
- From the Department of Neurosurgery, Washington University School of Medicine, St Louis, Missouri (JPM, LCR, DMM, DDL); Instituto de Antomía, Histologia y Patologia, Facultad de Medicina, Universidad Austral de Chile, Valdivia, Chile (MMG, EMR); Instituto de Biología Celular, Genética y Fisiología Facultad de Ciencias, Universidad de Malaga, Malaga, Spain and Instituto de Investigación Biomédica (IBIMA), Malaga, Spain (AJJ, DDP); Departments of Pediatrics, Pathology and Medical Biology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands (DS, WD); Department of Pathology and Immunology, Washington University School of Medicine, St Louis, Missouri (RES); and Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri (DDL)
| | - Wilfred den Dunnen
- From the Department of Neurosurgery, Washington University School of Medicine, St Louis, Missouri (JPM, LCR, DMM, DDL); Instituto de Antomía, Histologia y Patologia, Facultad de Medicina, Universidad Austral de Chile, Valdivia, Chile (MMG, EMR); Instituto de Biología Celular, Genética y Fisiología Facultad de Ciencias, Universidad de Malaga, Malaga, Spain and Instituto de Investigación Biomédica (IBIMA), Malaga, Spain (AJJ, DDP); Departments of Pediatrics, Pathology and Medical Biology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands (DS, WD); Department of Pathology and Immunology, Washington University School of Medicine, St Louis, Missouri (RES); and Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri (DDL)
| | - Diego M Morales
- From the Department of Neurosurgery, Washington University School of Medicine, St Louis, Missouri (JPM, LCR, DMM, DDL); Instituto de Antomía, Histologia y Patologia, Facultad de Medicina, Universidad Austral de Chile, Valdivia, Chile (MMG, EMR); Instituto de Biología Celular, Genética y Fisiología Facultad de Ciencias, Universidad de Malaga, Malaga, Spain and Instituto de Investigación Biomédica (IBIMA), Malaga, Spain (AJJ, DDP); Departments of Pediatrics, Pathology and Medical Biology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands (DS, WD); Department of Pathology and Immunology, Washington University School of Medicine, St Louis, Missouri (RES); and Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri (DDL)
| | - Robert E Schmidt
- From the Department of Neurosurgery, Washington University School of Medicine, St Louis, Missouri (JPM, LCR, DMM, DDL); Instituto de Antomía, Histologia y Patologia, Facultad de Medicina, Universidad Austral de Chile, Valdivia, Chile (MMG, EMR); Instituto de Biología Celular, Genética y Fisiología Facultad de Ciencias, Universidad de Malaga, Malaga, Spain and Instituto de Investigación Biomédica (IBIMA), Malaga, Spain (AJJ, DDP); Departments of Pediatrics, Pathology and Medical Biology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands (DS, WD); Department of Pathology and Immunology, Washington University School of Medicine, St Louis, Missouri (RES); and Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri (DDL)
| | - Esteban M Rodriguez
- From the Department of Neurosurgery, Washington University School of Medicine, St Louis, Missouri (JPM, LCR, DMM, DDL); Instituto de Antomía, Histologia y Patologia, Facultad de Medicina, Universidad Austral de Chile, Valdivia, Chile (MMG, EMR); Instituto de Biología Celular, Genética y Fisiología Facultad de Ciencias, Universidad de Malaga, Malaga, Spain and Instituto de Investigación Biomédica (IBIMA), Malaga, Spain (AJJ, DDP); Departments of Pediatrics, Pathology and Medical Biology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands (DS, WD); Department of Pathology and Immunology, Washington University School of Medicine, St Louis, Missouri (RES); and Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri (DDL)
| | - David D Limbrick
- From the Department of Neurosurgery, Washington University School of Medicine, St Louis, Missouri (JPM, LCR, DMM, DDL); Instituto de Antomía, Histologia y Patologia, Facultad de Medicina, Universidad Austral de Chile, Valdivia, Chile (MMG, EMR); Instituto de Biología Celular, Genética y Fisiología Facultad de Ciencias, Universidad de Malaga, Malaga, Spain and Instituto de Investigación Biomédica (IBIMA), Malaga, Spain (AJJ, DDP); Departments of Pediatrics, Pathology and Medical Biology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands (DS, WD); Department of Pathology and Immunology, Washington University School of Medicine, St Louis, Missouri (RES); and Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri (DDL)
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22
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Adam A, Robison J, Lu J, Jose R, Badran N, Vivas-Buitrago T, Rigamonti D, Sattar A, Omoush O, Hammad M, Dawood M, Maghaslah M, Belcher T, Carson K, Hoffberger J, Jusué Torres I, Foley S, Yasar S, Thai QA, Wemmer J, Klinge P, Al-Mutawa L, Al-Ghamdi H, Carson KA, Asgari M, de Zélicourt D, Kurtcuoglu V, Garnotel S, Salmon S, Balédent O, Lokossou A, Page G, Balardy L, Czosnyka Z, Payoux P, Schmidt EA, Zitoun M, Sevestre MA, Alperin N, Baudracco I, Craven C, Matloob S, Thompson S, Haylock Vize P, Thorne L, Watkins LD, Toma AK, Bechter K, Pong AC, Jugé L, Bilston LE, Cheng S, Bradley W, Hakim F, Ramón JF, Cárdenas MF, Davidson JS, García C, González D, Bermúdez S, Useche N, Mejía JA, Mayorga P, Cruz F, Martinez C, Matiz MC, Vallejo M, Ghotme K, Soto HA, Riveros D, Buitrago A, Mora M, Murcia L, Bermudez S, Cohen D, Dasgupta D, Curtis C, Domínguez L, Remolina AJ, Grijalba MA, Whitehouse KJ, Edwards RJ, Eleftheriou A, Lundin F, Fountas KN, Kapsalaki EZ, Smisson HF, Robinson JS, Fritsch MJ, Arouk W, Garzon M, Kang M, Sandhu K, Baghawatti D, Aquilina K, James G, Thompson D, Gehlen M, Schmid Daners M, Eklund A, Malm J, Gomez D, Guerra M, Jara M, Flores M, Vío K, Moreno I, Rodríguez S, Ortega E, Rodríguez EM, McAllister JP, Guerra MM, Morales DM, Sival D, Jimenez A, Limbrick DD, Ishikawa M, Yamada S, Yamamoto K, Junkkari A, Häyrinen A, Rauramaa T, Sintonen H, Nerg O, Koivisto AM, Roine RP, Viinamäki H, Soininen H, Luikku A, Jääskeläinen JE, Leinonen V, Kehler U, Lilja-Lund O, Kockum K, Larsson EM, Riklund K, Söderström L, Hellström P, Laurell K, Kojoukhova M, Sutela A, Vanninen R, Vanha KI, Timonen M, Rummukainen J, Korhonen V, Helisalmi S, Solje E, Remes AM, Huovinen J, Paananen J, Hiltunen M, Kurki M, Martin B, Loth F, Luciano M, Luikku AJ, Hall A, Herukka SK, Mattila J, Lötjönen J, Alafuzoff I, Jurjević I, Miyajima M, Nakajima M, Murai H, Shin T, Kawaguchi D, Akiba C, Ogino I, Karagiozov K, Arai H, Reis RC, Teixeira MJ, Valêncio CG, da Vigua D, Almeida-Lopes L, Mancini MW, Pinto FCG, Maykot RH, Calia G, Tornai J, Silvestre SSS, Mendes G, Sousa V, Bezerra B, Dutra P, Modesto P, Oliveira MF, Petitto CE, Pulhorn H, Chandran A, McMahon C, Rao AS, Jumaly M, Solomon D, Moghekar A, Relkin N, Hamilton M, Katzen H, Williams M, Bach T, Zuspan S, Holubkov R, Rigamonti A, Clemens G, Sharkey P, Sanyal A, Sankey E, Rigamonti K, Naqvi S, Hung A, Schmidt E, Ory-Magne F, Gantet P, Guenego A, Januel AC, Tall P, Fabre N, Mahieu L, Cognard C, Gray L, Buttner-Ennever JA, Takagi K, Onouchi K, Thompson SD, Thorne LD, Tully HM, Wenger TL, Kukull WA, Doherty D, Dobyns WB, Moran D, Vakili S, Patel MA, Elder B, Goodwin CR, Crawford JA, Pletnikov MV, Xu J, Blitz A, Herzka DA, Guerrero-Cazares H, Quiñones-Hinojosa A, Mori S, Saavedra P, Treviño H, Maitani K, Ziai WC, Eslami V, Nekoovaght-Tak S, Dlugash R, Yenokyan G, McBee N, Hanley DF. Abstracts from Hydrocephalus 2016. Fluids Barriers CNS 2017; 14:15. [PMID: 28929972 PMCID: PMC5471936 DOI: 10.1186/s12987-017-0054-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- A Adam
- Johns Hopkins University, Baltimore, MD, USA.,Department of Neurosurgery, Johns Hopkins University, Baltimore, MD, USA.,Johns Hopkins Biostatistics Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - J Robison
- Johns Hopkins University, Baltimore, MD, USA.,Department of Neurosurgery, Johns Hopkins University, Baltimore, MD, USA.,Department of Neurosurgery, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - J Lu
- Johns Hopkins University, Baltimore, MD, USA.,Department of Neurosurgery, Johns Hopkins University, Baltimore, MD, USA.,Department of Neurosurgery, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - R Jose
- Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia
| | - N Badran
- Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia
| | - T Vivas-Buitrago
- Johns Hopkins University, Baltimore, MD, USA.,Department of Neurosurgery, Johns Hopkins University, Baltimore, MD, USA.,Department of Neurosurgery, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - D Rigamonti
- Johns Hopkins University, Baltimore, MD, USA.,Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia.,Department of Neurosurgery, Johns Hopkins University, Baltimore, MD, USA.,Department of Neurosurgery, Johns Hopkins University, School of Medicine, Baltimore, MD, USA.,Johns Hopkins Hopkins Aramco Healthcare, Dhahran, Saudi Arabia
| | - A Sattar
- Johns Hopkins Aramco Healthcare, Ras Tanura, Saudi Arabia.,Primary Care, Johns Hopkins Aramco Healthcare, Ras Tanura, Saudi Arabia
| | - O Omoush
- Johns Hopkins Aramco Healthcare, Ras Tanura, Saudi Arabia.,Primary Care, Johns Hopkins Aramco Healthcare, Ras Tanura, Saudi Arabia
| | - M Hammad
- Johns Hopkins Aramco Healthcare, Ras Tanura, Saudi Arabia
| | - M Dawood
- Johns Hopkins Aramco Healthcare, Ras Tanura, Saudi Arabia
| | - M Maghaslah
- Johns Hopkins Aramco Healthcare, Ras Tanura, Saudi Arabia
| | - T Belcher
- Johns Hopkins Aramco Healthcare, Ras Tanura, Saudi Arabia
| | - K Carson
- Department of Neurosurgery, Johns Hopkins University, Baltimore, MD, USA.,Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - J Hoffberger
- Department of Neurosurgery, Johns Hopkins University, Baltimore, MD, USA
| | - I Jusué Torres
- Department of Neurosurgery, Johns Hopkins University, Baltimore, MD, USA.,Department of Neurosurgery, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - S Foley
- Department of Neurosurgery, Rhode Island Hospital, Providence, RI, USA
| | - S Yasar
- Department of Neurosurgery, Johns Hopkins University, Baltimore, MD, USA
| | - Q A Thai
- Department of Neurosurgery, Johns Hopkins University, Baltimore, MD, USA
| | - J Wemmer
- Department of Neurosurgery, Johns Hopkins University, Baltimore, MD, USA
| | - P Klinge
- Department of Neurosurgery, Johns Hopkins University, Baltimore, MD, USA
| | - L Al-Mutawa
- Department of Neurosurgery, Johns Hopkins University, Baltimore, MD, USA
| | - H Al-Ghamdi
- Department of Neurosurgery, Rhode Island Hospital, Providence, RI, USA
| | - K A Carson
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - M Asgari
- The Interface Group, Institute of PhysiologyUniversity of Zurich, Zurich, Switzerland
| | - D de Zélicourt
- The Interface Group, Institute of PhysiologyUniversity of Zurich, Zurich, Switzerland
| | - V Kurtcuoglu
- The Interface Group, Institute of PhysiologyUniversity of Zurich, Zurich, Switzerland.,Institute of Physiology, University of Zurich, Zurich, Switzerland.,Neuroscience Center Zurich and the Zurich Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
| | - S Garnotel
- BioFlowImage Laboratory, University of Picardie Jules Verne, Amiens, France.,Reims Mathematics Laboratory, University of Reims Champagne-Ardenne, Reims, France.,Image Processing Laboratory, University Hospital of Amiens-Picardie, Amiens, France.,BioFlowImage Laboratory, Department of Medical Image Processing, University Hospital of Picardie Jules Verne, Amiens, France
| | - S Salmon
- Reims Mathematics Laboratory, University of Reims Champagne-Ardenne, Reims, France
| | - O Balédent
- BioFlowImage Laboratory, University of Picardie Jules Verne, Amiens, France.,Image Processing Laboratory, University Hospital of Amiens-Picardie, Amiens, France.,BioFlowImage Laboratory, Department of Medical Image Processing, University Hospital of Picardie Jules Verne, Amiens, France
| | - A Lokossou
- BioFlowImage Laboratory, Department of Medical Image Processing, University Hospital of Picardie Jules Verne, Amiens, France
| | - G Page
- BioFlowImage Laboratory, Department of Medical Image Processing, University Hospital of Picardie Jules Verne, Amiens, France
| | - L Balardy
- Department of Geriatric, University Hospital of Toulouse, Toulouse, France.,Departments of Geriatric, University Hospital of Toulouse, Toulouse, France.,Department of Geriatry, University Hospital Toulouse, Toulouse, France
| | - Z Czosnyka
- Neurosciences department, University of Cambridge, Cambridge, UK.,Brain Physics Lab, Academic Neurosurgery, University of Cambridge, Cambridge, UK
| | - P Payoux
- Department of Nuclear Medicine, University Hospital of Toulouse, Toulouse, France.,Department of Nuclear Medicine, University Hospital Toulouse, Toulouse, France.,INSER TONIC 1014, Toulouse Neuroimaging Center, Toulouse, France
| | - E A Schmidt
- UMR 1214-INSERM/UPS-TONIC Toulouse Neuro-Imaging Center, Toulouse, France.,Department of Neurosurgery, University Hospital of Toulouse, Toulouse, France.,Department of Neurosurgery, University Hospital Toulouse, Toulouse, France
| | - M Zitoun
- BioFlowImage, University Hospital of Picardie Jules Verne, Amiens, France
| | - M A Sevestre
- BioFlowImage, University Hospital of Picardie Jules Verne, Amiens, France
| | - N Alperin
- University of Miami Health System, Miami, FL, USA
| | - I Baudracco
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
| | - C Craven
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
| | - S Matloob
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
| | - S Thompson
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
| | - P Haylock Vize
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
| | - L Thorne
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
| | - L D Watkins
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK.,The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - A K Toma
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK.,The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Karl Bechter
- Department Psychiatry II/Bezirkskliniken, Ulm University, Günzburg, Germany
| | - A C Pong
- Neuroscience Research Australia, Randwick, Australia.,School of Medical Sciences, University of New South Wales, Kensington, Australia
| | - L Jugé
- Neuroscience Research Australia, Randwick, Australia.,School of Medical Sciences, University of New South Wales, Kensington, Australia
| | - L E Bilston
- Neuroscience Research Australia, Randwick, Australia.,Prince of Wales Clinical School, University of New South Wales, Kensington, Australia
| | - S Cheng
- Neuroscience Research Australia, Randwick, Australia.,Department of Engineering, Faculty of Science and Engineering, Macquarie University, Sydney, Australia
| | - W Bradley
- Department of Radiology, University of California San Diego Health System, San Diego, CA, USA
| | - F Hakim
- Department of Surgery, Section of Neurosurgery, Fundación Santa Fe de Bogotá, Bogotá, Colombia.,Neurosurgery Department, Hospital Universitario, Fundación Santafe de Bogota, Bogota, Colombia
| | - J F Ramón
- Department of Surgery, Section of Neurosurgery, Fundación Santa Fe de Bogotá, Bogotá, Colombia.,Grupo de Hidrocefalia con Presión Normal, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia.,Neurosurgery Department, Hospital Universitario, Fundación Santafe de Bogota, Bogota, Colombia
| | - M F Cárdenas
- Department of Surgery, Section of Neurosurgery, Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - J S Davidson
- Department of Surgery, Section of Neurosurgery, Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - C García
- Department of Surgery, Section of Neurosurgery, Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - D González
- Department of Surgery, Section of Neurosurgery, Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - S Bermúdez
- Department of Diagnostic Imaging, Section of Neuroradiology, Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - N Useche
- Department of Diagnostic Imaging, Section of Neuroradiology, Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - J A Mejía
- Grupo de Hidrocefalia con Presión Normal, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - P Mayorga
- Grupo de Hidrocefalia con Presión Normal, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - F Cruz
- Grupo de Hidrocefalia con Presión Normal, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - C Martinez
- Grupo de Hidrocefalia con Presión Normal, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - M C Matiz
- Grupo de Hidrocefalia con Presión Normal, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - M Vallejo
- Grupo de Hidrocefalia con Presión Normal, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - K Ghotme
- Grupo de Hidrocefalia con Presión Normal, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - H A Soto
- Grupo de Hidrocefalia con Presión Normal, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - D Riveros
- Grupo de Hidrocefalia con Presión Normal, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - A Buitrago
- Grupo de Hidrocefalia con Presión Normal, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - M Mora
- Grupo de Hidrocefalia con Presión Normal, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - L Murcia
- Grupo de Hidrocefalia con Presión Normal, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - S Bermudez
- Grupo de Hidrocefalia con Presión Normal, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - D Cohen
- Grupo de Hidrocefalia con Presión Normal, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - D Dasgupta
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
| | - C Curtis
- Department of Microbiology, University College London Hospital NHS Foundation Trust, London, UK
| | - L Domínguez
- Neurosurgery Department, Cartagena University, Cartagena de Indias, Colombia
| | - A J Remolina
- Neurosurgery Department, Cartagena University, Cartagena de Indias, Colombia
| | - M A Grijalba
- Neurosurgery Department, Cartagena University, Cartagena de Indias, Colombia
| | - K J Whitehouse
- Department of Paediatric Neurosurgery, Bristol Royal Hospital for Children, Bristol, UK
| | - R J Edwards
- Department of Paediatric Neurosurgery, Bristol Royal Hospital for Children, Bristol, UK
| | - A Eleftheriou
- Department of Neurology, University Hospital, Linköping, Sweden
| | - F Lundin
- Division of Neuroscience, Department of Clinical and Experimental Medicine (IKE), Linköping University, Linköping, Sweden
| | - K N Fountas
- Department of Neurosurgery, School of Medicine, University of Thessaly, Larisa, Greece
| | - E Z Kapsalaki
- Department of Diagnostic Radiology, School of Medicine, University of Thessaly, Larisa, Greece
| | - H F Smisson
- Department of Neurosurgery, Georgia Neurosurgical Institute, Macon, GA, USA
| | - J S Robinson
- Department of Neurosurgery, Georgia Neurosurgical Institute, Macon, GA, USA
| | - M J Fritsch
- Klinik für Neurochirurgie, Dietrich-Bonhoeffer-Klinikum, Neubrandenburg, Germany
| | - W Arouk
- Klinik für Neurochirurgie, Dietrich-Bonhoeffer-Klinikum, Neubrandenburg, Germany
| | - M Garzon
- Great Ormond Street Hospital, London, UK
| | - M Kang
- Great Ormond Street Hospital, London, UK
| | - K Sandhu
- Great Ormond Street Hospital, London, UK
| | | | - K Aquilina
- Great Ormond Street Hospital, London, UK
| | - G James
- Great Ormond Street Hospital, London, UK
| | - D Thompson
- Great Ormond Street Hospital, London, UK
| | - M Gehlen
- Department of Mechanical and Process Engineering, ETH Zurich, Zurich, Switzerland.,Institute of Physiology, University of Zurich, Zurich, Switzerland
| | - M Schmid Daners
- Department of Mechanical and Process Engineering, ETH Zurich, Zurich, Switzerland
| | - A Eklund
- Department of Radiation Sciences, Umeå University, Umeå, Sweden
| | - J Malm
- Department of Pharmacology and Clinical Neuroscience, Umeå University, Umeå, Sweden
| | - D Gomez
- Neurosurgery Department, Hospital Universitario, Fundación Santafe de Bogota, Bogota, Colombia
| | - M Guerra
- Instituto de Anatomía, Histología y Patología, Facultad de Medicina, UACh, Valdivia, Chile
| | - M Jara
- Instituto de Anatomía, Histología y Patología, Facultad de Medicina, UACh, Valdivia, Chile
| | - M Flores
- Laboratorio de Polímeros, Facultad de Ciencias, UACh, Valdivia, Chile
| | - K Vío
- Instituto de Anatomía, Histología y Patología, Facultad de Medicina, UACh, Valdivia, Chile
| | - I Moreno
- Laboratorio de Polímeros, Facultad de Ciencias, UACh, Valdivia, Chile
| | - S Rodríguez
- Instituto de Anatomía, Histología y Patología, Facultad de Medicina, UACh, Valdivia, Chile
| | - E Ortega
- Instituto de Neurociencias Clínicas, Facultad de Medicina, UACh, Valdivia, Chile
| | - E M Rodríguez
- Instituto de Anatomía, Histología y Patología, Facultad de Medicina, UACh, Valdivia, Chile.,Instituto de Histologia y Patologia, Facultad de Medicina, Universidad Austral de Chile, Valdivia, Chile
| | - J P McAllister
- Department of Neurosurgery, St. Louis Children's Hospital, St. Louis, MO, USA
| | - M M Guerra
- Instituto de Histologia y Patologia, Facultad de Medicina, Universidad Austral de Chile, Valdivia, Chile
| | - D M Morales
- Department of Neurosurgery, St. Louis Children's Hospital, St. Louis, MO, USA
| | - D Sival
- Department of Pediatrics Pathology and Medical Biology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - A Jimenez
- Departamento de Biología Celular, Genética y Fisiología Facultad de Ciencias, Universidad de Malaga, Malaga, Spain
| | - D D Limbrick
- Department of Neurosurgery, St. Louis Children's Hospital, St. Louis, MO, USA.,Department of Pediatrics, St. Louis Children's Hospital, St. Louis, MO, USA
| | - M Ishikawa
- Rakuwa Villa Ilios, Kyoto, Japan.,Normal Pressure Hydrocephalus Center, Otowa Hospital, Kyoto, Japan
| | - S Yamada
- Normal Pressure Hydrocephalus Center, Otowa Hospital, Kyoto, Japan.,Department of Neurosurgery, Otowa Hospital, Kyoto, Japan
| | - K Yamamoto
- Department of Neurosurgery, Otowa Hospital, Kyoto, Japan
| | - A Junkkari
- Neurosurgery of NeuroCenter, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland.,Neurosurgery of NeuroCenter, Kuopio University Hospital, Kuopio, Finland
| | - A Häyrinen
- Neurosurgery of NeuroCenter, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
| | - T Rauramaa
- Department of Pathology, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland.,Department of Pathology, Kuopio University Hospital, Kuopio, Finland.,Institute of Clinical Medicine-Pathology, University of Eastern Finland, Kuopio, Finland
| | - H Sintonen
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - O Nerg
- Neurology of NeuroCenter, University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland.,Neurology of NeuroCenter, Kuopio University Hospital, Kuopio, Finland.,Institute of Clinical Medicine-Neurology, University of Eastern Finland, Kuopio, Finland
| | - A M Koivisto
- Neurology of NeuroCenter, University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland.,Unit of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.,Neurology of NeuroCenter, Kuopio University Hospital, Kuopio, Finland.,Institute of Clinical Medicine-Neurology, University of Eastern Finland, Kuopio, Finland.,Department of Neurology, Kuopio University Hospital, Kuopio, Finland
| | - R P Roine
- University of Eastern Finland, Kuopio Finland and Helsinki and Uusimaa Hospital DistrictGroup Administration, Helsinki, Finland
| | - H Viinamäki
- Department of Psychiatry, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
| | - H Soininen
- Department of Neurology, University of Eastern Finland, Kuopio, Finland.,Unit of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.,Neurology of NeuroCenter, Kuopio University Hospital, Kuopio, Finland.,Institute of Clinical Medicine-Neurology, University of Eastern Finland, Kuopio, Finland.,Department of Neurology, Kuopio University Hospital, Kuopio, Finland
| | - A Luikku
- Neurology of NeuroCenter, University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland
| | - J E Jääskeläinen
- Neurosurgery of NeuroCenter, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland.,Department of Neurosurgery, Kuopio University Hospital, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.,Neurosurgery of NeuroCenter, Kuopio University Hospital, Kuopio, Finland
| | - V Leinonen
- Neurosurgery of NeuroCenter, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland.,Department of Neurosurgery, University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland.,Department of Neurosurgery, Kuopio University Hospital, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.,Neurosurgery of NeuroCenter, Kuopio University Hospital, Kuopio, Finland
| | - U Kehler
- Neurosurgical Department, Asklepios Klinik Hamburg Altona, Hamburg, Germany
| | - O Lilja-Lund
- Department of Pharmacology and Clinical Neuroscience, Unit of Neurology, Östersund, Umeå University, Umeå, Sweden
| | - K Kockum
- Department of Pharmacology and Clinical Neuroscience, Unit of Neurology, Östersund, Umeå University, Umeå, Sweden
| | - E M Larsson
- Department of Radiology, Uppsala University, Uppsala, Sweden
| | - K Riklund
- Department of Radiation Sciences, Umeå University, Umeå, Sweden
| | - L Söderström
- Department of Pharmacology and Clinical Neuroscience, Unit of Neurology, Östersund, Umeå University, Umeå, Sweden
| | - P Hellström
- Hydrocephalus Research Unit, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - K Laurell
- Department of Pharmacology and Clinical Neuroscience, Unit of Neurology, Östersund, Umeå University, Umeå, Sweden
| | - M Kojoukhova
- Neurosurgery of NeuroCenter, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland.,Neurosurgery of NeuroCenter, Kuopio University Hospital, Kuopio, Finland.,Department of Radiology, Kuopio University Hospital, Kuopio, Finland
| | - A Sutela
- Department of Radiology, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland.,Department of Radiology, Kuopio University Hospital, Kuopio, Finland
| | - R Vanninen
- Department of Radiology, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
| | - K I Vanha
- Neurosurgery of NeuroCenter, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
| | - M Timonen
- Neurosurgery of NeuroCenter, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
| | - J Rummukainen
- Department of Pathology, Kuopio University Hospital, Kuopio, Finland
| | - V Korhonen
- Department of Neurosurgery, University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland
| | - S Helisalmi
- Unit of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.,Institute of Clinical Medicine-Neurology, University of Eastern Finland, Kuopio, Finland.,Department of Neurology, Kuopio University Hospital, Kuopio, Finland
| | - E Solje
- Institute of Clinical Medicine-Neurology, University of Eastern Finland, Kuopio, Finland.,Department of Neurology, Kuopio University Hospital, Kuopio, Finland
| | - A M Remes
- Unit of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.,Neurology of NeuroCenter, Kuopio University Hospital, Kuopio, Finland.,Institute of Clinical Medicine-Neurology, University of Eastern Finland, Kuopio, Finland.,Department of Neurology, Kuopio University Hospital, Kuopio, Finland
| | - J Huovinen
- Department of Neurosurgery, Kuopio University Hospital, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - J Paananen
- Unit of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.,Department of Neurology, Kuopio University Hospital, Kuopio, Finland.,Institute of Biomedicine, University of Eastern Finland, Kuopio, Finland
| | - M Hiltunen
- Unit of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.,Neurology of NeuroCenter, Kuopio University Hospital, Kuopio, Finland.,Institute of Clinical Medicine-Neurology, University of Eastern Finland, Kuopio, Finland.,Department of Neurology, Kuopio University Hospital, Kuopio, Finland.,Institute of Biomedicine, University of Eastern Finland, Kuopio, Finland
| | - M Kurki
- Department of Neurosurgery, Kuopio University Hospital, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.,Analytical and Translational Genetics Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.,Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA.,Stanley Center for Psychiatric Research, Broad Institute for Harvard and MIT, Cambridge, MA, USA
| | - B Martin
- Biological Engineering, University of Idaho, Moscow, ID, USA
| | - F Loth
- Mechanical Engineering, University of Akron, Akron, Ohio, USA
| | - M Luciano
- Neurosurgery, Johns Hopkins University, Baltimore, MA, USA.,Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - A J Luikku
- Institute of Clinical Medicine-Neurology, University of Eastern Finland, Kuopio, Finland.,Neurosurgery of NeuroCenter, Kuopio University Hospital, Kuopio, Finland
| | - A Hall
- Institute of Clinical Medicine-Neurology, University of Eastern Finland, Kuopio, Finland
| | - S K Herukka
- Neurology of NeuroCenter, Kuopio University Hospital, Kuopio, Finland.,Institute of Clinical Medicine-Neurology, University of Eastern Finland, Kuopio, Finland
| | - J Mattila
- VTT Technical Research Centre of Finland, Tampere, Finland.,Combinostics Ltd, Tampere, Finland
| | - J Lötjönen
- VTT Technical Research Centre of Finland, Tampere, Finland.,Combinostics Ltd, Tampere, Finland
| | - I Alafuzoff
- Institute of Clinical Medicine-Neurology, University of Eastern Finland, Kuopio, Finland.,Rudbeck Laboratory, Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden.,Department of Pathology and Cytology, Uppsala University Hospital, Uppsala, Sweden
| | - I Jurjević
- Department of Neurosurgery, Graduate School of Medicine, Juntendo University, Tokyo, Japan.,Department of Pharmacology and Department of Neurology, University of Zagreb School of Medicine, Zagreb, Croatia
| | - M Miyajima
- Department of Neurosurgery, Graduate School of Medicine, Juntendo University, Tokyo, Japan.,Department of Neurosurgery, Juntendo University School of Medicine, Tokyo, Japan
| | - M Nakajima
- Department of Neurosurgery, Graduate School of Medicine, Juntendo University, Tokyo, Japan.,Department of Neurosurgery, Juntendo University School of Medicine, Tokyo, Japan
| | - H Murai
- Department of Neurosurgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - T Shin
- Department of Neurosurgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - D Kawaguchi
- Department of Neurosurgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - C Akiba
- Department of Neurosurgery, Juntendo University School of Medicine, Tokyo, Japan
| | - I Ogino
- Department of Neurosurgery, Juntendo University School of Medicine, Tokyo, Japan
| | - K Karagiozov
- Department of Neurosurgery, Juntendo University School of Medicine, Tokyo, Japan
| | - H Arai
- Department of Neurosurgery, Juntendo University School of Medicine, Tokyo, Japan
| | - R C Reis
- Group of Cerebral Hydrodynamics, Division of Functional Neurosurgery, Institute of Psychiatry, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
| | - M J Teixeira
- Group of Cerebral Hydrodynamics, Division of Functional Neurosurgery, Institute of Psychiatry, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
| | - C G Valêncio
- Group of Cerebral Hydrodynamics, Division of Functional Neurosurgery, Institute of Psychiatry, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
| | - D da Vigua
- Group of Cerebral Hydrodynamics, Division of Functional Neurosurgery, Institute of Psychiatry, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
| | - L Almeida-Lopes
- Núcleo de Pesquisa e Ensino de Fototerapia nas Ciências da Saúde (NUPEN), São Carlos, Brazil
| | - M W Mancini
- Núcleo de Pesquisa e Ensino de Fototerapia nas Ciências da Saúde (NUPEN), São Carlos, Brazil
| | - F C G Pinto
- Group of Cerebral Hydrodynamics, Division of Functional Neurosurgery, Institute of Psychiatry, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
| | - R H Maykot
- Group of Cerebral Hydrodynamics, Division of Functional Neurosurgery, Institute of Psychiatry, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
| | - G Calia
- Group of Cerebral Hydrodynamics, Division of Functional Neurosurgery, Institute of Psychiatry, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
| | - J Tornai
- Group of Cerebral Hydrodynamics, Division of Functional Neurosurgery, Institute of Psychiatry, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
| | - S S S Silvestre
- Group of Cerebral Hydrodynamics, Division of Functional Neurosurgery, Institute of Psychiatry, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
| | - G Mendes
- Group of Cerebral Hydrodynamics, Division of Functional Neurosurgery, Institute of Psychiatry, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
| | - V Sousa
- Group of Cerebral Hydrodynamics, Division of Functional Neurosurgery, Institute of Psychiatry, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
| | - B Bezerra
- Group of Cerebral Hydrodynamics, Division of Functional Neurosurgery, Institute of Psychiatry, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
| | - P Dutra
- Group of Cerebral Hydrodynamics, Division of Functional Neurosurgery, Institute of Psychiatry, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
| | - P Modesto
- Group of Cerebral Hydrodynamics, Division of Functional Neurosurgery, Institute of Psychiatry, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
| | - M F Oliveira
- Group of Cerebral Hydrodynamics, Division of Functional Neurosurgery, Institute of Psychiatry, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
| | - C E Petitto
- Group of Cerebral Hydrodynamics, Division of Functional Neurosurgery, Institute of Psychiatry, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
| | - H Pulhorn
- Department of Neurosurgery, The Walton Centre, Liverpool, UK
| | - A Chandran
- Department of Neuroradiology, The Walton Centre, Liverpool, UK
| | - C McMahon
- Department of Neurosurgery, The Walton Centre, Liverpool, UK
| | - A S Rao
- The Johns Hopkins Hospital, Baltimore, MD, USA
| | - M Jumaly
- The Johns Hopkins Hospital, Baltimore, MD, USA
| | - D Solomon
- The Johns Hopkins Hospital, Baltimore, MD, USA.,Neurology, Johns Hopkins Hospital, Baltimore, MD, USA.,Department of Neurology, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA
| | - A Moghekar
- The Johns Hopkins Hospital, Baltimore, MD, USA
| | - N Relkin
- Department of Neurology, Weill Cornell Medical College, New York, NY, USA
| | - M Hamilton
- Department of Neurosurgery, University of Calgary, Alberta, Canada
| | - H Katzen
- Department of Neurology, University of Miami, Miami, FL, USA
| | - M Williams
- Department of Neurosurgery, Washington University, Seattle, WA, USA
| | - T Bach
- Utah Data Collection Center (DCC), University of Utah, Salt Lake City, UT, USA
| | - S Zuspan
- Utah Data Collection Center (DCC), University of Utah, Salt Lake City, UT, USA
| | - R Holubkov
- Utah Data Collection Center (DCC), University of Utah, Salt Lake City, UT, USA
| | | | - G Clemens
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - P Sharkey
- School of Business, Loyola University Maryland, Baltimore, MD, USA
| | - A Sanyal
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - E Sankey
- Department of Neurosurgery, Johns Hopkins University, Baltimore, MD, USA.,Department of Neurosurgery, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - K Rigamonti
- Department of Neurosurgery, Johns Hopkins University, Baltimore, MD, USA
| | - S Naqvi
- Primary Care, Johns Hopkins Aramco Healthcare, Abqaiq, Saudi Arabia
| | - A Hung
- Department of Neurosurgery, Johns Hopkins University, Baltimore, MD, USA.,Department of Neurosurgery, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - E Schmidt
- Department of Neurosurgery, University Hospital Toulouse, Toulouse, France
| | - F Ory-Magne
- Department of Neurology, University Hospital Toulouse, Toulouse, France.,INSER TONIC 1014, Toulouse Neuroimaging Center, Toulouse, France
| | - P Gantet
- Department of Nuclear Medicine, University Hospital Toulouse, Toulouse, France
| | - A Guenego
- Department of Neurosurgery, University Hospital Toulouse, Toulouse, France.,Department of Neuroradiology, University Hospital Toulouse, Toulouse, France
| | - A C Januel
- Department of Neuroradiology, University Hospital Toulouse, Toulouse, France
| | - P Tall
- Department of Neuroradiology, University Hospital Toulouse, Toulouse, France
| | - N Fabre
- Department of Neurology, University Hospital Toulouse, Toulouse, France
| | - L Mahieu
- Department of Ophtalmology, University Hospital Toulouse, Toulouse, France
| | - C Cognard
- Department of Neuroradiology, University Hospital Toulouse, Toulouse, France
| | - L Gray
- Department of Physiology, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | | | - K Takagi
- Normal Pressure Hydrocephalus Center, Kashiwa-Tanaka Hospital, Kashiwa, Japan
| | - K Onouchi
- Department of Neurology, Kashiwa-Tanaka Hospital, Kashiwa, Japan
| | - S D Thompson
- The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - L D Thorne
- The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - H M Tully
- Department of Neurology, University of Washington, Seattle, WA, USA
| | - T L Wenger
- Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - W A Kukull
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - D Doherty
- Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - W B Dobyns
- Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - D Moran
- Department of Neurosurgery, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - S Vakili
- Department of Neurosurgery, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - M A Patel
- Department of Neurosurgery, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - B Elder
- Department of Neurosurgery, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - C R Goodwin
- Department of Neurosurgery, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - J A Crawford
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - M V Pletnikov
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - J Xu
- F. M. Kirby Research Center for Functional Brain Imaging at the Kennedy Krieger Institute, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - A Blitz
- Department of Radiology and Radiological Science, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - D A Herzka
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - H Guerrero-Cazares
- Department of Neurosurgery, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - A Quiñones-Hinojosa
- Department of Neurosurgery, Johns Hopkins University, School of Medicine, Baltimore, MD, USA.,Department of Oncology, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - S Mori
- Department of Radiology-Magnetic Resonance Research, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - P Saavedra
- Department of Neurosurgery, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - H Treviño
- Department of Neurosurgery, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - K Maitani
- Department of Neurosurgery, Johns Hopkins University, School of Medicine, Baltimore, MD, USA.,Tohoku University School of Medicine, Sendai, Japan
| | - W C Ziai
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - V Eslami
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - S Nekoovaght-Tak
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - R Dlugash
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - G Yenokyan
- Department of Biostatistics, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - N McBee
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - D F Hanley
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
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23
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Limbrick DD, Castaneyra-Ruiz L, Han RH, Berger D, McAllister JP, Morales DM. Cerebrospinal Fluid Biomarkers of Pediatric Hydrocephalus. Pediatr Neurosurg 2017; 52:426-435. [PMID: 28797007 DOI: 10.1159/000477175] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 05/02/2017] [Indexed: 11/19/2022]
Abstract
Hydrocephalus (HC) is a common, debilitating neurological condition that requires urgent clinical decision-making. At present, neurosurgeons rely heavily on a patient's history, physical examination findings, neuroimaging, and clinical judgment to make the diagnosis of HC or treatment failure (e.g., shunt malfunction). Unfortunately, these tools, even in combination, do not eliminate subjectivity in clinical decisions. In order to improve the management of infants and children with HC, there is an urgent need for new biomarkers to complement currently available tools and enable clinicians to confidently establish the diagnosis of HC, assess therapeutic efficacy/treatment failure, and evaluate current and future developmental challenges, so that every child has access to the resources they need to optimize their outcome and quality of life.
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Affiliation(s)
- David D Limbrick
- Division of Pediatric Neurosurgery, Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO, USA
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24
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Jusué-Torres I, Jeon LH, Sankey EW, Lu J, Vivas-Buitrago T, Crawford JA, Pletnikov MV, Xu J, Blitz A, Herzka DA, Crain B, Hulbert A, Guerrero-Cazares H, Gonzalez-Perez O, McAllister JP, Quiñones-Hinojosa A, Rigamonti D. A Novel Experimental Animal Model of Adult Chronic Hydrocephalus. Neurosurgery 2016; 79:746-756. [DOI: 10.1227/neu.0000000000001405] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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25
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Ortega E, Muñoz RI, Luza N, Guerra F, Guerra M, Vio K, Henzi R, Jaque J, Rodriguez S, McAllister JP, Rodriguez E. The value of early and comprehensive diagnoses in a human fetus with hydrocephalus and progressive obliteration of the aqueduct of Sylvius: Case Report. BMC Neurol 2016; 16:45. [PMID: 27067115 PMCID: PMC4828774 DOI: 10.1186/s12883-016-0566-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 03/25/2016] [Indexed: 01/08/2023] Open
Abstract
Background Mutant rodent models have highlighted the importance of the ventricular ependymal cells and the subcommissural organ (a brain gland secreting glycoproteins into the cerebrospinal fluid) in the development of fetal onset hydrocephalus. Evidence indicates that communicating and non-communicating hydrocephalus can be two sequential phases of a single pathological phenomenon triggered by ependymal disruption and/or abnormal function of the subcommissural organ. We have hypothesized that a similar phenomenon may occur in human cases with fetal onset hydrocephalus. Case presentation We report here on a case of human fetal communicating hydrocephalus with no central nervous system abnormalities other than stenosis of the aqueduct of Sylvius (SA) that became non-communicating hydrocephalus during the first postnatal week due to obliteration of the cerebral aqueduct. The case was followed closely by a team of basic and clinic investigators allowing an early diagnosis and prediction of the evolving pathophysiology. This information prompted neurosurgeons to perform a third ventriculostomy at postnatal day 14. The fetus was monitored by ultrasound, computerized axial tomography and magnetic resonance imaging (MRI). After birth, the follow up was by MRI, electroencephalography and neurological and neurocognitive assessments. Cerebrospinal fluid (CSF) collected at surgery showed abnormalities in the subcommissural organ proteins and the membrane proteins L1-neural cell adhesion molecule and aquaporin-4. The neurological and neurocognitive assessments at 3 and 6 years of age showed neurological impairments (epilepsy and cognitive deficits). Conclusions (1) In a hydrocephalic fetus, a stenosed SA can become obliterated at perinatal stages. (2) In the case reported, a close follow up of a communicating hydrocephalus detected in utero allowed a prompt postnatal surgery aiming to avoid as much brain damage as possible. (3) The clinical and pathological evolution of this patient supports the possibility that the progressive stenosis of the SA initiated during the embryonic period may have resulted from ependymal disruption of the cerebral aqueduct and dysfunction of the subcommissural organ. The analysis of subcommissural organ glycoproteins present in the CSF may be a valuable diagnostic tool for the pathogenesis of congenital hydrocephalus.
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Affiliation(s)
- Eduardo Ortega
- Unidad de Neurocirugía, Instituto de Neurociencias Clínicas, Facultad de Medicina, Universidad Austral de Chile, Valdivia, Chile
| | - Rosa I Muñoz
- Instituto de Anatomía, Histología y Patología, Facultad de Medicina, Universidad Austral de Chile, Valdivia, Chile
| | - Nelly Luza
- Instituto de Anatomía, Histología y Patología, Facultad de Medicina, Universidad Austral de Chile, Valdivia, Chile
| | - Francisco Guerra
- Instituto de Fisiología, Facultad de Medicina, Universidad Austral de Chile, Casilla 456, Valdivia, Chile
| | - Monserrat Guerra
- Instituto de Anatomía, Histología y Patología, Facultad de Medicina, Universidad Austral de Chile, Valdivia, Chile.
| | - Karin Vio
- Instituto de Anatomía, Histología y Patología, Facultad de Medicina, Universidad Austral de Chile, Valdivia, Chile
| | - Roberto Henzi
- Instituto de Anatomía, Histología y Patología, Facultad de Medicina, Universidad Austral de Chile, Valdivia, Chile
| | - Jaime Jaque
- Unidad de Neurocirugía, Instituto de Neurociencias Clínicas, Facultad de Medicina, Universidad Austral de Chile, Valdivia, Chile
| | - Sara Rodriguez
- Instituto de Anatomía, Histología y Patología, Facultad de Medicina, Universidad Austral de Chile, Valdivia, Chile
| | - James P McAllister
- Department of Neurosurgery, Division of Pediatric Neurosurgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Esteban Rodriguez
- Instituto de Anatomía, Histología y Patología, Facultad de Medicina, Universidad Austral de Chile, Valdivia, Chile
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26
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McAllister JP, Williams MA, Walker ML, Kestle JRW, Relkin NR, Anderson AM, Gross PH, Browd SR. An update on research priorities in hydrocephalus: overview of the third National Institutes of Health-sponsored symposium "Opportunities for Hydrocephalus Research: Pathways to Better Outcomes". J Neurosurg 2015; 123:1427-38. [PMID: 26090833 DOI: 10.3171/2014.12.jns132352] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Building on previous National Institutes of Health-sponsored symposia on hydrocephalus research, "Opportunities for Hydrocephalus Research: Pathways to Better Outcomes" was held in Seattle, Washington, July 9-11, 2012. Plenary sessions were organized into four major themes, each with two subtopics: Causes of Hydrocephalus (Genetics and Pathophysiological Modifications); Diagnosis of Hydrocephalus (Biomarkers and Neuroimaging); Treatment of Hydrocephalus (Bioengineering Advances and Surgical Treatments); and Outcome in Hydrocephalus (Neuropsychological and Neurological). International experts gave plenary talks, and extensive group discussions were held for each of the major themes. The conference emphasized patient-centered care and translational research, with the main objective to arrive at a consensus on priorities in hydrocephalus that have the potential to impact patient care in the next 5 years. The current state of hydrocephalus research and treatment was presented, and the following priorities for research were recommended for each theme. 1) Causes of Hydrocephalus-CSF absorption, production, and related drug therapies; pathogenesis of human hydrocephalus; improved animal and in vitro models of hydrocephalus; developmental and macromolecular transport mechanisms; biomechanical changes in hydrocephalus; and age-dependent mechanisms in the development of hydrocephalus. 2) Diagnosis of Hydrocephalus-implementation of a standardized set of protocols and a shared repository of technical information; prospective studies of multimodal techniques including MRI and CSF biomarkers to test potential pharmacological treatments; and quantitative and cost-effective CSF assessment techniques. 3) Treatment of Hydrocephalus-improved bioengineering efforts to reduce proximal catheter and overall shunt failure; external or implantable diagnostics and support for the biological infrastructure research that informs these efforts; and evidence-based surgical standardization with longitudinal metrics to validate or refute implemented practices, procedures, or tests. 4) Outcome in Hydrocephalus-development of specific, reliable batteries with metrics focused on the hydrocephalic patient; measurements of neurocognitive outcome and quality-of-life measures that are adaptable, trackable across the growth spectrum, and applicable cross-culturally; development of comparison metrics against normal aging and sensitive screening tools to diagnose idiopathic normal pressure hydrocephalus against appropriate normative age-based data; better understanding of the incidence and prevalence of hydrocephalus within both pediatric and adult populations; and comparisons of aging patterns in adults with hydrocephalus against normal aging patterns.
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Affiliation(s)
- James P McAllister
- Department of Neurosurgery, Division of Pediatric Neurosurgery, Washington University School of Medicine and St. Louis Children's Hospital, St. Louis, Missouri
| | - Michael A Williams
- Department of Neurology, The Sandra and Malcolm Berman Brain & Spine Institute and Adult Hydrocephalus Center, Sinai Hospital, Baltimore, Maryland
| | - Marion L Walker
- Department of Neurosurgery, Division of Pediatric Neurosurgery, University of Utah, Primary Children's Medical Center, Salt Lake City, Utah
| | - John R W Kestle
- Department of Neurosurgery, Division of Pediatric Neurosurgery, University of Utah, Primary Children's Medical Center, Salt Lake City, Utah
| | - Norman R Relkin
- Department of Neurology, Weill Cornell Medical College, New York, New York
| | - Amy M Anderson
- Department of Neurosurgery, Seattle Children's Hospital, Seattle, Washington; and
| | | | - Samuel R Browd
- Departments of Neurosurgery and Bioengineering, University of Washington and Seattle Children's Hospital, Seattle, Washington
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Morales DM, Holubkov R, Inder TE, Ahn HC, Mercer D, Rao R, McAllister JP, Holtzman DM, Limbrick DD. Cerebrospinal fluid levels of amyloid precursor protein are associated with ventricular size in post-hemorrhagic hydrocephalus of prematurity. PLoS One 2015; 10:e0115045. [PMID: 25738507 PMCID: PMC4349693 DOI: 10.1371/journal.pone.0115045] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Accepted: 11/18/2014] [Indexed: 02/03/2023] Open
Abstract
Background Neurological outcomes of preterm infants with post-hemorrhagic hydrocephalus (PHH) remain among the worst in infancy, yet there remain few instruments to inform the treatment of PHH. We previously observed PHH-associated elevations in cerebrospinal fluid (CSF) amyloid precursor protein (APP), neural cell adhesion molecule-L1 (L1CAM), neural cell adhesion molecule-1 (NCAM-1), and other protein mediators of neurodevelopment. Objective The objective of this study was to examine the association of CSF APP, L1CAM, and NCAM-1 with ventricular size as an early step toward developing CSF markers of PHH. Methods CSF levels of APP, L1CAM, NCAM-1, and total protein (TP) were measured in 12 preterm infants undergoing PHH treatment. Ventricular size was determined using cranial ultrasounds. The relationships between CSF APP, L1CAM, and NCAM-1, occipitofrontal circumference (OFC), volume of CSF removed, and ventricular size were examined using correlation and regression analyses. Results CSF levels of APP, L1CAM, and NCAM-1 but not TP paralleled treatment-related changes in ventricular size. CSF APP demonstrated the strongest association with ventricular size, estimated by frontal-occipital horn ratio (FOR) (Pearson R = 0.76, p = 0.004), followed by NCAM-1 (R = 0.66, p = 0.02) and L1CAM (R = 0.57,p = 0.055). TP was not correlated with FOR (R = 0.02, p = 0.95). Conclusions Herein, we report the novel observation that CSF APP shows a robust association with ventricular size in preterm infants treated for PHH. The results from this study suggest that CSF APP and related proteins at once hold promise as biomarkers of PHH and provide insight into the neurological consequences of PHH in the preterm infant.
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Affiliation(s)
- Diego M. Morales
- Department of Neurological Surgery, Washington University in St. Louis, School of Medicine, Saint Louis, Missouri, United States of America
- * E-mail:
| | - Richard Holubkov
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
| | - Terri E. Inder
- Department of Pediatrics, Washington University in St. Louis, School of Medicine, Saint Louis, Missouri, United States of America
| | - Haejun C. Ahn
- Department of Neurological Surgery, Washington University in St. Louis, School of Medicine, Saint Louis, Missouri, United States of America
| | - Deanna Mercer
- Department of Neurological Surgery, Washington University in St. Louis, School of Medicine, Saint Louis, Missouri, United States of America
| | - Rakesh Rao
- Department of Newborn Medicine, Washington University in St. Louis, School of Medicine, Saint Louis, Missouri, United States of America
| | - James P. McAllister
- Department of Neurological Surgery, Washington University in St. Louis, School of Medicine, Saint Louis, Missouri, United States of America
| | - David M. Holtzman
- Department of Neurology, Washington University in St. Louis, School of Medicine, Saint Louis, Missouri, United States of America
- The Hope Center for Neurological Disorders, Washington University in St. Louis, School of Medicine, Saint Louis, Missouri, United States of America
| | - David D. Limbrick
- Department of Neurological Surgery, Washington University in St. Louis, School of Medicine, Saint Louis, Missouri, United States of America
- Department of Pediatrics, Washington University in St. Louis, School of Medicine, Saint Louis, Missouri, United States of America
- The Hope Center for Neurological Disorders, Washington University in St. Louis, School of Medicine, Saint Louis, Missouri, United States of America
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Morgan C, Morales DM, Habiyaremye G, McAllister JP, Limbrick DD. Cerebrospinal fluid biomarkers of malfunctioning ventriculoperitoneal shunts: a pilot study. Fluids Barriers CNS 2015. [PMCID: PMC4582242 DOI: 10.1186/2045-8118-12-s1-o20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
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Habiyaremye G, Morales DM, Morgan CD, McAllister JP, Limbrick DD. Differentiation of cerebrospinal fluid inflammatory biomarkers between neonatal post-hemorrhagic and congenital hydrocephalus. Fluids Barriers CNS 2015. [PMCID: PMC4582254 DOI: 10.1186/2045-8118-12-s1-p15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
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Habiyaremye G, Morales DM, Morgan CD, McAllister JP, Limbrick DD. Novel cerebrospinal fluid inflammatory biomarkers in neonatal post-hemorrhagic hydrocephalus. Fluids Barriers CNS 2015. [PMCID: PMC4582297 DOI: 10.1186/2045-8118-12-s1-o19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Eskandari R, Abdullah O, Mason C, Lloyd KE, Oeschle AN, McAllister JP. Differential vulnerability of white matter structures to experimental infantile hydrocephalus detected by diffusion tensor imaging. Childs Nerv Syst 2014; 30:1651-61. [PMID: 25070594 DOI: 10.1007/s00381-014-2500-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Accepted: 07/14/2014] [Indexed: 12/22/2022]
Abstract
PURPOSE The differential vulnerability of white matter (WM) to acute and chronic infantile hydrocephalus and the related effects of early and late reservoir treatment are unknown, but diffusion tensor imaging (DTI) could provide this information. Thus, we characterized WM integrity using DTI in a clinically relevant model. METHODS Obstructive hydrocephalus was induced in 2-week-old felines by intracisternal kaolin injection. Ventricular reservoirs were placed 1 (early) or 2 (late) weeks post-kaolin and tapped frequently based solely on neurological deficit. Hydrocephalic and age-matched control animals were sacrificed 12 weeks postreservoir. WM integrity was evaluated in the optic system, corpus callosum, and internal capsule prereservoir and every 3 weeks using DTI. Analyses were grouped as acute (<6 weeks) or chronic (≥6 weeks). RESULTS In the corpus callosum during acute stages, fractional anisotropy (FA) decreased significantly with early and late reservoir placement (p = 0.0008 and 0.0008, respectively), and diffusivity increased significantly in early (axial, radial, and mean diffusivity, p = 0.0026, 0.0012, and 0.0002, respectively) and late (radial and mean diffusivity, p = 0.01 and 0.0038, respectively) groups. Chronically, the corpus callosum was thinned and not detectable by DTI. FA was significantly lower in the optic chiasm and tracts (p = 0.0496 and 0.0052, respectively) with late but not early reservoir placement. In the internal capsule, FA in both reservoir groups increased significantly with age (p < 0.05) but diffusivity remained unchanged. CONCLUSIONS All hydrocephalic animals treated with intermittent ventricular reservoir tapping demonstrated progressive ventriculomegaly. Both reservoir groups demonstrated WM integrity loss, with the CC the most vulnerable and the optic system the most resilient.
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Affiliation(s)
- Ramin Eskandari
- Stanford Children's Health, Lucile Packard Children's Hospital, 725 Welch Road, Palo Alto, CA, USA,
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Rodríguez EM, Guerra MM, Vío K, González C, Ortloff A, Bátiz LF, Rodríguez S, Jara MC, Muñoz RI, Ortega E, Jaque J, Guerra F, Sival DA, den Dunnen WFA, Jiménez AJ, Domínguez-Pinos MD, Pérez-Fígares JM, McAllister JP, Johanson C. A cell junction pathology of neural stem cells leads to abnormal neurogenesis and hydrocephalus. Biol Res 2014; 45:231-42. [PMID: 23283433 DOI: 10.4067/s0716-97602012000300005] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2012] [Accepted: 09/19/2012] [Indexed: 11/17/2022] Open
Abstract
Most cells of the developing mammalian brain derive from the ventricular (VZ) and the subventricular (SVZ) zones. The VZ is formed by the multipotent radial glia/neural stem cells (NSCs) while the SVZ harbors the rapidly proliferative neural precursor cells (NPCs). Evidence from human and animal models indicates that the common history of hydrocephalus and brain maldevelopment starts early in embryonic life with disruption of the VZ and SVZ. We propose that a "cell junction pathology" involving adherent and gap junctions is a final common outcome of a wide range of gene mutations resulting in proteins abnormally expressed by the VZ cells undergoing disruption. Disruption of the VZ during fetal development implies the loss of NSCs whereas VZ disruption during the perinatal period implies the loss of ependyma. The process of disruption occurs in specific regions of the ventricular system and at specific stages of brain development. This explains why only certain brain structures have an abnormal development, which in turn results in a specific neurological impairment of the newborn. Disruption of the VZ of the Sylvian aqueduct (SA) leads to aqueductal stenosis and hydrocephalus, while disruption of the VZ of telencephalon impairs neurogenesis. We are currently investigating whether grafting of NSCs/neurospheres from normal rats into the CSF of hydrocephalic mutants helps to diminish/repair the outcomes of VZ disruption.
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Affiliation(s)
- Esteban M Rodríguez
- Instituto de Anatomía, Histología y Patología, Universidad Austral de Chile, Valdivia, Chile.
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Williams MT, Braun AA, Amos-Kroohs RM, McAllister JP, Lindquist DM, Mangano FT, Vorhees CV, Yuan W. Kaolin-induced ventriculomegaly at weaning produces long-term learning, memory, and motor deficits in rats. Int J Dev Neurosci 2014; 35:7-15. [PMID: 24594360 DOI: 10.1016/j.ijdevneu.2014.02.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Revised: 02/21/2014] [Accepted: 02/21/2014] [Indexed: 11/25/2022] Open
Abstract
Ventriculomegaly occurs when there is imbalance between creation and absorption of cerebrospinal fluid (CSF); even when treated, long-term behavioral changes occur. Kaolin injection in the cisterna magna of rats produces an obstruction of CSF outflow and models one type of hydrocephalus. Previous research with this model shows that neonatal onset has mixed effects on Morris water maze (MWM) and motoric performance; we hypothesized that this might be because the severity of ventricular enlargement was not taken into consideration. In the present experiment, rats were injected with kaolin or saline on postnatal day (P)21 and analyzed in subgroups based on Evan's ratios (ERs) of the severity of ventricular enlargement at the end of testing to create 4 subgroups from least to most severe: ER0.4-0.5, ER0.51-0.6, ER0.61-0.7, and ER0.71-0.82, respectively. Locomotor activity (dry land and swimming), acoustic startle with prepulse inhibition (PPI), and MWM performance were tested starting on P28 (122cm maze) and again on P42 (244cm maze). Kaolin-treated animals weighed significantly less than controls at all times. Differences in locomotor activity were seen at P42 but not P28. On P28 there was an increase in PPI for all but the least severe kaolin-treated group, but no difference at P42 compared with controls. In the MWM at P28, all kaolin-treated groups had longer path lengths than controls, but comparable swim speeds. With the exception of the least severe group, probe trial performance was worse in the kaolin-treated animals. On P42, only the most severely affected kaolin-treated group showed deficits compared with control animals. This group showed no MWM learning and no memory for the platform position during probe trial testing. Swim speed was unaffected, indicating motor deficits were not responsible for impaired learning and memory. These findings indicate that kaolin-induced ventriculomegaly in rats interferes with cognition regardless of the final enlargement of the cerebral ventricles, but final size critically determines whether lasting locomotor, learning, and memory impairments occur.
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Affiliation(s)
- Michael T Williams
- Division of Neurology, Cincinnati Children's Research Foundation, Cincinnati, OH 45229, United States; University of Cincinnati College of Medicine, Cincinnati, OH 45229, United States.
| | - Amanda A Braun
- Division of Neurology, Cincinnati Children's Research Foundation, Cincinnati, OH 45229, United States; University of Cincinnati College of Medicine, Cincinnati, OH 45229, United States
| | - Robyn M Amos-Kroohs
- Division of Neurology, Cincinnati Children's Research Foundation, Cincinnati, OH 45229, United States; University of Cincinnati College of Medicine, Cincinnati, OH 45229, United States
| | - James P McAllister
- Department of Neurosurgery, Division of Pediatric Neurosurgery, University of Utah School of Medicine, Salt Lake City, UT 84132, United States
| | - Diana M Lindquist
- University of Cincinnati College of Medicine, Cincinnati, OH 45229, United States; Division of Radiology, Cincinnati Children's Research Foundation, Cincinnati, OH 45229, United States
| | - Francesco T Mangano
- University of Cincinnati College of Medicine, Cincinnati, OH 45229, United States; Division of Pediatric Neurosurgery, Cincinnati Children's Research Foundation, Cincinnati, OH 45229, United States
| | - Charles V Vorhees
- Division of Neurology, Cincinnati Children's Research Foundation, Cincinnati, OH 45229, United States; University of Cincinnati College of Medicine, Cincinnati, OH 45229, United States
| | - Weihong Yuan
- University of Cincinnati College of Medicine, Cincinnati, OH 45229, United States; Division of Radiology, Cincinnati Children's Research Foundation, Cincinnati, OH 45229, United States
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Simon TD, Van Yserloo B, Nelson K, Gillespie D, Jensen R, McAllister JP, Riva-Cambrin J, Stockmann C, Daly JA, Blaschke AJ. Use of quantitative 16S rRNA PCR to determine bacterial load does not augment conventional cerebrospinal fluid (CSF) cultures among children undergoing treatment for CSF shunt infection. Diagn Microbiol Infect Dis 2013; 78:188-95. [PMID: 23953744 DOI: 10.1016/j.diagmicrobio.2013.06.027] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Revised: 05/24/2013] [Accepted: 06/23/2013] [Indexed: 10/26/2022]
Abstract
The aim of this study was to develop a quantitative 16S rRNA assay for determination of bacterial nucleic acid load in cerebrospinal fluid (CSF) shunt infection and to compare quantitative 16S rRNA polymerase chain reaction (PCR) findings to those of conventional bacterial culture in patients treated for CSF shunt infection. We developed a quantitative 16S rRNA PCR assay that detected bacterial load across a range of 2.5 × 10(9) down to 2.5 × 10(4) 16S copies/mL CSF under experimental conditions for numerous Gram-positive and Gram-negative organisms. However, when applied to archived CSF samples from 25 shunt infection episodes, correlations between positive bacterial culture and 16S rRNA levels were seen in only half of infections, and 16S rRNA levels dropped precipitously after an initial peak on the first day of sample collection. Bacterial load measured using 16S rRNA PCR does not provide sufficient information beyond bacterial culture to inform CSF shunt infection treatment.
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Affiliation(s)
- Tamara D Simon
- Department of Pediatrics, Division of Hospital Medicine, University of Washington/Seattle Children's Hospital, Seattle, WA, USA.
| | - Brian Van Yserloo
- Virus, Molecular Biology and Cell Core, Diabetes and Endocrinology Research Center, University of Washington, Seattle, WA, USA
| | - Kevin Nelson
- Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - David Gillespie
- Department of Neurosurgery, University of Utah, Salt Lake City, UT, USA
| | - Randy Jensen
- Department of Neurosurgery, University of Utah, Salt Lake City, UT, USA
| | | | - Jay Riva-Cambrin
- Department of Neurosurgery, University of Utah, Salt Lake City, UT, USA
| | - Chris Stockmann
- Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - Judy A Daly
- Microbiology Laboratory, Primary Children's Medical Center, Salt Lake City, UT, USA; Department of Pathology, University of Utah, Salt Lake City, UT, USA
| | - Anne J Blaschke
- Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
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Li J, Luan X, Lai Q, Clark JC, McAllister JP, Fessler R, Diaz FG, Ding Y. Long-term neuroprotection induced by regional brain cooling with saline infusion into ischemic territory in rats: a behavioral analysis. Neurol Res 2013; 26:677-83. [PMID: 15327759 DOI: 10.1179/016164104225015903] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
The neuroprotective effect of hypothermia has long been recognized. Our recent studies have demonstrated the significant therapeutic value of local brain cooling in the ischemic territory prior to reperfusion in stroke, with reduced infarction and inflammatory responses up to 48 hours of reperfusion. The goal of this study was to determine if local brain cooling, produced by infusion of cold saline, could induce long-term functional improvement after stroke. A hollow filament was used to block the middle cerebral artery (MCA) for 3 hours, and then to locally infuse the ischemic territory with 6 ml cold saline (20 degrees C) for 10 minutes prior to reperfusion. This brain cooling infusion induced a significant (p < 0.01) decrease in neurologic deficits and significantly (p < 0.01) improved motor behavior in ischemic rats after 14 days of reperfusion, compared with ischemic rats without local cold saline infusion. This improvement continued for up to 28 days after reperfusion. No significant difference in motor performance was observed between the brain cooling infusion and normal control groups. Significant (p < 0.01) reductions in infarct volume were also evident. In conclusion, a local cerebral hypothermia induced by local saline infusion prior to reperfusion produced a long-term functional recovery after ischemic stroke. A therapeutic procedure, which combines prereperfusion infusion into an ischemic region with coincident cerebral hypothermia and perhaps subsequent recanalization of an occluded intracranial vessel, may improve the outcome for stroke patients.
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Affiliation(s)
- Jie Li
- Department of Neurological Surgery, Wayne State University School of Medicine, Canfield, Detroit, MI 48201, USA
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Eskandari R, Packer M, Burdett EC, McAllister JP. Effect of delayed intermittent ventricular drainage on ventriculomegaly and neurological deficits in experimental neonatal hydrocephalus. Childs Nerv Syst 2012; 28:1849-61. [PMID: 22767377 DOI: 10.1007/s00381-012-1848-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2012] [Accepted: 06/19/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE Evidence-based guidelines do not indicate when ventricular reservoirs should be placed in children with neonatal hydrocephalus, and delayed intervention is common. We hypothesize that delayed ventricular drainage has adverse effects on structural development and functional outcomes. METHODS Using a well-established animal model of kaolin-induced obstructive hydrocephalus, we evaluated neurologic deficit after early (~1 week post-kaolin) or late (~2 weeks post-kaolin) placement of ventricular reservoirs which were tapped according to strict neurologic criteria. RESULTS Progressive ventriculomegaly was similar in early- and late-reservoir implantation groups. The average neurologic deficit scores (NDSs) over the experimental period were 0 (n=6), 2.74 (n=5), and 2.01 (n=3) for the control, early-, and late-reservoir groups, respectively. At reservoir placement, early-group animals displayed enlarged ventricles without neurologic deficits (mean NDS=0.17), while the late group displayed ventriculomegaly with clinical signs of hydrocephalus (mean NDS=3.13). The correlation between ventriculomegaly severity and NDS in the early group was strongly positive in the acute (before surgery to 3 weeks post-reservoir placement) (R(2)=0.65) and chronic (6 to 12 weeks post-reservoir placement) (R(2)=0.65) phases, while the late group was less correlated (acute R(2)=0.51; chronic R(2)=0.19). CONCLUSIONS Current practice favors delaying reservoir implantation until signs of elevated intracranial pressure and neurologic deficit appear. Our results demonstrate that animals in early and late groups undergo the same course of ventriculomegaly. The findings also show that tapping reservoirs in these neonatal hydrocephalic animals based on neurologic deficit does not halt progressive ventricular enlargement and that neurologic deficit correlates strongly with ventricular enlargement.
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Affiliation(s)
- Ramin Eskandari
- Department of Neurosurgery, Division of Pediatric Neurosurgery, University of Utah, 175 N. Medical Drive East, Salt Lake City, UT 84132, USA
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Abstract
The pathophysiology of congenital and neonatal hydrocephalus is not well understood although the prognosis for patients with this disorder is far from optimal. A major obstacle to advancing our knowledge of the causes of this disorder and the cellular responses that accompany it is the multifactorial nature of hydrocephalus. Not only is the epidemiology varied and complex, but the injury mechanisms are numerous and overlapping. Nevertheless, several conclusions can be made with certainty: the age of onset strongly influences the degree of impairment; injury severity is dependent on the magnitude and duration of ventriculomegaly; the primary targets are periventricular axons, myelin, and microvessels; cerebrovascular injury mechanisms are prominent; gliosis and neuroinflammation play major roles; some but not all changes are preventable by draining cerebrospinal fluid with shunts and third ventriculostomies; cellular plasticity and physiological compensation probably occur but this is a major under-studied area; and pharmacologic interventions are promising. Rat and mouse models have provided important insights into the pathogenesis of congenital and neonatal hydrocephalus. Ependymal denudation of the ventricular lining appears to affect the development of neural progenitors exposed to cerebrospinal fluid, and alterations of the subcommissural organ influence the patency of the cerebral aqueduct. Recently these impairments have been observed in patients with fetal-onset hydrocephalus, so experimental findings are beginning to be corroborated in humans. These correlations, coupled with advanced genetic manipulations in animals and successful pharmacologic interventions, support the view that improved treatments for congenital and neonatal hydrocephalus are on the horizon.
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Affiliation(s)
- James P McAllister
- Department of Neurosurgery, Division of Pediatric Neurosurgery, University of Utah and Primary Children's Medical Center, Salt Lake City, UT 84132, USA.
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Liang X, Wang A, Tang H, Cao T, McAllister JP, Salley SO, Ng KYS. The effect of self-assembled layers on the release behavior of rifampicin-loaded silicone. Journal of Biomaterials Science, Polymer Edition 2012; 18:687-700. [PMID: 17623551 DOI: 10.1163/156856207781034142] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Providing a long period of sustained antibiotic release is one of the important challenges in the development of clinical shunts for long-term implantation. A cast-molding approach was used to load rifampicin into the silicone precursor before curing. Sustained in vitro release from rifampicin-loaded silicone for upwards of 110 days at a level of approximately 2-4 microg/cm2 per day was achieved. Quantitative comparisons of Staphylococcus epidermidis adhesion on untreated and rifampicin-loaded silicone surfaces were carried out to demonstrate the effect of rifampicin to discourage the bacterial adhesion. It was shown that the fresh 8.3% rifampicin-loaded silicone decreased bacterial adherence by 99.8%. Bacterial adherence on rifampicin-loaded silicone surfaces after 90 days release (eluted silicone) was decreased by 94.8%. A new approach was used to tune the initial burst effect and prolong long lasting release by introducing self-assembled perfluorodecyltrichlorosilane (FAS) and octadecyltrichlorosilane (OTS) layers. FAS layered structures can tune the burst effect and prolong the subsequent continuous release to achieve the long-term delivery. Significant decreases in initial burst effect (70.3% for multi-FAS layers and 39.7% for FAS monolayer) and enhanced long-term release (approx. 10 microg/cm2 per day for FAS monolayer for 110 days and approx. 15 microg/cm2 per day for multi-FAS layers for 60 days) were observed.
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Affiliation(s)
- Xuemei Liang
- Department of Chemical Engineering and Materials Science, Wayne State University, 5050 Anthony Wayne Drive, Detroit, MI 48202, USA
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Yuan W, McAllister JP, Lindquist DM, Gill N, Holland SK, Henkel D, Rajagopal A, Mangano FT. Diffusion tensor imaging of white matter injury in a rat model of infantile hydrocephalus. Childs Nerv Syst 2012; 28:47-54. [PMID: 21994049 DOI: 10.1007/s00381-011-1590-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2011] [Accepted: 09/09/2011] [Indexed: 10/16/2022]
Abstract
OBJECTIVE Diffusion tensor imaging (DTI) is a non-invasive MRI technique that has been used to quantify white matter (WM) abnormality in both clinical and experimental hydrocephalus (HCP). However, no DTI study has been conducted to characterize anisotropic diffusion properties in an animal model of infantile HCP. This DTI study was designed to investigate a rat model of HCP induced at postnatal day 21, a time developmentally equivalent to the human infancy. METHODS DTI data were acquired at approximately 4 weeks after the induction of HCP with kaolin injection. Using a 7 Tesla small animal MRI scanner we performed high-resolution DTI on 12 rats with HCP and 6 saline controls. Regions of interest (ROI) examined with quantitative comparisons include the genu, body, and splenium of the corpus callosum (gCC, bCC, and sCC, respectively), anterior, middle, and posterior external capsule (aEC, mEC, and pEC, respectively), internal capsule (IC), and fornix (FX). For each ROI, DTI metrics including fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (Dax), and radial diffusivity (Drad) were calculated. RESULTS We found that the anisotropic diffusion properties were abnormal across multiple WM regions in the brains of the HCP rats. Statistically significant differences included: (1) decreased FA and increased MD and Drad values in the gCC and bCC; (2) increased Dax in the sCC; (3) increased FA and Dax in the aEC; (4) increased FA in the mEC; (5) increased MD and Drad in the pEC; (6) increased FA and Dax in IC; (7) increased FA in FX. CONCLUSIONS These preliminary results provide the first evidence of WM injury quantified by DTI in a rat model of infantile HCP. Our data showed that DTI is a sensitive tool to characterize patterns of WM abnormalities and support the notion that WM impairment is region specific in response to HCP.
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Affiliation(s)
- Weihong Yuan
- Department of Radiology, Pediatric Neuroimaging Research Consortium, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 44529, USA
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Harris CA, McAllister JP. What We Should Know About the Cellular and Tissue Response Causing Catheter Obstruction in the Treatment of Hydrocephalus. Neurosurgery 2011; 70:1589-601; discussion 1601-2. [DOI: 10.1227/neu.0b013e318244695f] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
The treatment of hydrocephalus by cerebrospinal fluid shunting is plagued by ventricular catheter obstruction. Shunts can become obstructed by cells originating from tissue normal to the brain or by pathological cells in the cerebrospinal fluid for a variety of reasons. In this review, the authors examine ventricular catheter obstruction and identify some of the modifications to the ventricular catheter that may alter the mechanical and chemical cues involved in obstruction, including alterations to the surgical strategy, modifications to the chemical surface of the catheter, and changes to the catheter architecture. It is likely a combination of catheter modifications that will improve the treatment of hydrocephalus by prolonging the life of ventricular catheters to improve patient outcome.
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Affiliation(s)
- Carolyn A. Harris
- Department of Neurosurgery, Division of Pediatric Neurosurgery, University of Utah, Salt Lake City, Utah
- Department of Bioengineering, University of Utah, Salt Lake City, Utah
| | - James P. McAllister
- Department of Neurosurgery, Division of Pediatric Neurosurgery, University of Utah, Salt Lake City, Utah
- Department of Bioengineering, University of Utah, Salt Lake City, Utah
- Department of Physiology, University of Utah, Salt Lake City, Utah
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Eskandari R, Harris CA, McAllister JP. Reactive astrocytosis in feline neonatal hydrocephalus: acute, chronic, and shunt-induced changes. Childs Nerv Syst 2011; 27:2067-76. [PMID: 21847645 DOI: 10.1007/s00381-011-1552-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2011] [Accepted: 07/29/2011] [Indexed: 10/17/2022]
Abstract
PURPOSE Reactive astrocytosis has been implicated in injury and recovery patterns associated with hydrocephalus. To investigate temporal changes in astrogliosis during the early progression of hydrocephalus, after shunting, and after long-term ventriculomegaly, glial fibrillary protein (GFAP) levels were analyzed in a feline model. METHODS Obstructive hydrocephalus was induced in 10-day-old kittens by intracisternal injections of 25% kaolin. Acute non-shunted animals were killed 15 days post-kaolin injection to represent the pre-shunt condition. Shunt-treated animals received ventriculoperitoneal shunts 15 days post-injection and were killed 10 or 60 days later to represent short- and long-term recovery periods. Chronic untreated animals had Ommaya reservoirs implanted 15 days post-kaolin, which were tapped intermittently until they were killed 60 days later. Ventriculomegaly was monitored by neuroimaging before and after shunting and at death. RNA and total protein from primary visual cortex were analyzed by Northern and Western blotting. RESULTS GFAP RNA and protein levels for acute and chronic non-shunted hydrocephalic animals were 77% and 247% (p < 0.01) and 659% (p < 0.05) and 871% (p < 0.05) higher than controls, respectively. Shunted animals with short-term recovery demonstrated a mismatch in GFAP levels, with RNA expression decreasing 26% and protein increasing 335% (p < 0.01). Shunted animals with a long-term recovery exhibited GFAP RNA and protein levels 201% and 357% above normal, respectively. CONCLUSIONS These results indicate that a reactive astrocytic response continues to rise dramatically in chronic hydrocephalus, suggesting ongoing gliosis and potential damage. Shunting partially ameliorates the continuation of astrogliosis, but does not completely reverse this inflammatory reaction even after a long recovery.
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Affiliation(s)
- Ramin Eskandari
- Division of Pediatric Neurosurgery, Department of Neurosurgery, University of Utah, 175 North Medical Drive, Salt Lake City, UT 84132, USA
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Abstract
PURPOSE Ventricular catheter drainage holes of shunt systems used to treat hydrocephalus obstruct with tissue commonly comprising monocytes/macrophages, astrocytes, and giant cells. Despite high rates of obstruction, very few studies have manipulated drainage hole orientation, number, position, or diameter. By altering the hole diameter but maintaining a constant hole surface area, we manipulated shear stress through the holes, which we hypothesized would change the degree of macrophage and astrocyte attachment. METHODS First, a hole fabrication method was chosen from two fabrication techniques including punched holes in catheter tubing and constructed holes using nanofabrication techniques. RESULTS Punched holes were chosen to vary hole size from 282 to 975 μm because (1) samples were geometrically similar to commercially available ventricular catheters without significant microscopic differences in roughness values and (2) total macrophage and astrocyte adhesion on the punched holes was not significantly different from adhesion on the commercially available catheters. Overall adhesion from least to most adherent appeared to follow 975 < 754 ≈ 500 < 282-μm hole diameter for macrophages and 975 < 500 < 754 < 282 for astrocytes with an obvious dependency on catheter orientation with respect to the horizontal; a dependency to the proximity of the hole to the catheter tip was not observed. CONCLUSION This study suggests that macrophage and astrocyte adhesion generally decreases with increasing hole diameter under flow conditions and underscores the necessity for future work to examine how hole diameter impacts inflammatory-based shunt obstruction.
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Affiliation(s)
- Carolyn A Harris
- Department of Bioengineering, University of Utah, Salt Lake City, UT, 84112, USA.
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Harris CA, Resau JH, Hudson EA, West RA, Moon C, Black AD, McAllister JP. Reduction of protein adsorption and macrophage and astrocyte adhesion on ventricular catheters by polyethylene glycol and N-acetyl-L-cysteine. J Biomed Mater Res A 2011; 98:425-33. [DOI: 10.1002/jbm.a.33130] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2011] [Revised: 03/22/2011] [Accepted: 04/07/2011] [Indexed: 12/20/2022]
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Harris CA, Resau JH, Hudson EA, West RA, Moon C, Black AD, McAllister JP. Effects of surface wettability, flow, and protein concentration on macrophage and astrocyte adhesion in an in vitro model of central nervous system catheter obstruction. J Biomed Mater Res A 2011; 97:433-40. [DOI: 10.1002/jbm.a.33078] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2010] [Revised: 01/21/2011] [Accepted: 01/31/2011] [Indexed: 11/07/2022]
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Wagshul ME, Rashid S, McAllister JP, Schuhmann MU. The effect of decompressive craniectomy on CSF pulsatility in experimental communicating hydrocephalus. Cerebrospinal Fluid Res 2010. [PMCID: PMC3026513 DOI: 10.1186/1743-8454-7-s1-s35] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Yuan W, McAllister JP, Deren K, Mangano F. Comparison of mild and severe forms of hydrocephalus using diffusion tensor imaging in neonatal rats. Cerebrospinal Fluid Res 2010. [PMCID: PMC3026516 DOI: 10.1186/1743-8454-7-s1-s38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Yuan W, Deren KE, McAllister JP, Holland SK, Lindquist DM, Cancelliere A, Mason M, Shereen A, Hertzler DA, Altaye M, Mangano FT. Diffusion tensor imaging correlates with cytopathology in a rat model of neonatal hydrocephalus. Cerebrospinal Fluid Res 2010; 7:19. [PMID: 21054844 PMCID: PMC2989304 DOI: 10.1186/1743-8454-7-19] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2010] [Accepted: 11/05/2010] [Indexed: 11/23/2022] Open
Abstract
Background Diffusion tensor imaging (DTI) is a non-invasive MRI technique that has been used to quantify CNS abnormalities in various pathologic conditions. This study was designed to quantify the anisotropic diffusion properties in the brain of neonatal rats with hydrocephalus (HCP) and to investigate association between DTI measurements and cytopathology. Methods DTI data were acquired between postnatal day 7 (P7) and P12 in 12 rats with HCP induced at P2 and in 15 age-matched controls. Animals were euthanized at P11 or P22/P23 and brains were processed with immunohistochemistry for glial fibrillary acidic protein (GFAP), ionized calcium-binding adaptor molecule (Iba-1), and luxol fast blue (LFB) to assess astrocytosis, microglial reactivity and degree of myelination, respectively. Results Hydrocephalic rats were consistently found to have an abnormally low (at corrected p-level of <0.05) fractional anisotropy (FA) value and an abnormally high mean diffusivity (MD) value in the cerebral cortex (CX), the corpus callosum (CC), and the internal capsule (IC). Immunohistochemical analysis demonstrated trends of increasing astrocyte and microglial reactivity in HCP rats at P11 that reached statistical significance at P22/P23. A trend toward reduced myelination in the HCP rats was also found at P22/P23. Correlation analysis at P11 for the CC demonstrated statistically significant correlations (or trends) between the DTI measurement (the decreased FA and increased MD values) and the GFAP or Iba-1 rankings. The immunohistochemical rankings in the IC at P22/P23 were also significantly correlated or demonstrated a trend with both FA and MD values. Conclusions This study demonstrates the feasibility of employing DTI on the brain in experimental hydrocephalus in neonatal rats and reveals impairments in multiple regions of interest in both grey and white matter. A strong correlation was found between the immunohistochemical results and the changes in anisotropic diffusion properties.
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Affiliation(s)
- Weihong Yuan
- Division of Pediatric Neurosurgery, University of Cincinnati, Cincinnati Children's Hospital Medical Center MLC 2016, 3333 Burnet Avenue, Cincinnati, OH 45229, USA.
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Deren KE, Packer M, Forsyth J, Milash B, Abdullah OM, Hsu EW, McAllister JP. Reactive astrocytosis, microgliosis and inflammation in rats with neonatal hydrocephalus. Exp Neurol 2010; 226:110-9. [PMID: 20713048 DOI: 10.1016/j.expneurol.2010.08.010] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2010] [Revised: 07/30/2010] [Accepted: 08/07/2010] [Indexed: 11/15/2022]
Abstract
The deleterious effects of hydrocephalus, a disorder that primarily affects children, include reactive astrocytosis, microgliosis and inflammatory responses; however, the roles that these mechanisms play in the pathophysiology of hydrocephalus are still not clear in terms of cytopathology and gene expression. Therefore we have examined neuroinflammation at both the cellular and the molecular levels in an experimental model of neonatal obstructive hydrocephalus. On post-natal day 1, rats received an intracisternal injection of kaolin to induce hydrocephalus; control animals received saline injections. Prior to sacrifice on post-natal day 22, animals underwent magnetic resonance imaging to quantify ventricular enlargement, and the parietal cortex was harvested for analysis. Immunohistochemistry and light microscopy were performed on 5 hydrocephalic and 5 control animals; another set of 5 hydrocephalic and 5 control animals underwent molecular testing with Western blots and a gene microarray. Scoring of immunoreactivity on a 4-point ranking scale for GFAP and Iba-1 demonstrated an increase in reactive astrocytes and reactive microglia respectively in the hydrocephalic animals compared to controls (2.90±0.11 vs. 0.28±0.26; 2.91±0.11 vs. 0.58±0.23, respectively). Western blots confirmed these results. Microarray analysis identified significant (1.5-fold) changes in 1729 of 33,951 genes, including 26 genes out of 185 genes (26/185) in the cytokine-cytokine receptor interaction pathway, antigen processing and presentation pathways (15/66), and the apoptosis pathway (10/69). Collectively, these results demonstrate alterations in normal physiology and an up-regulation of the inflammatory response. These findings lead to a better understanding of neonatal hydrocephalus and begin to form a baseline for future treatments that may reverse these effects.
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Affiliation(s)
- Kelley E Deren
- Department of Neurosurgery, Division of Pediatric Neurosurgery, Primary Children's Medical Center, and The University of Utah, 175 N. Medical Drive East, Salt Lake City, UT 84132, USA.
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McAllister JP, Miller JM. Minocycline inhibits glial proliferation in the H-Tx rat model of congenital hydrocephalus. Cerebrospinal Fluid Res 2010; 7:7. [PMID: 20507614 PMCID: PMC2889858 DOI: 10.1186/1743-8454-7-7] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2009] [Accepted: 05/27/2010] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Reactive astrocytosis and microgliosis are important features of the pathophysiology of hydrocephalus, and persistent glial "scars" that form could exacerbate neuroinflammation, impair cerebral perfusion, impede neuronal regeneration, and alter biomechanical properties. The purpose of this study was to determine the efficacy of minocycline, an antibiotic known for its anti-inflammatory properties, to reduce gliosis in the H-Tx rat model of congenital hydrocephalus. METHODS Minocycline (45 mg/kg/day i.p. in 5% sucrose at a concentration of 5-10 mg/ml) was administered to hydrocephalic H-Tx rats from postnatal day 15 to day 21, when ventriculomegaly had reached moderate to severe stages. Treated animals were compared to age-matched non-hydrocephalic and untreated hydrocephalic littermates. The cerebral cortex (both gray matter laminae and white matter) was processed for immunohistochemistry (glial fibrillary acidic protein, GFAP, for astrocytes and ionized calcium binding adaptor molecule, Iba-1, for microglia) and analyzed by qualitative and quantitative light microscopy. RESULTS The mean number of GFAP-immunoreactive astrocytes was significantly higher in untreated hydrocephalic animals compared to both types of controls (p < 0.001). Minocycline treatment of hydrocephalic animals reduced the number of GFAP immunoreactive cells significantly (p < 0.001). Likewise, the mean number of Iba-1 immunoreactive microglia was significantly higher in untreated hydrocephalic animals compared to both types of controls (p < 0.001). Furthermore, no differences in the numbers of GFAP-positive astrocytes or Iba-1-positive microglia were noted between control animals receiving no minocycline and control animals receiving minocycline, suggesting that minocycline does not produce an effect under non-injury conditions. Additionally, in six out of nine regions sampled, hydrocephalic animals that received minocycline injections had significantly thicker cortices when compared to their untreated hydrocephalic littermates. CONCLUSIONS Overall, these data suggest that minocycline treatment is effective in reducing the gliosis that accompanies hydrocephalus, and thus may provide an added benefit when used as a supplement to ventricular shunting.
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Affiliation(s)
- James P McAllister
- Department of Biology, Central Michigan University, Mt, Pleasant, MI 48859, USA.
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Harris CA, Resau JH, Hudson EA, West RA, Moon C, McAllister JP. Mechanical contributions to astrocyte adhesion using a novel in vitro model of catheter obstruction. Exp Neurol 2010; 222:204-10. [PMID: 20051241 DOI: 10.1016/j.expneurol.2009.12.027] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2009] [Revised: 12/22/2009] [Accepted: 12/23/2009] [Indexed: 02/06/2023]
Abstract
Drainage and diversion of cerebrospinal fluid (CSF) through shunt systems is the most common treatment for hydrocephalus, but complications due to tissue obstruction of the catheter occur in up to 61% of patients. Although shunt systems have undergone limited technological advancements to resist mammalian cell adhesion, there is a need to further reduce adhesion that can exacerbate obstruction. The high intrinsic variability in clinical studies and an inability to predict chronic adhesion of host cells in vitro while maintaining the environmental conditions observed in hydrocephalus have impeded progress. We designed the hydrocephalus shunt catheter bioreactor (HSCB) to measure inflammatory cell adhesion under experimentally manipulated conditions of CSF pressure, pulsation rate, and flow rates. For a 20-h period, astrocytes were perfused through the pulsatile flow system, and adhesion on silicone catheters was recorded. These results were compared with those obtained under static cell culture conditions. Astrocyte adhesion was significantly increased under conditions of increased flow rate (0.25 and 0.30 mL/min), and a trend toward increased adhesion was observed under conditions of elevated pressure and pulsation rate. Because the HSCB represents physiologic conditions more accurately than static cell culture, our results suggest that standard static cell culturing techniques are insufficient to model inflammatory cell adhesion on catheters used in the treatment of hydrocephalus and that changes to the ventricular microenvironment can alter the mechanisms of cellular adhesion. The HSCB represents a relevant test system and is an effective model system for the analysis of cellular adhesion and occlusion of shunt catheters.
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Affiliation(s)
- Carolyn A Harris
- Department of Bioengineering, University of Utah, Salt Lake City, UT 84112, USA.
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