Abstract
Hydrocephalus is an extremely frequent condition either as a disease entity on its own or as a complication or sequelae to other brain diseases. The tradition for many decades to divide hydrocephalus into “obstructive” and “communicating” is being re-evaluated, as developments in imaging technology are greatly improving visualization of obstruction sites and as it is now increasingly perceived that turnover and absorbtion of CSF occur by several probably parallel physiologies.
New technology for measuring ICP allows mobile measurements during full mobilization and under normal everyday conditions and provides the possibility to approach ICP measurement in normal or “pseudo-normals” (patients with other diseases but without any clinical suspicion of an ICP or CSF circulation disorder). This is changing our perception of reference values for ICP, which are highly dependent on body posture and probably considerably lower than previously assumed.
Treatment is still based on two surgical principles; CSF diversion via valve-regulated drains from the ventricles into an extracranial absorbtion site (most frequently the peritoneum) or endoscopically created communication between the ventricular system and the subarachnoid space; most frequently into the basal cisterns. Although hydrocephalus is not one disease, but a group of conditions spanning age groups from the neonate to the elderly with several underlying pathologies and a diversity of clinical presentations, these two surgical procedures remain the only treatment options. This restriction of treatment options to just two despite the obvious diversity of hydrocephalus is probably one of the major explanations for significant shortcomings of treatment resulting in high surgical revision rates. The need for new therapy concepts based on improved and more detailed physiological understanding of normal brain water physiology and different types of hydrocephalic pathophysiology is highly needed.
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Juhler, M. (2020). Hydrocephalus. In: Praetorius, J., Blazer-Yost, B., Damkier, H. (eds) Role of the Choroid Plexus in Health and Disease. Physiology in Health and Disease. Springer, New York, NY. https://doi.org/10.1007/978-1-0716-0536-3_12
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