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Purpose: The craniometrics of head circumference (HC) and ventricular size are part of the clinical assessment of infants with hydrocephalus and are often utilized in conjunction with other clinical and radiological parameters to determine the success of treatment. We aimed to assess the effect of endoscopic third ventriculostomy (ETV) and shunting on craniometric measurements during the follow-up of a cohort of infants with symptomatic triventricular hydrocephalus secondary to aqueductal stenosis. Methods: We performed a post hoc analysis of data from the International Infant Hydrocephalus Study (IIHS)—a prospective, multicenter study of infants (< 24 months old) with hydrocephalus from aqueductal stenosis who were treated with either an ETV or shunt. During various stages of a 5-year follow-up period, the following craniometrics were measured: HC, HC centile, HC z-score, and frontal-occipital horn ratio (FOR). Data were compared in an analysis of covariance, adjusting for baseline variables including age at surgery and sex. Results: Of 158 enrolled patients, 115 underwent an ETV, while 43 received a shunt. Both procedures led to improvements in the mean HC centile position and z-score, a trend which continued until the 5-year assessment point. A similar trend was noted for FOR which was measured at 12 months and 3 years following initial treatment. Although the values were consistently higher for ETV compared with shunt, the differences in HC value, centile, and z-score were not significant. ETV was associated with a significantly higher FOR compared with shunting at 12 months (0.52 vs 0.44; p = 0.002) and 3 years (0.46 vs 0.38; p = 0.03) of follow-up. Conclusion: ETV and shunting led to improvements in HC centile, z-score, and FOR measurements during long-term follow-up of infants with hydrocephalus secondary to aqueductal stenosis. Head size did not significantly differ between the treatment groups during follow-up, however ventricle size was greater in those undergoing ETV when measured at 1 and 3 years following treatment. [ABSTRACT FROM AUTHOR]

Hydrocephalus is an abnormal accumulation of fluid in the brain that causes the cerebral ventricles to dilate. A shunt or bypass is often inserted to treat this abnormality by preventing the fluid from accumulating. Sometimes the shunt will fail, resulting in an increased intracranial pressure (ICP). Prolonged visual impairment is a frequent side effect of ICP. The cases are reported of three hydrocephalic children, impaired visually because of shunt failure, who underwent shunt revision. Shortly following the revision, the visual impairment quickly improved in all three children. The first case involved a female infant who had a shunt inserted shortly after birth. Shunt revision was performed at ages 2.5 months and four months. She was blind from birth and remained so until the successful revision was performed at age four months. Her sight began to improve within hours after the shunt was placed. In the second case, a male infant had a shunt placed soon after his birth. He was blind until the shunt was replaced at age five months. His vision improved rapidly soon after the original shunt was replaced. In the third case, a male infant's sight improved after his shunt was replaced at age seven months. His vision was gradually lost again at age 6.5 years when ICP occurred, but was recovered when the ICP was relieved. At eight years of age, shunt malfunction again caused vision loss, which resolved when the shunt was replaced. These cases indicate that ICP causes chronic hypoperfusion of the parieto-occipital lobes of the brain with resulting impairment of vision. (Consumer Summary produced by Reliance Medical Information, Inc.)

Objective: To investigate the role of hypertension in the pathogenesis of cerebral aneurysms in rats., Methods: Twenty spontaneous hypertensive rats (SHR) and 10 Wistar-Kyoto rats (WKY) were included in this observational study. Animals were fed with normal diet and drinking water. No experimental modifications were undertaken in either group. They were sacrificed at one year of age, the bifurcations of the circle of Willis were dissected and longitudinal serial sections were prepared for light microscopic and transmission electron microscopic study., Results: In the SHR group, 2 of the 20 rats formed an aneurysm respectively at the bifurcations of the basilar artery. As revealed by electron microscopy, injury at the bifurcation of the artery first occurred on the steeper side of the intimal pad. Furthermore, loss of endothelial cells, small depressions on the intima, disruptive internal elastic lamina and lymphocytes or red blood cells infiltration were noted at the steeper side of the intimal pad. No significant changes were observed in WKY group., Conclusions: Cerebral aneurysms can form spontaneously in SHR without ligation of the common carotid artery and without a diet containing beta-aminoproprionitrile. Long-standing systemic arterial hypertension is one of the etiological factors that contributes to aneurysm formation in SHR rats.