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What We Should Know About HydrocephalusWhat We Should Know About Hydrocephalus
Luiza da Silva LopesLuiza da Silva LopesRibeirão PretoRibeirão Preto
20122012
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What We Should Know About HydrocephalusWhat We Should Know About Hydrocephalus
Luiza da Silva LopesLuiza da Silva LopesRibeirão PretoRibeirão Preto
20122012
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• Destruction of periventricular axons = mechanical injury and accumulation of waste products in the CSF and extracellular compartment
• Reduced blood flow in periventricular white matter = hypoxic and oxidative damage
• Some of the brain dysfunction is reversible by shunting. However, destroyed axons cannot be restored.
Hydrocephalus
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So, is it worth searching more?So, is it worth searching more?
Hydrocephalus
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hydrocephalushydrocephalus
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Hydrocephalus• Questions still remain without answer:1. Who really needs a shunt?2. What would be the best point in the ventriculomegaly
evolution to insert a shunt?3. Can the damage due to hydrocephalus be prevented?
(neuroprotective intervention by supplemental therapies)4. How is the ICP dynamic during the ventricular enlargement? Also, we remain ignorant about pathophysiology of the brain
damage in hydrocephalus.
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Experimental model to produce hydrocephalus
RatsKaolin injection into cisterna magna
simple and inexpensive
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14 days after kaolin injection(21 days-old)
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Outcome measuresBehaviorMagnetic resonance imagingHistological measuresBiochemical assays (ELISA for biomarkers)Molecular biologyICP monitoring
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Behavior
Open field gait (motor behavior test)
T maze (memory test)
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Magnetic resonance imaging
Control rat Hydrocephalic rat
# lateral ventriclescoronal image
3T field MRI
#
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Histological measures
Solochrome cyanine staining (myelin stained in blue)
Immunohistochemistry: GFAP (astrocytes)Ki67 (cell proliferation)caspase-3
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Solochrome cyanine staining (myelin stained in blue)
control hydrocephalic
coronal slice
corpus callosum*
* *LV
LV lateral ventricle
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ImmunohistochemistryGFAP (astrocytes)
control hydrocephalic
Reactive astrocyte
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Immunohistochemistry
control hydrocephalic
External angle of lateral ventricleProliferative cells in pinkish-brown
Hydrocephalic shows less number of proliferative cells
Ki67 (cell proliferation)
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ICP monitoring
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ICP monitoring
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Other studies
Shunt: retrievable X permanent damagesNeuroprotective procedures and drugs
catechins derived from green teaenvironmental enrichment and essential stimulation ketoprofenothers
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Shunt procedure
A= subcutaneous dissectionB= shunt into subcutaneous spaceC= proximal catheter placed into lateral ventricleD= skin closure
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biomarkers
PIC
pathogenesis
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Thank you!Thank you!