Cytokine and Growth Factor Concentration in Cerebrospinal Fluid from Patients with Hydrocephalus Following Endovascular Embolization of Unruptured Aneurysms in Comparison with Other Types of Hydrocephalus

Abstract

To better understand the development of hydrocephalus of different origins, we evaluated cytokine and growth factor concentration in cerebrospinal fluid from patients with hydrocephalus. CSF was collected from patients developing hydrocephalus following hemorrhage (n = 15), patients with normal pressure hydrocephalus (n = 10), and following the embolization of unruptured intracranial aneurysms (n = 9). Myelography patients (n = 15) served as controls. Quantification of 11 molecules relating angiogenesis, inflammation, and wound healing in the CSF was performed using ELISA. All three hydrocephalus groups had decreased concentration of TIMP-4 compared to the normal group. The hemorrhage group showed increased concentration of IL-6, IL-8, MCP-1, MMP-9, and TIMP-1 compared to the control group. The unruptured aneurysm group had increased concentration of IL-6 and decreased concentration of TIMP-2 compared to the control group. Compared to the normal patients, increased concentrations of wound healing molecules were evident in all three groups. Increased inflammation was evident in the hemorrhage and unruptured aneurysm groups.

Levels of selected pro- and anti-inflammatory cytokines in cerebrospinal fluid in patients with hydrocephalus

“…In our group of subjects with active iNPH, the CSF level of IL-6 was significantly elevated compared to control. This is consistent with studies reported by other authors [17,42].…”

“…Cytokines are the best known mediators of inflammation and play important roles within and outside the brain. Different levels of cytokines in CSF were reported in various types of adult hydrocephalus [17,19,20,32,34,42,43]. In our study we distinguished three different groups of NPH patients: with active idiopathic hydrocephalus, arrested hydrocephalus and hydrocephalus with brain atrophy.…”

“…Moreover, the concentration of IL-8 was significantly lower in patients with arrested hydrocephalus compared to the group with active iNPH. Killer [17] observed an increase in IL-8 level in patients developing hydrocephalus following hemorrhage. In the study performed by Pyykko [32] the lumbar CSF samples showed higher IL-8 levels compared to ventricular samples in NPH patients.…”

Analysis of risk factors for perifocal oedema after endovascular embolization of unruptured intracranial arterial aneurysms

“…Moreover, larger aneurysms have bigger endothelial surface, which when damaged by coils and blood jet produces larger quantity of autacoids that can initiate process of inflammation. 1 As a confirmation of these hypotheses, both release of cytokines to cerebrospinal liquor 13 and inflammation of meninges 12 were found in patients with perianeurysmal oedema after endovascular coiling. However, although clinical improvement of perianeurysmal oedema was demonstrated in some studies 12 , 13 , others did not confirm such beneficial effect.…”

“… 5 We are currently unaware of any risk factors that could predetermine appearance or severity of the perianeurysmal oedema after endovascular coiling. 10 – 13 …”