Normal pressure hydrocephalus associated with cauda equina neurinoma

Ohta, Kouichi; Gotoh, Fumio; Amano, Takahiro; Obara, Katsuyuki

doi:10.1002/ana.410270414

Cited by 21 publications

(7 citation statements)

References 14 publications

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“…Higher levels of thrombopoietin [34], ferritin [35], nerve growth factor[36], chondroitin sulfate proteoglycan [37] transforming growth factor β1 [38,39], transforming growth factor β2 [37], S-100 protein [40,41], and vascular endothelial growth factor [42] have been found in ventricular CSF in patients with hydrocephalus resulting from intraventricular hemorrhage. Even in patients without any intraventricular blood, elevated proteins have been found in ventricular CSF in hydrocephalus resulting from intracranial schwannomas [7], a few cases of spinal schwannomas [8,9], and in about 4% of patients with Guillain-Barre' syndrome [10,11]. In a review of potential biomarkers for chronic hydrocephalus, Tarnaris et al concluded that tumor necrosis factor, tau protein, lactate, sulfatide and neurofilament triple protein are elevated in chronic hydrocephalus to make them the most promising CSF markers [43].…”

Section: Discussionmentioning

confidence: 99%

Intraventricular infusion of hyperosmolar dextran induces hydrocephalus: a novel animal model of hydrocephalus

Krishnamurthy

Schultz

et al. 2009

Fluids Barriers CNS

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BackgroundPopular circulation theory of hydrocephalus assumes that the brain is impermeable to cerebrospinal fluid (CSF), and is therefore incapable of absorbing the CSF accumulating within the ventricles. However, the brain parenchyma is permeable to water due to the presence of specific ion channels as well as aquaporin channels. Thus, the movement of water into and out of the ventricles may be determined by the osmotic load of the CSF. If osmotic load determines the aqueous content of CSF in this manner, it is reasonable to hypothesize that hydrocephalus may be precipitated by pathologies and/or insults that produce sustained elevations of osmotic content within the ventricles.MethodsWe investigated this hypothesis by manipulating the osmotic content of CSF and assaying the development of hydrocephalus in the rat brain. This was achieved by continuously infusing artificial CSF (negative control; group I), fibroblast growth factor (FGF2) solution (positive control; group II) and hyperosmotic dextran solutions (10 KD and 40 KD as experimental solutions: groups III and IV) for 12 days at 0.5 μL/h. The osmolality of the fluid infused was 307, 664, 337 and 328 mOsm/L in Groups I, II, III and IV, respectively. Magnetic resonance imaging (MRI) was used to evaluate the ventricular volumes. Analysis of variance (ANOVA) with pairwise group comparisons was done to assess the differences in ventricular volumes among the four groups.ResultsGroup I had no hydrocephalus. Group II, group III and group IV animals exhibited significant enlargement of the ventricles (hydrocephalus) compared to group I. There was no statistically significant difference in the size of the ventricles between groups II, III and IV. None of the animals with hydrocephalus had obstruction of the aqueduct or other parts of CSF pathways on MRI.ConclusionInfusing hyperosmolar solutions of dextran, or FGF into the ventricles chronically, resulted in ventricular enlargement. These solutions increase the osmotic load in the ventricles. Water influx (through the choroid plexus CSF secretion and/or through the brain) into the ventricles to normalize this osmotic gradient results in hydrocephalus. We need to revise the popular theory of how fluid accumulates in the ventricles at least in some forms of hydrocephalus.

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Section: Discussionmentioning

confidence: 99%

Intraventricular infusion of hyperosmolar dextran induces hydrocephalus: a novel animal model of hydrocephalus

Krishnamurthy

Schultz

et al. 2009

Fluids Barriers CNS

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“…Because the CSF protein level of our patient was elevated, his characteristics are more reminiscent of sNPH. Previous reports show that spinal cord tumors can be associated with NPH [4][5][6][7][8][9]. Hyperviscosity in cases with elevated CSF proteins produced by spinal cord tumors may cause obstructive hydrocephalus.…”

Section: Discussionmentioning

confidence: 97%

“…We summarized the previously reported cases of neurinoma with hydrocephalus in Table 1 [4][5][7][8][9][10]. Middle-age, female gender, and high CSF protein levels are risk factors of sNPH with spinal neurinoma.…”

Section: Discussionmentioning

confidence: 99%

Resection of Multiple Neurinomas of the Cauda Equina Improves Normal Pressure Hydrocephalus

Fuse¹,

Nishioka²,

Shimura³

et al. 2012

OJMN

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Normal pressure hydrocephalus (NPH) is a treatable neurological condition characterized by dementia, gait disturbances, and urinary incontinence. This case study aimed to evaluate the effectiveness of surgical intervention in treating NPH associated with spinal cord tumors. A patient suffering with NPH underwent a spinal tap procedure and surgical resectioning of three neurinomas on the cauda equina. The patient exhibited marked improvement in neurological and motor symptoms related to NPH following surgical intervention. These findings suggest that surgical resectioning of neurinomas is an effective intervention for treating NPH associated with spinal cord tumors.

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“…24,25 High CSF fibrinogen concentration in patients with glioma or spinal cord tumors was also considered a cause of hydrocephalus. 26,27 Several other mechanisms might be correlated to nonobstructive hydrocephalus development. Finally, we could not perform surgical removal as an initial treatment because of poor general condition, and VP shunt occlusion remains a possibility.…”

Section: Discussionmentioning

confidence: 99%

Continuous Minor Bleeding from Tumor Surface in Patients with Craniopharyngiomas: Case Series of Nonobstructive Hydrocephalus

Shoji

Kawaguchi

Ogawa

et al. 2018

J Neurol Surg A Cent Eur Neurosurg

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Nonobstructive hydrocephalus in patients with craniopharyngiomas is uncommon. We describe our surgical series of 25 consecutive patients with craniopharyngioma who presented with hydrocephalus. Obstructive hydrocephalus was evident in most cases, and nonobstructive hydrocephalus was revealed in three cases. Even after improvement of cerebrospinal fluid (CSF) pathway obstruction by tumor removal, 10 patients (40%) required CSF diversion. Preoperative imaging study revealed thin intraventricular hemorrhage or superficial siderosis in five cases, and CSF examination revealed hemosiderin-laden phagocytes in one case. These findings indicate continuous bleeding into the CSF that might be associated with CSF malabsorption. We also describe a representative case of craniopharyngioma associated with nonobstructive hydrocephalus due to continuous minor bleeding from the tumor surface in a 62-year-old man with a complaint of disorientation and a decline in daily living activity.Our study demonstrated that minor bleeding into the CSF is a possible mechanism of the development of nonobstructive hydrocephalus in patients with craniopharyngiomas.

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Normal pressure hydrocephalus associated with cauda equina neurinoma

Abstract: A 65-year-old woman with normal pressure hydrocephalus experienced improved gait and hydrocephalus following surgical resection of a cauda equina neurinoma. Fibrinogen, detected in the cerebrospinal fluid, may be involved in the pathophysiological process of normal pressure hydrocephalus.

Cited by 21 publications

References 14 publications

Intraventricular infusion of hyperosmolar dextran induces hydrocephalus: a novel animal model of hydrocephalus

Intraventricular infusion of hyperosmolar dextran induces hydrocephalus: a novel animal model of hydrocephalus

Resection of Multiple Neurinomas of the Cauda Equina Improves Normal Pressure Hydrocephalus

Continuous Minor Bleeding from Tumor Surface in Patients with Craniopharyngiomas: Case Series of Nonobstructive Hydrocephalus

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