What We Should Know About HydrocephalusWhat We Should Know About Hydrocephalus

Luiza da Silva LopesLuiza da Silva LopesRibeirão PretoRibeirão Preto

20122012

What We Should Know About HydrocephalusWhat We Should Know About Hydrocephalus

Luiza da Silva LopesLuiza da Silva LopesRibeirão PretoRibeirão Preto

20122012

• 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

So, is it worth searching more?So, is it worth searching more?

Hydrocephalus

hydrocephalushydrocephalus

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.

Experimental model to produce hydrocephalus

RatsKaolin injection into cisterna magna

simple and inexpensive

14 days after kaolin injection(21 days-old)

Outcome measuresBehaviorMagnetic resonance imagingHistological measuresBiochemical assays (ELISA for biomarkers)Molecular biologyICP monitoring

Behavior

Open field gait (motor behavior test)

T maze (memory test)

Magnetic resonance imaging

Control rat Hydrocephalic rat

# lateral ventriclescoronal image

3T field MRI

#

Histological measures

Solochrome cyanine staining (myelin stained in blue)

Immunohistochemistry: GFAP (astrocytes)Ki67 (cell proliferation)caspase-3

Solochrome cyanine staining (myelin stained in blue)

control hydrocephalic

coronal slice

corpus callosum*

* *LV

LV lateral ventricle

ImmunohistochemistryGFAP (astrocytes)

control hydrocephalic

Reactive astrocyte

Immunohistochemistry

control hydrocephalic

External angle of lateral ventricleProliferative cells in pinkish-brown

Hydrocephalic shows less number of proliferative cells

Ki67 (cell proliferation)

ICP monitoring

ICP monitoring

Other studies

Shunt: retrievable X permanent damagesNeuroprotective procedures and drugs

catechins derived from green teaenvironmental enrichment and essential stimulation ketoprofenothers

Shunt procedure

A= subcutaneous dissectionB= shunt into subcutaneous spaceC= proximal catheter placed into lateral ventricleD= skin closure

biomarkers

PIC

pathogenesis

Thank you!Thank you!