When hydrocephalus develops, excessive cerebrospinal fluid accumulation usually occurs within the ventricular system, leading to a ventriculomegaly caused by increased intracranial pressure. Shunt malfunction, a common complication after a shunt operation, usually occurs, together with recurring ventricular dilatation. The authors report a case of shunt malfunction which manifested as a porencephalic cyst along the proximal catheter. The cyst subsided after the replacement of the shunt system, and this led to the patient's clinical improvement. We postulate that although the region around a catheter is an unusual site for cerebrospinal fluid collection, this finding should be considered as a shunt obstruction. The possible mechanism of reversible porencephaly is discussed and the literature is briefly reviewed.
Catheters ; Cerebrospinal Fluid ; Dilatation ; Hydrocephalus ; Intracranial Pressure

Isoflurane is often prefered to for neuroanesthesia because it has the least effect on cerebral blood flow (CBF) and cerebrospinal fluid pressure changes. The author performed this study to compare the change of the intracranial pressure following the increasing concentration of isoflurane in 10 cats. The results were as follows, 1) 1ntracranial pressure was increased significantly with 1.5% (p<0.05) and 2.0% (p < 0.005) isoflurane administration, but there was no significant increase with administration of 1.0% isoflurane. 2) Cerebral perfusion pressure was decreased significantly with 1.0% (p<0.01), 1.5% (p<0.005) and 2.0% (p<0.005) isoflurane administration. So it is recommend to administrate less than 1.0% isoflurane in increased intracranial pressure patient.
Animals ; Cats* ; Cerebrospinal Fluid Pressure ; Humans ; Intracranial Pressure* ; Isoflurane* ; Perfusion

Brain tumors are manifest in a limited variety of ways, presenting with symptoms of increased intracranial pressure and of localized destruction or compression of nervous tissue. Two cases of brain tumor were reported, in which clinical manifestations resembled those of the meningitis, that is, clinical signs and symptoms, as well as cerebrospinal fluid pleocytosis, were consistent with the diagnosis of meningitis.
Brain Neoplasms* ; Brain* ; Cerebrospinal Fluid ; Diagnosis ; Intracranial Pressure ; Leukocytosis ; Meningitis*

Brain tumors are manifest in a limited variety of ways, presenting with symptoms of increased intracranial pressure and of localized destruction or compression of nervous tissue. Two cases of brain tumor were reported, in which clinical manifestations resembled those of the meningitis, that is, clinical signs and symptoms, as well as cerebrospinal fluid pleocytosis, were consistent with the diagnosis of meningitis.
Brain Neoplasms* ; Brain* ; Cerebrospinal Fluid ; Diagnosis ; Intracranial Pressure ; Leukocytosis ; Meningitis*

Recently the influence of respiratory depression, hypercarbia and hypoxia on the intracranial pressure during general inhalation anesthesia has been strongly stressed. The study was taken to determine quantatively the effect on the cerebrospinal fluid pressure in dogs. 1) CSF pressure was determined during anesthesia via cisternal puncture with direct water-manometer and polygraph recording. 2) The changes in blood pressure, pulse rate and temperature with 0.5% halothane were observed. 8) CSF pressure was apt to rise within 30 minutes with halothane but later It gradually returned to normal or decreased slightly. This was associated with little changes or with slight rise in central venous pressure. 4) This emphasized factors related to good anesthetic technic in neurosurgery. it is recommended that preoxygenation before the induction period should be done in the administration of halothane.
Anesthesia ; Anesthesia, Inhalation ; Animals ; Anoxia ; Blood Pressure ; Central Venous Pressure ; Cerebrospinal Fluid Pressure* ; Cerebrospinal Fluid* ; Dogs* ; Halothane* ; Heart Rate ; Intracranial Pressure ; Neurosurgery ; Punctures ; Respiratory Insufficiency

BACKGROUND: A hypertensive response is seen when a skull pin is inserted for a craniotomy. The risk of morbidity and mortality is high in patients with intracranial pathology. Many methods have been introduced to overcome the problem. We compared the hemodynamic effects and changes of intracranial pressure when we used lidocaine or fentanyl for blunting the hypertensive response. METHODS: Thirty-two patients scheduled for a craniectomy were divided into two groups: an IV (intravenous) bolus of fentanyl (2micro gram/kg) group or lidocaine (1.5 mg/kg) group. An anesthesia was induced with fentanyl (2micro gram/kg), thiopental (5-7 mg/kg), lidocaine (1.5 mg/kg) and vecuronium (0.1 mg/kg), and was maintained with isoflurane 1 MAC (minimum alveolar anesthetic concentration) in nitrous oxide 50% and oxygen. After induction of anesthesia, a lumbar subarachnoid catheter was inserted for CSFP (cerebrospinal fluid pressure) measurement. An IV bolus of either fentanyl (2micro gram/kg) or lidocaine (1.5 mg/kg) was administered prior to insertion of the skull pin by a randomized method. CSFP, MAP (mean arterial pressure), and HR (heart rate) were measured before and 5 min after induction of anesthesia, immediately before and each mininute for five measurements after skull pin insertion. RESULTS: There were no intergroup differences in the values of CSFP and HR. The MAP increased 9+/-14 (mean+/-SD) mmHg and 4+/-12 (mean+/-SD) mmHg 1 min after the skull pin insertion compared with immediately before skull pin insertion in the fentanyl group and lidocaine group respectively. The MAP recovered 2 min after the skull pin insertion in both groups. CPP (cerebral perfusion pressure) recovered 3 min and 2 min after the skull pin insertion in the fentanyl group and lidocaine group respectively. CONCLUSIONS: An IV bolus of either fentanyl or lidocaine before skull pin insertion resulted in a stable value of CSFP, CPP and HR.
Anesthesia ; Catheters ; Cerebrospinal Fluid Pressure* ; Cerebrospinal Fluid* ; Craniotomy ; Fentanyl* ; Hemodynamics ; Humans ; Intracranial Pressure ; Isoflurane ; Lidocaine* ; Mortality ; Nitrous Oxide ; Oxygen ; Pathology ; Perfusion* ; Skull* ; Thiopental ; Vecuronium Bromide

The cranium can be thought of a as shallow, rigid sphere of contrast volume. There are three main components within the intracranial space : brain, cerebrospinal fluid and blood. Intracranial volume and pressure are maintained constantly by Monroe-Kellie doctrine. Also intracranial pressure is influenced by a number of physiologic factors and it will be changed with intracranial lesion. Now we were look for the possible factors that influence the intracranial pressure with continuous intracranial pressure monitoring. At the same time we studied the possibility of the relationship between factors that influence ICP and ADL(Ability of Daily Life) in 43 severe brain lesions(33 cases ; intracerebral hematoma, 10 cases ; head injury). In cases of higher GCS, smaller hematoma, lower amplitude of ICP, lesser frequency of A-wave and lower elastance, the ICP were lowed. Ninety percent of cases that GCS is over 12 was belong to ADL I and II, but only nineteen percent of cases that GCS is under 7 was belong to ADL I and II. No case of internal capsule involved group was belong to ADL I but forty-eight percent of cases whose hematoma volume is under 10ml was belong to ADL I. Fifty percent of cases whose hematoma volume is under 10ml was belong to ADL I and no case that hematoma volume is over 20ml was belong to ADL I. Cases that PCO2 is in the range of 25mmHg-29mmHg were not belong to ADL I. In cases of higher amplitude of ICP, higher frequency of A-wave and higher elastance, the patient's ADL was grave. And in cases of ICP was progressively increased, the prognosis was also grave. Consequently we are able to guess that patient's prognosis will be influenced by initial GCS, internal capsule involvement, hematoma volume, PCO2, amplitude of ICP, frequency of A-Wave, brain elastance and curve of ICP.
Activities of Daily Living ; Brain ; Cerebrospinal Fluid ; Head ; Hematoma ; Internal Capsule ; Intracranial Pressure* ; Prognosis* ; Skull

OBJECTIVE: The LiquoGuard® system is a new ventricular-type monitoring device that facilitates intracranial pressure (ICP)-controlled or volume-controlled drainage of cerebrospinal fluid (CSF). The purpose of this study is to report the authors' experience with the LiquoGuard® ICP monitoring system, as well as the clinical safety, usefulness, and limitations of this device in the management of patients with traumatic brain injury (TBI). METHODS: Intraventricular ICP monitoring was performed on 10 patients with TBI using the LiquoGuard® monitoring system. ICP measurements, volume of drained CSF, and clinical outcomes were analyzed and discussed. RESULTS: ICP monitoring was performed on 10 patients for a mean duration of 6.9 days. With a mean 82,718 records per patient, the mean initial ICP was 16.4 mm Hg and the average ICP across the total duration of monitoring was 15.5 mm Hg. The mean volume of drained CSF was 29.2 cc/day, with no CSF drained in 4 patients. Seven of 10 patients showed 1 or 2 episodes of abnormal ICP measurements. No patient exhibited complications associated with ICP monitoring. CONCLUSION: The LiquoGuard® system is a versatile tool in the management of TBI patients. Its use is both reliable and feasible for ICP monitoring and therapeutic drainage of CSF. However, episodes of abnormal ICP measurements were frequently observed in patients with slit ventricles, and further study may be needed to overcome this issue.
Brain Injuries* ; Cerebrospinal Fluid ; Drainage ; Humans ; Injections, Intraventricular ; Intracranial Pressure* ; Monitoring, Physiologic

Cerebrospinal fluid lactate and intracranial pressure were measured in 24 severely head-injured patients with Glasgow coma scale below 8. Cerebral perfusion pressure, vital sign and CVP were also measured simultaneously. Severely head-injured patients revealed increased CSF lactate and intracranial pressure which have been significantly correlated with outcome. But changes of vital sign, cerebral perfusion pressure and CVP were not correlated with outcome. The elevation of intracranial pressure checked on arrival was statistically significant in correlation to outcome. And the elevation of CSF lactate were correlated with statistically significance in correlation with outcome and lactate level checked on time interval(arrival, 12hr, 24hr, 48hr after trauma). And so CSF lactate levels are statistically more significant than intracranial pressure in predicting prognosis. We will expect good prognosis in severely head-injured patient by reducing intracranial pressure and CSF lactate, oxygenation and increasing cerebral perfusion.
Cerebrospinal Fluid ; Glasgow Coma Scale ; Humans ; Intracranial Pressure ; Lactic Acid* ; Oxygen ; Perfusion ; Prognosis* ; Vital Signs

Pneumocephalus is exceedingly rare in the absence of trauma or recent surgery. It is most commonly seen after severe head injury, with disruption of the dura and subsequent cerebrospinal fluid leakage. Intracranial air has also been reported as a complication of shunting. This may be secondary to intermittent shunt failure or a persistent communication between the extracranial and intracranial space that permits the entrance of air. In the present case, air appeared to enter the ventricular system through the fistula that connected the frontal sinus. This air replaced the CSF being drained into the peritoneal cavity by the shunt. The decrease of intracranial pressure after a shunt might play a role in causing pneumocephalus. We report a case of tension pneumocephalus after shunting for hydrocephalus as a life-threatning complication.
Cerebrospinal Fluid ; Craniocerebral Trauma ; Fistula ; Frontal Sinus ; Hydrocephalus* ; Intracranial Pressure ; Peritoneal Cavity ; Pneumocephalus*