Proximal cerebrospinal fluid shuntmalfunction due to ventricular catheter occlusion remains the most common sourceof the shunt problem. The position of the hole-bearing segment of the catheter affects the long term patency of the ventricular catheter of a cerebrospinalfluid shunt.Placementof thissegmentnear thechoroidplexus or injured ependyma increases the probability of obstruction. Accurate locationof ventriculoperitoneal(V-P)shunt tip inrelation to foramen Monro canbe well establishedby plain radiographyregardless of agesor sizes and shapes of head dueto the fact that foramen Monro tothe spatial matrix of the skull is constant. Of 147patients who underwentV-P shunt operations, 49(33.3%)patients had more thanone operations. Radiologicgradingof theventricularcatheterposition is compared betweensingle operatedgroup andreoperated group.Single operated group showed excellentin 33.6%, good41.8%, poor 24.4%of accuracy rateof catheter tip position. Incases ofreoperation, placement ofcatheter tipresulted in excellent 12.5%, good21.8%, and poor 65.6%.These results indicatethat accurate location of ventricular catheter tip affects favorably to the patency of V-P shunt.
Catheters ; Cerebrospinal Fluid ; Ependyma ; Head ; Skull ; Ventriculoperitoneal Shunt*

The authors attempted to make experimental intraventricular hemorrhage by injection of autogenous whole blood into the lateral ventricle through a small burr hole and to observe the outcome of the intraventricular hematoma and the consequent change of the ventricular system in the rabbits. 1) The maximum duration of remaining hematoma was 4 days in the ventricular system and 28 days in the subarachnoid space. 2) In the ventricular hemorrhage group, the ventricular began to dilate after 1 day of hemorrhage. 3) The degree of the ventricular dilatation related to the amount of the injected blood into the lateral ventricle. 4) In the microscopic findings of the ventricular dilatation, flattening of the periventricular white matter fiber were more prominent in acute phase and subsided thereafter. Hemosiderin or siderophage observed before 1 week at the ventricular wall and after 1 week at the leptomeninges. The meningeal fibrosis or thickening was almost constantly presented throughout the 4 weeks. 5) The gross and microscopic changes were milder in the steroid therapy group than the others.
Dilatation ; Ependyma ; Fibrosis ; Hematoma ; Hemorrhage ; Hemosiderin ; Hydrocephalus ; Injections, Intraventricular* ; Lateral Ventricles ; Rabbits ; Subarachnoid Space

For the reduction of morbidity, such as an acute hydrocephalus, following intraventricular hemorrhage, we attempted to produce a lysis of the experimental intraventricular hemorrhage by a direct intraventricular injection of fibrinolytic agent. Urokinase was used as the fibrinolytic activator. Sixty-four adult rabbits were used in this study. The animals were divided into 5 groups to investigate the effect of urokinase in different time interval of urokinase injection. Intraventricular hemorrhage was made by an injection of 0.3cc of autogenous venous blood. Group I was the control group in which intraventricular injection of blood or urokinase was only done. In Group II and III urokinase was injected into the ventricule 30 minutes and 2 hours after the blood injection. In Group IV urokinase was injected into the ventricle at the same time of the blood injection. In Group V urokinase was injected into the ventricle at the same time of the blood injection, and then the urokinase injection was repeated 24 hours later. The animals of each group were sacrificed on the 1st, 2nd, 3rd and 7th day successively after the experimental procedures. The brains were examined to observe the outcome of intraventricular hematoma with urokinase injection and the consequent changes of the ventricular system grossly and microscopically. The results were as follows : The duration of the remaining hematoma in the ventricles and basal cisterns was 7 days in both the control and the urokinase injection groups equally. In the group of repeated urokinase injection the duration of remaining hematoma in the ventricular system was shortened to 5 days after the blood injection. Upon the ventricular dilatation, the blood injection control group showed moderate dilatation persistently for 1 week ; from minimal to moderate dilatations were found in the urokinase injection groups. In the microscopic examination there were no definite abnormal changes on the ventricular walls and leptomeninges throughout 1 week in the urokinase injection control group. The group of repeated urokinase injection revealed mild flattening and denudation of the ependyma of the ventricular system than the group of single urokinase injection.
Adult ; Animals ; Brain ; Dilatation ; Ependyma ; Hematoma ; Hemorrhage* ; Humans ; Hydrocephalus ; Injections, Intraventricular ; Rabbits ; Urokinase-Type Plasminogen Activator*

The distinguishing morphological features of the ependyma lining ventriculus terminalis in human fetus have suggested that its differentiation would be somewhat delayed or arrested as compared with the ependyma lining central canal. To demonstrate this hypothesis, GFAP was used as a marker to compare the developmental state of the ependyma lining ventriculus terminalis and central canal along fetal age (18 -to 24 -week -old fetuses were investigat-ed). PCNA was also used as a marker to identify whether proliferation potentiality of the ependyma lining ventriculus terminalis lasted longer than that of the ependyma lining central canal as a result of differentiation delay. GFAP -positive ependymal cells were restricted to dorsal plate at central canal but at ventriculus terminalis, many positive cells were identified in all regions compared with the ependyma lining central canal. The number of PCNA -positive ependymal cells lining central canal decreased sharply about the time of 20th week, but at ventriculus terminalis, many ependymal cells continued to express PCNA after 20th week. As a result, we could conclude that differentiation of the ependyma lining ventriculus terminalis is delayed as compared with the ependyma lining central canal. In accordance with its developmental delay, it lasts longer proliferation potentiality than the ependyma lining central canal.
Ependyma* ; Fetus* ; Gestational Age ; Glial Fibrillary Acidic Protein* ; Humans* ; Proliferating Cell Nuclear Antigen*

Isolated fourth(IV) ventricle in shunted patients has been reported with increasing frequency. Symptomatic isolated IV ventricular hydrocephalus in adults, however, has seldom been described. We report five such cases among total of 420 shunted cases in our institution from January 1992 to December 1995. The causes of initial hydrocephalus were postsurgical meningitis(SAH, teratoma and abscess of posterior fossa), tuberculous meningitis and neurocysticercosis of the IV ventricle. All cases were symptomatic with clinical findings related to posterior fossa lesions. Two patients developd symptoms in 2 months after V-P shunts and the others between 17 and 118 months after V-P shunts. These 5 patients required IV ventricular shunting. All patients improve postoperatively except one patient who developed 6th nerve palsy related to secondary irritation of the brainstem by the IV ventricular catheter. Inflammatory changes in the ependyma of both aqueduct of Sylvius, foramina Luschka and Magendi have been regarded as the most important factors in the development of the isolation of IV ventricle, especially in adults. It is generally recommended to shunt in cases of the adult symptomatic isolated IV ventricle. Alternative surgical techniques and prevention of such complications are discussed.
Abducens Nerve Diseases ; Abscess ; Adult* ; Brain Stem ; Catheters ; Cerebral Aqueduct ; Diagnosis* ; Ependyma ; Humans ; Hydrocephalus* ; Neurocysticercosis ; Teratoma ; Tuberculosis, Meningeal

Morphological changes in the ependymal lining of the hydrocephalic brain included stretching and tearing of the ependyma, thickening and gliosis of the subependymal layer, progressive loss of cilia and microvilli from the ependymal surface, and widening of the extracellular space. In the CT scan of the brain, periventricular low density was one of the common findings in hydrocephalus. The present experiment was performed to investigate not only the ultrastructural changes of the ventricular walls in hydrocephalus but also the morphological basis of periventricular lucency detected in the brain CT scan of the hydrocephalic patients. Hydrocephalus was induced in rats by intracisternal injection of thick kaolin suspension after surgical exposure of atlanto-occipital membrane. Lateral wall of the lateral ventricle was examined with transmission electron microscope in 3 different groups(6 rats at 1 week after the hydrocephalus, 8 at 2 weeks, and 4 at 8 weeks). The results were as follows: 1) Ultrastructural changes of the ependymal lining in hydrocephalic rat were flattening of ependymal cell and its nucleus, loss of cilia and microvilli from the ependymal surface, widening of the junctional complex, vacuoles and enlargement of cisternal space of rough endoplasmic reticulum in cytoplasm, and thicking and gliosis of subependymal layer. 2) These changes became more severe with longer duration of hydrocephalus. 3) Widening of junctional complex was considered to be the morphological basis for migration of ventricular cerebrospinal fluid into the periventricular white matter with resultant periventricular low density in the CT scan of the brain.
Animals ; Brain ; Cerebrospinal Fluid ; Cilia ; Cytoplasm ; Endoplasmic Reticulum, Rough ; Ependyma ; Extracellular Space ; Gliosis ; Humans ; Hydrocephalus ; Kaolin ; Lateral Ventricles ; Membranes ; Microvilli ; Rats* ; Tomography, X-Ray Computed ; Vacuoles

OBJECTIVE: This study investigates the effect of valproic acid (VPA) on expression of neural stem/progenitor cells (NSPCs) in a rat spinal cord injury (SCI) model. METHODS: Adult male rats (n=24) were randomly and blindly allocated into three groups. Laminectomy at T9 was performed in all three groups. In group 1 (sham), only laminectomy was performed. In group 2 (SCI-VPA), the animals received a dose of 200 mg/kg of VPA. In group 3 (SCI-saline), animals received 1.0 mL of the saline vehicle solution. A modified aneurysm clip with a closing force of 30 grams was applied extradurally around the spinal cord at T9, and then rapidly released with cord compression persisting for 2 minutes. The rats were sacrificed and the spinal cord were collected one week after SCI. Immunohistochemistry (IHC) and western blotting sample were obtained from 5 mm rostral region to the lesion and prepared. We analyzed the nestin immunoreactivity from the white matter of ventral cord and the ependyma of central canal. Nestin and SOX2 were used for markers for NSPCs and analyzed by IHC and western blotting, respectively. RESULTS: Nestin and SOX2 were expressed significantly in the SCI groups but not in the sham group. Comparing SCI groups, nestin and SOX2 expression were much stronger in SCI-VPA group than in SCI-saline group. CONCLUSION: Nestin and SOX2 as markers for NSPCs showed increased expression in SCI-VPA group in comparison with SCI-saline group. This result suggests VPA increases expression of spinal NSPCs in SCI.
Aneurysm ; Animals ; Blotting, Western ; Ependyma ; Immunohistochemistry ; Intermediate Filament Proteins ; Laminectomy ; Male ; Nerve Tissue Proteins ; Neurons ; Rats ; Spinal Cord ; Spinal Cord Injuries ; Valproic Acid

Intrathird ventricular tumors that mainly occupy the ventricle cavity without extending to the neighbouring structures are rare. These tumors are developed from the choroids plexus, tela, ependyma, subjacent neuroglia and embryonic cell rest. The authors experienced 11 cases of rare intrathird ventricular tumors during the past 10 years. During the same period, number of surgically proven brain tumors were 990 and intrathird ventricular tumors comprised 1.1%. These are two cases of choroids plexus papillomas, three craniopharyngiomas, two germ cell tumors, one meningioma, one glioependymal cyst, one ependymoma, one astrocytoma. Suprasellar craniopharyngiomas, thalamic gliomas, optic and hypothalamic gliomas were excluded. The age distribution was from 6 years old to 59 years old. The clinical manifestation was characteristic in that they usually had the sudden intermittent headache without specific localizing signs. Surgical approach to this area is by transcallosal or transcortical approach. Surgical total removal was quite feasible by either approach and outcome was rather favorable.
Age Distribution ; Astrocytoma ; Brain Neoplasms ; Child ; Choroid ; Craniopharyngioma ; Ependyma ; Ependymoma ; Glioma ; Headache ; Humans ; Meningioma ; Middle Aged ; Neoplasms, Germ Cell and Embryonal ; Neuroglia ; Optic Nerve Glioma ; Papilloma ; Papilloma, Choroid Plexus

Intrathird ventricular tumors that mainly occupy the ventricle cavity without extending to the neighbouring structures are rare. These tumors are developed from the choroids plexus, tela, ependyma, subjacent neuroglia and embryonic cell rest. The authors experienced 11 cases of rare intrathird ventricular tumors during the past 10 years. During the same period, number of surgically proven brain tumors were 990 and intrathird ventricular tumors comprised 1.1%. These are two cases of choroids plexus papillomas, three craniopharyngiomas, two germ cell tumors, one meningioma, one glioependymal cyst, one ependymoma, one astrocytoma. Suprasellar craniopharyngiomas, thalamic gliomas, optic and hypothalamic gliomas were excluded. The age distribution was from 6 years old to 59 years old. The clinical manifestation was characteristic in that they usually had the sudden intermittent headache without specific localizing signs. Surgical approach to this area is by transcallosal or transcortical approach. Surgical total removal was quite feasible by either approach and outcome was rather favorable.
Age Distribution ; Astrocytoma ; Brain Neoplasms ; Child ; Choroid ; Craniopharyngioma ; Ependyma ; Ependymoma ; Glioma ; Headache ; Humans ; Meningioma ; Middle Aged ; Neoplasms, Germ Cell and Embryonal ; Neuroglia ; Optic Nerve Glioma ; Papilloma ; Papilloma, Choroid Plexus

Ependymal cysts are rare entities that have evoked much controversies regarding their pathogenesis. We report a case of an intracerebral ependymal cyst associated with periventricular heterotopia and microgyria in a 16-year-old girl who was admitted in our institution for evaluation of a 4-year history of seizure. Neurological examination revealed nothing remarkable. Brain magnetic resonance imaging(MRI) showed a cystic mass in the right temporal lobe communicating with the posterior horn of the lateral ventricle by a narrow fistula. Also, Periventricular heterotopia and microgyria of the right cerebral hemisphere were also seen. A right temporal lobectomy that included complete exision of the cyst was performed;during surgery, the fistula connecting the cyst with the lateral ventricle was noted in the posterior temporal lobe. Microscpic examination of the specimen confirmed that the lining of the cyst consisted of simple, ciliated cuboidal epithelium that was similar to that in an ependyma and the lining showed no basement membrane. Adjacent to the cyst, heterotopic gray matter was seen and the cortex of the temporal lobe showed ischemic changes. Postoperatively, the patient made unremarkable recovery except for intermittent episodes of seizure. The clinicopathological features, radiological findings and surgical treatments are discussed in the context of the literature.
Adolescent ; Animals ; Basement Membrane ; Brain ; Cerebrum ; Ependyma ; Epithelium ; Female ; Fistula ; Horns ; Humans ; Lateral Ventricles ; Neurologic Examination ; Periventricular Nodular Heterotopia ; Seizures ; Temporal Lobe