SVIBOR - Project code: 3-01-267

MINISTRY OF SCIENCE AND TECHNOLOGY

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Project code: 3-01-267


CHANGES IN TELENCEPHALON WALL IN PERINATAL HYDROCEPHALUS


Main researcher: JELIČIĆ, IVAN (18406)


Assistants
Type of research: applied
Duration from: 01/01/91.
Papers on project (total): 18
Institution name: Medicinski fakultet, Zagreb (108)
Department/Institute: DEPARTMENT OF NEUROSURGERY
Address: KIŠPATIĆEVA 12, KBC ZAGREB REBRO,
City: 10000 - Zagreb, Croatia
Communication
Phone: 385 (0)1 21 38 57
Summary: In the period from 1.1.1991. to 31.8.1995. in the Department of neurosurgery in Zagreb 77 infants with hydrocephalus (H) were operated on.The most frequent was hydrocephalus secondary to neonatal intraventricular hemorrhage(30),H with spinal dysraphism(24), congenital H (15), neoplastic H (5), and H with Dandy-Walker malformation(3). The number of shunt operations for neoplastic H was diminished through direct removal of neoplasm without the antecedant shunt operation.In the majority of infants the clincal laboratory diagnosis included: cranial ultrasonography,NMRI or CT and visual evoked potentials. All infants were operated on according to new operating protocol which includes: unit shunt system(Pudenz-Schulte medical), reduced number of skin incisions, frontal placement of ventricular catheter,intraoperative intracranial pressure mesurement, biochemical and microbiological CSF analysis and perioperative natibiotic prophylaxis. With the implementation of the new operatin protocol the rate of shunt infections has been significantly reduced: from 20% to 10%.Shunt infection were treated after biochemical and microbiological verification according to the following protocol: 1. removal of the shunt system,2.placement of external ventricular drainage, 3.antimicrobial therapy in the Department of infectology inZagreb and 4.conversion of external ventricular drainage in ventriculoperitoneal shunt after the infection has been cured. In the same period in 10 premature infants and newborns with bacterial meningitis and ventriculitis and progressive H beside the antimicrobial therapy surgical therapy has been undertaken: at first the placement of external ventricular drainage for the control of intracranial hypertension and for intraventricular adminstration of antimicrobial therapy, and the conversion of external ventricular drainage in ventriculoperitoneal shunt after the meningitis has been cured and biochemical and microbiological findings of CSF has been normalized.In the same period in the Department of pediatrics 300 infants with risc factors for H has been cliniucaly and with ultrasound controled. In the majority the intracranial pressure became normal and enlarged venmtricles stable.The surgical treatment was undertaken only in infants with intracranial hypertension and progressive enlagement of ventricles.All operatino of spinal dysraphism in the same period has been performed in the microneurosurgical technique without blood loss,with accurate reconstruction of neural elements, spinal covering and skin, and simultaneus resolving of eventual other malforamtions(hydrocepahlus, spinal tumors,tight filum terminale).It has been operated on 40 myelomeningoceles. H was presented at birth in 14 newborns and was operated on in the same anesthesia as spinal dysraphism.In 10 infants H has developed in period from several days to several months after the operation of myelomeningocele.In the 16 the intracranial pressure became normal , enklarged ventrcles stable, so that surgical tratment was not necessary.Inthe group of infants with myelomeningoceles MRI control has shown in 20 infants tethered cord sindrome caused with postoperative adhesions.Tehering was resolved in all infants through reoparation which incuded:adhesyiolisis and mibilisation of conus medullaris.In our group of 77 infants 50 are achieving normal development.One of the most difficult tasks is to discern between the effects caused by the H itself and the underlying damage to neural function resulting from the cause of the H. So in the group of hydrocephalic infants with DFandy-Walker malformation only one was achieving normal development.

Keywords: man, hydrocephalus, perinatal lesion, plasticity, spinal dysraphism

Research goals: General aim of this investigation is how to develop strategy for prevention of hydrocephalus consequences in perinatal period based upon neurobiological,neurological and neurosurgical chriteria.The purpose of this investigation is:a)how te determine meaning of development period in which operative procedure is performed in relation with following neurological and neuropsychological child development,b) morphometrical examination of telencohalic wall changes based upon ultrasonic data and CT - data, c)how to make neuroanatomical comparative study of development in ralation with normal parameters which are examined in Department of anatomy - Division for neuroanatomy, d)how to determine the most vulnerable part of telencephalic wall in hydrocephalus in relation with child ages, e)how to compare outcome of H in children based upon neurological and neuropsychological following children status in relation with period in which H is diagnosed(children whom H was diagnosed until 27th week of gestation and children whom H was diagnosed between 32nd and 36th week of gestation), f) to compare outcome in relation with hydrocephalus stages and regional spread, g) to determine character of operative procedures upon brain palsticity.More over in this we expect as follows:determination of the most vulnerable telencephalic region in H in relation with children age, as well as neurological outcome chriteria connected with degrees and spreadness of H and neurosurgical chriteria in relation with operative procedure types and children ages when the last is performed. These chriteria allow better and whole determination of: a)operative treatment necessity in hydrocephalic deseased children, b)optimal period of time and operative technique.Furthermore, reduction opertive treated patients as well as direction children with H on the best rahblitational programs at the right time we expected.
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