The Clinical And Primary Experimental Study Of Hydrocephalus And Symptomatic Septum Pellucidum Cysts Underwent Neuroendoscopic Operation

Background Hydrocephalus is a major complication of intracerebral haemorrhage. The incidence of intraventricular hemorrhage amalgamating intracerebral haemorrhage is greater than 50%,of which 35%will develop into progressive posthemorrhagic hydrocephalus(PPHH).PPHH can induce secondary injury to brain,and is an important causation of mortality and morbidity in these intracerebral haemorrhages.Up to date,the definite pathogenesis of posthaemorrhagic chronic hydrocephalus is not clear.It is speculated that the obstruction of CSF absorption induced by subarachnoid space fibrosis after intraventricular hemorrhage might be the cause of posthaemorrhagic chronic hydrocephalus;however,there is no definite evidence to support it and many disputes still exist.So,it is very difficult to seek the proper treatment for posthaemorrhagic chronic hydrocephalus.The traditional ventriculoperitoneal shunt has not achieved satisfactory curative effects because of the complications such as blockages and infections.Lately, although posthaemorrhagic chronic hydrocephalus via neuroendoscopic approach is more effectual than the traditional shunt,in some cases such treatment still faces great challenges.We reviewed 184 cases patients with hydrocephalus or intracranial cyst underwent neuroendoscopic operation.Based on the clinical discovery of fibrous tissues deposit in ventricles of posthaemorrhagic chronic hydrocephalus,we think these fibrous tissues deposit of ventricles might be the aetiology of chronic hydrocephalus and the cause of shunt blockages,and the primary experimental study of the pathogenesis of posthaemorrhagic chronic hydrocephalus was made.Methods 184 cases patients with hydrocephalus or symptomatic septum pellucidum cysts underwent neuroendoscopic operation were reviewed.The levels of procollagen I C-propeptide(PⅠCP),procollagenⅢN-propeptide(PⅢNP),hyaluronic acid(HA) and laminin(LN) in patients with posthaemorrhagic chronic hydrocephalus were detected by radioimmunoassay.The experimental models of posthaemorrhagic chronic hydrocephalus in pigs and rats were founded.The changes of pigs' ventricular dimension were observed with MRI and CSF circulation in subarachnoid space observed by SPECT.The changes of structures in pigs' brains after intraventricular hemorrhage were investigated by light and electron microscopy,and the changes of structures in rats' brains were investigated by light microscopy.The changes of LN,laminin receptor1(LNR1),AQP1 and AQP1 mRNA expressions in rats brains after intraventricular hemorrhage were detected with the aid of immunohistochemical techniques and in situ hybridization,respectively,and the effect of urokinase was observed synchronously.The possible pathogenesis of posthaemorrhagic chronic hydrocephalus was discussed.Results 1.184 cases patients with hydrocephalus or symptomatic septum pellucidum cysts underwent neuroendoscopic surgery.The total rate of cure was 79.35%(146/184), 14.67%(27/184) had catabatic symptom;total effectual rate was 94.02%(173/184),and 9.24%(17/184) had complications.2.The levels of PICP,PⅢNP,HA and LN in patients with posthaemorrhagic chronic hydrocephalus group were significantly increased than those in the controlled group(P＜0.01).3.In 30 days after intraventricular hemorrhage, chronic hydrocephaluses were found by MRI in 7 experimental pigs,63.64%(7/11).In 30 days after intraventricular hemorrhage,4 rats(80%) and 3 rats(60%) chronic hydrocephalus were produced in the experimental group and the urokinase therapeutic group,respectively.4.The persistently obstruction of CSF circulation and absorption in pigs subarachnoid space after intraventricular hemorrhage was detected by SPECT.5.After hemorrhage,the major changes in pigs' brains included enlargement of subarachnoid space, atrophy of choroids plexus and ependyma.Non- hydrocephalus pigs had less obvious changes than hydrocephalus pigs did.6.Augmented fibrous tissues in hydrocephalus pigs arachnoid space were found by electron microscopy,and these changes were less obvious in non- hydrocephalus pigs.7.The major changes in rats' brains included ventricular dilatation,enlargement and edema of subarachnoid space,atrophy of choroids plexus and ependyma.The changes in non- hydrocephalus rats were less obvious than that in hydrocephalus animals.8.After intraventricular hemorrhage,the increases of LN expressions in experimental rats' brains were found in loose connective tissue stroma of choroids plexus,pia mater,arachnoid,dura and vascular wall.On the 14^th day,the expressions of LN reached to the peak and had evident increase compared with the controlled group(P＜0.01).The Urokinase therapeutic group had no difference with the experimental group.9.The increase of LNR1 expressions in the experimental rats' brains were found in cuboidal epithelium of choroids plexus,epithelium of pia,arachnoid,dura and vascular endothelial cell.On the 14^th day,the expressions of LNR1 reached to the peak and had evident increase compared with the control group(P＜0.01).The Urokinase therapeutic group had no difference with the experimental group.10.In the controlled group rats,the intense expressions of AQP1 were found in the apical of cuboidal epithelium of choroids plexus,ependyma,pia mater,arachnoid and dura.After intraventricular hemorrhage,the expressions of AQP1 gradually descended in experimental group rats and dropped to bottom on the 14^th day(P＜0.01).The Urokinase therapeutic group had evident increase compared with the experimental group(P＜0.01).11.The expressions of AQP1 mRNA accorded with those of AQP1 basically.Conclusions 1.Neuroendoscopic operation could be an effective,safe,convenient and preferred therapeutic method for simplex obstructive hydrocephalus and symptomatic septum pellucidum cysts.The irrigation of ventricles via neuroendoscopic approach might reduce the blockages of shunt in posthaemorrhagic chronic hydrocephalus.2.The increases of PⅠCP,PⅢNP,HA and LN of cerebrospinal fluid in patients with posthaemorrhagic hydrocephalus imply that there is a tendency of arachnoidal fibrosis after intracerebral haemorrhage.3.The obstruction of CSF circulation and absorption after pigs' intraventricular hemorrhage might be derived from arachnoid fibrosis detected by electron microscopy.4.The increase of LN and LNR1 expressions after rats' intraventricular hemorrhage might involve the development of arachnoidal fibrosis.5.The decrease of CSF absorption induced by the decline of AQP1 expressions after rats' intraventricular hemorrhage might also relate to the development of posthaemorrhagic chronic hydrocephalus.