Symptomatic Isolated IV Ventricular Hydrocephalus in Adults: Clinical Diagnosis and Management of Five Cases

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.

Immunohistochemical Detection of p53 and c-fos in Brain Gliomas

The epidemiology of cancer has long been suggested that cancer is multistep disease. We suspect some of these steps might be lated with activation of oncogenes and loss of tumor suppressor genes in primary brain tumors. Moreover, recent reports suggest that astrocytomas have shown alterations in chromosome 17p, and this chromosomal location that encodes the p53 protein, as well as c-fos gene may take an important role in the carcinogenesis of human primary brain tumors. Expression of p53 protein was detected in 12 of 17 cases(70.6%) of glioblastoma multiforme, 4 of 6 cases(66.6%) of anaplastic astrocytoma with positive nuclear p53 staining. All low grade astrocytomas and normal brain tissue failed to express p53. Correlation of p53 protein levels with mRNA alterations or genomic DNA alterations may help to guide future therapy or diagnosis of brain tumors. On the other hand, the level of c-fos oncoprotein expression may be correlated with the degree of cell differentiation and proliferation. The presence of these expression in low-grade astrocytoma suggest that activation of the c-fos gene is an early step in tumor development.