ABSTRACT
Aim of this study was to discover the causes of critical hydrocephalus in children, determine prognostic factors of possibility of reparative processes in the brain and to analyze the results of shunting procedures in critical hydrocephalus. The series included 96 pediatric patients aged from 3 months to 2 years. All patients underwent ventriculoperitoneostomy. Optical and electron microscopy of brain tissue samples was performed in 10 cases. Follow-up period varied between 2 and 17 years. We observed negative effect of inflammatory and ischemic-hemorrhagic etiology of hydrocephalus on outcome as well as number of surgeries. Positive factors included: congenital hydrocephalus and early surgical treatment. Sizes of ventricles normalized in 25% of cases, decreased in 38.5% and remained unchanged in 36.5% of cases. Dynamics of ventriculomegaly correlated with quality of life. Almost in half of cases good (19%) of average (30%) level of quality of life was achieved. Microscopic examination of cortex and white matter discovered correlation of destructive changes with severity of hydrocephalus not only due to CSF hypertension. These alterations were present predominantly in glial cells. Preservation of most neurons and proliferation of glia provide high chance of nervous tissue reparation and restoration of cerebral functions after cessation of CSF hypertension.
