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There is no evidence to indicate whether placement of a shunt to remove fluid is effective in the management of normal pressure hydrocephalus

Normal pressure hydrocephalus is a rare but potentially treatable cause of dementia. Since the condition was first described in 1965, it has conventionally been treated by placement of a shunt to remove cerebrospinal fluid (CSF) from the ventricles of the brain. No trial has yet compared the placement of a shunt versus no shunt in a randomized controlled manner. Nor have the long‐term outcomes of treated and untreated normal pressure hydrocephalus been compared. There is, therefore, no evidence for the use of shunts in the management of normal pressure hydrocephalus.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2008

Flow‐regulated versus differential pressure‐regulated shunt valves for adult patients with normal pressure hydrocephalus

Normal pressure hydrocephalus (NPH) is a condition in which the fluid around the brain is not properly absorbed, adversely affecting brain function. It is often treated using a shunt, which drains the extra fluid from the brain into the peritoneal cavity in the abdomen, where the fluid can be absorbed (a ventriculo‐peritoneal shunt). Currently about 5.5 ventriculo‐peritoneal shunt implantations are performed per 100,000 inhabitants in industrial countries per year, even though evidence supporting shunting as treatment for NPH is poor. Approximately 30% to 40% of implanted shunts fail and have to be revised during the first year. To try to reduce the number of complications, many valve and shunt system designs have been developed. These valves can be classified, according to the mechanical design, into two main groups: differential pressure valves and flow‐regulated valves. No randomised clinical trial so far has compared these two types of valve. Thus, there is no high‐quality evidence indicating that flow‐regulated and differential pressure‐regulated shunt valves differ in efficacy or complication rates.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Endoscopic third ventriculostomy for idiopathic normal pressure hydrocephalus

Cerebrospinal fluid (CSF) is the fluid which circulates around the brain and spinal cord and through spaces called ventricles within the brain. It protects the brain, supplies nutrients and removes waste products. Normally, its production and reabsorption are tightly controlled. In idiopathic normal pressure hydrocephalus (iNPH), there is an increase in the volume of CSF for unknown reasons. This causes the ventricles to enlarge and eventually leads to damage to surrounding brain tissue. It usually occurs in older people. Its characteristic symptoms are deterioration in balance and gait, urinary incontinence and cognitive decline. It is one of the less common causes of dementia.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Intraventricular streptokinase after intraventricular hemorrhage in newborn infants

There is no evidence of benefit from giving streptokinase to newborn babies after brain haemorrhage.Bleeding (hemorrhage) into the ventricles of the brain is a serious complication of premature birth and large hemorrhages often lead to hydrocephalus, the process by which fluid accumulates under pressure inside the brain, expanding the head excessively and damaging the brain tissue. The insertion of a valve and drainage system (ventriculoperitoneal shunt) is fraught with problems in this patient group and alternatives to this therapy are needed. A possible approach is to try to dissolve the blood clots initially blocking the reabsorption of fluid in the brain. Streptokinase is a "clot‐busting" agent that has been successfully used to unblock coronary arteries. The review found no good evidence that intraventricular injection of streptokinase to infants with large intraventricular hemorrhage or post‐hemorrhagic ventricular enlargement reduces the need for ventriculoperitoneal shunt or improves outcome.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2008

Diuretic therapy for newborn infants with posthemorrhagic ventricular dilatation

Bleeding (hemorrhage) into the fluid‐producing cavities (ventricles) of the brain is a serious complication of premature birth. Large hemorrhages may result in fluid building up under pressure, progressively enlarging the brain and head. Current treatment approaches, including the insertion of a valve drainage system (shunt) are fraught with problems. Acetazolamide and furosemide, two drugs with diuretic action, reduce the production of fluid in the ventricles of the brain and have been proposed as safe treatments to treat dilatation of the ventricles after intraventricular hemorrhage in newborn infants. When compared with standard treatment, diuretic therapy was found not to reduce the need for shunt surgery. Diuretic drugs are neither safe nor effective in treating ventricular dilatation in infants with intraventricular hemorrhage.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2008

Repeated lumbar or ventricular punctures in newborns with intraventricular hemorrhage

Intraventricular hemorrhage (IVH) is a major complication of premature birth and a cause of cerebral palsy and hydrocephalus. Repeated early lumbar puncture or ventricular taps have been advocated as a way of avoiding hydrocephalus and protecting the brain from pressure. It was thought that the risk of hydrocephalus and the need for a ventriculoperitoneal shunt might be reduced by the removal of protein and old blood in the cerebrospinal fluid. This hypothesis has been tested in four randomised trials involving premature infants in whom IVH (with or without established enlargement) was diagnosed by ultrasound. There is no evidence that early tapping of cerebrospinal fluid by lumbar puncture or ventricular tap reduces the risk of shunt dependence, disability, multiple disability or death. The use of repeated taps was associated with an increased risk of central nervous system infection. Thus the early use of early tapping cannot be recommended. Removing cerebrospinal fluid should be reserved for cases where there is symptomatic raised intracranial pressure.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Spina bifida repair and infant and maternal health

Spina bifida is the term used to describe a group of neural tube conditions where the fetal spinal cord does not close properly during the first month of pregnancy. With open spina bifida some of the vertebrae are not completely formed but are split or divided and the spinal cord and its coverings (the meninges) protrude through the opening. The most severe is where the spinal cord and meninges come out of the child's back (myelomeningocele). Open spina bifida is often associated with hindbrain herniation, where the cerebellum and brainstem tissue extend into the large opening in the base of the skull, and hydrocephalus (enlargement of the fluid filled cavities in the brain). Resulting disabilities include bladder and bowel incontinence, difficulties in moving about due to limb weakness, paralysis, deformity and loss of sensation. Conventional treatment of spina bifida is surgical repair within two days of birth, which may include the placement of a shunt between the ventricles of the baby’s brain and the belly (peritoneum) to relieve hydrocephalus. Spina bifida can be diagnosed with prenatal ultrasound or maternal serum alpha‐feto protein and in utero treatment could improve outcomes; although it involves surgical incision into the mother’s abdomen and uterus to access the unborn baby.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Postnatal phenobarbital for the prevention of intraventricular haemorrhage in preterm infants

Large bleeds in the centre of the brain can cause disability or death in preterm babies. Unstable blood pressure and blood flow to the brain are believed to cause intraventricular haemorrhage (IVH) (bleeding into the fluid‐filled cavities of the brain (ventricles). The drug phenobarbital is believed to stabilise blood pressure and, therefore, potentially help prevent IVH. The review of trials found that there was not enough evidence that postnatal phenobarbital is effective in preventing IVH. Furthermore, phenobarbital suppresses breathing in infants who are breathing spontaneously, causing a need for mechanical ventilation.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Drugs for preventing blood clot dissolution (antifibrinolytic therapy) to reduce the occurrence of rebleeding in aneurysmal subarachnoid haemorrhage

A subarachnoid haemorrhage (SAH) is a bleed into the small space between the brain and skull that contains blood vessels that supply the brain (the subarachnoid space). The cause of a bleeding here is usually a rupture of a weak spot in one of these vessels. A SAH is a relatively uncommon type of stroke, but it often occurs at a young age (half the patients are younger than 50 years). The outcome of SAH is often poor: one‐third of people die after the haemorrhage and of those who survive, one‐fifth will require help for everyday activities. An important cause of poor recovery after SAH is a second bleed from the weakened vessel (rebleeding). This is thought to be caused by the dissolving of the blood clot at the original bleeding site that results from natural blood clot dissolving (fibrinolytic) activity. Antifibrinolytic therapy that reduces this activity was introduced as a treatment for reducing rebleeding and therefore for improving recovery after SAH. This review included 10 trials, totaling 1904 participants that investigated the effect of these drugs in people with SAH. Antifibrinolytic treatment does indeed reduce the risk of rebleeding, but does not improve survival or the chance of being independent in everyday activities. This may be due to an increase in one of the other common complications of SAH. We conclude that antifibrinolytic treatment should not routinely be given to people with SAH, but new randomised trials are needed to establish if short‐term treatment might be beneficial.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Fibrinolytic therapy for intraventricular hemorrhage in adults

There is no evidence available on the effect of clot dissolving drugs for intraventricular hemorrhage. About one‐sixth of all acute strokes are due to bleeding in the brain. Sometimes the blood enters the ventricles, the fluid‐filled spaces within the brain. This can block the circulation of fluid around the brain, causing rapid neurologic deterioration and even death. Fibrinolytic (or clot dissolving) treatment might help to break up blood clots, promote clearance of blood and reduce the risk of poor outcome. This review was not able to find sufficient good quality evidence from randomized trials to show whether this treatment does more good than harm. This therapy appears promising but further trials are needed to fully assess safety and efficacy.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2008

Treatment of epilepsy in people with neurocysticercosis

Neurocysticercosis is a common infection of the brain caused by the larvae of the pork tapeworm, migrating to the brain. Seizure is the most common symptom, while some people may present with headache, vomiting or brain swelling. This review investigates the usefulness of antiepileptic drugs (AEDs) in preventing seizures in people who did not have seizures but presented with headache or brain oedema. We also examined the usefulness of the AEDS in people with neurocysticercosis with epilepsy in terms of choice of drug, dosage, duration of treatment, cost, side effects and the quality of life.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Intracystic bleomycin for children with cystic craniopharyngiomas

Craniopharyngiomas are rare, slow‐growing, benign tumours in the hypothalamic‐pituitary region of the brain. Although they are benign, i.e. the tumour lacks the ability to invade neighbouring tissue or metastasise (spread to other sites), there is considerable morbidity and disability even when the tumour can be resected completely. Cystic craniopharyngiomas are the most common type of craniopharyngiomas. They consist of a solid portion that contains fluid‐filled balloon‐like structures (cysts). Cysts are a problem because secretion of fluid into them allows the tumour to increase in size, which puts pressure on parts of the brain and can cause damage. Radical resection (removal by surgery) alone is not sufficient because the rate of recurrence is high and this procedure has a high risk of endocrinological/neurological deficits such as blindness; loss of control of appetite, urine production, emotional behaviour and physical co‐ordination; memory loss; sleep disturbances; cessation of growth and sexual development; low thyroxine levels; hydrocephalus (high pressure inside the skull); and death. While in adults radiotherapy represents a valid postoperative adjunctive (additional) therapy, in children it has a high risk of side effects including further damage to any remaining sight, with reduction of intelligence quotient (IQ) and ability to perform complex tasks in later life. Intracystic bleomycin (i.e. a type of chemotherapeutic agent injected into the cyst) has been used to potentially decrease the damage associated with cystic craniopharyngioma.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

Late Effects of Treatment for Childhood Cancer (PDQ®): Patient Version

Expert-reviewed information summary about the health problems that continue or appear after cancer treatment has ended.

PDQ Cancer Information Summaries [Internet] - National Cancer Institute (US).

Version: August 11, 2016

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