Recent Advances and Current Controversies in Hydrocephalus

Dear Colleagues,

The past two decades have seen an unprecedented increase in our knowledge of the physiology and dynamics of human cerebrospinal fluid (CSF). New experimental and clinical investigations that can be summed up by the so-called Bulat–Klarica–Oreskovic hypothesis have recently cast doubt on the canonical understanding of CSF generation and reabsorption. Experimental investigations and human studies have shown that water enters every CNS compartment and that there is a constant water exchange between the CSF, interstitial fluid, and brain capillaries. The hypothesis of diffuse CSF generation and reabsorption has been supported by the finding of the significance of aquaporins, particularly AQP4 in astrocytes and endothelial cells. Another finding that supports these hypotheses is the description of the glymphatic system as a low-resistance network for the bulk flow of CSF running along the periarterial spaces and driven by a combination of arterial pulsatility, respiration, and CSF pressure gradients.

Variability in treatments is still the norm when treating hydrocephalus at any age. Shunting and endoscopic third ventriculostomy (ETV) are options that are applied despite a lack of consensus about indications or in the evaluation of outcomes. Because of the significant clinical and methodological heterogeneity, it is challenging for neurosurgeons to make decisions based on the best available evidence. The success–failure of ETV is still based in very crude estimators or suboptimal biomarkers such as the time to failure, in which ‘failure‘ is defined under the ambiguous term ‘need for surgical revision’.

Despite the popularity of ETV in the neurosurgical armamentarium, most patients with hydrocephalus are still managed with the implantation of a shunt in which the CSF’s flow is regulated by a differential-pressure valve. With today's shunt technology, neurosurgeons can choose from a wide range of hardware and customize it for each patient according to their age, height, weight, and clinical and neuroradiological parameters. This selection is especially important for patients with normal pressure hydrocephalus since it will help lower the number of non-responders and complications associated with shunts. In the pediatric population, the goal of selecting the most adequate shunt hardware is to reduce the number of shunt failures that infants and children will have until they become adults, an important factor in obtaining their best long-term outcomes and social integration.

In this Special Issue, we will present manuscripts that update contemporary concepts in the production, circulation, and reabsorption of the CSF. In order to individualize care and enhance surgical results, we will address contentious issues relating to screening procedures; diagnostic tests, including ICP monitoring; and the treatment of patients with hydrocephalus. We think that a more rational and individualized approach for choosing the best treatment, (neuroendoscopic or shunt implant) and the right choice of the best device—fixed or programmable valves with or without gravitational devices—can reduce variabilities in management, increase the likelihood of a successful outcome, and lessen long-term complications in patients with hydrocephalus. An individualized approach to treating hydrocephalus in children would aid in proper brain development and provide these kids the best chance of being able to adjust socially and professionally to a world that is becoming more and more demanding. If detected early and treated effectively, cognitive decline brought on by normal pressure hydrocephalus in the elderly, whose life expectancy is increasing, can be reversed. This will enhance the patient's and their family's quality of life.

Prof. Dr. Maria A. Poca
Prof. Dr. Juan Sahuquillo
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

• hydrocephalus
• normal pressure hydrocephalus
• adult chronic hydrocephalus
• Hakim and Adams’ syndrome
• CSF dynamic studies
• intracranial pressure monitoring
• shunt selection
• congenital hydrocephalus
• shunt overdrainage
• shunt–patient mismatch
• Hakim's Syndrome
• ventriculo-peritoneal shunts
• cerebrospinal fluid shunts