OUR POLICY IN DIAGNOSIS AND TREATMENT OF HYDROCEPHALUS

The authors present the policy they have worked out for hydrocephalus patients with special reference to the pressure measurement and test m ethods and to rCBF, SPECT and transcranial Doppler sonography (TDC) st udies. For diagnosis, the protocol proposed by Gjerris and Borgesen wa s followed in 75 cases: besides other methods (CT, radionuclide cister nography, MRI) the intracranial pressure waves routinely recorded and analyzed by means of ventricular catheters for 24 h. The patients were roughly divided into groups in terms of diagnosis, baseline pressure, compliance, results of infusion tests and of surgery. In 13 patients the investigations were supplemented by rCBF SPECT and in 42 patients by TCD studies before and after CSF shunting or withdrawal to analyze the acute effects on cerebral circulation. Clinical follow-up shows th at need for shunting was indicated fairly well by the common results o f baseline ICP, compliance and infusion loading. The rCBF SPECT studie s revealed a significant increase of the cerebral perfusion at the bas al ganglia after shunting while, on the basis of CBF velocity changes three types of vasoregulatory response could be defined with TCD. In o ur hands, monitoring of the pressure and craniospinal capacity has pro ved to be a valuable aid in decisions on surgery; however, for a more precise (and beneficial) appreciation of whether surgery is indicated the vasoregulatory responses should also be taken into account in futu re.