Hydrocephalus is a common finding in patient with extensive intracranial pathology. This finding may have obvious cause or even happened by a subtle abnormality. Some of the normal looking ventricles are really Hydrocephalus when compare with previous images and some are due to NPH. Communicating and non-communicating Hydrocephalus should be separated to divided pathologic causes. This session is about production, circulation, absorption, technical MRI evaluation and pathology of Hydrocephalus. CISS is the main MRI sequence that use to evaluation which give an excellent image for diagnosis. Ventriculostomy is also one of the main surgical procedures which could be done for treatment of many pathological conditions and will be shown by films.

Objectives: Tuberculous Meningitis (TBM) remains a serious health threat in developing countries. Hydrocephalus in TBM significantly influenced the prognosis and unlike other prognositic factors its presence would change the management of the patients. This study was aimed to evaluate the incidence of hydrocephalous in TBM and relation between management of Hydrocephalus and therapeutic outcomes of TBM. Patients and methods: Over a period of 10 years (1991-2001) patients with diagnosis of TBM retrospectively identified. Computerized Tomography (CT) scan features in these patients and therapeutic outcome were analyzed.Results: Ninety six patients fulfilled the diagnostic criteria and 21 patients (22%) died during admission. Seventy seven patients (80.2%) had hydrocephalous in their cranial CT scan, and of these, 23.4% underwent special treatment. 5.5% patients with special treatment of hydrocephalous and 33.9% patients without treatment deceased (P=0.0I8).Conclusion: Early diagnosis and proper management of hyrocephalus should be considered in management of patients with TBM

Background and Importance: This interesting case is about the presence of normal pressure Hydrocephalus and a large pseudomeningocele at the same time after 13 months of posterior fossa surgery. Although the occurrence of a pseudomeningocele following posterior fossa surgery is not so rare, such a late large pseudomeningocele development with signs and symptoms of NPH after 13 months of surgery is rather peculiar.Case Presentation: A 59-year-old man referred to our clinic for a cerebellopontine angle tumor. The patient presented with right hearing loss and mild facial palsy. We operated the patient with retrosigmoid approach, and we discharged him after five days. After about 13 months, the patient referred to our center again with complaint of progressive bulging of previous surgical region and gait apraxia, urinary incontinence and dementia. A large pseudomeningocele in the site of previous surgery was seen.Conclusion: The authors presented a case report on late development (13 months) of a huge pseudomeningocele following vestibular schwannoma surgery with signs and symptoms of normal pressure Hydrocephalus. Such a late big pseudomeningocele presentation with signs and symptoms of normal pressure Hydrocephalus after posterior fossa surgery is peculiar.

Background: Brucellosis is an endemic infectious disease in Iran. The neurological involvement of the central nervous system in brucellosis patients is about 3 to 5 %.Case: The case was a 25-year old Afghan man with weakness and arthralgia for one year as well as terrible headache, vertigo, vomiting, cough, sputum, and disequilibrium. Brain CT-Scan indicated communicating Hydrocephalus in four ventricles. Since Hydrocephalus was idiopathic and noticing the prevalence of tuberculosis among Afghan immigrants that can also cause Hydrocephalus, ventriculo-peritoneal shunt was inserted for the patient. Pressure in CSF increased and had a turbid appearance. Glucose value of CSF decreased (35 mg/dl), whereas protein value increased (724 mg/dl). Leukocyte count was 10 mm3 with 80% neutrophils and 20% lymphocytes. The presence of brucella species in CSF culture confirmed that subacute meningitis had caused Hydrocephalus due to delay in diagnosis and treatment. The patient was treated for brucellosis and discharged after 10 days with oral medications.Conclusion: Noticing this case and other studies, it is recommended that patients with neurological symptoms, such as Hydrocephalus, be evaluated for neuro-brucellosis in endemic areas for brucellosis.

Background: Currently, the treatment of Hydrocephalus in children involves numerous operations and often results in poor prognosis, complicating their condition. Objectives: To reduce the number of operations and improve the treatment of pediatric complex Hydrocephalus, we propose a definition of pediatric complex Hydrocephalus and a surgical treatment procedure. Methods: This study retrospectively reviewed data from patients with pediatric complex Hydrocephalus admitted to Xiangya Hospital between January 2019 and January 2024. The data include basic demographic characteristics, etiology, complicating factors, surgery, and prognosis. We analyzed the therapeutic effect of the new surgical management procedure on complex Hydrocephalus in children. Additionally, we refined valuable experiences from previous studies by extensively reviewing the literature and integrating it with our clinical work. Results: We collected data from 114 pediatric patients with complex Hydrocephalus, including 72 males and 42 females. There were 5 patients aged within 1 month, 38 patients aged between 1 month and 1 year, and 71 patients aged between 1 year and 14 years. According to the etiology and risk factors for surgical failure, there were 20 premature infants with very low birth weight, 54 patients with intracranial hemorrhage, 59 patients with intracranial infection, 24 patients with multiloculated Hydrocephalus, and 26 patients who had undergone previous surgeries. These patients underwent a total of 279 surgeries, ranging from 1 to 7 per patient, with an average of 2.4 surgeries per patient. Of these, 35 involved extra ventricular drainage with an Ommaya reservoir, 22 involved cyst fenestration, 91 involved ventriculoperitoneal shunt, 5 involved ventriculoatrial shunt, 25 involved endoscopic third ventriculostomy, 17 involved choroid plexus cauterization, and 84 involved other types of surgeries. After a mean follow-up time of 5.4 months, 113 patients experienced symptom relief post-surgery, 79 patients showed normalization of ventricles on imaging, 94 patients had normal cognition, 89 patients had normal development, 87 patients had normal function, 81 patients experienced complications, 81 patients required reoperations, and 113 patients survived. More specific information and statistical comparison results are shown in the table. Different responsiveness to surgery between premature infants with very low birth weight and full-term infants is shown in the table.Conclusions: We propose a comprehensive definition of complex Hydrocephalus, which includes cases requiring multiple surgeries, associated with hemorrhage and/or infection, multiloculated Hydrocephalus, and preterm infants with very low birth weight. A surgical management procedure for pediatric complex Hydrocephalus was summarized. Early identification and diagnosis enable personalized treatment approaches, which are divided into two stages. Postoperative follow-up and regular radiological examinations are essential to assess ventricular system restoration and promptly identify any changes in the patient's condition, facilitating the implementation of necessary interventions.