TIPS

The case of the
•regenerating

cortex
W hen shown the scan of a pa-
tient with gross hydrocephalus, col-
leagues often ask whether there is any
point in treating the patient. The
CT scans reproduced here dramati-
cally show the process of cortical re-
generation in a neonate presenting

with congenital hy-
drocephalus .The
first scan is two days
post-delivery, the sec-
ond immediately af-
ter insertion of a
ventriculo-peritoneal
shunt, and the final
scan at age two. The
child is develop-
mentally normal on
clinical testing.

D Carter
MBChB

Department of Neurosurgery,
University of Cape Town

SB SA JOURNAL OF RADIOLOGY· February 2001

Until recently there were few
studies concerning reversal of the
patholological changes following
shunting. Newer animal models are
showing that there is indeed a reversal
in at least some of the deficits occur-
ring with hydrocephalus, if treated
early: remyelination can occur, corti-
cal vasculature may return to a nor-
mal configuration, there may be res-
toration of ependyma and

peri ventricular capillaries, and there
is at least partial restoration of corti-
cal gray matter cytoarchitecture.

These processes are as yet still
poorly explained, but these scans

demonstrate well the
macroscopic regenera-
tion of the cerebral
cortex with early
treatment of hydro-
cephalus

Reference
Choux M et al. Paediatric
neurosurgery. Churchill
Livingstone. 1999.