Exploring and translating novel approaches targeting the choroid plexus for the treatment of hydrocephalus: a literature review

Can stereotactic radiosurgery treat idiopathic normal pressure hydrocephalus? literature-based evidence

Skogholt’s disease: multimodal evidence for choroid plexus–centred clearance failure

In vivo evidence is provided for choroid plexus dysfunction in a maternally inherited disorder with convergent evidence supporting a mitochondrial aetiology, associated with reduced CSF production and impaired blood–CSF barrier transport, substantially altering biomarker profiles in the absence of cortical atrophy or blood–brain barrier disruption.

Progress in the diagnosis and treatment of post-traumatic hydrocephalus

Objective Post-traumatic hydrocephalus (PTH) is a frequent secondary complication after traumatic brain injury and significantly affects neurological recovery and prognosis. This review summarizes epidemiology, mechanisms, risk factors, diagnostic advances, and treatment strategies to improve clinical recognition and management. Methods A narrative literature review was conducted using major medical databases to identify clinical, imaging, and experimental studies addressing incidence, pathophysiology, diagnosis, and therapy of PTH. Relevant findings were synthesized qualitatively. Results PTH occurs across injury severities and is associated with subarachnoid hemorrhage, decompressive craniectomy, infection, and advanced age. Proposed mechanisms include cerebrospinal fluid circulation disturbance, impaired absorption, neuroinflammation, and altered intracranial compliance. Diagnostic accuracy has improved with advanced neuroimaging and dynamic cerebrospinal fluid assessment. Therapeutic approaches have evolved from conventional shunting to individualized strategies incorporating endoscopic techniques and adjustable shunt systems. Discussion PTH remains underdiagnosed due to heterogeneous presentations. Future efforts should focus on standardized diagnostic criteria and early risk stratification, integration of glymphatic and aquaporin-4 (AQP4) pathways, biomarker- and AI-guided diagnostics, and mechanism-targeted preventive strategies across the acute, subacute, and chronic phases of PTH.

Hydrocephalus beyond cerebrospinal fluid obstruction: systems biology mechanisms and AI-enabled multimodal imaging for precision diagnosis and management

Research paradigms in hydrocephalus are undergoing a profound shift—from a singular emphasis on CSF flow disturbance to a multi-mechanistic, network-interaction model. This review systematically integrates cutting-edge advances from fundamental biology to clinical diagnosis and therapy. Mechanistically, we delineate an interconnected pathological network encompassing neuroinflammation (e.g., the TLR4/NF-κB axis), glymphatic system dysfunction, cilia–ependymal dysregulation, and genetic susceptibility. This broad perspective underscores hydrocephalus as a systemic disorder rather than a purely hydrodynamic abnormality. Technologically, we highlight innovations driven by artificial intelligence (AI) and multimodal neuroimaging—including 4D flow MRI, DTI, and radiomics. These tools enable automated ventricular segmentation, quantitative fluid-dynamic profiling, and robust predictions of surgical outcomes. Consequently, they establish the technical foundation for a "data-driven" paradigm in diagnostics and therapeutics. Therapeutically, we discuss the expanding repertoire of interventions, extending beyond conventional shunt surgery to refined microsurgical techniques, targeted pharmacotherapies, and stem cell–based strategies. Finally, we argue that future progress will depend on integrating multicentre datasets with multi-omics technologies. Establishing this coordinated “mechanism–technology–clinic” framework will accelerate hydrocephalus management toward truly personalized precision medicine.

Understanding the role of neuroendoscopy for treatment of hydrocephalus in adults with intracranial mass lesions: a case series

Hydrocephalus can result from mass lesions for several reasons. Due to limited numbers of adult patients with mass lesions in studies that examine outcomes of endoscopic third ventriculostomy, success in this population is unclear. Additionally, the role of other ventriculoscopic procedures in the management of associated hydrocephalus is unclear. In this retrospective case series, the authors investigated optimal management strategies for patients with mass lesions and hydrocephalus. A list of patients who underwent ventriculoscopic procedures or shunting procedures was compiled. Basic demographics, pathology, etiology of hydrocephalus, imaging, surgical procedures, complications, and long-term outcomes were obtained from the electronic medical record. Patients were subanalyzed in groups based on pathology, type of hydrocephalus, and initial management strategy. A total of 98 patients were identified. The most common pathologies causing hydrocephalus were gliomas, (n = 33, 33.67%), metastatic lesions (n = 17, 17.35%), pineal region tumors (n = 13, 13.27%), and cystic lesions (n = 13, 13.27%). Colloid cysts were excluded. Obstructive hydrocephalus was the most common cause of hydrocephalus (n = 102, 81.60%). All patients who presented with communicating hydrocephalus were treated with shunting. The long-term success of endoscopic approaches was 83.33%. Patients with gliomas and CNS lymphoma were least likely to be shunt free after endoscopic management. The etiology of hydrocephalus in patients with mass lesions is heterogeneous. Shunting is effective in patients with communicating hydrocephalus. Endoscopic management is successful in patients with obstructive hydrocephalus if their tumors do not have a propensity for leptomeningeal disease, such as high-grade gliomas or CNS lymphoma.

Draining the Brain: A Novel Noninvasive Lymphatic Therapy for Parkinson’s Disease

The discovery of the glymphatic system and meningeal lymphatic vessels established that the brain possesses an organized lymphatic clearance network that drains to the deep cervical lymphatics. Disruption of this system has been suggested to contribute to the accumulation of pathogenic proteins implicated in neurodegeneration. Cervical lymphatic reconstruction has been associated with some neurological benefit in Alzheimer’s and Parkinson’s disease, and preclinical work has demonstrated that noninvasive manipulation of superficial cervical lymphatics can increase cerebrospinal fluid outflow. Whether noninvasive cervicofacial lymphedema therapy can produce comparable neurological effects remains unknown. We report two men with Parkinson’s disease (Hoehn and Yahr stages 2.5 and 3) treated with a standardized cervicofacial lymphedema therapy protocol targeting cervical and facial lymphatic pathways. Total MDS-UPDRS scores decreased by 19 points (34.5%) in Patient 1 and 5 points in Patient 2. The reduction in Patient 1 exceeded the published threshold for clinically meaningful total-score improvement. Benefits were reproducible and session-linked, and were accompanied by motor and non-motor gains in cognition, alertness, mood, energy, and sleep; interruption of therapy was associated with return toward baseline. Cervicofacial lymphedema therapy may represent a low-risk, noninvasive intervention hypothesized to influence brain lymphatic clearance in Parkinson’s disease.