• Tito Vivas-Buitrago, Gabriel Pinilla-Monsalve, Ignacio Jusué-Torres, Kumiko Oishi, Jamie Robison, Joshua A Crawford, Mikhail Pletnikov, Jiadi Xu, Olivier Baledént, Armelle Lokossou, Alice L Hung, Ari M Blitz, Jennifer Lu, Daniel A Herzka, Hugo Guerrero-Cazares, Kenichi Oishi, Susumu Mori, Alfredo Quiñones-Hinojosa, and Daniele Rigamonti.
• Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA; Department of Neurosurgery, Mayo Clinic Florida, Jacksonville, Florida, USA; Faculty of Health Sciences, School of Medicine, Universidad de Santander UDES, Bucaramanga, Colombia.
• World Neurosurg. 2018 Dec 1; 120: e1120e1127e1120-e1127.

IntroductionThe pathophysiology of normal-pressure hydrocephalus and the correlation with its symptomatology is not well understood.ObjectiveTo monitor and evaluate the enlargement patterns of the ventricular system for each ventricle and its correlation with the presenting symptoms.MethodsBilateral kaolin injection into the subarachnoid space overlying the cranial convexities was done in 18 adult rats. Magnetic resonance imaging was performed on an 11.7-T scanner 15, 60, 90, and 120 days after injection. Volumes of the ventricular system were measured for each ventricle and correlated with biweekly behavioral findings.ResultsThere was a progressive increase in the ventricular volume for the lateral ventricles since day 15 in the kaolin-injected animals. There was a nonsignificant trend in volume growth for the third ventricle, but its enlargement was synchronous with the lateral ventricles. No significant change for the fourth ventricle. No symptoms were detected in the first 60 days. Association was found between the ventricular volume and locomotor changes. In addition, the odds of locomotor symptoms increased by 3% for every additional cubic millimeter of volume in the left (P < 0.001) and right (P = 0.023) ventricles, and for the total magnetic resonance imaging volume by 1% (P = 0.013).ConclusionsExpansion of the lateral ventricles maintained similar proportions over time, accompanied by a synchronous third ventricular expansion with less proportion and a nonsignificant fourth enlargement. Lateral ventricles enlarged most in those animals that were to develop late locomotor deterioration. Further research using this animal model combined with different radiologic imaging techniques, such as diffusion tensor imaging and perfusion studies, is recommended.Copyright © 2018 Elsevier Inc. All rights reserved.

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