Reversibility of functionally injured neurotransmitter systems with shunt placement in hydrocephalic rats: implications for intellectual impairment in hydrocephalus

J Neurosurg. 1998 Apr;88(4):709-17. doi: 10.3171/jns.1998.88.4.0709.


Intellectual impairment has been related to alteration of neuronal innervation in the following regions: cholinergic basal forebrain nuclei (Ch1-Ch6, learning and memory), dopaminergic ventral tegmental area (emotional control), and noradrenergic locus ceruleus (cognition). Recent studies have implicated neuronal injury in the pathogenesis of hydrocephalus.

Object: The authors used immunohistochemical techniques to investigate functional injury in these regions in animals with progressive hydrocephalus, following shunt placement for cerebrospinal fluid (CSF) drainage.

Methods: Hydrocephalus was induced in 20 Wistar rats by intracisternal injection of 0.05 ml of 25% kaolin solution. Four control animals (Group 1) received the same volume of saline. Ventriculoperitoneal shunts were inserted in eight rats at 2 and 4 weeks after kaolin injection and the animals were killed at 8 weeks (Group 2). The other 12 hydrocephalic animals were killed at 2, 4, and 8 weeks without undergoing shunt placement (Group 3). Immunoreactive (IR) neurons to choline acetyltransferase (ChAT) in Ch1-Ch6, tyrosine hydroxylase (TH) in the ventral tegmental area, and dopamine B-hydroxylase (DBH) in the locus ceruleus, as well as IR projection fibers in the terminal areas, were compared between groups. The number of ChAT- and TH-IR neurons in rats with and without shunt placement was counted for quantitative analysis. The number of ChAT-IR neurons was progressively reduced during the development of hydrocephalus in Ch1, Ch2, Ch3, and Ch4 (p < 0.05). Tyrosine-hydroxylase-immunoreactive neurons were also reduced in number, and demonstrated decreased projection fibers and terminals. Early shunting (at 2 weeks) restored ChAT and TH immunoreactivity to control levels, but late shunting (at 4 weeks) did not (p < 0.05). The DBH-IR neurons in the locus ceruleus were remarkably compressed by the dilated fourth ventricle, and diminished immunoreactivity was observed in the terminal areas. Shunt placement for CSF also restored the immunoreactivity in this system.

Conclusions: These findings indicate that a progressive functional injury occurs in the cholinergic, dopaminergic, and noradrenergic systems as a result of hydrocephalus. This may contribute to intellectual impairment and might be prevented by early treatment with shunt placement.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Animals
  • Choline O-Acetyltransferase / metabolism
  • Dopamine / metabolism
  • Dopamine beta-Hydroxylase / metabolism
  • Hydrocephalus / physiopathology*
  • Hydrocephalus / psychology
  • Hydrocephalus / surgery*
  • Immunohistochemistry
  • Intelligence / physiology
  • Male
  • Neurons / cytology
  • Neurons / metabolism*
  • Neurotransmitter Agents / physiology*
  • Nissl Bodies / ultrastructure
  • Norepinephrine / metabolism
  • Rats
  • Rats, Wistar
  • Staining and Labeling
  • Tyrosine 3-Monooxygenase / metabolism
  • Ventriculoperitoneal Shunt*


  • Neurotransmitter Agents
  • Tyrosine 3-Monooxygenase
  • Dopamine beta-Hydroxylase
  • Choline O-Acetyltransferase
  • Dopamine
  • Norepinephrine