Hydrocephalus (pronounced hi-dro-SEF-a-lus) is a potentially harmful build up of cerebrospinal fluid (CSF) in parts of the brain.
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Cerebrospinal fluid (CSF)A clear fluid produced in the brain’s ventricular system – the four cavities in the brain. It travels throughout the brain and in the area outside the brain and spinal cord. It bathes and protects or cushions the brain and spinal cord.
Hydrocephalus literally means water (hydro) in the head (cephalus). It is sometimes called water on the brain. The “water” is actually cerebrospinal fluid. Cerebrospinal fluid is normally present in areas both inside and outside the brain.
Children with hydrocephalus have too much cerebrospinal fluid in the areas of the brain called ventricles.
Ventricles are four small cavities in the brain that produce cerebrospinal fluid (CSF). This fluid flows through the ventricles to the area around the brain and spinal cord.
The ventricles store and circulate cerebrospinal fluid. Children with hydrocephalus may also have extra fluid in spaces between the brain and the skull called the subarachnoid spaces
Subarachnoid spaces are the spaces lie between the three membranes protecting the brain. Cerebrospinal fluid moves through these spaces. Delicate connective tissue extends across them.
When a child’s cerebrospinal fluid cannot flow or be reabsorbed properly, it builds up. This makes the ventricles bigger and puts pressure on the tissues of the brain
Hydrocephalus is sometimes present at birth, although it may develop later. About 1 out of 500 children is born with the disorder. The outlook if some one has hydrocephalus depends on how quickly the condition is diagnosed and whether any underlying disorders are present.
The signs and symptoms of hydrocephalus vary by age group and disease progression.
In infants, common signs and symptoms of hydrocephalus include:
*An unusually large head
*A rapid increase in the size of the head
*A bulging “soft spot” on the top of the head
*Eyes fixed downward (sunsetting of the eyes)
In older children and adults, common signs and symptoms of hydrocephalus include:
*Headache followed by vomiting
*Blurred or double vision
*Eyes fixed downward (sunsetting of the eyes)
*Problems with balance, coordination or gait
*Sluggishness or lack of energy
*Slowing or regression of development
*Changes in personality
*Impaired performance in school or work
Hydrocephalus produces different combinations of these signs and symptoms, depending on its cause, which also varies by age. For example, a condition known as normal pressure hydrocephalus, which mainly affects older people, typically starts with difficulty walking. Urinary incontinence often develops, along with a type of dementia marked by slowness of thinking and information processing.
The cause of hydrocephalus is excess fluid buildup in the brain.
Our brain is the consistency of gelatin, and it floats in a bath of cerebrospinal fluid. This fluid also fills large open structures, called ventricles, which lie deep inside the brain. The fluid-filled ventricles help keep the brain buoyant and cushioned.
Cerebrospinal fluid flows through the ventricles by way of interconnecting channels. The fluid eventually flows into spaces around the brain, where it’s absorbed into your bloodstream.
Keeping the production, flow and absorption of cerebrospinal fluid in balance is important to maintaining normal pressure inside your skull. Hydrocephalus results when the flow of cerebrospinal fluid is disrupted — for example, when a channel between ventricles becomes narrowed — or when your body doesn’t properly absorb this fluid.
Defective absorption of cerebrospinal fluid causes normal pressure hydrocephalus, seen most often in older people. In normal pressure hydrocephalus, excess fluid enlarges the ventricles but does not increase pressure on the brain. Normal pressure hydrocephalus may be the result of injury or illness, but in many cases the cause is unknown.
Premature infants have an increased risk of severe bleeding within the ventricles of the brain (intraventricular hemorrhage), which can lead to hydrocephalus.
Certain problems during pregnancy may increase an infant’s risk of developing hydrocephalus, including:
*An infection within the uterus
*Problems in fetal development, such as incomplete closure of the spinal column
Congenital or developmental defects not apparent at birth also can increase older children’s risk of hydrocephalus.
Other factors that increase your risk of hydrocephalus include:
*Lesions or tumors of the brain or spinal cord
*Central nervous system infections
*Bleeding in the brain
*Severe head injury
The severity of hydrocephalus depends on the age at which the condition develops and the course it follows. If the condition is well advanced at birth, major brain damage and physical disabilities are likely. In less severe cases, with proper treatment, it’s possible to have a nearly normal life span and intelligence
Doctors will examine the child, looking for signs of hydrocephalus. They may also use techniques to monitor pressure inside your baby’s head. Doctors also use imaging tests to see signs of hydrocephalus. These tests include:
*CT scan (computerized tomography) of the head
*MRI (magnetic resonance imaging)
If the child has hydrocephalus, doctors may use ultrasound images of the brain to monitor the condition.
To treat hydrocephalus, doctors try to improve the flow of cerebrospinal fluid. Most often, they use surgery to do this.
Neurosurgeons most often perform three types of operations for hydrocephalus.
The most common surgery for hydrocephalus is putting in a shunt.
A shunt is a small tube (catheter) that drains extra cerebrospinal fluid from a ventricle in your child’s brain to another area in the body. There, the fluid is either reabsorbed by your child’s body or passed out through the kidneys.
Neurosurgeons place one end of the small tube in the ventricle where extra fluid is causing problems. A valve in the tube controls the amount of fluid that runs through it. This controls the pressure in your child’s head. It also makes sure that the fluid flows in only one direction, away from the brain.
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The three areas a VP shunt can be placed in the head
The tube is placed under the skin and drains the fluid to another area of the body. The end of the tube most often is placed in the belly (abdomen). This is called a ventricular to peritoneal shunt. If the abdomen is not suitable for the tube, it may be placed in the heart (ventricular to atrial shunt), chest, or other areas. No matter where the tube ends, the fluid from the brain is reabsorbed by the body.
Placement of a VP shunt from the head to the belly.
Our neurosurgeons choose from many different types of shunts and valves, depending on your child’s needs. In some cases, they use a valve that can be adjusted from the outside by a small magnet. If your child has an MRI, these types of valves must always be reset immediately by one of our neurosurgery nurse practitioners.
An endoscope is a thin, flexible tube that carries a light and a camera. Surgeons can use it to see inside the body and perform some operations. Endoscopy requires smaller cuts (incisions) than other types of surgery (open surgery). It is a minimally invasive technique. Neurosurgeons use it to treat some types of hydrocephalus.
The approach made by an endoscope to make a hole in the ventricle so that the patient can avoid needing a shunt.
Some children have a complex type of the condition called multiloculated hydrocephalus. This happens when bleeding or infection causes scars within the ventricles of the brain. The scaring causes many small compartments of spinal fluid that do not connect with each other to develop.
In the past, doctors treated this condition by placing a separate shunt in each area with fluid and draining it. But by using an endoscope, they can make small holes in each of the areas. This connects them so they need only one shunt to drain the entire system.
3.Endoscopic third ventriculostomy (ETV)
Depending on your child’s brain structures and age, the neurosurgeon may talk with you about using an ETV instead of putting in a shunt.
During an ETV, the neurosurgeon makes a small hole in your child’s skull. Then the neurosurgeon uses an endoscope to reach the third ventricle in brain. Using the endoscope, the neurosurgeon makes a hole in the ventricle. This lets the extra fluid drain out and be reabsorbed.
An ETV lets neurosurgeons avoid putting in any permanent hardware, such as a shunt. Such a treatment may avoid the complications of using shunt hardware. But the treatment may fail and a shunt may be needed.
This video, developed by Anthony M. Avellino, MD, shows an example of an endoscopic third ventriculostomy procedure for treatment of obstructed hydrocephalus.
To reduce the risk of hydrocephalus:
*If you’re pregnant, get regular prenatal care. Following your doctor’s recommended schedule for checkups during pregnancy can reduce your risk of premature labor, which places your baby at risk of hydrocephalus and other complications.
*Protect against infectious illness. Follow the recommended vaccination and screening schedules for your age and sex. Preventing and promptly treating the infections and other illnesses associated with hydrocephalus may reduce your risk.
To prevent head injury:
*Use appropriate safety equipment. For babies and children, use a properly installed, age- and size-appropriate child safety seat on all car trips. Make sure all your baby equipment — crib, stroller, swing, highchair — meets all safety standards and is properly adjusted for your baby’s size and development. Older children and adults should wear a helmet while riding a bicycle, skateboard, motorcycle, snowmobile or all-terrain vehicle.
*Always wear a seat belt in a motor vehicle. Small children should be secured in child safety seats or booster seats. Depending on their size, older children may be adequately restrained with seat belts.
Should you be vaccinated against meningitis?
Ask your doctor if you or your child should receive a vaccine against meningitis, once a common cause of hydrocephalus. A meningitis vaccine is now recommended for people ages 2 and older who are at increased risk of this disease due to:
*Traveling to countries where meningitis is common
*Having an immune system disorder called terminal complement deficiency
*Having a damaged spleen or having had your spleen removed
*Living in a dormitory as a college freshman
*Joining the military
Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose
Click to access What-is-ETV.pdf
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