Neuro and Spine Surgeries
Brain AneurysmWhat is Brain Aneurysm?Read more...
Brain SurgeryWhat is Brain Surgery?Read more...
Brain TumorWhat is Brain Tumor?Read more...
CraniosynostosisWhat is Craniosynostosis?Read more...
Carotid Artery DiseaseWhat is Carotid Artery Disease?Read more...
Carpel Tunnel SyndromeWhat is Carpel Tunnel Syndrome?Read more...
EpilepsyWhat is Epilepsy?Read more...
HydrocephalusWhat is Hydrocephalus?Read more...
Herniated DiscWhat is Herniated Disc?Read more...
HeadacheWhat is Headache?Read more...
Lumbar Spinal StenosisWhat is Lumbar Spinal Stenosis?Read more...
Parkinson DiseaseWhat is Parkinson Disease?Read more...
StrokeWhat is Stroke?Read more...
Spina BifidaWhat is Spina Bifida?Read more...
Spinal Cord InjuryWhat is Spinal Cord Injury?Read more...
Spinal FusionWhat is Spinal Fusion?Read more...
Spinal LaminectomyWhat is Spinal Laminectomy?Read more...
Spinal TumorWhat is Spinal Tumor?Read more...
What is Hydrocephalus ?
The word Hydrocephalus is the condition where there is an abnormal enlargement of the brain ventricles (cavities) due to the accumulation of cerebro-spinal fluid (CSF). Hydrocephalus, also called water on the Brain is a condition in which there is an abnormal build up of CSF (Cerebro Spinal Fluid) in the cavities (ventricles) of the brain. Cerebro-spinal fluid is a clear fluid absorbed by the brain.
The buildup is often caused by an obstruction which prevents proper fluid drainage. The fluid buildup can raise intracranial pressure inside the skull which compresses surrounding brain tissue, possibly causing progressive enlargement of the head, convulsions, and brain damage. Hydrocephalus can be fatal if left untreated.
This CSF circulates from the brain cavity system and thereafter from the subarachnoid space surrounding the spinal cord and brain. CSF nourishes and protects both the spinal cord and brain. Damaged to the brain is caused if hydrocephalus is left untreated. It has been seen that hydrocephalus is more common in infants and adults who are 60 or above.
The damage to the brain can cause headaches, vomiting, blurred vision, cognitive problems, and walking difficulties. The term water on the brain is incorrect, because the brain is surrounded by CSF (cerebrospinal fluid), and not water. CSF has three vital functions:
The brain produces about 1 pint of CSF each day. The old CSF is absorbed into blood vessels. If the process of replenishment and release of old CSF is disturbed, CSF levels can accumulate, causing hydrocephalus.
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Types of Hydrocephalus
There are three types of hydrocephalus:
Normal pressure hydrocephalus (NPH) - only affects people aged 60 years or more. NPH occurs when the amount of cerebro-spinal fluid increases in the ventricles of the brain with no or little increase in the pressure within the head. It may develop after stroke or injury. In most cases doctors do not know why it occurred.
Congenital hydrocephalus - This type of hydrocephalus can occur due to environmental influences at the time of fetal development or also due to genetic factors. It can develop either before or soon after birth. It may be caused by an infection in the mother during pregnancy, such as rubella or mumps, or a birth defect, such as spina bifida. It is one of the most common developmental disabilities, more common than Down syndrome or deafness.
Acquired hydrocephalus - Hydrocephalus can be acquired later in life if something causes an increase in the resistance to the drainage of CSF, such as an obstruction. Acquired hydrocephalus can also be caused by brain tumor, arachnoid cyst, intracranial or intraventricular hemorrhaging (IVH), trauma to the head, or by infections such as meningitis.
Causes of Hydrocephalus
Causes of normal pressure Hydrocephalus - head injury, the mechanisms behind normal pressure hydrocephalus are unknown, tumor, subarachnoid hemorrhage, infection such as meningitis, previous posterior fossa surgery.
Congenital causes in infants and adults - neurofibromatosis, congenital infections such as toxoplasmosis, cytomegalovirus and rubella, aqueductal abnormalities. Dandy-Walker syndrome - a condition where there is enlarged ventricle caused by obstruction in the pathway. Internal bleeding in the brain or hemorrhage, arteriovenous malformation such as vein of Galen, chiari malformations, neural tube defects (NTDs) and Spina bifida
Acquired causes in adults - infections such as cerebral abscess, malignant or benign tumors may result in blockage of CSF flow, head injury, medication- Infiximab infusion may cause communicating hydrocephalus, subarachnoid hemorrhage, idiopathic hydrocephalus, congenital aqueductal stenosis.
Acquired causes in children and infants - malignant or benign brain tumors, infection such as cerebral abscess and bacterial meningitis, subarachnoid hemorrhage, leukemic infiltrates of CNS, an increased venous sinus pressure associated with venous thrombosis, craniostenosis and achondroplasia.
Symptoms of Hydrocephalus
Symptoms of hydrocephalus vary with age, disease progression, and individual differences in tolerance to the condition. For example, an infant’s ability to compensate for increased CSF pressure and enlargement of the ventricles differs from an adult’s. The infant skull can expand to accommodate the buildup of CSF because the sutures (the fibrous joints that connect the bones of the skull) have not yet closed.
Symptoms in Infants - common signs and symptoms of hydrocephalus in infants include:
Symptoms in Toddlers and Older Children - among toddlers and older children, signs and symptoms may include:
Symptoms in Young and middle-aged adults
Common signs and symptoms in this age group include:
Symptoms in Older adults
Among adults 60 years of age and older, the more common signs and symptoms of hydrocephalus are:
Treatment for Hydrocephalus
Shunt Operation for Hydrocephalus - Shunt insertion procedure is considered as the most common surgical procedure for treating hydrocephalus (fluid on the brain). The shunt procedure is performed in the same way in adults, infants and children. During ventricular shunt surgery, a shunt (a thin tube) is implanted inside the brain. The excess CSF in the brain travels from this shunt to another body part generally in the abdomen. The fluid is then absorbed in the blood stream. In order to control the CSF flow, there is a valve within the shunt. This valve also ensures that the fluid doe not drain rapidly.
Endoscopic Third Ventriculostomy (ETV) - a second treatment option is a surgical procedure called endoscopic third ventriculostomy (ETV). An endoscope is used to puncture a membrane in the floor of the third ventricle creating a pathway for CSF flow within the cavities in the brain. ETV is an important alternative to shunting for obstructive hydrocephalus and may be useful in other cases as well.
Unlike many other operations in which the risks are highest during the surgical procedure, most problems associated with shunting occur weeks or even years afterward. Shunt obstruction and malfunction occur in approximately one third of children in the first year after a shunt-related operation and studies have shown that ETVs can close up after time. We cannot overstate the importance of learning the signs and symptoms of treatment failure. Staying in close contact with neurosurgeons if you have a shunt or an ETV is critical.
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