Hydrocephalus
What is it?
Hydrocephalus is not a pathology per se, but a manifestation of another underlying brain problem. Therefore, the prognosis for a child with hydrocephalus depends not only on the hydrocephalus, but also on its cause.
The most common causes of hydrocephalus are:
- congenital malformations (Sylvio aqueduct stenosis, spina bifida, Chiari malformation, Dandy-Walker syndrome, arachnoid or ventricular cysts);
- embryonic matrix hemorrhages in premature infants (intraventricular);
- intrauterine infections (TORCH, cytomegalovirus, mystery infections, etc.) or in the perinatal period (bacterial meningitis);
- cerebral neoplasms located in such a way as to obstruct the circulation of the cerebrospinal fluid.
Some of them occur during pregnancy and others after birth.
Causes and risk factors
Hydrocephalus is caused by an accumulation of cerebrospinal fluid (CSF) in the ventricular cavities of the brain, resulting in increased pressure inside the skull.
The cerebrospinal fluid accumulates because it finds an obstacle to its physiological circulation or because of a change in the reabsorption mechanism.
Under normal conditions, the cerebrospinal fluid is very similar to the liquid part of the blood and contains sugar and various mineral salts. It is produced by special structures called chorioid plexuses and carries out its circulation through the ventricles and on the surface of the brain and spinal cord; it is eventually reabsorbed by some veins located on the surface of the brain and enters the bloodstream.
Its main task is to keep the brain and spinal cord in a protective environment.
Which are the symptoms?
Regardless of the cause, the signs and symptoms are distinctive and vary according to the age at which the problem occurred.
The newborn has an abnormal increase in the head circumference (macrocrania), with protrusion and tension of the anterior fontanelle, stagnation of the supracranial venous network, lethargy or irritability.
A child after one year of age who has had a fusion of the cranial sutures has:
- recurrent vomiting;
- headache;
- tendency to drowsiness;
- visual disturbances;
- sometimes epileptic seizures.
How is it diagnosed?
Diagnostic studies can be performed as early as during pregnancy (morphologic ultrasound). After birth, transfontanellar ultrasound and magnetic resonance imaging of the brain are performed, which also reveals even the concomitant presence of underlying brain damage.
Suggested exams
How is it treated?
Hydrocephalus is successfully treated, while the underlying cause may or may not lead to permanent brain tissue damage.
Treatment of hydrocephalus depends on the cause, the clinical course, and a careful assessment of the risks and benefits associated with surgery.
In cases of obstructive hydrocephalus caused by a lesion obstructing the circulation of the cerebrospinal fluid, surgical treatment of the lesion (neoplasm, arachnoid cyst, etc.) can solve the hydrocephalus problem in almost all cases.
There are currently two options for surgical treatment:
- implantation of ventriculoperitoneal cerebrospinal fluid shunts;
- application of endoscopic methods (ventriculocysternostomy).
In children with hydrocephalus without obvious problems of cerebrospinal fluid reabsorption (Silvio aqueduct stenosis, intraventricular arachnoid cysts) using an endoscope, which is a fiber-optic instrument, it is possible to créate under direct supervision a communication between the fundus of the third ventricle and cisterns containing the cerebrospinal fluid in the skull base, through which an alternative path for cerebrospinal fluid circulation is created to the blockage site.
The method involves a single cranial incision in the right frontal region of about 2 cm in length.
In 1-2% of cases, intraventricular bleeding may occur, which may require temporary external drainage of the cerebrospinal fluid; in other cases, stoma failure may occur (15-25% of cases), which can be eliminated during a second endoscopic procedure or by implantation of a ventriculoperitoneal shunt system.
With both surgical techniques, the average length of hospital stay after surgery is 4-6 days; after 7-10 days, the sutures are removed.
Where do we treat it?
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