doctors

Hydrocephalus is a condition defined by the dangerous accumulation of an abnormal amount of cerebrospinal fluid in the cavities of the brain which cause excessive intracranial pressure. The condition is most recognized by a noticeably enlarged head and is triggered by CSF flow obstruction, reabsorption and overproduction.

The medical term is derived from the Greek words for water (hydro) and head (cephalus) and is normally referred to as “water on the brain.” It affects an estimated 1 out of every 500 children and can develop in adults.

Life-supporting Functions of CSF

Cerebrospinal fluid (CSF) is a clear liquid which surrounds the brain and spinal cord. Specifically, it is located in the subarachnoid space of the skull and the spinal canal. CSF serves many important functions and is known to:

  • Act as a shock-absorber to cushion and protect the brain from trauma
  • Deliver necessary nutrients to the brain for nourishment
  • Remove waste from surrounding tissues
  • Regulate pressure within the brain
  • Filter chemicals from blood

Types of Hydrocephalus

There are several types of hydrocephalus conditions which present various symptoms differing in each individual.

Congenital Hydrocephalus is present at birth. It affects children in the womb as a result of genetic or environmental factors. Bleeding in the fetus, syphilis acquired by the mother and spina bifida contributes to the buildup of CSF in fetuses.

Acquired hydrocephalus develops soon after birth or later in life. It is a result of injury or trauma to the brain. Meningitis, intracranial hemorrhage and CNS infections are conditions which can cause hydrocephalus in children and adults.

Communicating hydrocephalus is activated by CSF flow impairment which prevents functional circulation within the ventricles. CSF is blocked soon after it exits the ventricles; therefore, reabsorption never occurs.

Non-communicating hydrocephalus evolves from an obstruction within the ventricles that inhibits normal CSF flow. It is also known as obstructive hydrocephalus.

Hydrocephalus ex-vacuo occurs in adults following a stroke or brain injury. Brain tissue begins to shrink and the presence of CSF exceeds the normal volume, yet intracranial pressure is unaltered.

Normal pressure hydrocephalus (NPH) occurs after a gradual blockage in the ventricles that promote CSF drainage. As with hydrocephalus ex-vacuo, NPH develops only in adults and does not affect pressure.

Symptoms of Hydrocephalus

As mentioned above, hydrocephalus is characterized by multiple and various symptoms depending on the type of condition. Other factors that dictate the occurrence of symptoms include disease progression, age and individual tolerance.

Symptoms in babies include:

  • Abnormally shaped head
  • Swollen veins
  • Bulging appearance in soft spot areas
  • Sunsetting, or downward cast of the eyes
  • Reduced appetite
  • Problems sleeping

Symptoms in children include:

  • Seizures
  • Balance and motor skill problems
  • Personality changes
  • Memory loss
  • Excessive sleepiness
  • Nausea
  • Vomiting

Symptoms in adults include:

  • Nausea
  • Headaches
  • Drowsiness
  • Sudden falls
  • Memory loss
  • Behavioral changes
  • Seizures

Surgery for Effective Treatment

There are several options available for treatment of hydrocephalus. Two popular and effective choices include shunt placement (indirect treatment) and endoscopic third ventriculostomy (ETV, direct treatment).

A shunt, or ventricular catheter, is a device implanted into the cerebral ventricles to bypass the flow’s obstruction and drain the excess CSF into other body cavities for reabsorption. The fluid is normally drained into surrounding cavities to prevent fluid from entering the ventricles:

  • Peritoneal cavity (ventriculo-peritoneal shunt)
  • Right atrium (ventriculo-atrial shunt)
  • Pleural cavity (ventriculo-pleural shunt)
  • Gallbladder

ETV is based on the individual anatomy of select patients only. An opening is surgically made in the floor of the third ventricle to allow CSF flow directly into the basal cisterns. It shortcuts any obstruction, known as aqueductal stenosis.

Recovery and Prognosis

Neurological function is evaluated promptly post-surgery to determine the presence of certain neurological problems. Follow-up tests (CT scans, MRIs, X-rays) are necessary to properly examine how well the shunt is working and if it is working properly. The sooner hydrocephalus is diagnosed, the better your chances are for treatment and recovery. Several patients are fortunate enough to experience headache relief and dementia reversal.

Get Your Life Back

There is hope for the treatment of hydrocephalus in your child or loved one. Our leading edge practice employs highly educated and fully-trained neurosurgeons that perform minimal invasive neurosurgery to help patients get their life back on track. Treatment in New Jersey is a phone call away at (908) 688-8800.