Hydrocephalus is a combination of the words hydro=water and cephalic=head. It is generally known as excessive accumulation of water in the brain. The water referred to here is “cerebrospinal fluid”. An increase in the amount of this fluid in some of the brain's chambers causes an increase in intracranial pressure and damage to the brain.
Cerebrospinal fluid is made and reabsorbed continuously throughout the day. This fluid surrounds the brain and spinal cord and circulates continuously. It has three main functions: To reduce the harmful effects of blows to the brain and spinal cord, to help nourish the brain and transport waste, and to regulate pressure changes in the brain by circulating between the brain and spinal cord.
Hydrocephalus can occur at any age, but is most common in children and the elderly (over 60 years of age). About one in 500 children has hydrocephalus. In most of these patients, the diagnosis is made at birth, before birth or in early infancy. Although rare, it may be due to genetic (inherited) disorders or developmental disorders. Common causes are intracerebral hemorrhages, head trauma, brain tumors, hemorrhages due to premature birth and meningitis.
Findings
Symptoms of hydrocephalus vary from person to person. Common findings are listed below according to age groups.
In newborns (0-2 months); Abnormal growth of the head, thinning of the scalp, prominent veins in the head, vomiting, restlessness, eyes shifting downwards, seizures or inability to communicate.
In children (2 months and older): Abnormal growth of the head, headache, nausea, vomiting, fever, double vision, restlessness, regression in walking or speech, impaired communication, loss of sensory-motor functions, seizures. Older children may have difficulty staying awake or waking up.
In middle-aged adults; Headache, difficulty waking up or staying awake, balance disorder, urinary incontinence, personality disorder, dementia, visual impairment
In the elderly; impaired communication, unstable gait, difficulty remembering, headaches, urinary incontinence.
In a patient with hydrocephalus, your doctor will talk to you, ask questions, examine you and order some tests (Brain Tomography, Magnetic Resonance Imaging, Brain Ultrasonography) before starting any treatment. The diagnosis of hydrocephalus, why it occurs and what kind of treatment is needed will be determined after these tests. In children, a large head size alone does not indicate hydrocephalus. However, the diagnosis is confirmed using imaging techniques of the brain.
If the diagnosis is made in the womb before the baby is born; according to the laws in force, a report from the ethics committee committee in hospitals is needed to terminate the pregnancy.
Causes of Hydrocephalus
The causes of hydrocephalus vary according to age group.
- Newborn (0-2 months): Congenital: These patients constitute the largest group. It may be only hydrocephalus or may be associated with other congenital anomalies developing in the spine (meningomyelocele). Intracerebral hemorrhages: The brain chambers enlarge after bleeding that usually occurs spontaneously.
- Children and adults: Brain infections, brain hemorrhages, brain tumors and head injuries.
- Elderly: Normal pressure hydrocephalus; enlargement of the brain chambers after decreased absorption of cerebrospinal fluid; gait disturbance, urinary incontinence, dementia; classic triad of findings.
Hydrocephalus Treatment
Hydrocephalus cannot be treated with medication. Only surgical interventions by neurosurgeons can correct hydrocephalus. The type of surgical intervention chosen will depend on the underlying cause of hydrocephalus.
If there is an obstruction that causes the circulation of cerebrospinal fluid to be impaired, surgical treatment can be performed for the obstruction (tumor, cyst, etc.). If the obstruction cannot be removed, the intracranial circulation pathways of the cerebrospinal fluid can be changed with surgical interventions.
Since it is not possible to restore the circulation of cerebrospinal fluid in the majority of patients, the fluid must be transferred from the brain to another body cavity. For this transfer, a thin, long, elastic, silicone tube called a “shunt” is used. A part of the system called a “pump” is located under the scalp so that it works in one direction and at a controlled speed. Excess cerebrospinal fluid is transported through this thin tube to another part of the body. This prevents the pressure inside the brain from increasing. However, because the brain is constantly producing water, this system has to work continuously. Since the shunt is under the skin, it is only noticeable in infants when viewed from the outside. In children and adults, the tube under the skin can be felt when palpated.
The most common method for babies diagnosed in the womb is to deliver the baby as early as possible and to perform surgery as early as possible.
The shunt is surgically placed under general anesthesia. A small hole is made in the skull and the end of the shunt is inserted into the cerebrospinal fluid chamber in the brain. A tunnel is then cut under the skin of the head, neck and abdomen and the other end of the shunt is directed into the heart or abdominal cavity where this fluid can be easily absorbed. A short course of antibiotics may be used to prevent postoperative infection.
After surgery, the patient is observed in the hospital for a while. Usually the patient's complaints improve after a while. However, if permanent damage to brain tissue has occurred, some of the patient's functions may not improve. The most important reason for not recovering functions such as vision and intelligence is delayed treatment. The length of hospitalization depends on the patient's recovery. These patients need long-term follow-up to monitor whether the shunt is working or not. A significant proportion of patients treated for hydrocephalus can lead normal lives. The shunt may need to be replaced in case of malfunction and infection.
The shunt does not need a power source such as a battery.
Head radiography and brain tomography do not harm the shunt system. The type of shunt must be suitable for magnetic resonance examination. If there is a shunt that can be adjusted externally and is affected by the magnetic field, your doctor should be asked before the magnetic resonance examination is performed.
No type of shunt can be pressed manually from the outside to make it work. The doctor performs the manual examination of the shunt. Excessive pressure on the pump will cause it to malfunction.
It is not appropriate to lay the baby on the side of the shunt, especially during infancy.
The dependence of the brain on the shunt system may continue for many years. In most patients, the need for a shunt continues for life. Removal of the shunt is not recommended in most patients if there is no problem.
Things to watch out for:
Regular and frequent examinations should be performed to prevent shunt complications. If;
- Redness and tenderness at the surgical site and on the shunt line,
- Patient restlessness, nausea, vomiting,
- Headache, double vision, fever, abdominal pain, convulsions,
If there is a recurrence of pre-operative complaints, you should consult a doctor. If the problems are not recognized and corrected early, there may be bad consequences that can lead to death. Shunt-related problems can develop very quickly, sometimes within hours. In case of any doubt, it is important to contact the nearest neurosurgery center and/or the doctor who performed the surgery.
