Hydrocephalus: Key Information and Insights - Neurosurgery

Dr. Qiu Yushu reply Neurosurgery

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Hello: Here is the information regarding hydrocephalus.
(I apologize for not being able to attach images of the ventricular changes before and after surgery at this time.)
Hydrocephalus
What is hydrocephalus? Hydrocephalus, commonly known as water on the brain, is one of the most common issues in neurosurgery.
In fact, the term "water on the brain" is misleading.
Hydrocephalus refers to the abnormal accumulation of cerebrospinal fluid (CSF) in the brain.
Normal individuals produce cerebrospinal fluid continuously, which has a composition similar to blood, containing various salts and electrolytes such as sodium and glucose.
Once produced, the cerebrospinal fluid flows within interconnected ventricles.
An adult produces approximately 500 cc of cerebrospinal fluid daily.
The CSF circulates through the ventricles and surrounds the surface of the brain and spinal cord.
Ultimately, it drains into large cerebral veins on the surface of the brain and returns to the heart.
The production, flow, circulation, and absorption of cerebrospinal fluid maintain a stable environment to protect the nervous system.
Causes of Hydrocephalus
The occurrence of hydrocephalus is due to various factors disrupting the originally orderly environment of the brain.
The prognosis for affected children is related to the underlying condition rather than hydrocephalus itself, which is an important fact.
In many patients, a clear cause cannot be identified.
Some diseases that can lead to hydrocephalus include: intracranial hemorrhage, infections, trauma, tumors, cerebrovascular diseases, and structural problems within the brain.
Some cases of hydrocephalus occur during pregnancy, while others develop after birth.
A small number of cases may have a genetic component.
If hydrocephalus occurs and is not treated, cerebrospinal fluid can accumulate in the brain, potentially causing brain damage or even death.
How is Hydrocephalus Diagnosed?
In infants, a rapidly enlarging head is often quickly diagnosed as infantile hydrocephalus by family doctors or pediatricians, which may or may not present with symptoms of increased intracranial pressure, such as vomiting, growth delays, irritability, and developmental delays.
In slightly older children, rapid changes in head circumference are less common, but the aforementioned symptoms of increased intracranial pressure are more frequently observed.
Different imaging studies are used to confirm the diagnosis based on the age at which hydrocephalus is detected in children.
For infants aged six to twelve months, a brain ultrasound can often provide an accurate diagnosis.
Once the skull has fused, a computed tomography (CT) scan or magnetic resonance imaging (MRI) is preferred.
Each imaging modality has its advantages and disadvantages, but most physicians prefer MRI scans.
However, MRI is more time-consuming and may require sedation for children, but it provides better images and may help identify the cause of hydrocephalus, facilitating optimal treatment for the affected child.
In adults, hydrocephalus presents three specific symptoms:
1.
Dementia: Patients experience memory loss, forgetting phone numbers, names of acquaintances, and addresses, which can easily be misdiagnosed as Alzheimer's disease, when in fact it may be due to "Normal Pressure Hydrocephalus."
2.
Gait instability: Patients may exhibit unsteady walking and may eventually require a wheelchair.

3.
Urinary incontinence: Patients may experience involuntary urination without warning.
Hydrocephalus is treatable; however, the underlying causes may result in irreversible damage to the brain.
Physicians must also carefully determine whether the patient's hydrocephalus is progressive or has stabilized, meaning that while the ventricles may be enlarged, they have reached a stable state.
This determination can be challenging and often relies on various factors, including symptoms, eye examinations, and changes in daily activities or school performance.
Additionally, affected children may require repeated (serial) follow-up imaging studies to assess changes in the ventricles.
Treatment of Hydrocephalus
Once hydrocephalus is diagnosed, surgical intervention is the only treatment option.
If hydrocephalus is caused by a tumor obstructing the flow of cerebrospinal fluid, removing the tumor may restore normal CSF flow and resolve the hydrocephalus.
However, if the tumor cannot be removed, a shunt procedure is necessary to reroute the obstructed cerebrospinal fluid to restore normal circulation.
Most neurosurgeons utilize a shunt system to drain cerebrospinal fluid from the ventricles to other areas of the body, such as the abdominal cavity, pleural cavity, or atrium.
Each site has its own advantages and disadvantages, but currently, absorption via the abdominal cavity is the primary surgical approach.
In the abdominal cavity, cerebrospinal fluid is absorbed into the surface of the intestines and then enters the bloodstream, along with its salts and other substances being recycled.
There are many different shunt systems available on the market, some of which are quite expensive while others are more economical.
Most neurosurgeons are familiar with one or more systems and can use them correctly.
It is crucial that your surgeon is fully trained in shunt systems and the techniques for shunt surgery.
Simply put, a shunt is an inert (less likely to provoke a bodily rejection response) plastic tube that allows fluid to flow in one direction.
Typically, there is a valve system to regulate fluid flow, along with a reservoir that can be felt by touching the skin surface.
This reservoir can be accessed with a small needle to withdraw cerebrospinal fluid for testing the function of the shunt system or to perform a lumbar puncture when infection is suspected.
Like all foreign objects, the shunt system can malfunction or become infected, necessitating replacement of the entire system.
Currently, the most commonly used shunt systems include:
- Ventriculo-Peritoneal Shunt
- Ventriculo-Atrial Shunt
- Lumbo-Peritoneal Shunt
In addition to these shunt surgeries, obstructive hydrocephalus can be treated by creating a small hole in the third ventricle to restore normal cerebrospinal fluid flow.
This procedure is called third ventriculostomy.
Finally, it is important to note that patients with hydrocephalus who undergo successful treatment generally have a good prognosis.
However, the underlying cause of hydrocephalus will ultimately determine the patient's outcome.

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Reply Date: 2004/04/30