Hydrocephalus After Head Injury: When is Surgery Necessary?

Q: Hydrocephalus After Head Injury: When is Surgery Necessary?

There are two types of hydrocephalus： subdural effusion and true hydrocephalus. <br>They are different conditions. <br>Which type is your mother's issue?

Head trauma

Hello Dr.
Chang! My mother was in a car accident at the end of July, resulting in a subdural hematoma and cerebral contusion.
The attending physician mentioned that the contusion is not significant and can be absorbed naturally with rest.
Later, during a follow-up visit, my mother reported experiencing dizziness and requested a brain X-ray.
The results showed that there is a condition of hydrocephalus, but the area is small (the contusion has been absorbed).
The doctor advised us to monitor my mother's condition at home and mentioned that medication cannot treat this condition, and it is difficult for the body to absorb it on its own.
I would like to ask you, Dr.
Chang, what are the risks of surgery if hydrocephalus is indicated? If there are no clear symptoms of hydrocephalus, such as incontinence, is surgery still necessary? Thank you!

Xiao Hua, 30~39 year old female. Ask Date: 2015/10/04

Dr. Zhang Junwei reply Neurosurgery

There are two types of hydrocephalus: subdural effusion and true hydrocephalus.
They are different conditions.
Which type is your mother's issue?

Reply Date: 2015/10/04

More Info

Hydrocephalus, or the accumulation of cerebrospinal fluid (CSF) in the brain's ventricles, can occur after a head injury, such as the one your mother experienced in her car accident. The management of hydrocephalus, particularly in the context of a recent head injury, is nuanced and depends on several factors, including the severity of the condition, the presence of symptoms, and the overall clinical picture.

In your mother's case, it appears that the initial concern was a subdural hematoma and contusion, which can lead to increased intracranial pressure and potentially contribute to the development of hydrocephalus. The fact that the hematoma has absorbed is a positive sign, but the presence of hydrocephalus, even if it is not extensive, warrants careful monitoring.

Surgical intervention for hydrocephalus is typically considered when there are clear symptoms indicating that the fluid accumulation is causing significant pressure on the brain. Common symptoms that may necessitate surgery include:
1. Neurological Decline: Changes in consciousness, confusion, or significant cognitive decline.

2. Physical Symptoms: Difficulty with balance, coordination, or motor function.

3. Incontinence: Loss of bladder or bowel control can indicate increased pressure on the brain.

4. Headaches: Persistent or worsening headaches that do not respond to typical pain relief measures.

5. Vision Changes: Blurred or double vision can also be a sign of increased intracranial pressure.

If your mother is not exhibiting these symptoms, the decision to proceed with surgery may be more conservative. The risks associated with surgery for hydrocephalus can include:
- Infection: Any surgical procedure carries a risk of infection, particularly in the case of neurosurgery.

- Bleeding: There is a risk of bleeding during or after the procedure.

- Neurological Complications: There may be a risk of worsening neurological function or new deficits post-surgery.

- Shunt Complications: If a shunt is placed, it can malfunction or become obstructed, requiring further interventions.

In cases where the hydrocephalus is not causing significant symptoms, doctors may opt for a "watchful waiting" approach, monitoring the patient closely for any changes. This approach allows for the possibility that the body may resolve the issue without surgical intervention, particularly if the accumulation of CSF is minimal.

It is essential to maintain open communication with your mother's healthcare team. If there are any changes in her condition or if new symptoms arise, it is crucial to report these immediately. Additionally, regular follow-up appointments will help ensure that any developments in her condition are addressed promptly.

In summary, while surgery for hydrocephalus can be necessary in certain situations, it is not always the first course of action, especially if the patient is asymptomatic or only mildly symptomatic. The decision should be made collaboratively with the medical team, considering the risks and benefits specific to your mother's situation.

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