Hydrocephalus

What is Hydrocephalus?

Hydrocephalus by definition is a condition where cerebrospinal fluid (CSF) accumulates in the brain.   Cerebrospinal fluid is a clear liquid that looks like water and is produced in the 4 ventricles or cavities of the brain, which are connected by narrow pathways.   This fluid surrounds the brain and spinal cord.  The basic function of the CSF is to act as a shock absorber providing protection to the brain inside the skull.

In Hydrocephalus, the fluid builds up in the ventricles when there is an obstruction in the normal outflow or when there is decreased absorption of the fluid.  It is also commonly referred to as “water in the brain.”  This excess fluid puts pressure on the brain because of increase in size of the ventricles, which can lead to brain tissue damage.

What causes hydrocephalus?

Hydrocephalus is caused by an imbalance between how much cerebrospinal fluid is produced and how much is absorbed into the bloodstream.

Symptoms

The main symptoms are:

• headache
• nausea
• vomiting
• confusion
• problems with vision (for example, blurred or double vision).

Adults with this condition might also experience

• balance problems
• poor coordination
• shuffling when they walk, and
• urinary incontinence (a loss of control passing urine).
• People would not necessarily experience all of these symptoms, but they would usually experience more than one of them.

In cases of normal pressure hydrocephalus (NPH), the build-up of CSF can be gradual and the symptoms of hydrocephalus might develop slowly over long periods of time (months and years rather than weeks).

Tests and Investigations

The key test for hydrocephalus is a brain scan. This might be a CT (computerised tomography) scan or an MRI (magnetic resonance imaging) scan. The scan results can show signs of a build-up of CSF and increased pressure in the brain.

How is Hydrocephalus Treated?

There are no effective medicines for hydrocephalus. Most children require surgery. The goal is to lessen the pressure in the brain by providing another pathway for CSF to be drained and absorbed away from the brain.

There are two types of surgery for hydrocephalus:

• Ventriculoperitoneal Shunt (VP Shunt)
• Endoscopic Third Ventriculostomy (ETV)

Ventriculoperitoneal Shunt (VP Shunt)

The key treatment for hydrocephalus is a cerebral shunt.   A ventriculoperitoneal shunt or VP Shunt is a cerebral shunt that aids in draining the excess cerebrospinal fluid (CSF).  A VP shunt is a thin tube that is implanted in the brain, which drains away the excess cerebrospinal fluid to the peritoneal cavity (abdominal cavity), where it can be absorbed into the bloodstream.

The procedure is carried out by the surgeon making a small incision behind the ear, and a small hole is drilled in the skull.  Another incision is made in the belly. One end of the catheter is passed into a ventricle of the brain and the other end of the catheter is sent into the abdominal cavity.  When pressure builds up around the brain, the excess fluid is drained out through the catheter into the peritoneal cavity.  This helps in lowering the intracranial pressure.

Endoscopic Third Ventriculostomy (ETV Surgery).

Some children with non-communicating hydrocephalus can have surgery called an endoscopic third ventriculostomy (ETV). During an ETV, the surgeon makes an opening in the floor of the ventricle at the base of the brain. The CSF is then no longer blocked inside the ventricle. Now it can flow in and around the brain as it should. This means that the child will not need a shunt, but instead will rely on the opening made by the surgeon during surgery.

Doctors for Hydrocephalus Treatment at Keyhole Clinic

Dr. Sudish Karunakaran, Senior Consultant Neurosurgeon, is one of the Best Doctors for Hydrocephalus treatment in Kerala.  He has more than 20 Years of Experience in Complex Spine and Brain Disorders.