Hydrocephalus is a medical condition characterized by an abnormal accumulation of cerebrospinal fluid (CSF) within the cavities of the brain, leading to an increase in intracranial pressure. Cerebrospinal fluid is a clear fluid that surrounds the brain and spinal cord, providing cushioning, nutrients, and waste removal for these vital structures.
To understand hydrocephalus better, let’s break down its causes, types, symptoms, diagnosis, and treatment:
- Obstructive (non-communicating) hydrocephalus: This occurs when the flow of cerebrospinal fluid is blocked after it exits the ventricles of the brain. Common causes include congenital malformations, tumors, cysts, or other lesions that obstruct the pathways.
- Communicating hydrocephalus: In this type, the flow of cerebrospinal fluid is not blocked, but it is not properly absorbed by the body. This can be due to inflammation, bleeding, infection, or other conditions that affect the absorption sites.
- Congenital: Present at birth and often caused by developmental abnormalities during fetal growth.
- Acquired: Develops after birth due to injury, infection, tumor, or other factors.
The symptoms of hydrocephalus can vary depending on age and the rate of fluid accumulation. In infants, symptoms may include an enlarged head, vomiting, sleepiness, irritability, poor feeding, and downward deviation of the eyes (also known as “sunsetting”). In older children and adults, symptoms can include headache, nausea, vomiting, blurred vision, balance and coordination issues, cognitive difficulties, and changes in personality.
Diagnosing hydrocephalus typically involves a combination of medical history evaluation, physical examination, and neuroimaging techniques. These may include:
- Ultrasound: Used for infants, it can help visualize the brain and ventricles through the soft spots on the skull.
- CT (Computed Tomography) Scan: Provides detailed cross-sectional images of the brain, showing the ventricles and any potential blockages.
- MRI (Magnetic Resonance Imaging): Offers highly detailed images of the brain’s structures and can reveal abnormalities causing hydrocephalus.
- Pressure Monitoring: Invasive procedures like intracranial pressure monitoring may be performed to assess the pressure inside the skull.
The primary goal of treatment is to alleviate the pressure on the brain and restore the normal flow of cerebrospinal fluid.
Treatment options include:
- Shunt Placement: A common approach involves surgically placing a shunt system, which is a flexible tube with a one-way valve. This tube diverts excess fluid from the brain’s ventricles to another part of the body where it can be absorbed or eliminated (usually the abdominal cavity).
- Endoscopic Third Ventriculostomy (ETV): In some cases, a neurosurgeon might create a small hole in the floor of the third ventricle to allow cerebrospinal fluid to flow more freely without the need for a shunt.
- Surgery to Remove Obstructions: If the hydrocephalus is caused by an obstruction, surgical removal of the obstructing lesion might be necessary.