ADVANCE NEUROSURGERY

HYDROCEPHALUS (INCREASED CSF IN BRAIN)

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Cerebrospinal fluid (CSF) is a watery liquid that surrounds the brain and spinal cord, acting as a 'cushion'. It also supplies nutrients to the brain. Hydrocephalus occurs when it is stopped from circulating or being re-absorbed. The CSF builds up within the ventricles (cavities) of the brain resulting in increased pressure on the brain. In babies, this also causes the head to enlarge. In adults the complaints are that of headache , blurring of vision, drowsiness recurrent vomits, imbalance in walking or diplopia.

Causes of Hydrocephalus

The most common causes are:

Congenital - It means that child was born with hydrocephalus. Children born with spina bifida often develop hydrocephalus. Dandy Walker syndrome and primary aqua ductal stenosis are other important cause of congenital hydrocephalus.

Prematurity - Hydrocephalus can occur as a complication of being born too early, and when there has been bleeding in the brain.

Infection - Most common cause of non obstructive Hydrocephalus. It occurs as a complication of meningitis as the infection may cause a problem with reabsorption of CSF. TB Meningitis is a very common cause in indian subcontinent leading to hydrocephalus.

Brain tumour - May cause obstruction to CSF outflow leading to hydrocephalus.

Unknown - in many cases, we do not know what caused the hydrocephalus.

How is hydrocephalus diagnosed?

It is usually diagnosed by an increasing head circumference in infants, an ultrasound scan, a CT scan or sometimes an MRI scan.

How is hydrocephalus treated?

The aim of treatment is to reduce the pressure on the brain by draining the CSF away. Delay in treatment of this condition can lead to permanent developmental issues in children along with visual decline or blindness.

The fluid is drained away using a 'shunt', which is a long tube made of silicone. It is inserted in to the ventricles in an operation and drains the CSF away to either the abdomen The shunt contains a valve so that the fluid can only drain away from the head at the desired rate.

Endoscopic Third Ventriculostomy is another treatment option. The aim of the operation is to drain CSF from the ventricle freely, without the need for a shunt. Dr Tandon and his team would discuss with you regarding this surgery.

Complications of a shunt

There can be complications to having a shunt inserted, of which you should be aware. If you notice any of the following, please call on the emergency mobile nos provided to you.

Infection

An infection is most likely to develop in the first three months after shunt insertion. The symptoms of an infection in the shunt may include:

• 1. headache
• 2. irritability
• 3. high temperature (over 37 ^o C)
• 4. not feeding well
• 5. possibly vomiting
• 6. possibly drowsy

A blocked shunt

The symptoms of a blocked shunt include:

• 1. a bulging fontanelle (soft part of the top of the head)
• 2. vomiting
• 3. crying and irritability
• 4. becoming sleepy (less responsive)
• 5. looking pale
• 6. increased head size

Low pressure

The symptoms of low pressure are:

• 1. sunken fontanelle
• 2. miserable
• 3. pale and possibly shocked
• 4. sweaty
• 5. vomiting

In the majority of cases, the symptoms will disappear after lying flat for a while.