Hydrocephalus Facts

WHAT IS HYDROCEPHALUS?  (Normal; Left, Hydrocephalus; Right)

·         Hydrocephalus is an excessive build-up of cerebrospinal fluid (CSF) within cavities or  ventricles in the brain.

·         The term hydrocephalus is derived from the Greek words: hydro, meaning water and cephalus, meaning head.

·         Under normal conditions, the choroid plexus, a bundle of blood vessels wrapped in a tissue membrane and located in the ventricles, produces CSF. The fluid circulates through the brain, its ventricles and the spinal cord acting as a protective cushion and provider of nutrients. Usually, the bloodstream reabsorbs most of the CSF produced on a daily basis. Hydrocephalus results when the flow of CSF is disrupted in some way.

WHAT IS THE CAUSE OF HYDROCEPHALUS?

·         Hydrocephalus is the result of a disruption in the normal circulation and absorption of CSF due to:

·         Overproduction of CSF

·         Obstruction of CSF flow

·         Under absorption of CSF into the bloodstream

WHAT ARE THE TYPES OF HYDROCEPHALUS?

·         Communicating Hydrocephalus

·         Caused by the overproduction or under absorption of CSF

·         Non-Communicating Hydrocephalus

·         Caused by a blockage of the flow of CSF

·         Congenital

·         Present since birth

·         Acquired

·         Develops after birth as a result of one of a number of causes such as head injury, tumors or meningitis.

WHAT ARE THE SYMPTOMS OF HYDROCEPHALUS?

·         Symptoms are dependent upon the age of the patient, the cause of the disruption of CSF circulation and the extent of resulting brain tissue damage.

·         Because the skull of an infant or newborn is not fused, accumulating fluid causes the fontanel or soft spot to swell and the entire head to enlarge.

·         In older infants and children, symptoms caused by fluid build-up include headaches, nausea, vomiting, vision changes, loss of coordination and change in mental function.

·         The elderly exhibit normal pressure hydrocephalus, which presents one or more of a classic triad of symptoms: dementia, incontinence and/or gait disturbance.

WHAT IS THE INCIDENCE OF HYDROCEPHALUS?

·         Hydrocephalus occurs in about 2 out of every 1000 births.

HOW IS HYDROCEPHALUS DIAGNOSED?

·         A number of tests and procedures are used in the diagnosis of hydrocephalus including:

·         Clinical exam

·         Percussion on the skull to hear sounds associated with changing bones

·         Measurement of the circumference of the head, repeated to show change

·         Neurological exam

·         Transillumination to the head to reveal fluid accumulation

·         CT Scan to show size of the ventricles

·         MRI to form images of the ventricles for evaluation

·         X-rays to show thinning or separation of skull bones

·         Ultrasound to outline the structures within the skull

·         CSF flow studies to trace the path of CSF
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WHAT IS THE TREATMENT FOR HYDROCEPHALUS?

Although Hydrocephalus cannot be cured, it can be controlled.

The objective of treatment is to restore proper CSF flow.

·         A surgical procedure may be performed to divert the CSF from the ventricles in the brain to either the abdominal cavity or to a chamber in the heart called the atrium. This procedure is performed by a neurosurgeon who implants a shunt system consisting of a flexible tube and a valve mechanism (see above close-up). The valve mechanism regulates the flow of CSF from the ventricles. Valves are manufactured to open at a specific pressure range. The neurosurgeon selects the setting based on his evaluation of the patient. By removing the CSF from the brain, the pressure in the skull may return to normal.

Now two types of shunt systems are made, one with a single pressure setting for the valve mechanism, the other is a programmable valve system is available from Codman, a Johnson & Johnson company. The CODMAN HAKIM Programmable Valve allows the neurosurgeon to adjust the pressure setting non-invasively using a magnetic device (see above blue programmer).

Disclaimer

For questions or comments, please contact: bostj@upmc.edu

© 2010 Tri-State Neurosurgical Associates – UPMC

Tri-State Neurosurgical Associates-UPMC
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