Hydrocephalus

Overview of Hydrocephalus in India

Hydrocephalus indicates the abnormal accumulation of cerebrospinal fluid (CSF) in the brain's cavities. The accumulation of fluid in the brain puts tremendous pressure on the brain's tissues; larger amounts of fluid will also cause an increase in size and appearance of a person's head. A certain amount of fluid is normally in the brain and spinal cord. Therefore, with elevated levels of fluid, this creates force upon all structures, resulting in abnormal functioning of the brain and spinal cords. Hydrocephalus may develop in groups or single patients; older adults and infants are typically most commonly affected. However, individuals of any age may be affected.

The management of hydrocephalus may differ in techniques, given the different types of patients with hydrocephalus and what would best fit those patients' needs. Each person with hydrocephalus has a unique combination of symptoms based on their own personal experience with hydrocephalus. Hydrocephalus results primarily from one of the three main reasons: the obstruction/blockage of the CSF flowing within the brain and spinal cord. These obstructions/blockages may occur for different reasons; therefore, some of the risk factors associated with them may be preventable.

Hydrocephalus can result in a great many degrees of physical/psychological complications, which may adversely impact one's quality of life. Therefore, it is very important that if one ever experiences any symptoms of hydrocephalus, medical intervention should be sought promptly to avoid life-threatening conditions.

What Is Hydrocephalus?

Hydrocephalus occurs when there is an excess of cerebrospinal fluid (CSF) in the brain and spinal cord. When CSF is produced or absorbed at an abnormal rate, it can cause an increase in the amount of CSF and, subsequently, an increase in the size of the ventricles (cavities) in which it is stored. This can increase pressure inside the head and, as a result, impair normal brain function.

In normal circumstances, the body produces and absorbs a specific volume of CSF daily. When there is a problem either with the production or absorption of CSF, the volume of CSF can begin to accumulate (due to a lack of absorption), resulting in increased volume and pressure in the brain and spinal cord. 

The way that our body uses CSF is to transport nutrients to cells throughout the central nervous system (CNS) and remove any waste products from those cells as well. Therefore, without the proper flow or absorption of CSF, the CNS cells may not receive the nourishment that they need to sustain normal function. 

Due to the increasing amount of CSF in the brain due to impaired flow or absorption at the level of the ventricles, the brain does not function as it should. If you have a child diagnosed with hydrocephalus, please discuss any concerns or questions that you may have with your child's physician.

Types of Hydrocephalus:

Congenital hydrocephalus  

This kind begins before birth, like it starts while you’re still in the womb. It can occur because the brain doesn’t grow in the way it should, or because of changes in genes that affect development.

Communicating hydrocephalus  

This one shows up when the CSF flow gets stopped after it leaves the ventricles. So, the fluid can’t move freely, often because the membranes at the base of your brain get thicker, those membranes are called the arachnoid. That thickened area basically blocks the smooth circulation. It’s called communicating because the CSF can still travel between your ventricles, and they stay open.

Non-communicating hydrocephalus  

You might also hear it called obstructive hydrocephalus. Non-communicating hydrocephalus happens when the CSF flow is blocked in one or more of the thin passages that connect your ventricles, as a narrow route gets shut off.

Normal pressure hydrocephalus (NPH)  

This type occurs when CSF buildup makes the ventricles enlarge, but there’s little or no noticeable rise in pressure. What separates NPH from the other kinds is that even with more CSF than normal, the pressure inside the ventricles does not really change. The CSF tends to gather slowly, and symptoms tend to develop gradually, too. NPH is seen most often in older adults.

Hydrocephalus ex-vacuo  

This one happens after brain damage, such as from a head injury or a stroke. In those situations, the brain tissue near the ventricles shrinks. Then, CSF fills in the extra room that’s left behind, so the ventricles get larger, but the pressure in your head is usually normal.

Procedure:

Treatment for hydrocephalus usually means doing something to handle the extra buildup of cerebrospinal fluid, or CSF, that gathers inside the brain. What you choose really depends on why it’s happening, what kind of hydrocephalus it is, and how severe the symptoms are. There are a few common approaches, and each one fits different circumstances, even though people often hope for the simplest path. If it is caught early enough, a patient can sometimes return to normal life and avoid later issues, or at least reduce them a lot. In general, treatment options for hydrocephalus include :

Shunt Placement Surgery

Shunt placement is one of the most typical and usually effective surgical interventions for hydrocephalus. In simple terms, a shunt system is made up of a catheter, a one-way valve, and a distal catheter. The catheter goes into a brain ventricle so the excess CSF can be drained away. The one-way valve controls how the fluid moves, and the distal catheter then guides the CSF to another area of the body, often the abdominal cavity or sometimes the heart.

This is done under general anaesthesia. A small incision is made in the scalp, so the surgeon can reach the ventricle that needs attention. Next, the catheter is inserted carefully, and then the valve is positioned under the skin. After the procedure, regular checks and follow-up care are important, so the shunt keeps working properly, and so any unexpected complications can be noticed and handled quickly.

Endoscopic Third Ventriculostomy

ETV is a surgical alternative to shunt systems that allows patients to become independent of needing shunts for treating their condition. The minimally invasive technique is performed using an endoscope to create a hole through which cerebrospinal fluid accumulates in the third ventricle of the brain so that it flows freely around the outside of the brain and is reabsorbed back into the body like normal.

While various types of shunts have been shown to work in a number of ways, studies also indicate success rates of 65-70% for ETV as a treatment for patients having their shunt malfunction. Additionally, ETV is a one-time surgical procedure, whereas shunts can require numerous revisions, and also in cases where there is an obstruction, such as with a tumour, ETV can be performed. Finally, ETV provides continued CSF access around the brain and spine without losing CSF access to other areas of the body.

Medications

Acetazolamide and Furosemide are examples of medications that can reduce CSF/CSF levels by acting on the choroid plexus (the intraventricular tissue that produces CSF) to produce more than normal amounts of the fluid. However, using only medications to treat hydrocephalus is rarely beneficial to the successful management of this disease and should be used as a temporary measure or as a last resort when surgical and other procedures are not possible.

Monitoring

When the hydrocephalus isn’t that severe, or if the real reason behind the hydrocephalus is only temporary, doctors may choose close monitoring. In this approach, they observe the patient, while no specific treatment is given for a while. Neuroendoscopy: Neuroendoscopy is a minimally invasive procedure, where a camera is used to see and also treat problems inside the cavities of the brain.

Epilepsy Management

Epilepsy can be one of the complications that comes along with hydrocephalus. To manage epilepsy in people who have hydrocephalus, doctors may prescribe certain medicines. These medications aim to control seizures as well as other related symptoms.

Treatment of the Underlying Cause

To truly get hydrocephalus under control, treating the underlying cause matters a lot. That can mean addressing infections, tumours, or other health conditions that started the problem in the first place.