Hydrocephalus in Children

Hydrocephalus in Children Leslie Acakpo-Satchivi, MD-PhD, Neurosurgerywww.SpringfieldClinic.com

What is Hydrocephalus • “Water on the Brain” • CSF constantly produced and absorbed • Caused by lack of absorption • Results in increased fluid pressure in brain • Can be present at birth or later in life

Function of CSF • Maintenance of a constant external environment for neurons and glia • Mechanical cushion to protect the brain and provide buoyancy to the heavy brain (1400 g) • Serves as a lymphatic system and a conduit for neuropeptides • pH of CSF regulates pulmonary ventilation and CBF

Causes • Congenital • Acquired – Prematurity – Infection – Tumor – Bleeding in brain – Trauma

Signs and Symptoms • In Young Children – Abnormal increase in head size – Irritability – Sleepiness – Vomiting – “Sunset” eyes

Signs and Symptoms • In older Children – Headache – Poor school performance – Loss of coordination and difficulty walking – Sleepiness – Vomiting – Loss of bladder control

Treatment Goals • To restore normal pressure in head – 1. restoring normal CSF flow – 2. divert CSF to another part of body

From Anatomography website maintained by Life Science Databases(LSDB)

Ventricular AnatomyFrom: Gray’s anatomy

Causes of OBSTRUCTIVEHydrocephalus • Congenital Malformations – Aqueductal Stenosis – Arachnoid Cysts • Acute Post-hemorrhagic • Mass lesion

Causes of COMMUNICATINGHydrocephalus •Defective absorption of CSF – Chronic Post-hemorrhagic – Chronic Post-Infectious •Venous drainage insufficiency •Overproduction of CSF (RARE)

Normal Head CT

Hydrocephalus

Aqueductal Stenosis • Obstructive hydrocephalus • Most common cause of congenital HCP (43%) • Asymptomatic at early age • OFC increase • May present later with headaches

Endoscopic 3rdVentriculostomy (ETV)

Before 14 months After

Ventriculoperitoneal (VP) ShuntJournal of NeurosurgeryPediatrics

Mayo Foundation for Medical Education and Research

Shunt Survival

Signs & Symptoms ofShunt Malfunction • Same as hydrocephalus • But also signs of infection – Fever – Swelling – Redness – Drainage

Preventative Medicine • Education • Routine Clinic Follow-up • Surveillance Imaging – Ultrasound – CT scan – MRI

Hydrocephalus inPremature Infants • VP Shunting is poor option due to: – Small size – Abdomen is poor terminus – Blood in ventricles causes shunt malfunction

Germinal Matrix Hemorrhage •Grade 1: Hemorrhage confined to the germinal matrix •Grade 2: Extension into the ventricle but w/o hydrocephalus •Grade 3: Ventricular Extension with Hydrocephalus •Grade 4: Parenchymal hemorrhage

Subgaleal Shunt

External Hydrocephalus

Post-Infectious Hydrocephalus

ARACHNOID CYST • 14 month-old • Inappropriate head size increase • Unable to walk • Abnormal reflexes • No irritability • No vomiting • No excessive somnolence

PRE-OP 6 MONTHS POST-OP

Prognosis • 6 in 10 will die if untreated – Survivors left with neurologic deficits • Prompt treatment • Prognosis dependent on cause of Hydrocephalus: – Infection/ Trauma / Tumors – Aqueductal Stenosis/ Arachnoid cyst

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Hydrocephalus in Children

by Springfield Clinic on Aug 02, 2012

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