Hydrocephalus in Children                            Leslie Acakpo-Satchivi, MD-PhD,                            Neurosurge...
What is Hydrocephalus • “Water on the Brain” • CSF constantly produced and absorbed • Caused by lack of absorption • Resul...
Function of CSF   • Maintenance of a constant external     environment for neurons and glia   • Mechanical cushion to prot...
Causes • Congenital • Acquired   – Prematurity   – Infection   – Tumor   – Bleeding in brain   – Trauma
Signs and Symptoms • In Young Children   – Abnormal increase in head size   – Irritability   – Sleepiness   – Vomiting   –...
Signs and Symptoms • In older Children   – Headache   – Poor school performance   – Loss of coordination and difficulty wa...
Treatment Goals • To restore normal pressure in head   – 1. restoring normal CSF flow   – 2. divert CSF to another part of...
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...
Causes of COMMUNICATINGHydrocephalus  •Defective absorption of CSF    – Chronic Post-hemorrhagic    – Chronic Post-Infecti...
Normal Head CT
Hydrocephalus
Aqueductal Stenosis   • Obstructive hydrocephalus   • Most common cause of congenital     HCP (43%)   • Asymptomatic at ea...
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   – Redn...
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   – Blo...
Germinal Matrix Hemorrhage  •Grade 1: Hemorrhage confined to the  germinal matrix  •Grade 2: Extension into the ventricle ...
Subgaleal Shunt
External Hydrocephalus
Post-Infectious Hydrocephalus
ARACHNOID CYST •   14 month-old •   Inappropriate head size increase •   Unable to walk •   Abnormal reflexes •   No irrit...
PRE-OP   6 MONTHS POST-OP
Prognosis • 6 in 10 will die if untreated   – Survivors left with neurologic deficits • Prompt treatment • Prognosis depen...
Questions?
Hydrocephalus in Children
Hydrocephalus in Children
Hydrocephalus in Children
Hydrocephalus in Children
Hydrocephalus in Children
Hydrocephalus in Children
Hydrocephalus in Children
Hydrocephalus in Children
Hydrocephalus in Children
Hydrocephalus in Children
Hydrocephalus in Children
Hydrocephalus in Children
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Hydrocephalus in Children

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As a parent, nothing is more frightening than a sick child. When that sickness involves the brain, it becomes terrifying. It is estimated that 1 in 500 children will be diagnosed with hydrocephalus, a condition causing excessive fluid around the brain and spinal cord. Whether your child was born with hydrocephalus or developed it later, please join Dr. Leslie Satchivi as he discusses this condition, how to treat it and what it means for your child developmentally.

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Hydrocephalus in Children

  1. 1. Hydrocephalus in Children Leslie Acakpo-Satchivi, MD-PhD, Neurosurgerywww.SpringfieldClinic.com
  2. 2. 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
  3. 3. 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
  4. 4. Causes • Congenital • Acquired – Prematurity – Infection – Tumor – Bleeding in brain – Trauma
  5. 5. Signs and Symptoms • In Young Children – Abnormal increase in head size – Irritability – Sleepiness – Vomiting – “Sunset” eyes
  6. 6. Signs and Symptoms • In older Children – Headache – Poor school performance – Loss of coordination and difficulty walking – Sleepiness – Vomiting – Loss of bladder control
  7. 7. Treatment Goals • To restore normal pressure in head – 1. restoring normal CSF flow – 2. divert CSF to another part of body
  8. 8. From Anatomography website maintained by Life Science Databases(LSDB)
  9. 9. Ventricular AnatomyFrom: Gray’s anatomy
  10. 10. Causes of OBSTRUCTIVEHydrocephalus • Congenital Malformations – Aqueductal Stenosis – Arachnoid Cysts • Acute Post-hemorrhagic • Mass lesion
  11. 11. Causes of COMMUNICATINGHydrocephalus •Defective absorption of CSF – Chronic Post-hemorrhagic – Chronic Post-Infectious •Venous drainage insufficiency •Overproduction of CSF (RARE)
  12. 12. Normal Head CT
  13. 13. Hydrocephalus
  14. 14. Aqueductal Stenosis • Obstructive hydrocephalus • Most common cause of congenital HCP (43%) • Asymptomatic at early age • OFC increase • May present later with headaches
  15. 15. Endoscopic 3rdVentriculostomy (ETV)
  16. 16. Before 14 months After
  17. 17. Ventriculoperitoneal (VP) ShuntJournal of NeurosurgeryPediatrics
  18. 18. Mayo Foundation for Medical Education and Research
  19. 19. Shunt Survival
  20. 20. Signs & Symptoms ofShunt Malfunction • Same as hydrocephalus • But also signs of infection – Fever – Swelling – Redness – Drainage
  21. 21. Preventative Medicine • Education • Routine Clinic Follow-up • Surveillance Imaging – Ultrasound – CT scan – MRI
  22. 22. Hydrocephalus inPremature Infants • VP Shunting is poor option due to: – Small size – Abdomen is poor terminus – Blood in ventricles causes shunt malfunction
  23. 23. 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
  24. 24. Subgaleal Shunt
  25. 25. External Hydrocephalus
  26. 26. Post-Infectious Hydrocephalus
  27. 27. ARACHNOID CYST • 14 month-old • Inappropriate head size increase • Unable to walk • Abnormal reflexes • No irritability • No vomiting • No excessive somnolence
  28. 28. PRE-OP 6 MONTHS POST-OP
  29. 29. 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
  30. 30. Questions?

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