Hydrocephalus

Hydrocephalus, commonly referred to as "water in the head", is the accumulation of excessive cerebrospinal fluid (CSF) in the brain. This accumulation of CSF results in the abnormal widening of ventricles or the spaces in the brain, and creates a potentially harmful pressure on the tissues of the brain leading to damage.

Under normal conditions, the CSF which flows through the brain and the spinal cord is soaked into the bloodstream. Factors that can lead to the increase of CSF in the brain tissue are when there is blockage in the CSF flow, the CSF does not get absorbed properly into the blood or the brain produces too much CSF. Hydrocephalus is a condition that can also happen while a baby is still developing in the mother's womb. This is especially the case on babies who have myelomeningocele, a birth defect wherein the spinal column does not close properly.

During pregnancy, the condition can also be due to genetic defects or certain infections. Hydrocephalus on a child who has already been born can be a result of infections that affect the central nervous system such as meningitis or encephalitis; bleeding in the brain during or soon after delivery especially in premature babies; and injury before, during, or after childbirth, including subarachnoid hemorrhage; tumors of the central nervous system, including the brain or spinal cord.

Although the signs and symptoms of a baby with hydrocephalus vary depending on a child's age, perhaps the most discernible sign of a hydrocephalic baby is that it has a swollen head, and appears larger than the heads of babies of the same age. The reason for the bulge is that the baby's skull bones is that the bones are connected by fibrous tissue, called sutures, that have not yet hardened thus it will stretch and protrude to accommodate the excess CSF. Other signs include:

• Abnormally shaped head
• Bulging at the soft spots
• Split sutures — a gap can be felt between skull bones
• Rapid increase in head circumference
• Swollen veins that are recognizable to the naked eye

Symptoms will include the following:

• Irritability
• Seizures
• Sleepiness
• Vomiting

In older children, the signs and symptoms will include brief, shrill, high-pitched cry; changes in personality, memory, or the ability to reason or think; changes in facial appearance and eye spacing; crossed eyes or uncontrolled eye movements; difficulty feeding; excessive sleepiness; headache; irritability, poor temper control; loss of bladder control; loss of coordination and trouble walking; muscle spasticity; slow growth; slow or restricted movement; and vomiting.

Treatment for Hydrocephalus

There is one major goal in treating hydrocephalus and that is to reduce or prevent brain damage by improving the flow of the CSF. Tests that are done to confirm the condition are a head CT scan, arteriography, brain scan using radioisotopes, cranial ultrasound, lumbar puncture and examination of the CSF and skull x-rays. Most common treatment for hydrocephalus is surgery—the shunt or the ventriculostomy.

Of the two surgical procedures, the most commonly used is the shunt. It is the surgical insertion of a drainage system that consists of a long flexible tube equipped with a valve that keeps the fluid from the brain flowing in the right direction and at the proper rate. It is done by inserting one end of the tube in one of the brain's ventricles, then tunneled under the skin to another part of the body where the excess CSF can be more easily absorbed such as the abdomen or a chamber in the heart. A hydrocephalic baby will need a shunt for the rest of his or her life.

The ventriculostomy, on the other hand, is a surgical treatment that can be used only for some people. This procedure uses a small video camera inside the brain so the surgeon can make a hole in the bottom of one of the ventricles or between the ventricles so the CSF can flow out of the brain.

As with every surgical treatment, complications can arise so regular monitoring is mandatory. In the shunt procedure, the system can malfunction which can result into the stoppage of the drainage or poorly regulated drainage, while the passage created via the ventriculostomy can suddenly close.